West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards
Section 114-12-1 - General

Universal Citation: 114 WV Code of State Rules 114-12-1

Current through Register Vol. XLI, No. 38, September 20, 2024

1.1. Scope. -- The purpose of this legislative rule is to provide reasonable standardization of coverage and simplification of terms and benefits of individual accident and sickness insurance policies; to facilitate public understanding and comparison of such policies and contracts; to eliminate provisions contained in such policies and contracts which may be misleading or confusing in connection with either their purchase or the settlement of claims; and to provide for full disclosure in the sale of such policies and contracts. This rule applies to all individual accident and sickness insurance policies and all individual subscriber contracts of hospital, medical, dental and health service corporations, health care corporations, fraternal benefit societies, and all individual enrollee agreements of health maintenance organizations delivered or issued for delivery in this State on and after the effective date of this rule, except that it does not apply to:

a. Individual policies or contracts issued pursuant to a conversion privilege under a policy or contract of group or individual insurance when the group or individual policy or contract includes provisions which are inconsistent with the requirements of this rule;

b. Credit accident and sickness insurance subject to WV 114 CSR 6 "Regulation of Credit Life Insurance and Credit Accident and Sickness Insurance;@

c. Medicare supplement insurance policies subject to WV 114 CSR 24 "Medicare Supplement Insurance;@

d. Long-term care insurance policies subject to WV 114 CSR 32 "Long-Term Care Insurance;@

e. Coverage under the West Virginia Public Employees Insurance Act (W. Va. Code ''5-16-1 et seq.);

f. Coverage under Medicare or Medicaid; and

g. Coverage under any automobile no-fault, workers' compensation, employer's liability, occupational disease or similar law.

The requirements contained in this rule are in addition to any other applicable rules previously or subsequently promulgated.

1.2. Authority. -- W. Va. Code ''33-2-10, 33-28-4, 33-28-5 and 33-28-6.

1.3. Filing Date. -- April 30, 1999.

1.4. Effective Date. -- April 30, 1999.

Disclaimer: These regulations may not be the most recent version. West Virginia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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