West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-55 - Guaranteed Issue Of Individual Accident And Sickness Insurance
Section 114-55-6 - Determination of an Eligible Individual
Universal Citation: 114 WV Code of State Rules 114-55-6
Current through Register Vol. XLI, No. 38, September 20, 2024
6.1. Each insurer offering accident and sickness insurance coverage in the individual market is responsible for determining whether an applicant for coverage is an eligible individual and must exercise reasonable diligence in making this determination in a timely fashion.
a. If an
insurer determines that an individual is an eligible individual, the insurer must
promptly issue a policy to that individual.
b. If the information presented in or with an
application is substantially insufficient for the insurer to make the determination
described in subsection 6.1, the insurer may immediately request additional
information from the individual, and must act promptly to make its determination
after receipt of the requested information.
c. If an entity fails to provide a certificate of
creditable coverage as required by this section, the insurer is subject to the
procedures set forth in subsection 5.9 of this rule concerning the individual's
right to demonstrate creditable coverage.
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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