§ 26-18-205 — Multi-state consortium; reciprocity requirements

Wyoming § 26-18-205

• Jurisdiction: Wyoming
• Title 26: Insurance Code
• Ch. 18: DISABILITY INSURANCE POLICIES

Text

(a) The commissioner shall explore with other insurance
commissioners the creation of a consortium of like-minded states
that could establish rules of reciprocity for the approval of
comprehensive individual medical and surgical health insurance
policies among the participating states.
(b) The commissioner shall solicit the thoughts and report
a consensus, where one exists, of the other commissioners
interested in creating a consortium of like minded states in
establishing rules of reciprocity for the approval of health
insurance policies. Issues to be considered include but are not
limited to:
(i) Whether the consortium should involve only high
deductible individual policies, all comprehensive individual
medical and surgical health insurance policies, both of these
types of individual policies plus small group policies or all
health insurance policies;
(ii) Whether insurers should be free to price
differently among consortium states dependent on local health
care costs and market conditions;
(iii) Whether a policy approved in a primary state
shall be automatically available in all secondary states of the
consortium, or available at the option of the insurer;
(iv) In areas where an associated preferred provider
network is absent, whether sale of policies should be
prohibited, disclaimers should be required or the sale of
policies should be regulated only by market forces and
conditions;
(v) The adequacy for a multi-state consortium of
existing state laws on insurer financial solvency, guarantee
funds and imposition and collection of premium taxes;
(vi) The authority of a secondary state to deal with
customer complaints concerning a multi-state policy;
(vii) Whether and when an insurer selling a policy
approved in a primary state must notify the commissioner of a
secondary state that the insurer is marketing the policy in the
secondary state;
(viii) Whether secondary state insurers, in order to
sell competitive policies, may match any less restrictive
primary state rules governing policies sold in the secondary
state, and whether disclaimers to warn potential customers shall
be required on policies and promotional materials in the
secondary state;
(ix) Whether any of the issues identified in this
subsection require the enactment of uniform laws in the
consortium states;
(x) Estimated savings to customers from policy
approval only in the primary state and from uniform or less
restrictive policies across the consortium states;
(xi) Other issues deemed appropriate by the
commissioners to implement a multi-state consortium.
(c) The commissioner shall make an initial proposal that
Wyoming recommends the rules of approval for reciprocity should
include terms and conditions to protect customers similar to the
following:
(i) An issuer, with respect to a particular policy,
may only designate one (1) state as its primary state with
respect to all coverage it offers using that policy. An issuer
may not change the designated primary state with respect to
individual health insurance coverage once the policy is issued;
provided, however, that a change in designation may be made upon
renewal of the policy with approval of the policyholder. With
respect to the designated primary state, the issuer shall be
licensed and approved to be doing business in that state;
(ii) In the case of a health insurance issuer that is
selling a policy in, or to a resident of, a secondary state, the
issuer shall be licensed and approved to be doing business in
that secondary state; and
(iii) The covered laws of the primary state shall
apply to individual health insurance coverage offered by a
health insurance issuer in the primary state and policies sold
in any secondary state. The coverage and issuer shall comply
with these terms and conditions with respect to the offering of
coverage in Wyoming.
(d) Except as provided in this section, a health insurance
issuer with respect to its offer, sale, rating (including
medical underwriting), benefit payment requirements, renewal and
issuance of comprehensive individual medical and surgical health
insurance coverage in Wyoming is exempt from any covered laws of
Wyoming as the secondary state and any rules, regulations,
agreements or orders sought or issued by the commissioner under
or related to the covered laws to the extent that the laws
would:
(i) Make unlawful or regulate, directly or
indirectly, the operation of the health insurance issuer
operating in Wyoming as a secondary state, except that the
commissioner may require an issuer:
(A) To pay on a nondiscriminatory basis
applicable premium and other taxes, including high risk pool
assessments and other assessments which are levied on insurers
and surplus lines insurers, brokers or policyholders under the
laws of Wyoming;
(B) To register with and designate the
commissioner as its agent solely for the purpose of receiving
service of legal documents or process;
(C) To submit to examinations of its financial
condition in accordance with the policies and regulations
established through the national association of insurance
commissioners for accreditation of states to perform these
examinations;
(D) To comply with an injunction issued by a
court of competent jurisdiction, upon a petition by the
commissioner acting pursuant to chapters 28 of this code,
chapter 48 of this code or W.S. 26-34-122 or 26-34-123;
(E) To participate, on a nondiscriminatory
basis, in any insurance insolvency guaranty association or
similar association to which a health insurance issuer in the
state is required to belong;
(F) To comply with any state law regarding fraud
and abuse, except that if the state seeks an injunction
regarding the conduct described in this subparagraph, the
injunction shall be obtained from a court of competent
jurisdiction;
(G) To comply with any state law regarding
unfair claims settlement practices; and
(H) To comply with the applicable requirements
for external review procedures with respect to coverage offered
in the state.
(ii) Discriminate against the issuer issuing
insurance in both the primary state and in any secondary state.
(e) Nothing in this section shall be construed to prohibit
a health insurance issuer:
(i) From terminating or discontinuing coverage or a
class of coverage in accordance with the laws of the primary
state;
(ii) From reinstating lapsed coverage; or
(iii) From retroactively adjusting the rates charged
an insured individual if the initial rates were set based on
material misrepresentation by the individual at the time of
issue.
(f) A health insurance issuer may not offer for sale
individual health insurance coverage in Wyoming unless that
coverage is currently offered for sale in the primary state.
(g) A person acting, or offering to act, as an agent or
broker for a health insurance issuer with respect to the
offering of individual health insurance coverage shall obtain a
license from Wyoming, with commissions or other compensation
subject to the provisions of the laws of Wyoming, except that
Wyoming may not impose any qualification or requirement which
discriminates against a nonresident agent or broker.
(h) Each health insurance issuer issuing individual health
insurance coverage in both primary and secondary states shall
submit to the insurance commissioner of each state in which it
intends to offer the coverage before it may offer individual
health insurance coverage in the state:
(i) A copy of the plan of operation or feasibility
study or any similar statement of the policy being offered and
its coverage which shall include the name of its primary state
and its principal place of business;
(ii) Written notice of any change in its designation
of its primary state; and
(iii) Written notice from the issuer of the issuer's
compliance with all the laws of the primary state.
(j) Nothing in this section shall be construed to affect
the authority of any federal or state court to enjoin the
solicitation or sale of individual health insurance coverage by
a health insurance issuer to any person or group who is not
eligible for that insurance.
(k) Out-of-state companies offering health benefit plans
under this article shall be subject to regulation by the
commissioner with regard to enforcement of the contractual
benefits under the health benefit plan, including the
requirements regarding prompt payment of claims for benefits
pursuant to W.S. 26-13-124 and 26-15-124.