Wyoming Administrative Rules 044 — Insurance Dept.

197 General Agency, Board or Commission Rules

Chapter 1 Authority

Wyo. Code R. 044.0002.1.12311996 Authority

CHAPTER 1

AUTHORITY

Section 1. Duties and Powers of Commissioner

The Insurance Commissioner, pursuant to Section 26-2-110, Insurance Code of Wyoming, has the power to make all reasonable rules and regulations necessary to enforce the laws of this state relating to the business of insurance.

STATEMENT OF PRINCIPAL REASONS

FOR

Amendments to Chapter 1 of Wyoming Insurance Department Regulation

Authority

The only amendments to this Chapter, entitled Authority, are to change the chapter numbering and the chapter pagination.

Presently the Chapter is designated by the Roman number symbol “I.” It will be amended to be designated by the Arabic number symbol “1.”

Pagination of the chapter will be amended from the present continuous and sequential numbering from chapter-to-chapter, to chapter-specific numbering. As an example, each page will be designated first by a chapter number and then page number, as in 1-1, etc. Amending the method by which the pages are numbered will allow for simpler amendments in the future, and for easier reader identification of the chapter and pages with which they are concerned.

History

• Effective 1996-12-31

Chapter 2 Funeral Contract Trust Funds

Wyo. Code R. 044.0002.2.05042026 § 1 Authority

These rules are being promulgated by the Insurance Commissioner pursuant to W.S. §§ 26-2-110 and 26-32-101.

History

• Effective 2026-05-04

Wyo. Code R. 044.0002.2.05042026 § 2 Definitions

When used in this article, the term:

(a) "Person" unless the context otherwise requires, means an individual, partnership, firm, joint venture, corporation, company, association, or joint stock association.

(b) "Contract" means any contract, agreement, mutual understanding, series or combination of contracts, agreements, mutual understandings, and any security or other instrument which is convertible into a contract, agreement, or mutual understanding, whereby it is agreed that upon the death of any person a final resting place, personal property, or services of any nature shall be provided, delivered, or performed in connection with the preparation or cremation of such person's body for final disposition or in connection with the interment, entombment, or other final disposition of such person's remains or in connection with the memorializing or marking of the decedent, the decedent's remains, or the final resting place of such remains; and for which the contract seller receives depository funds as consideration for the contract, to be held by the contract seller for the benefit of the contract buyer as required by this regulation until performance of the contract. This term shall not include contracts for which the contract seller does not receive depository funds to be held for the benefit of the contract buyer, and the consideration for the contract is paid by beneficiary designations in policies of life insurance payable in money which are subject to regulation under other laws of this state. This term also shall not include a sale by the owner thereof of a cemetery lot, plot, grave space, niche or crypt if, upon receipt of full payment therefore, the purchaser acquires a conveyance of and a vested interest in an existing, specific, and identifiable lot, plot, grave space, niche, or crypt.

(c) "Contract seller" means any person who engages in the business of selling contracts, also called "seller".

(d) "Contract buyer" means any person who buys a contract from a contract seller, also called "buyer".

(e) "Decedent" means any person specified or included in the contract upon whose death a final resting place, personal property, or services of any nature shall be provided, delivered, or performed.

(f) "Commissioner" means the Commissioner of Insurance.

(g) "Depository" means a chartered state or national bank, authorized to do business in the state, or any savings and loan association in Wyoming, which is a member of the Federal Savings and Loan Insurance Corporation, with which a contract seller deposits funds received from the sale of contracts and so designated under a depository agreement.

(h) "Funds" or "Depository funds" means money, cash, cash equivalents, electronic funds transfer, or other negotiable instruments deposited by a contract seller with a depository from a contract buyer in consequence of and in consideration for the sale of a contract representing not less than 100% of the total selling price of a contract. In the event the contract buyer is making installment deposits, 100% of each installment shall become a part of the fund.

(i) "Performer" means the individual, partnership, association, company or corporation named in the pre-need funeral or burial contract who will provide the services enumerated in the contract for the decedent at the time of his death.

