Introduced Version
Senate Bill 158 History
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Senate Bill No. 158
(By Senators Minard and Love)
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[Introduced January 16, 2006; referred to the Committee
on Banking and Insurance.]
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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. Filing of forms.
(a) No insurance policy form, no group certificate form, no
insurance application form where a 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 the commissioner and, to the extent required by
subdivision (1), subsection (b) of this section, 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 does 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)(1) Forms for noncommercial lines shall be filed by an
insurer no less than sixty days in advance of any delivery. At the
expiration of the sixty-day period, unless the period was extended
by the commissioner to obtain additional information from the
insurer, the form is deemed to be approved unless prior thereto it
was affirmatively approved or disapproved by the commissioner.
Approval of any form by the commissioner constitutes a waiver of
any unexpired portion of the sixty-day period.
(2) Forms for: (A) Commercial lines property and casualty
risks; and (B) any mass-marketed life and/or health insurance policy offered to members of any association by the association
shall be filed with the commissioner and need not be approved by
the commissioner prior to use. The commissioner may, within the
first thirty days after receipt of the form, request information to
ensure compliance with applicable statutory provisions and may
disapprove forms not in compliance with the provisions of this
chapter. If the commissioner does not disapprove the form within
the thirty-day period, the form is effective upon its first use
after filing.
(c) When an insurer does not submit supporting information
with the form filing that allows the commissioner to determine
whether the form meets all applicable statutory requirements, the
commissioner shall require the insurer to furnish supporting
information. The sixty-day period for personal lines risks shall
be suspended on the date the commissioner requests additional
information and shall recommence on the date the commissioner
receives the supporting information: Provided, That the
commissioner shall have no less than fifteen days from receipt of
the supporting information to act. The commissioner may request
additional information after the initial sixty-day period with
respect to noncommercial lines, or thirty-day period with respect
to commercial lines and mass-marketed life and/or health insurance
to associations, to ensure continuing compliance with applicable
statutory provisions and may at any time, after notice and for cause shown, withdraw any approval or disapprove any form:
Provided, however, That any disapproval by the commissioner of any
form or withdrawal of a previous approval shall state the grounds
therefor and shall include a notice that the insurer may request a
hearing on the denial or withdrawal of approval.
(d) The commissioner may, by order, exempt from the
requirements of this section for so long as he or she considers
proper any insurance document or form or type specified in the
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:
(1) An association must 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. The association shall also have been in active existence for at least two years and shall have a constitution and
bylaws which provide that: (A) The association holds annual
meetings to further purposes of its members; (B) except in the case
of credit unions, the association collects dues or solicits
contributions from members; and (C) the members have voting
privileges and representation on the governing board and committees
that exist under the authority of the association: Provided, 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.
(2) "Commercial lines" means insurance for business and
professional interests, except that it does not include medical
malpractice insurance.
(3) "Noncommercial lines" means all insurance other than
commercial lines and includes medical malpractice and insurance for
personal, family and household needs.
(f) This section also applies to any form used by domestic
insurers for delivery in a jurisdiction outside West Virginia if
the insurance supervisory official of the jurisdiction informs the
commissioner that the form is not subject to approval or
disapproval by the official and upon the commissioner's order
requiring the form to be submitted to him or her for that purpose.
The same standards applicable to forms for domestic use apply to
forms used by domestic insurers for delivery in a jurisdiction outside West Virginia.
ARTICLE 16B. ACCIDENT AND SICKNESS RATES.
§33-16B-1. Filing and approval of accident and sickness rates.
(a) Premium rate charges for any individual or group accident
and sickness insurance policy, certificate or other evidence of
insurance issued, endorsed or delivered in this state shall be
filed with the commissioner for a waiting period of sixty days
before the charges become effective. At the expiration of sixty
days the premium rate charges filed are deemed approved unless
prior thereto the charges have been affirmatively approved or
disapproved by the commissioner.
(b)
Notwithstanding any other provisions of this section, any
mass marketed group health insurance policy offered to members of
any association by the association shall be 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 such sixty
days the premium rate charges so filed shall be deemed approved
unless prior thereto 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 the 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. Rate-making 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 does not apply to policies issued 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 employer group
policyholder and are experienced rated.
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, and limiting 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.