Senate Bill No. 77
(By Senator Minard and Deem)
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[Introduced January 9, 2002; referred to the Committee
on Banking and Insurance.]
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A BILL to amend and reenact section four, article fifteen-a,
chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, relating to
long-term care insurance; and reducing the requirement for
minimum duration of continuous care to twelve consecutive
months.
Be it enacted by the Legislature of West Virginia:
That section four, article fifteen-a, 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 15A. WEST VIRGINIA LONG-TERM CARE INSURANCE ACT.
§33-15A-4. Definitions.
(a) "Long-term care insurance" means any insurance policy
or rider advertised, marketed, offered or designed to provide benefits for not less than
twenty-four twelve consecutive months
for each covered person on an expense incurred, indemnity,
prepaid or other basis; for one or more necessary or medically
necessary diagnostic, preventive, therapeutic, rehabilitative,
maintenance or personal care services, provided in a setting
other than an acute care unit of a hospital. The term includes
group and individual policies or riders whether issued by
insurers; fraternal benefit societies; nonprofit health,
hospital and medical service corporations; prepaid health plans;
health maintenance organizations, prepaid limited health service
organizations or any similar organization. Any insurance
policy which is offered primarily to provide basic medicare
supplement coverage, basic hospital expense coverage, basic
medical-surgical expense coverage, hospital confinement
indemnity coverage, major medical expense coverage, disability
income protection coverage, accident only coverage, specified
disease or specified accident coverage or limited benefit health
coverage which also contains long-term care insurance benefits
for at least six months shall comply with the provisions of this
article.
(b) "Applicant" means:
(1) In the case of an individual long-term care insurance
policy, the person who seeks to contract for benefits; and
(2) In the case of a group long-term care insurance policy,
the proposed certificate holder.
(c) "Certificate" means, for the purposes of this article,
any certificate issued under a group long-term care insurance
policy, which policy has been delivered or issued for delivery
in this state.
(d) "Commissioner" means the insurance commissioner of this
state.
(e) "Group long-term care insurance" means a long-term care
insurance policy which is delivered or issued for delivery in
this state and issued to:
(1) One or more employers or labor organizations, or to a
trust or to the trustees of a fund established by one or more
employers or labor organizations, or a combination thereof, for
employees or former employees or a combination thereof or for
members or former members or a combination thereof, of the labor
organizations; or
(2) Any professional, trade or occupational association for
its members or former or retired members, or combination
thereof, if the association:
(A) Is composed of individuals all of whom are or were
actively engaged in the same profession, trade or occupation;
and
(B) Has been maintained in good faith for purposes other
than obtaining insurance; or
(3) An association or a trust or the trustee or trustees of
a fund established, created or maintained for the benefit of
members of one or more associations. Prior to advertising,
marketing or offering the policy within this state, the
association or associations, or the insurer of the association
or associations, shall file evidence with the commissioner that
the association or associations have at the outset a minimum of
one hundred persons and have been organized and maintained in
good faith for the purposes other than that of obtaining
insurance; have been in active existence for at least one year;
and have a constitution and bylaws which provide that:
(A) The association or associations hold regular meetings
not less than annually to further purposes of the members;
(B) Except for credit unions, the association or
associations collect dues or solicit contributions from members;
and
(C) The members have voting privileges and representation
on the governing board and committees.
Thirty days after the filing the association or associations
will be
deemed considered to satisfy
such the organizational
requirements, unless the commissioner makes a finding that the association or associations do not satisfy those organizational
requirements.
(4) A group other than as described in subdivisions (1), (2)
and (3), subsection (e) of this section, subject to a finding by
the commissioner that:
(A) The issuance of the group policy is not contrary to the
best interest of the public;
(B) The issuance of the group policy would result in
economies of acquisition or administration;
(C) The benefits are reasonable in relation to the premiums
charged.
(f) "Policy" means, for the purposes of this article, any
policy, contract, subscriber agreement, rider or endorsement
delivered or issued for delivery in this state by an insurer;
fraternal benefit society; nonprofit health, hospital or medical
service corporation; prepaid health plan; health maintenance
organization, prepaid limited health service organization or any
similar organization.
NOTE: The purpose of this bill is to change the definition
of "long-term care insurance" to include policies providing
benefits for not less than twelve continuous months.
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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