History

• Effective 2026-05-04

Wyo. Code R. 044.0002.2.05042026 § 3 Deposit of Funds with Depository

Not less than 100% of all funds received by the contract seller shall be deposited in the depository or otherwise invested pursuant to Section 4 of these regulations within thirty days after receipt thereof by a contract seller. Such funds shall be deposited under the terms of a depository agreement in a form to be approved by the insurance commissioner. Such funds deposited shall be held pursuant to the provisions of this regulation. The contract seller, at the time of each deposit of funds, shall make a record of the name of each contract buyer and the amount of the payment made by the contract buyer for which deposit is then being made, and shall keep such record, as to each contract buyer, until three years after the death of the decedent.

History

• Effective 2026-05-04

Wyo. Code R. 044.0002.2.05042026 § 4 Investments

(a) For all revocable contracts:

(i) The contract seller shall limit his deposits after 1 July 1979 to obligations of the United States of America or of any states thereof; obligations and stock of federal government agencies; demand deposits, savings accounts, certificates of deposit, or shares of savings and loan associations.

(ii) The contract seller may invest, notwithstanding the limitations of this section, funds in an amount not to exceed in the aggregate the amount of the seller's bond posted in accordance with Section 10 of these rules, in such types of investments which men of prudence, discretion and intelligence would acquire or retain for their own account.

(b) For all irrevocable contracts entered on or after January 1, 2026, the contract seller may invest in any investment allowed pursuant to W.S. § 4-10-901 and 4-10-902.

(c) Any checking account, savings account, certificate of deposit or other evidence of investment for credit jointly held in the names of a person (as defined in these regulations) and a licensed embalmer, undertaker, funeral director or other person regularly engaged in selling or furnishing funeral supplies or services (which include any embalming; caskets, cemetery lots, plots, niches, crypts, vaults, markers; cremations or any other thing incident to the ultimate disposal of dead bodies) shall be conclusively presumed to have with it an underlying contract which specifically provides for said services, and shall be construed to be part of a pre-need contract (as defined herein) and subject to these regulations.

(d) For all contracts, whether revocable or irrevocable, the contract seller shall be strictly accountable for the corpus of the funds to the contract buyer.

History

• Effective 2026-05-04

Wyo. Code R. 044.0002.2.05042026 § 5 License to Accept Funds, Application, Records, Annual Report, Investigation of Records

(a) No contract seller, also referred to herein as "licensee" or "applicant," shall accept any funds without first securing from the commissioner a license to accept funds.

(i) Application for license shall be in writing, signed by the applicant and duly verified on forms furnished by the commissioner. Each application shall contain at least the following information:

(A) The full name and address (both residence and place of business) of the applicant and every member, officer, and director thereof, if the applicant is a firm, partnership, association or corporation; and

(B) A detailed statement of the applicant's assets and liabilities.

(b) Upon receipt of an application and payment of the fee identified in W.S. § 26-4-101, the commissioner shall issue a license, unless he determines that the applicant has made false statements or representations in the application, or is insolvent, or is not fully authorized or licensed to transact a funeral business in the State of Wyoming, or has been convicted of fraud or misappropriation or misuse of funds. Every license issued pursuant to this subsection shall expire every other year on the licensee's birth month, but upon application and payment of the fee prescribed in W.S. § 26-4-101 may be renewed.

(c) The licensee shall keep accurate accounts, books, and records in this state of all transactions, copies of all contracts, dates and amounts of payments made and accepted thereon, the name and address of each contract buyer; the name of the decedent as to each contract, the name of the depository holding funds received under each contract, and shall make an annual report. Every application shall be accompanied by a fee of fifty dollars, and every annual report shall be accompanied by a fee of ten dollars.

(d) The licensee shall make all books and records pertaining to depository funds available to the commissioner for examination.

(i) The commissioner, or a qualified person designated by him may from time to time, during ordinary business hours examine the books, records, and accounts of the licensee with respect to funds received by said licensee and for that purpose may require the attendance of and examine under oath all persons whose testimony he may require. Said examination shall be made in accordance with generally accepted insurance accounting standards and shall be conducted pursuant to the examination procedures identified in W.S. § 26-2-116 through 26-2-122.

