Current through Register Vol. XLI, No. 38, September 20, 2024
2.1. In order to implement a guaranteed loss ratio
as established by the Commissioner, an insurer offering individual sickness and
accident insurance policies must make application to the Commissioner on the form
described in subsection 2.2 of this rule. The Commissioner shall have the discretion
to approve or reject any such application after reviewing the same. The application
form is set forth in Appendix A to this rule.
2.2. Each application filed with the Commissioner
pursuant to this rule must include a written loss ratio guarantee that at minimum
contains the following information:
a. Policy form
number;
b. The anticipated lifetime and
durational target loss ratios contained in the original actuarial memorandum filed
with the policy form when it was originally approved;
c. A designation of the first calendar year in
which the loss ratio guarantee is to be effective;
d. A guarantee that the actual West Virginia or,
if applicable, national loss ratios for each experience period shall meet or exceed
the anticipated lifetime and durational target loss ratios contained in the original
actuarial memorandum described in subdivision b of this subsection;
e. The source and dates of data used by the
insurer in determining lifetime and durational target loss ratios and credibility
data;
f. A guarantee that the actual
West Virginia, or, if applicable, national, loss ratio results for the experience
period at issue will be independently audited as described more fully in Section 4
of this rule;
g. The name and
qualifications of the independent auditor who will perform the annual audit
described in Section 4 of this rule;
h.
A guarantee that if the actual loss ratio during an experience period is less than
the anticipated loss ratio for that period, then West Virginia policyholders shall
receive proportional refunds based on premium earned, which refunds shall be
calculated and paid pursuant to W. Va. Code §
33-6C-5;
i. A sample calculation and illustration of the
refund methodology used to comply with this rule;
j. A non-discrimination guarantee as required by
W. Va. Code §
33-6C-4(c)(5);
and
k. The signature of an officer of
the insurer.
2.3. The
Commissioner shall notify an insurer of the acceptance or rejection of an
application to operate on a guaranteed loss ratio basis within sixty (60) days of
the date that such an application is received.
