Title 26, Title 26 — Insurance Code

Definitions. (a) As used in this article: (i) "Adjusted RBC report" means an RBC report which has been adjusted by the commissioner in accordance with W.S. 26-48-202(c); (ii) "Corrective order" means an order issued by the commissioner specifying corrective actions which the comm…

Risk-based capital reports. (a) A domestic health organization shall, annually on or prior to March 1, prepare and submit to the commissioner a report of its RBC levels as of the end of the calendar year just ended, in a form and containing information as required by the RBC inst…

Company action level event. (a) "Company action level event" means any of the following events: (i) The filing of an RBC report by a health organization that indicates that the health organization's total adjusted capital is greater than or equal to its regulatory action level RB…

Regulatory action level event. (a) "Regulatory action level event" means, with respect to a health organization, any of the following events: (i) The filing of an RBC report by the health organization that indicates that the health organization's total adjusted capital is greater…

Authorized control level event. (a) "Authorized control level event" means any of the following events: (i) The filing of an RBC report by the health organization that indicates that the health organization's total adjusted capital is greater than or equal to its mandatory contro…

Mandatory control level event. (a) "Mandatory control level event" means any of the following events: (i) The filing of an RBC report which indicates that the health organization's total adjusted capital is less than its mandatory control level RBC; (ii) Notification by the commi…

Hearings. (a) A health organization shall have the right to an administrative hearing, on a record, at which the health organization may challenge any of the following determinations or actions by the commissioner: (i) Notification to a health organization by the commissioner of …

Confidentiality; prohibition on announcements; prohibition on use in ratemaking. (a) All RBC reports, to the extent the information is not required to be set forth in a publicly available annual statement schedule, and RBC plans, including the results or report of any examination…

Supplemental provisions; rules; exemptions. (a) The provisions of this article are supplemental to any other provisions of the laws of this state, and shall not preclude or limit any other powers or duties of the commissioner under such laws, including, but not limited to, W.S. 2…

Foreign health organizations. (a) A foreign health organization shall, upon the written request of the commissioner, submit to the commissioner an RBC report as of the end of the calendar year just ended by the later of: (i) The date an RBC report would be required to be filed by…

Immunity. There shall be no liability on the part of, and no cause of action shall arise against, the commissioner or the insurance department or its employees or agents for any action taken by them in the performance of their powers and duties under this article.

Notices. All notices by the commissioner to a health organization that may result in regulatory action under this article shall be effective upon dispatch if transmitted by registered or certified mail, or in the case of any other transmission shall be effective upon the health o…

Scope and purposes. (a) The purpose of this article is to create a legal framework within which service contracts may be sold in this state. (b) The following are exempt from W.S. 26-49-103 through 26-49-111: (i) Warranties; (ii) Maintenance agreements; (iii) Warranties, service …

Definitions. (a) As used in this article: (i) "Administrator" means the person who is responsible for the administration of the service contracts or the service contracts plans or who is responsible for any filings required by this article; (ii) "Consumer" means a natural person …

Requirements for doing business. (a) A provider may, but is not required to, appoint an administrator or other designee to be responsible for any or all of the administration of service contracts and compliance with this article. (b) Service contracts shall not be issued, sold or…

Required provisions; reimbursement insurance policy. (a) Reimbursement insurance policies insuring service contracts issued, sold or offered for sale in this state shall state that the insurer that issued the reimbursement insurance policy shall reimburse or pay on behalf of the …

Required disclosures; service contracts. (a) Service contracts marketed, sold, offered for sale, issued, made, proposed to be made, or administered in this state shall be written, printed or typed in clear, understandable language that is easy to read and shall disclose the requi…

Prohibited acts. (a) A provider shall not use in its name the words insurance, casualty, surety, mutual or any other words descriptive of the insurance, casualty or surety business; or a name deceptively similar to the name or description of any insurance or surety corporation, o…

Record keeping requirements. (a) The provider shall keep accurate accounts, books, and records concerning transactions regulated under this article. The provider’s accounts, books and records shall include the following: (i) Copies of each type of service contract sold; (ii) The …

Cancellation of reimbursement insurance policy. As applicable, an insurer that issued a reimbursement insurance policy shall not terminate the policy until a notice of termination in accordance with chapter 35 of this code, has been mailed or delivered to the commissioner. The te…

Obligations of reimbursement insurance policy insurers. (a) Providers are considered to be the agent of the insurer which issued the reimbursement insurance policy for purposes of obligating the insurer to service contract holders in accordance with the service contract and this …

Enforcement provisions. (a) The commissioner may conduct examinations of providers, administrators, insurers or other persons to enforce this article and protect service contract holders in this state. Upon request of the commissioner, the provider shall make all accounts, books …

Authority to develop regulations. The commissioner may promulgate reasonable rules and regulations necessary to implement this article.