(ii) The cost of the examination shall be borne by the licensee, according to the provisions of the Wyoming Insurance Code pertaining to the examination of insurers.

History

• Effective 2026-05-04

Wyo. Code R. 044.0002.2.05042026 § 6 Assets, Income of Depository Funds

Income from depository funds shall inure to the benefit of the contract seller and may be withdrawn by him so long as the corpus of the deposit remains intact.

History

• Effective 2026-05-04

Wyo. Code R. 044.0002.2.05042026 § 7 Annual Report

Each contract seller shall file an annual report with the commissioner on or before March 1st of each year, in such form as the commissioner may require, stating the names of the depositories with which it has funds on deposit and the amount remaining on deposit in the fund on the preceding December 31st or such other annual and reporting period as the commissioner may establish. Any contract seller which has discontinued the sale of contracts but which still has outstanding contracts shall, nevertheless be required to obtain a renewal of its license, and shall continue to make annual reports to the commissioner until all such contracts have been fully performed by it.

History

• Effective 2026-05-04

Wyo. Code R. 044.0002.2.05042026 § 8 Contents of Contracts - Procedure

(a) At the time the contract is entered into the contract seller shall furnish each contract buyer with a duplicate original of the contract and, if said contract requires services to be performed at a future time by a person other than the contract seller, then the contract seller shall furnish the contract buyer with a copy of the instrument between the contract seller and such person obligated to perform the services agreed upon to be furnished and performed at the price provided in the contract.

(b) The contract seller shall file with the commissioner a master copy of each form of contract offered or sold by such contract seller and a master copy of any form instrument between the contract seller and a person licensed by the state whereby said person agreed to actually perform any services under any contracts offered or sold by the contract seller. In addition, the contract seller shall furnish the commissioner a written instrument on each contract sold, showing the names of all parties, the goods or services sold, the consideration therefor, and the terms of payment.

(c) If any contract contains an agreement for the performer to furnish services at a future time, the contract shall state the name and address of the principal office of the person licensed by the state who will perform such services. If no request for performance of the contract shall have been received by the contract seller from the next of kin or legal representative of the decedent within seventy-two hours after the death of the decedent, then the contract seller shall cause such services to be performed and such goods supplied in the manner provided in the contract, and upon the performance of such services, liability under such contract shall be conclusively deemed terminated.

(i) Any checking account, savings account, certificate of deposit or other evidence of investment for credit jointly held in the names of a person (as defined in these regulations) and a licensed embalmer, undertaker, funeral director or other person regularly engaged in selling or furnishing funeral supplies or services (which include any embalming, caskets, cemetery lots, plots; niches, crypts, vaults, markers; cremations or any other thing incident to the ultimate disposal of dead bodies) shall be conclusively presumed to have with it an underlying contract which specifically provides for said services, and said account etc., shall be construed to be a part of a pre-need contract (as defined herein) and subject to these regulations.

(ii) No contract, rider or addendum thereto, shall be offered for sale in Wyoming if such shall fail to provide for the furnishing of specific goods or services or both for a specified amount and no contract, rider or addendum shall contain a clause which provides for the diminution of the value of said goods or services or both or for an increase in the cost of same, contingent upon the happening of a future event or the existence in the future of any condition, economic or otherwise.

(d) Default, Termination, or Cancellation of Contract.

(i) In the event of default, termination, or cancellation by the contract seller for any reason whatsoever, said contract seller shall forthwith tender to the contract buyer all funds deposited on behalf of the contract buyer in the depository maintained by the contract seller. Said contract seller shall at the same time pay to the buyer all interest which has accrued on said funds as determined by the records of the depository and which otherwise is or was to be the property of the seller. (The fact that these regulations otherwise allow the contract seller to retain the interest shall not abrogate this requirement).

(ii) Unless designated as an irrevocable contract pursuant to subsection (f) of this section, below, in the event of default, termination, or cancellation by the contract buyer, other than by death, the contract seller shall forthwith tender to the contract buyer 80% of all principal funds which are on deposit as aforesaid. Accrued interest may be retained by the contract seller.

(e) Notice requirements for all contracts. All contracts shall:

(i) Contain the words "not insurance" in bold face type on the face of each contract.

