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Introduced Version House Bill 2204 History

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hb2204 intr
H. B. 2204


(By Delegates H. White, Frich and Hrutkay)
[Introduced February 11, 2005; referred to the
Committee on Banking and Insurance then the Judiciary.]




A BILL to amend and reenact §33-6-8 of the Code of West Virginia, 1931, as amended; and to amend and reenact §33-16B-1, §33-16B-2 and §33-16B-3 of said code, all relating to rate and form filing for group accident and sickness policies.

Be it enacted by the Legislature of West Virginia:
That §33-6-8 of the Code of West Virginia, 1931, as amended, be amended and reenacted; and that §33-16B-1, §33-16B-2 and §33-16B-3 of said code be amended and reenacted, all to read as follows:
ARTICLE 6. THE INSURANCE POLICY.

§33-6-8. Approval of forms.

(a) Except as provided in section eight, article seventeen of this chapter (fire and marine forms), no insurance policy form, no group certificate form, no insurance application form where written application is required and is to be made a part of the policy, and no rider, endorsement or other form to be attached to any policy, shall be delivered or issued for delivery in this State by an insurer unless it has been filed with and approved by the Commissioner, except that as to group insurance policies delivered outside this State, only the group certificates to be delivered or issued for delivery in this State shall be filed for approval with the Commissioner. This section shall not apply to policies, riders, endorsements or forms of unique character designed for and used with relation to insurance upon a particular subject, or which relate to the manner of distribution of benefits or to the reservation of rights and benefits under life or accident and sickness insurance policies, and are used at the request of the individual policyholder, contract holder or certificate holder, nor to the surety bond forms.
(b) Every such filing shall be made not less than sixty days in advance of any such delivery. At the expiration of such sixty days, the form so filed shall be deemed approved unless prior thereto it has been affirmatively approved or disapproved by the Commissioner. Approval of any such form by the Commissioner shall constitute a waiver of any unexpired portion of such waiting period. The Commissioner may at any time, after notice and for cause shown, withdraw any such approval.
(c) Any order of the Commissioner disapproving any such form or withdrawing a previous approval shall state the grounds therefor.
(d) The Commissioner may, by order, exempt from the requirements of this section for so long as he or she deems proper any insurance document or form or type thereof as specified in such order, to which, in his or her opinion, this section may not practicably be applied, or the filing and approval of which are, in his or her opinion, not desirable or necessary for the protection of the public.
(e) Notwithstanding any other provisions of this section, any mass marketed life and/or health insurance policy offered to members of any association by the association shall be exempt from the provision requiring prior approval under this section. These forms are effective upon filing, but the Commissioner may review these forms for reasonableness pursuant to section nine of this article: Provided, That for purposes of this section, the association shall have a minimum of sixty-one members at the outset of the issuance of the mass marketed life and/or health insurance policy and shall have been organized and maintained in good faith for purposes other than that of obtaining or providing insurance: Provided, however, That the association shall also have been in active existence for at least two years and shall have a constitution and bylaws which provide that: (1) The association holds annual meetings to further purposes of its members; (2) except in the case of credit unions, the association collects dues or solicits contributions from members; and (3) the members have voting privileges and representation on the governing board and committees that exist under the authority of the association: Provided further, That upon written application by an association and for good cause shown, the Commissioner may grant an exemption to the association from the minimum member requirements of this section.
(f) This section shall apply also to any form used by domestic insurers for delivery in a jurisdiction outside West Virginia, if the insurance supervisory official of such jurisdiction informs the Commissioner that such form is not subject to approval or disapproval by such official, and upon the Commissioner's order requiring the form to be submitted to him or her for the purpose. The applicable same standards shall apply to such forms as apply to forms for domestic use.
ARTICLE 16B. ACCIDENT AND SICKNESS RATES.
§33-16B-1. Filing and approval of accident and sickness rates.

(a) Premium rate charges for any individual accident and sickness insurance policy or for any group accident and sickness insurance policy, certificate or other evidence of insurance issued, pursuant to this chapter endorsed, or delivered in this State shall be filed with the Commissioner for a waiting period of sixty days before such charges become effective. At the expiration of such sixty days the premium rate charges so filed shall be deemed approved unless prior thereto the charges have been affirmatively approved or disapproved by the Commissioner.
(b) Notwithstanding any other provisions of law to the contrary, any mass marketed group health insurance policy offered to members of any association by the association is exempt from the provision requiring prior approval of premium charges under this section: Provided, That for purposes of this subsection, the association shall meet the requirements for an association set forth in subsection (e), section eight, article six of this chapter. These rates are effective upon filing, but the Commissioner may review and disapprove the premium charges within sixty days of the date of filing. At the expiration of the sixty days the premium rate charges previously filed shall be considered approved unless prior to the filing the premium charges have been affirmatively disapproved by the Commissioner.
(c) The Commissioner shall disapprove accident and health insurance premium rates which are not in compliance with the requirements of this chapter or any rule promulgated by the Commissioner pursuant to section two of this article. The Commissioner shall send written notice of such disapproval to the insurer. The Commissioner may approve the premium rates before the sixty-day period expires by giving written notice of approval.
§33-16B-2. Ratemaking standards.
Premium rates charged for any individual accident and health insurance policy or for any group accident and health insurance policy issued pursuant to this chapter shall be reasonable in relation to the benefits available under the policy. The Commissioner shall may promulgate rules pursuant to chapter twenty-nine-a to establish minimum ratemaking standards in accordance with accepted actuarial principles and practices. §33-16B-3. Exceptions.
This article shall not apply to group accident and health insurance plans providing coverage for employers who, during the preceding calendar year, employed an average of fifty-one or more employees and employs at least fifty-one employees on the first day of its group health plan year and upon which premiums are negotiated with the individual employer policyholder and are based on the historic and projected loss experience of the employer group to be insured.

NOTE: The purpose of this bill is to clarify the authority of the Commissioner to review for reasonableness mass marketed life and health policies, notwithstanding that they are effective upon filing, while limiting any exception from the application of the statute to those group accident and accident policies which cover employers with fifty-one or more employees.

Strike-throughs indicate language that would be stricken from the present law, and underscoring indicates new language that would be added.

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