W. Va. Code R. § 114-83-3

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

Section 114-83-3 - Licensing and Renewal Requirements

3.1. All Discount Medical Plan Organizations must obtain a license pursuant to W. Va. Code § 33-15E-4 and this rule to continue conducting business and prior to commencing operations in the state of West Virginia.

3.2. A person or entity must submit the following to obtain a license to conduct business as a Discount Medical Plan Organization:

3.2.a. A fully completed Discount Medical Plan Organization Application for License (Form DMP-1);

3.2.b. A $300 non-refundable application fee;

3.2.c. An original certificate of authority from the state of domicile;

3.2.d. Copies of all registration documents and licenses required by the State of West Virginia;

3.2.e. Articles of Incorporation and by-laws;

3.2.f. A description of the proposed method of marketing, including types of discounts to be offered and the advertising media to be used, including the procedures in place to approve advertising, prior to use;

3.2.g. An audited financial statement prepared in accordance with generally accepted accounting principals certified by an independent certified public accountant, including the balance sheet, income statement and statement of changes in cash flow for the preceding year or if an affiliate of a parent entity that is publicly traded, those audited financial statements and a written guarantee that the minimum capital as set forth in W. Va. Code § 33-15E-5 will be met by the parent entity;

3.2.h. List of names, official positions and addresses of all persons responsible for the conduct of the organization's affairs, including company officers, directors and shareholders owning ten percent or more shares in the organization;

3.2.i. The number of discount medical plan members in the state;

3.2.j. A copy of the form of all provider agreements offering medical or ancillary services to its members;

3.2.k. A list of all participating pharmacies offering discounts on prescription drugs to plan members or an Internet website address where such a list can be accessed by the Commissioner;

3.2.l. Organization chart including all entities within the ultimate parent company structure, if applicable;

3.2.m. Biographical affidavits for company officers, directors and shareholders owning ten percent or more shares in the organization;

3.2.n. Proof of compliance with the net worth requirement of $150,000; and

3.2.o. A surety bond in an amount not less than $35,000 for the benefit of any person that is damaged by any violation of W. Va. Code §33-15E, et seq. and this rule.

3.2.p. A description of the member complaint procedures.

3.3. Any incomplete application, as determined by the Commissioner, that remains incomplete for a period of four months will be considered withdrawn and a new application and new application fees are required.

3.4. The license of a Discount Medical Plan Organization must be renewed annually on or before the thirty first day of May next following the date of issuance. The renewal fee shall be in an amount of $100. If a Discount Medical Plan Organization fails to pay the renewal fee, the nonpayment shall result in a lapse of the license. A Discount Medical Plan Organization that allows its license to lapse may, within twelve months from the due date of the renewal fee, reinstate the same license, however, a penalty in the amount of $100 shall be required for any renewal fee received after the due date.

3.5. Along with the renewal fee, each licensee shall provide the Commissioner with the following in order to renew their license:

3.5.a. An audited financial statement prepared in accordance with generally accepted accounting principals certified by an independent certified public accountant, including the balance sheet, income statement and statement of changes in cash flow for the preceding year. If the Discount Medical Plan Organization is an affiliate of a parent entity that is publicly traded, those audited financial statements and a written guarantee that the minimum capital will be met by the parent entity;

3.5.b. Any changes in the list of names and addresses of all persons responsible for the conduct of the organization's affairs, including company officers, directors and shareholders owning ten percent or more shares in the organization;

3.5.c. The number of discount medical plan members in the state; and

3.5.d. Proof of compliance with the net worth requirement of $150,000.

3.6. The Insurance Commissioner may waive any requirement for a Discount Medical Plan Organization license for an applicant with a valid license from the organization's home state if the applicant's home state awards nonresident licenses to residents of this state on a reciprocal basis.

3.7. In the event a problem occurs with a particular provider, the Discount Medical Plan Organization shall provide that particular provider agreement to the Commissioner upon request by the Commissioner.

W. Va. Code R. § 114-83-3