(ii) Contain notice to the contract buyer of the types of investments into which the funds derived from the sale of these contracts may be deposited and the risks associated with those investments.

(iii) Contain notice that the contract buyer has the ability to cancel or terminate a contract or make demand for any amounts paid for the contract pursuant to the provisions of subsection (d) of this section, so long as the contract buyer has not elected an irrevocable contract pursuant to subsection (f) of this section.

(f) No contract shall restrict any contract buyer who is receiving State Medicaid benefits from making his contract irrevocable in accordance with the rules and regulations of the Wyoming Department of Family Services or Department of Health.

History

• Effective 2026-05-04

Wyo. Code R. 044.0002.2.05042026 § 9 Disbursements by Depositories

Disbursements of depository funds discharging any contract shall be made by the depository upon receipt of a document signed by the contract seller verifying that the contract has been fully performed, or is in default or a receipt signed by the contract buyer or his heirs or assigns discharging the contract seller from further obligations under the contract.

History

• Effective 2026-05-04

Wyo. Code R. 044.0002.2.05042026 § 10 Seller's Bond

(a) Every contract seller shall post with the insurance commissioner a surety bond in an amount of not less than five percent (5%) of all amounts received from all contract buyers or their representatives, whether deposited or invested, such amount to be determined as of the December 31st of the year next preceding, or such greater amount which the contract seller may wish to post, but in no event less than $10,000. The amount of such bond may not be reduced without the prior written approval of the commissioner.

(b) The State of Wyoming shall be named as the obligee in such bond for the benefit of the contract buyers, their heirs, legatees or assigns who are damaged by the loss of any funds paid to the contract seller after their receipt by the contract seller.

(c) This bond may consist of cash, demand deposits, savings accounts, certificates of deposit or a corporate surety bond or other such security as the insurance commissioner shall require.

History

• Effective 2026-05-04

Chapter 3 Regulation Governing the Transaction of Controlled Business by Title Insurers and Title Agents

Wyo. Code R. 044.0002.3.01272016 Regulation Governing the Transaction of Controlled Business by Title Insurers and Title Agents

CHAPTER 3

REGULATIONS GOVERNING THE TRANSACTION OF CONTROLLED BUSINESS BY TITLE INSURERS AND TITLE AGENTS

Section 1. Authority

These regulations governing the transaction of controlled business by title insurers and title agents supplement the provisions of W.S. § 26-23-301, et seq. They are promulgated by the authority of and pursuant to the Wyoming Administrative Procedure Act, W.S. §§ 16-3-101 through 16-3-115, W.S. § 26-23-333 and W.S. § 26-2-110.

Section 2. Definitions

All definitions shall be as identified in W.S. § 26-23-303.

Section 3. Disclosure by Producer of Controlled Business

Title insurers or agents may not transact any business for title insurance or title services if they know or have reason to believe that the insurance referral involves controlled business unless fully disclosed to the buyer, seller, or lender. The disclosure must be made by the producer or the producer's associate in writing on forms prescribed by the commissioner. The title insurer or agent shall maintain the disclosure forms for a period of five (5) years.

Section 4. Forms Showing Financial Interest to Be Filed with Commissioner

Each title insurer and title agent shall file with the commissioner, on forms prescribed by the commissioner, reports setting forth the names and addresses of those persons, if any, who have had a financial interest in the title insurer or title agent during the calendar year, who are known or reasonably believed by the title insurer or title agent to be producers or the producer's associates of title business.

(a) Each title insurer shall file the report required under this section with its application for a license, and upon renewal by March 1.

(b) Each title agent shall file the report required under this section upon initial application, and annually upon license renewal. An updated report shall be filed any time the information provided in the last report has changed.

Section 5. Restrictions upon the Writing of Controlled Business

No title insurer or title agent may accept an order for title insurance business, issue a title insurance policy, receive or retain any premium or charge in connection with any title insurance transaction if:

(a) The title insurer or title agent knows or has reason to believe that the transaction will constitute controlled business for that title insurer or title agent, and

(b) Twenty-five percent (25%) or more of the gross operating revenue of that title insurer or title agent in the calendar year in which the transaction takes place is derived from controlled business.

