Chapter 33, Chapter 33

The provision requiring coverage for 12-month refill for contraceptive drugs codified at §33-58-1 of this code is made applicable to the provisions of this article.

(a) A policy, provision, contract, plan, or agreement subject to this article may not impose a copayment, coinsurance, or office visit deductible amount charged to a subscriber or member for services rendered for each date of service by a licensed occupational therapist, licensed…

(a) As used in this section, the following words and phrases have the meaning given them in this section unless the context clearly indicates otherwise: To the extent that coverage is provided “behavioral health, mental health, and substance use disorder” means a condition or dis…

The provisions of the Health Benefit Plan Network Access and Adequacy Act codified at §33-55-1 et seq. of this code is made applicable to the provisions of this article.

(a) The following terms are defined: (1) "911 call" means a communication indicating that an individual may need emergency medical services; (2) "Alternative destination" means a lower-acuity facility that provides medical services, including without limitation: (A) A federally-q…

The provision requiring coverage for 12-month refill for contraceptive drugs codified at §33-58-1 of this code is made applicable to the provisions of this article.

(a) A health maintenance organization issuing coverage in this state pursuant to the provisions of this article may not impose a copayment, coinsurance, or office visit deductible amount charged to a subscriber or member for services rendered for each date of service by a license…

(a) The following terms are defined: (1) "911 call" means a communication indicating that an individual may need emergency medical services; (2) "Alternative destination" means a lower-acuity facility that provides medical services, including without limitation: (A) A federally-q…

(a) Any director, officer or other manager of a prepaid limited health service organization who receives, collects, disburses or invests funds in connection with the activities of the organization is responsible for the funds in a fiduciary relationship to the enrollees. (b) A pr…

Every corporation shall annually on or before March 1, file, with its application for renewal license, a report, verified by an officer of the corporation, with the commissioner, showing its condition on the last day of the preceding calendar year, on forms required by section fo…

Every health maintenance organization shall comply with and is subject to the provisions of §33-4-14 relating to filing of financial statements with the commissioner and the national association of Insurance Commissioners. The annual financial statement required by that section s…

On January 1, of each year the corporation shall report on its operations for the preceding fiscal year to the Governor and the State Legislature. The report shall include a summary of the activities of the corporation and a complete operating and financial statement. A corporati…

This article may be cited as the "West Virginia Insurance Guaranty Association Act."

This article shall be known and may be cited as the "West Virginia Life and Health Insurance Guaranty Association Act."

(a) The commissioner shall: (1) Notify the association of the existence of an insolvent insurer not later than three business days after he or she receives notice of the determination of the insolvency. (2) Upon request of the board of directors, provide the association a stateme…

(a) (1) The association shall submit to the commissioner a plan of operation and any amendments thereto necessary or suitable to assure the fair, reasonable and equitable administration of the association. The plan of operation and any amendments thereto shall become effective up…

In addition to the duties and powers enumerated elsewhere in this article: (a) The commissioner shall: (1) Upon request of the board of directors, provide the association with a statement of the premiums in this and any other appropriate states for each member insurer; (2) When a…

(a) Any person recovering under this article is considered to have assigned the person’s rights under the policy to the association to the extent of the person’s recovery from the association. Every insured or claimant seeking the protection of this article shall cooperate with t…

To aid in the detection and prevention of member insurer insolvencies or impairments: (a) It shall be the duty of the commissioner: (1) To notify the commissioners of all the other states, territories of the United States, and the District of Columbia within 30 days following the…

(a) Any person having a claim under an insurance policy, whether or not it is a policy issued by a member insurer, and the claim under such other policy arises from the same facts, injury, or loss that gave rise to the covered claim against the association, shall first exhaust al…

The association may recommend a natural person to serve as a special deputy to act for the commissioner and under his or her supervision in the liquidation, rehabilitation or conservation of any member insurer.

To aid in the detection and prevention of insurer insolvencies: (1) The board of directors may, upon majority vote, make recommendations to the commissioner on matters generally related to improving or enhancing regulation for solvency. (2) At the conclusion of any domestic insur…

The association shall be subject to examination and regulation by the commissioner. The board of directors shall submit, not later than April 30 of each year, a financial report for the preceding calendar year, in a form approved by the commissioner.

(a) Nothing in this article shall be construed to reduce the liability for unpaid assessments of the insureds of an impaired or insolvent insurer operating under a plan with assessment liability. (b) Records shall be kept of all negotiations and meetings in which the association …

The association shall be exempt from payment of all fees and all taxes levied by this state or any of its subdivisions except taxes levied on real or personal property.

