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
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
(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
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
shall may promulgate rules pursuant to chapter
twenty-nine-a to establish minimum ratemaking standards in
accordance with accepted actuarial principles and practices.
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