Section 6. Exemption

The restrictions imposed by these regulations shall not apply to any producer or associate who, on or before October 28, 1983, a financial interest in any title insurer or title agent to which business is referred and no additional financial interest in any title insurer or title agency has since been acquired.

Section 7. Effective Date

These regulations are effective immediately upon filing with the Secretary of State.

History

• Effective 2016-01-27

Chapter 4 Third-Party Administrators

Wyo. Code R. 044.0002.4.11022022 § 1 Authority

These regulations governing business relationships with administrators supplement the provisions of W.S. §§26-1-102(a)(xxx), 26-1-103, 26-2-109, 26-2-110, 26-2-116 through 26-2-124, 26-53-101 et seq., the Wyoming Administrative Procedures Act (W.S. §§ 16-3-101 through 16-3-115), and all other applicable provisions of the Wyoming Insurance Code [title 26].

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 2 Definitions

For purposes of this chapter:

(a) "Affiliate" or "affiliated" means a person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, another specified person.

(b) "Entity" means a corporation, association, partnership, limited liability company or other legal entity that is not an individual.

(c) "Collateral" means funds, letters of credit or any item with economic value owned by the payor but held by an entity or Third Party Administrator (TPA) in case it needs to be used to fulfill premium, plan contributions, or loss reimbursement obligations in accordance with a contract between the entity or TPA and the payor. "Collateral" shall include anticipated loss prepayments made prior to the payment of losses, pursuant to arrangements where reimbursement is not due until after losses have been paid.

(d) "Control" (including the terms "controlled by" and "under common control with") means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or non-management services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. Control shall be presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing, ten percent (10%) or more of the voting securities of any other person. This presumption may be rebutted by a showing made in the manner provided by W.S. § 26-44-104 that control does not exist in fact.

(e) "GAAP" means United States generally accepted accounting principles consistently applied.

(f) "Payor" means an entity that is required to be licensed or registered under the Wyoming insurance code [title 26].

(g) "Stop-loss insurance" means insurance protecting an employer, trust, or other person responsible for an otherwise self-insured health or life benefit plan against obligations under the plan, but "stop-loss insurance" does not include reinsurance written for an insurance company.

(h) "Third party administrator" or "TPA" is defined pursuant to W.S. § 26-53-101(a)(i).

(i) "Underwrites" or "underwriting" means, but is not limited to, the acceptance of employer or individual applications for coverage of individuals and the overall planning and coordination of a benefits program.

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 3 Licensing Necessary

No person shall act as a TPA in this state unless that person is licensed as a TPA pursuant to this chapter.

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 4 Payment to a TPA

If an entity utilizes the services of a TPA, any premiums, plan contributions, or charges for coverage paid to the TPA by or on behalf of the covered party, or any collateral furnished to the TPA by or on behalf of the covered party, shall be deemed to have been received by the entity, and the return of collateral, contributions, or the payment of return premiums, plan contributions, or claim payments forwarded by the entity to the TPA shall not be deemed to have been paid to the covered party or claimant until the payments are received by the covered party or claimant. Nothing in this section limits any right of the entity against the TPA resulting from the failure of the TPA to make payments to the entity, covered parties or claimants.

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 5 Maintenance of Information

(a) A TPA shall maintain and make available to the payor complete books and records of all transactions performed on behalf of the payor. The books and records shall be maintained in accordance with prudent standards of insurance record keeping and shall be maintained for a period of not less than five (5) years from the date of their creation.

(b) The commissioner shall have access to books and records maintained by a TPA for the purposes of examination, audit and inspection.

(c) Neither the commissioner nor any person who receives documents, materials or other information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning confidential documents, materials, or information subject to subsection (b) of this section.

(d) In order to assist in the performance of their duties, the commissioner may share or receive documents, materials or other information pursuant to W. S. §26-2-113(d).

(e) No waiver of any applicable privilege or claim of confidentiality in the documents, materials or information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subsection (d) of this section.