Purpose and scope. The requirements of this chapter shall apply to all insurers domiciled in this state unless exempt pursuant to W.S.

Definitions. (a) As used in this chapter: (i) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined in W.S. 26-44-101(a)(iv); (ii) "Insurer" shall have the same meaning as set forth in W.S. 26-1-102(a)(xvi), except th…

Risk management framework. An insurer shall maintain a risk management framework to assist the insurer with identifying, assessing, monitoring, managing and reporting on its material and relevant risks. This requirement may be satisfied if the insurance group of which the insurer…

ORSA requirement. Subject to W.S. 26-51-106, an insurer, or the insurance group of which the insurer is a member, shall regularly conduct an ORSA consistent with a process comparable to the ORSA guidance manual. The ORSA shall be conducted no less than annually but also at any ti…

ORSA summary report. (a) Upon the commissioner's request, and no more than once each year, an insurer shall submit to the commissioner an ORSA summary report or any combination of reports that together contain the information described in the ORSA guidance manual, applicable to t…

Exemption. (a) An insurer shall be exempt from the requirements of this chapter, if: (i) The insurer has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the federal crop insurance cor…

Contents of ORSA summary report. (a) The ORSA summary report shall be prepared consistent with the ORSA guidance manual, subject to the requirements of subsection (b) of this section. Documentation and supporting information shall be maintained and made available upon examination…

Confidentiality. (a) Documents, materials or other information, including the ORSA summary report, in the possession of or control of the department that are obtained by, created by or disclosed to the commissioner or any other person under this chapter, is recognized by this sta…

Sanctions. Any insurer failing, without just cause, to timely file the ORSA summary report as required in this chapter shall be required, after notice and hearing, to pay a penalty of two thousand five hundred dollars ($2,500.00) for each day's delay, to be recovered by the commi…

Applicability. The requirements of this chapter shall become effective on January 1, 2015. The first filing of the ORSA summary report shall be in 2015 pursuant to W.S. 26-51-105.

Licensure of pharmacy benefit managers. No person shall act or hold himself out as a pharmacy benefit manager in this state unless he obtains a license from the department. The department shall through rules establish license requirements and procedures for the licensing of pharm…

Definitions. (a) As used in this article: (i) "Claim" means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device; (ii) "Insurer" means the entity defined in W.S. 26-1- 1…

Pharmacy benefit manager audits. (a) Any pharmacy benefit manager or person acting on behalf of a pharmacy benefit manager who conducts an audit of a pharmacy shall follow the following procedures: (i) Provide written notice to the pharmacy not less than ten (10) business days be…

Maximum allowable cost; offering information and alternatives. (a) To place a drug on a maximum allowable cost list, a pharmacy benefit manager shall ensure that the drug is: (i) If the drug is a generically equivalent drug, rated "A" or "B" in the most recent version of the Unit…

Transparency; prohibitions. (a) A pharmacy benefit manager or an agent of a pharmacy benefit manager shall not: (i) Cause or knowingly permit the use of an advertisement, promotion, solicitation, representation, proposal or offer that is untrue, deceptive or misleading; (ii) Char…

Alternate reimbursement methodologies. All contracts between a pharmacy benefits manager and a pharmacy services administrative organization, or its contracted pharmacies, and all contracts directly between a pharmacy benefits manager and a pharmacy shall include a process to inv…

Certain claims excluded. W.S. 26-52-104 through 26-52-106 shall apply to all health benefit plan issuers and pharmacy benefit managers except those claims associated with the Wyoming Medicaid fee-for-service program, the Wyoming workers compensation division or those claims other…

Scope and applicability of chapter. The following provisions apply to situations where there is a contract between an insurer or the insurer's intermediary and a pharmacy regarding the payment of insurance claims for pharmacy services pursuant to W.S. 26-52-102(a)(ix) submitted t…

Definitions. (a) As used in this chapter: (i) "Applicable number of calendar days" means: (A) For claims submitted electronically, twenty- one (21) days; (B) For claims submitted in a manner other than electronically, thirty (30) days. (ii) "Clean claim" means a claim that has no…

Payment of claims to pharmacy providers. (a) A contract between an insurer or the insurer's intermediary and a pharmacy for prescription drug coverage offered by the insurer or the insurer's intermediary shall require the insurer or the insurer's intermediary to make payment to t…

Definitions. (a) As used in this chapter: (i) "Third party administrator" means a person who directly or indirectly underwrites, collects charges, collateral or premiums from, or adjusts or settles claims on residents of this state, in connection with life, annuity, health, or st…

Registration of third party administrators; rulemaking authority. No person shall act as a third party administrator in this state without a certificate of registration issued by the commissioner. The commissioner in compliance with the Wyoming Administrative Procedure Act shall …

Third party administrator fee. Every third party administrator registered with the department shall pay the fee provided for in W.S. 26-4-101(a)(xix).