W. Va. Code R. § 114-39-7

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-39-7 - Association Group Policy Disclosure, Affiliation of Association and Insurer

7.1. Each insurer offering coverage under a group accident and sickness policy which is issued to a non bona fide association shall be required to make full disclosure to each applicant who is not already a member of the association on a form approved by the Commissioner. Such disclosure shall be provided at the time the application for coverage is completed.

7.2. Full disclosure under 7.1 above shall state:

a. That the individual must already be or become a member of the association to be eligible for coverage under the group policy;

b. All costs related to association membership, including but not limited to initial association membership fee and the amount of the annual association dues;

c. That membership fees and/or dues are in addition to the policy premium;

d. That the association holds the master policy;

e. That the premium charged and the terms and conditions of coverage are determined between the association and the insurer; and

f. That the premium, terms and conditions of coverage may be changed by agreement of the association group policyholder and the insurer, without the consent of the individual certificate holder.

7.3. In the event the premium, terms and/or conditions of coverage change, a notice of the changes shall be provided to the certificate holders as follows:

a. If the master policyholder is not a bona fide association, the insurer shall notify the certificate holders no later than thirty (30) days prior to a change in the premium, terms and/or conditions of the coverage.

b. If the master policyholder is a bona fide association, the insurer shall notify the group certificate holder of changes in premium, terms and/or conditions of the coverage.

c. If the master policyholder is a bona fide association and there is not a group certificate holder, the insurer shall notify the individual certificate holder of changes in premium, terms and/or conditions of the coverage.

7.4. An insurer may not provide group accident and sickness insurance to an association or other eligible group in which the insurer has an affiliation. "Affiliation" includes but is not limited to:

a. Common board members, officers, executives or employees;

b. Common ownership or control of the insurer, association or other eligible group; or

c. Common use of the same office space or equipment utilized by the insurer to transact insurance.

7.5. An insurer offering group accident and sickness insurance may not make any false, deceptive or misleading statement regarding the insurer's endorsement by the association or other eligible group.

W. Va. Code R. § 114-39-7