(f) Nothing in this chapter shall prohibit the commissioner from releasing final, adjudicated actions including for cause terminations that are open to public inspection pursuant to W.S. § 16-4-201 et seq. to a database or other clearinghouse service maintained by the National Association of Insurance Commissioners, its affiliates or subsidiaries.

(g) Notwithstanding any contractual agreements between the payor and the TPA that operate to the contrary, the TPA shall retain the right to sufficient continuing access to books and records to permit the TPA to fulfill all of its contractual obligations to insured parties, claimants, and the payor.

(h) In the event the payor or the TPA cancel their agreement; notwithstanding the provisions of subsection (a) of this section, the TPA may, by written agreement with the payor, transfer all records to a new TPA rather than retain them for five (5) years. In such cases, the new TPA shall acknowledge, in writing, that it is responsible for retaining the records of the prior TPA as required in subsection (a) of this section.

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 6 Entity Approval of Advertising

. A TPA that advertises on behalf of an entity may only use advertising that has been approved in writing by the entity in advance of its use. A TPA that mentions any current or formerly contracted entity in its advertising must obtain the entity's prior written consent.

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 7 Responsibilities of the Payor and TPA

(a) No TPA shall act as such without a written agreement between the TPA and the payor. A copy of the agreement shall be retained by the TPA for the duration of the agreement and for five (5) years thereafter. The agreement shall contain all provisions required by this section, except insofar as the TPA does not perform all of the functions referenced in this section.

(b) A payor that utilizes the services of a TPA shall retain responsibility for the benefits, premium rates, plan contribution amounts, collateral and reimbursement procedures, underwriting criteria and claims payment procedures applicable to the coverage and for securing reinsurance or stop-loss insurance, if any. The rules pertaining to these matters, to the extent that they are relevant to the duties of the TPA, shall be agreed to in writing by the payor and the TPA.

(c) A payor utilizing the services of a TPA is responsible for the acts of the TPA and is responsible for providing, upon request of the commissioner, any books and records relevant to its relationship with the TPA.

(d) The written agreement between the TPA and the payor shall provide that communications between the TPA and claimants shall avoid deceptive statements with regard to the responsibilities of the TPA, payor and any entity with regard to claims, premiums, or plan contributions.

(e) In the event of a dispute between the payor and the TPA regarding which of them is to fulfill a lawful obligation with respect to a policy, certificate or claim subject to the written agreement, the payor shall fulfill such obligation.

(f) The payor has the duty to provide for competent administration of its programs administered by a TPA and within the scope of this chapter.

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 8 Fiduciary Responsibilities and Payment of Claims

(a) All monies or collateral collected by a TPA on behalf of or for a payor, the return of monies or collateral received from a payor, and any funds held by the TPA for the payment of claims, shall be held by the TPA in a fiduciary capacity. Funds shall be immediately remitted to the person entitled to them or shall be deposited promptly in a fiduciary account established and maintained by the TPA in a federally insured financial institution. The TPA shall render an accounting to the payor, at intervals acceptable to the payor, detailing all transactions performed by the TPA pertaining to the business of the payor, and the written agreement between the payor and the TPA shall include the specifications of this reporting.

(b) The TPA shall keep copies of all records of any fiduciary account maintained or controlled by the TPA, and, upon request of a payor, shall furnish the payor with copies of the records pertaining to the deposits and withdrawals made on behalf of the payor. If funds deposited in a fiduciary account have been collected on behalf of or for more than one payor, or for the payment of claims associated with more than one policy, the TPA shall keep records clearly recording the deposits in and withdrawals from the account on behalf of each payor and relating to each policyholder.

(c) The TPA shall not pay any claim by withdrawals from a fiduciary account in which premiums, plan contributions, or charges are deposited. Withdrawals from a fiduciary account shall be made as provided in the written agreement between the TPA and the payor, and only for the following purposes:

(i) Remittance to a payor entitled to remittance;

(ii) Deposit in an account maintained in the name of the payor;

(iii) Transfer to and deposit in a claims-paying account, with claims to be paid as provided in subsection (d) of this section;

(iv) Payment to a group policyholder for remittance to the payor entitled to such remittance;

(v) Payment to the TPA of its earned commissions, fees or charges;

(vi) Remittance of return premium or plan contributions to the person or persons entitled to such return premium or plan contributions; and

(vii) Payment to other service providers as authorized by the payor.

