W. Va. Code R. § 114-55-6

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

Section 114-55-6 - Determination of an Eligible Individual

6.1. Each insurer offering accident and sickness insurance coverage in the individual market is responsible for determining whether an applicant for coverage is an eligible individual and must exercise reasonable diligence in making this determination in a timely fashion.

a. If an insurer determines that an individual is an eligible individual, the insurer must promptly issue a policy to that individual.

b. If the information presented in or with an application is substantially insufficient for the insurer to make the determination described in subsection 6.1, the insurer may immediately request additional information from the individual, and must act promptly to make its determination after receipt of the requested information.

c. If an entity fails to provide a certificate of creditable coverage as required by this section, the insurer is subject to the procedures set forth in subsection 5.9 of this rule concerning the individual's right to demonstrate creditable coverage.

W. Va. Code R. § 114-55-6