The association shall be subject to examination and regulation by the commissioner. The board of directors shall submit to the commissioner, not later than May 1 of each year, a financial report for the preceding calendar year in a form approved by the commissioner and a report o…

The association shall be exempt from payment of all fees and all taxes levied by this state or any of its subdivisions, except taxes levied on real property.

The rates and premiums charged for insurance policies to which this article applies shall include amounts sufficient to recoup a sum equal to the amounts paid to the association by the member insurer less any amounts returned to the member insurer by the association and such rate…

There shall be no liability on the part of and no cause of action of any nature shall arise against any member insurer, the association or its agents or employees, the board of directors, or the commissioner or his representatives for any action taken by them in the exercise and …

There shall be no liability on the part of and no cause of action of any nature shall arise against any member insurer or its agents or employees, the association or its agents or employees, members of the board of directors, or the commissioner or his or her representatives, for…

All proceedings in which the impaired or insolvent insurer is a party in any court in this state shall be stayed one hundred eighty days from the date an order of liquidation, rehabilitation or conservation is final to permit proper legal action by the association on any matters …

(a) All proceedings in which the insolvent insurer is a party or obligated to defend a party in any court in this state shall, subject to waiver by the association in specific cases involving covered claims, be stayed for six months and such additional time as may be determined b…

(a) A person, including a member insurer, agent, or affiliate of a member insurer, shall not make, publish, disseminate, circulate, or place before the public, or cause directly or indirectly, to be made, published, disseminated, circulated, or placed before the public, in any ne…

In the event any part or provision of this article be held to be unconstitutional by any court of competent jurisdiction, such holding and decision of the court shall not affect the validity and Constitutionality of the remaining parts and provisions of this article.

The purpose of this article is to provide a mechanism for the payment of covered claims under certain insurance policies to avoid excessive delay in payment and to the extent provided in this article, minimize financial loss to claimants or policyholders because of the insolvency…

(a) The purpose of this article is to protect, subject to certain limitations, the persons specified in §33-26A-3(a) of this code against failure in the performance of contractual obligations, under life, health, and annuity policies, plans, or contracts specified in §33-26A-3(b)…

(a) This article shall provide coverage for the policies and contracts specified in §33-26A-3(b) of this code: (1) To persons who, regardless of where they reside (except for nonresident certificate holders under group policies or contracts), are the beneficiaries, assignees, or …

This article applies to all kinds of direct insurance, but is not applicable to the following: (1) Life, annuity, health or disability insurance; (2) Mortgage guaranty, financial guaranty or other forms of insurance offering protection against investment risks; (3) Fidelity or su…

This article shall be construed to effect the purpose under section two of this article which constitutes an aid and guide to interpretation.

This article shall be liberally construed to effect the purpose under section two of this article which shall constitute an aid and guide to interpretation.

As used in this article: (1) “Account” means either of the two accounts created under §33-26A-6 of this code. (2) “Association” means the West Virginia Life and Health Insurance Guaranty Association created under §33-26A-6 of this code. (3) “Authorized assessment” or the term “au…

As used in this article: (1) “Account” means any one of the three accounts created by section six of this article. (2) “Affiliate” means a person who directly or indirectly, through one or more intermediaries, controls, is controlled by or is under common control with another per…

(a) There is created a nonprofit legal entity to be known as the West Virginia Life and Health Insurance Guaranty Association. All member insurers shall be and remain members of the association as a condition of their authority to transact insurance or a health maintenance organi…

There is created a nonprofit unincorporated legal entity to be known as the West Virginia Insurance Guaranty Association. All insurers defined as member insurers in section five of this article shall be and remain members of the association as a condition of their authority to tr…

(1) The board of directors of the association shall consist of not less than five nor more than nine persons serving terms as established in the plan of operation. The members of the board shall be selected by member insurers subject to the approval of the commissioner. Vacancies…

(a) The board of directors of the association shall consist of not less than seven nor more than 11 member insurers serving terms as established in the plan of operation. The members of the board shall be selected by member insurers subject to the approval of the commissioner. Va…

(a) The association shall: (1) Be obligated to pay covered claims existing prior to the final order of liquidation, that arise within thirty days after the final order of liquidation or before the policy expiration date if the expiration date is less than thirty days after the fi…

(a) If a member insurer is an impaired insurer, the association may, in its discretion, and subject to any conditions imposed by the association that do not impair the contractual obligations of the impaired insurer, that are approved by the commissioner: (1) Guarantee, assume, r…

(a) The association shall: (1) Submit to the commissioner a plan of operation and any amendments thereto necessary or suitable to assure the fair, reasonable and equitable administration of the association. The plan of operation and any amendments thereto become effective upon ap…

(a) For the purpose of providing the funds necessary to carry out the powers and duties of the association, the board of directors shall assess the member insurers, separately for each account, at such time and for such amounts as the board finds necessary. Assessments shall be d…