044-65 Wyo. Code R. § 65-5

Current through April 27, 2019
Section 65-5 - Application

(a) Application Contents. Prior to the sale of out-of-state health insurance policies in Wyoming, the insurer must file an application as prescribed by the Wyoming insurance commissioner and are subject to the applicable SERFF filing fees. The application must include at a minimum the following:

  • (i) Proof of current approval and product line authority in domicile state including health policy form number and date approved in the domicile state;
  • (ii) Proof of authorization to transact insurance in Wyoming;
  • (iii) The price of the health policy as sold in the domicile state and whether the health policy will be at the same price or at a Wyoming specific price;
  • (iv) A network provider directory that must, at a minimum, include providers specialties, locations of providers, acceptance of new patient status, the total unduplicated providers, and the total number of essential community providers in the provider network; and
  • (v) A description of the relationship between the insurer making the filing and the affiliate insurer, if any, which currently has approval for the issuance of health insurance policies in another state, the original state where the proposed product was approved, and the date of such approval.

(b) Policy Filing Requirements

  • (i) All health insurance policies offered or intended to be sold pursuant to W.S. 26-18-301, et seq. shall be filed for prior review and approval and are subject to the applicable SERFF filing and policy form filing fees.
  • (ii) For each out-of-state health insurance policy sold or intended to be sold in Wyoming, the insurer must file an outline of coverage with the health policy form filings and are subject to the applicable SERFF filing fees. The outline of coverage must have a section defining the benefits the health insurance policy provides. The outline of coverage must state whether the policy offers any Wyoming mandated benefits, and, if so, what Wyoming mandated benefits the policy offers. The Wyoming insurance commissioner can require additional information be disclosed in the outline of coverage.

(c) Agreement Between Carrier and Commissioner

  • (i) Pursuant to W.S. W.S. 26-18-302(a)(iv) the insurer seeking to offer out-of-state health insurance policies in Wyoming must agree that the Wyoming insurance commissioner may enforce the provisions of the insurance policy and resolve disputes between the insurer and the policyholder.
  • (ii) The agreement will be a written agreement signed by the insurer. The agreement shall be on a form as prescribed by the Wyoming insurance commissioner.

(d) Should the insurer fail to comply with the application and filing procedures as prescribed by this regulation and as otherwise prescribed by the Wyoming insurance commissioner pursuant to Wyoming law, the insurers application may be rejected and the insurer may be denied the authority to issue out-of-state health insurance policies.

044-65 Wyo. Code R. § 65-5

Adopted, Eff. 1/8/2015.