H. B. 2174
(By Delegates Gallagher, Douglas, Compton, Linch,
Faircloth and Riggs)
[Introduced January 23, 1995; referred to the
Committee on Banking and Insurance then the Judiciary.]
A BILL to amend and reenact section two, article seven, chapter
sixty-four of the code of West Virginia, one thousand nine
hundred thirty-one, as amended, relating to authorizing the
insurance commissioner to promulgate legislative rules relating
to the regulation of credit life insurance and credit accident
and sickness insurance.
Be it enacted by the Legislature of West Virginia:
That section two, article seven, chapter sixty-four of the code
of West Virginia, one thousand nine hundred thirty-one, as amended,
be amended and reenacted, to read as follows:
ARTICLE 7. AUTHORIZATION FOR DEPARTMENT OF TAX AND REVENUE TO
PROMULGATE LEGISLATIVE RULES.
§64-7-2. Insurance commissioner.
(a) The legislative rules filed in the state register on the
eighteenth day of October, one thousand nine hundred eighty-three,
relating to the insurance commissioner (excess line brokers), are
authorized.
(b) The legislative rules filed in the state register on the
eighteenth day of August, one thousand nine hundred eighty-six,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the twelfth day of December, one thousand nine hundred
eighty-six, relating to the insurance commissioner (examiners'
compensation, qualification and classification), are authorized.
(c) The legislative rules filed in the state register on the
twentieth day of February, one thousand nine hundred eighty-seven,
relating to the insurance commissioner (West Virginia essential
property insurance association), are authorized.
(d) The legislative rules filed in the state register on the
twenty-ninth day of May, one thousand nine hundred eighty-seven,
relating to the insurance commissioner (medical malpractice annual
reporting requirements), are authorized.
(e) The legislative rules filed in the state register on the
thirty-first day of July, one thousand nine hundred eighty-seven,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the seventh day of November, one thousand nine hundred
eighty-seven, relating to the insurance commissioner (medical
malpractice loss experience and loss expense reporting requirements),
are authorized.
(f) The legislative rules filed in the state register on the
thirtieth day of November, one thousand nine hundred eighty-eight,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the twenty-first day of February, one thousand nine
hundred eighty-nine, relating to the insurance commissioner
(transitional requirements for the conversion of Medicare supplement
insurance benefits and premiums to conform to Medicare program
revisions), are authorized.
(g) The legislative rules filed in the state register on the
twenty-sixth day of May, one thousand nine hundred eighty-nine,
modified by the insurance commissioner to meet the objections of the legislative rule-making review committee and refiled in the state
register on the twenty-eighth day of September, one thousand nine
hundred eighty-nine, relating to the insurance commissioner
(insurance adjusters), are authorized.
(h) The legislative rules filed in the state register on the
second day of February, one thousand nine hundred ninety, modified
by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the twenty-ninth day of May, one thousand nine hundred
ninety, relating to the insurance commissioner (accident and sickness
rate filing), are authorized.
(i) The legislative rules filed in the state register on the
tenth day of August, one thousand nine hundred ninety, modified by
the insurance commissioner to meet the objections of the legislative
rule-making review committee and refiled in the state register on the
ninth day of October, one thousand nine hundred ninety, relating to
the insurance commissioner (group coordination of benefits), are
authorized.
(j) The legislative rules filed in the state register on the
tenth day of August, one thousand nine hundred ninety, modified by the insurance commissioner to meet the objections of the legislative
rule-making review committee and refiled in the state register on the
seventeenth day of January, one thousand nine hundred ninety-one,
relating to the insurance commissioner (AIDS regulations), are
authorized.
(k) The legislative rules filed in the state register on the
third day of December, one thousand nine hundred ninety, relating to
the insurance commissioner (health insurance benefits for
temporomandibular and craniomandibular disorders), are authorized.
(l) The legislative rules filed in the state register on the
twelfth day of August, one thousand nine hundred ninety-one, modified
by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the thirteenth day of January, one thousand nine hundred
ninety-two, relating to the insurance commissioner (guaranteed loss
ratios as applied to individual sickness and accident insurance
policies), are authorized.
(m) The legislative rules filed in the state register on the
ninth day of August, one thousand nine hundred ninety-one, modified
by the insurance commissioner to meet the objections of the legislative rule-making review committee and refiled in the state
register on the thirteenth day of January, one thousand nine hundred
ninety-two, relating to the insurance commissioner (examiners'
compensation, qualifications and classification), are authorized.
