Current through Register Vol. XLI, No. 38, September 20, 2024
1.1. Scope. -- The
purpose of this regulation is to establish certain minimum standards and provide
reasonable standardization and simplification of terms and coverages for policies or
subscriber contracts of accident and sickness insurance which are issued to persons
eligible for Medicare by reason of age and which are designed to supplement Medicare
or which are advertised, marketed or otherwise purported to be a supplement to
Medicare, to eliminate provisions contained in any policy or contract sold to a
person eligible for Medicare by reason of age which may be misleading or confusing,
to establish certain loss ratio requirements and provide for full disclosure in the
sale of such coverages.
(a) This regulation shall
apply to:
(1) All individual Medicare Supplement
or Limited Benefit Medicare Supplement policies and subscriber contracts delivered
or issued for delivery in this State on or after the effective date hereof,
and
(2) All certificates issued under
group Medicare Supplement or Limited Benefit Medicare Supplement policies or
subscriber contracts, which policies or contracts have been delivered or issued for
delivery in this State, and
(3) Where
applicable, all policies or contracts purporting to offer medical or surgical
coverage which are delivered or issued for delivery in this State to persons
eligible for Medicare by reason of age, including hospital confinement indemnity
coverage, nursing home coverage and specified disease coverage sold to such
persons.
(b) This regulation
shall not apply to:
(1) A policy or contract of one
or more employers or labor organizations, or of the trustees of a fund established
by one or more employers or labor organizations, or a combination thereof, for
employees or former employees, or combination thereof, or for members or former
members, or combination thereof, of the labor organizations;
(2) A policy or contract of any professional,
trade or occupational association for its members or former or retired members, or
combination thereof, if such association is composed of individuals all of whom are
actively engaged in the same profession, trade or occupation; has been maintained in
good faith for purposes other than obtaining insurance; and has been in existence
for at least two (2) years prior to the date of its initial offering of such policy
or plan to its members;
(3) Individual
policies or contracts issued pursuant to a conversion privilege under a policy or
contract of group or individual insurance when such group or individual policy or
contract includes provisions which are inconsistent with the requirements of this
section; or
(4) Individual or group
policies or contracts issued to employees or members as additions to franchise plans
in existence on the effective date of this regulation.
(c) This regulation shall apply in conjunction
with Series 12, Individual Accident and Sickness Insurance Minimum Standards,
together with all other applicable laws and regulation.
1.2. Authority. -- W. Va. Code '33-2-10,
'33-16-3d and '33-28-5b
1.3. Filing
Date. -- November 12, 1981
1.4.
Effective Date. -- December 28, 1981
