H. B. 4366
(By Delegates Walters, Ashley, Perry,
Varner, Michael, Hartman, White)
[Introduced February 5, 2010
; referred to the
Committee on Banking and Insurance then the Judiciary.]
A BILL to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new section, designated §33-16-18, relating
to requiring insurers issuing group accident and sickness
insurance policies to certain employers to furnish claims loss
experience to policyholders upon request of a policyholder;
and identifying the claims loss experience information to be
provided.
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new section, designated §33-16-18, to read as
follows:
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-18. Claims loss experience to be furnished to certain
employer group accident and sickness policyholders.
(a) In cases of employers providing group healthcare coverage
either insured or self-insured to fifty or more covered employees,
members or enrollees, not including dependents in the State of West Virginia, all third party administrators and insurers shall furnish
to the employer within thirty days of the renewal date if requested,
the employer's claims loss experience.
(b) All insurers and third party administrators will provide
such information annually to the employer group policyholder if
requested and shall include, but not limited to the following
information:
(1) Earned premiums separated by policy year for at least the
last two years, if applicable;
(2) Total paid claims and total incurred claims, inclusive of
any high dollar or pooled claims, including both capitated and
noncapitated expenses set forth in the same manner as premiums;
(3) Any amount in excess of the individual pooling or stop loss
trigger point applicable to the group; and
(4) The claims loss information may not include any information
prohibited from disclosure by any applicable federal law.
NOTE: The purpose of this bill is to require insurers issuing
group accident and sickness insurance policies to certain employers
to furnish claims loss experience to policyholders upon request of
a policyholder. It also identifies the claims loss experience
information to be provided.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added