(n) The legislative rules filed in the state register on the
seventeenth day of July, one thousand nine hundred ninety-one,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the thirteenth day of January, one thousand nine hundred
ninety-two, relating to the insurance commissioner (permanent
regulations on Medicare supplement insurance), are authorized.
(o) The legislative rules filed in the state register on the
twelfth day of August, one thousand nine hundred ninety-one, modified
by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the thirteenth day of January, one thousand nine hundred
ninety-two, relating to the insurance commissioner ("tail"
malpractice insurance covering certain medical and allied health care
providers), are authorized.
(p) The legislative rules filed in the state register on the eighteenth day of September, one thousand nine hundred ninety-two,
relating to the insurance commissioner (regulation of credit life
insurance and credit accident and sickness insurance), are
authorized.
(q) The legislative rules filed in the state register on the
eighteenth day of September, one thousand nine hundred ninety-two,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the tenth day of December, one thousand nine hundred
ninety-two, relating to the insurance commissioner (filing fees for
purchasing groups and for risk retention groups not chartered in this
state), are authorized.
(r) The legislative rules filed in the state register on the
fourteenth day of October, one thousand nine hundred ninety-two,
relating to the insurance commissioner (group coordination of
benefits), are authorized with the amendment set forth below:
"On page six, subsection 2.1.9., after the words 'If a person
is covered by more than one employer group minimum benefits plan, the
order of benefits determination rules of this regulation decide the
order in which their benefits are determined in relation to each other' by inserting a colon and the words 'Provided, That under the
provisions of West Virginia Code §5-16-12(a), coverage issued
pursuant to the Public Employees Insurance Act is secondary to an
employer group minimum benefits plan and any other applicable health
insurance coverage.' "
(s) The legislative rules filed in the state register on the
eighteenth day of September, one thousand nine hundred ninety-two,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the fifteenth day of January, one thousand nine hundred
ninety-three, relating to the insurance commissioner (permanent
regulations on medicare supplement insurance), are authorized.
(t) The legislative rules filed in the state register on the
eighteenth day of September, one thousand nine hundred ninety-two,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the fifteenth day of January, one thousand nine hundred
ninety-three, relating to the insurance commissioner (individual and
employer group minimum benefits, accident and sickness insurance
policies), are authorized with the amendment set forth below:
"On page two, subsection 3.2 by striking out the period and
inserting the following: 'other than coverage issued pursuant to the
Public Employees Insurance Act, as provided in West Virginia Code
§5-16-12(a).' "
(u) The legislative rules filed in the state register on the
eighteenth day of September, one thousand nine hundred ninety-two,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the fifteenth day of January, one thousand nine hundred
ninety-three, relating to the insurance commissioner (long-term care
insurance), are authorized.
(v) The legislative rules filed in the state register on the
eighteenth day of September, one thousand nine hundred ninety-two,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the fifteenth day of January, one thousand nine hundred
ninety-three, relating to the insurance commissioner (standards for
uniform health care administration), are authorized.
(w) The legislative rules filed in the state register on the
sixteenth day of August, one thousand nine hundred ninety-three, modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the twenty-ninth day of November, one thousand nine
hundred ninety-three, relating to the insurance commissioner
(insurance holding company systems reporting forms), are authorized.
(x) The legislative rules filed in the state register on the
sixteenth day of August, one thousand nine hundred ninety-three,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the twenty-ninth day of November, one thousand nine
hundred ninety-three, relating to the insurance commissioner
(substandard motor vehicle insurance notice requirements), are
authorized.
(y) The legislative rules filed in the state register on the
sixteenth day of August, one thousand nine hundred ninety-three,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the twenty-ninth day of November, one thousand nine
hundred ninety-three, relating to the insurance commissioner (filing
fees for purchasing groups and for risk retention groups not chartered in this state), are authorized.
(z) The legislative rules filed in the state register on the
sixteenth day of August, one thousand nine hundred ninety-three,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the twenty-ninth day of November, one thousand nine
hundred ninety-three, relating to the insurance commissioner
(continuation of coverage under automobile liability policies), are
authorized.
(aa) The legislative rules filed in the state register on the
sixteenth day of August, one thousand nine hundred ninety-three,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the twenty-ninth day of November, one thousand nine
hundred ninety-three, relating to the insurance commissioner (West
Virginia life and health insurance guaranty association act notice
requirements), are authorized.
