COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 326
(By Senators Minard and Helmick)
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[Originating in the Committee on Banking
and Insurance; reported March 18, 1993.]
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A BILL to amend and reenact section three, article sixteen,
chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, relating to
the promulgation of rules for minimum policy provisions on
group accident and sickness coverage.
Be it enacted by the Legislature of West Virginia:
That section three, article sixteen, chapter thirty-three of
the code of West Virginia, one thousand nine hundred thirty-one,
as amended, be amended and reenacted to read as follows:
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3. Required policy provisions.
Each such policy hereafter delivered or issued for delivery
in this state shall contain in substance the following
provisions:
(a) A provision that the policy, the application of the
policyholder, a copy of which shall be attached to such policy,
and the individual applications, if any, submitted in connectionwith such policy by the employees or members, shall constitute
the entire contract between the parties, and that all statements
made by any applicant or applicants shall be deemed
representations and not warranties, and that no such statement
shall void the insurance or reduce benefits thereunder unless
contained in a written application.
(b) A provision that the insurer will furnish to the
policyholder, for delivery to each employee or member of the
insured group, an individual certificate setting forth in
substance the essential features of the insurance coverage of
such employee or member and to whom benefits thereunder are
payable. If dependents are included in the coverage, only one
certificate need be issued for each family unit.
(c) A provision that all new employees or members, as the
case may be, in the groups or classes eligible for insurance,
shall from time to time be added to such groups or classes
eligible to obtain such insurance in accordance with the terms of
the policy.
(d) No provision relative to notice or proof of loss or the
time for paying benefits or the time within which suit may be
brought upon the policy shall be less favorable to the insured
than would be permitted in the case of an individual policy by
the provisions set forth in article fifteen of this chapter.
(e) A provision that all members in groups or classes
eligible for insurance provided through an employee's group plan
shall be permitted to pay the premiums at the same group rate and
receive the same coverages for a period not to exceed eighteen
months when they are involuntarily laid off from work.
(f) The commissioner may promulgate rules pursuant to
chapter twenty-nine-a of this code regarding the terminology and
format of group accident and sickness policies: Provided, That
the commissioner shall promulgate the first set of such rules as
emergency rules within forty-five days of the effective date of
this subsection.