(bb) The legislative rules filed in the state register on the
sixteenth day of August, one thousand nine hundred ninety-three,
modified by the insurance commissioner to meet the objections of the legislative rule-making review committee and refiled in the state
register on the twenty-ninth day of November, one thousand nine
hundred ninety-three, relating to the insurance commissioner (group
accident and sickness insurance minimum policy coverage standards),
are authorized with the amendments set forth below:
On page two, section one, by inserting five new subsections to
read as follows:
"1.2.j. Coverage under a managed care program.
1.2.k. Bona Fide Associations.
1.2.l. Basic Hospital and Medical-Surgical Expense Coverage.
1.2.m. Coverage under policies issued to groups of 61 or more
under which the coverage is negotiated by the policy holder.
1.2.n. Individual limited benefits policies subject to the
requirements of West Virginia Code §§ 33-16E-1, et. seq."
And,
On page two, section two, by inserting two new subsections,
designated subsections 2.2 and 2.3, to read as follows, and
renumbering the remaining subsections:
"2.2 Basic Hospital and Medical Surgical Expense Coverage" means
policies designed to provide coverage for hospital and medical surgical expenses only incurred as a result of a covered accident or
sickness. Coverage is provided for daily hospital room and board,
miscellaneous hospital services, hospital out-patient services,
surgical services, anesthesia services, and in-hospital medical
services, subject to any limitations, deductibles and copayment
requirements set forth in the policy. Coverage is not provided for
unlimited hospital or medical surgical expenses.
2.3 'Bona Fide Association' means plans with a minimum of one
hundred members which shall have been organized 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; (3) the members have voting privileges
and representation on the governing board and committees that exist
under the authority of the association.";
And,
On page four, subsection 3.1, by deleting references to "or certificate" and "or certificate holder" and by adding to the end of
the subsection the following:
"Certificates issued under a policy subject to this rule and the
terms used therein shall be consistent with this section.";
And,
On page nine, subsection 5.1, by deleting the following "on
certificates" and by adding the following at the end thereof:
"The benefits described in a certificate issued under a policy
subject to this rule shall be consistent with the benefits contained
in the policy and shall be no less than those required under this
section.";
And,
On page nine, subsection 5.1.b by striking out subsection 5.1.b
in its entirety and inserting in lieu thereof the following:
"5.1.b If an insurer terminates coverage under a policy
providing pregnancy coverage, such policy shall provide for an
extension of benefits as to pregnancy commencing while the policy is
in force and for which benefits would have been payable had the
policy remained in force, provided that this subsection shall not
apply when termination of coverage is due to fraud, nonpayment of premium or any breach of the terms of the policy for which
termination is authorized under chapter thirty-three of the code.";
And,
On page ten, subsection 5.1.3, by adding at the end of such
subsection the following:
"provided such benefits may be limited to those expenses
directly relating to the organ donation.";
And,
On page ten, subsection 5.1.i, by striking said subsection in
its entirety and inserting in lieu thereof the following:
"5.1.i. Termination of coverage under a policy shall be without
prejudice to any continuous loss which commenced while the policy was
in force, but the extension of benefits beyond the period the policy
was in force may be predicated upon the continuous disability of the
insured or limited to the duration of the policy benefit period if
any: Provided, That this subsection shall not apply when
termination of coverage is due to fraud, nonpayment of premium or any
breach of the terms of the policy for which termination is authorized
under chapter thirty-three of the code.";
And,
On page nineteen, subsection 6.1, by deleting the references to
"or certificate" and "or certificate holder";
And,
On page twenty, subsection 6.9, by adding at the end of the
section the following:
"The notice shall also state that in the event the policy holder
exercises this right, the insurer shall not be obligated to pay any
benefits under the policy for claims submitted to the insurer during
such ten (10) day period."
(cc) The legislative rules filed in the state register on the
fifteenth day of August, one thousand nine hundred ninety-four,
modified by the insurance commissioner to meet the objections of the
legislative rule-making review committee and refiled in the state
register on the twenty-eighth day of November, one thousand nine
hundred ninety-four, relating to the insurance commissioner
(regulation of credit life insurance and credit accident and sickness
insurance), are authorized.
NOTE: The purpose of this bill is to authorize the Insurance
Commissioner to promulgate legislative rules relating to the
regulation of credit life insurance and credit accident and sickness
insurance.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.