(d) All claims paid by the TPA from funds collected on behalf of or for a payor shall be paid only as authorized by the payor. Payments from an account maintained or controlled by the TPA for purposes including the payment of claims may be made only for the following purposes:

(i) Payment of valid claims;

(ii) Payment of expenses associated with claims handling to the TPA or to other service providers approved by the payor;

(iii) Remittance to the payor, or transfer to a successor TPA as directed by the payor, for the purpose of paying claims and associated expenses; and

(iv) Return of funds held as collateral or prepayment, to the person entitled to those funds, upon a determination by the payor that those funds are no longer necessary to secure or facilitate the payment of claims and associated expenses.

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 9 Compensation to the TPA

(a) A TPA shall not enter into an agreement or understanding with a payor in which the effect is to make the amount of the TPA's commissions, fees, or charges contingent upon savings effected in the payment of losses covered by the payor's obligations. This provision shall not prohibit a TPA from receiving performance-based compensation for providing hospital or other auditing services, from providing managed care or related services, or from being compensated for subrogation expenses.

(b) A payor shall not enter into an agreement with a TPA in violation of this section.

(c) This section shall not prevent the compensation of a TPA from being based on premiums, plan contributions, or charges collected or the number of claims paid or processed.

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 10 Disclosure of Charges and Fees

(a) When a TPA collects funds, the reason for collection of each item shall be identified to the insured party and each item shall be shown separately from any premiums or plan contributions. Additional charges may not be made for services to the extent the services have been already paid for by the payor.

(b) The TPA shall disclose to the payor all charges, fees and commissions that the TPA receives arising from services it provides for the payor, including any fees or commissions paid by payors providing reinsurance or stop-loss insurance.

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 11 Delivery of Materials to Covered Individuals

Any policies, certificates, booklets, termination notices or other written communications delivered by the payor to the TPA for delivery to insured parties and covered individuals shall be delivered by the TPA within fourteen (14) calendar days of receipt of instructions from the payor to deliver them.

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 12 Initial TPA License

(a) A TPA applying to this state shall apply for licensure using forms prescribed by the commissioner and designate an individual as the TPA's contact person for department communications.

(b) The application forms shall include or be accompanied by the following information and documents:

(i) Verification of registration with the Wyoming Secretary of State or documentation from the Wyoming Secretary of State verifying that registration is not necessary;

(ii) Audited annual financial statements or reports for the two (2) most recent fiscal years that prove that the applicant has a positive net worth. If the applicant has been in existence for less than two (2) fiscal years, the application shall include financial statements or reports, certified by an officer of the applicant and prepared in accordance with GAAP, for any completed fiscal years, and for any month during the current fiscal year for which such financial statements or reports have been completed. An audited financial report prepared on a consolidated basis shall include a columnar consolidating or combining worksheet that shall be filed with the application for licensure and include the following:

(A) Amounts shown on the consolidated audited financial report shall be shown on the worksheet;

(B) Amounts for each entity shall be stated separately; and

(C) Explanations of consolidating and eliminating entries shall be included. The applicant shall also include such other information as the commissioner may require to review the current financial condition of the applicant;

(iii) Completed Designation of Third Party Administrator Form for each active contract. A TPA license shall not be issued without at least one (1) active designation;

(iv) Completed Entity/Third Party Administrator Contract Checklist for each active contract. A TPA license shall not be issued without at least one (1) active written agreement; and

(v) Such other pertinent information as may be required by the commissioner.

(c) A TPA licensed or applying for licensure under this section shall make available for inspection by the commissioner copies of all contracts with payors or other persons utilizing the services of the TPA.

(d) A TPA licensed or applying for licensure under this section shall produce its accounts, records and files for examination, and make its officers available to give information with respect to its affairs, as often as reasonably required by the commissioner.

(e) The commissioner may refuse to issue a license if the commissioner determines that the TPA or any individual responsible for the conduct of affairs of the TPA is not competent, trustworthy, financially sound or of good personal and business reputation, or has had an insurance or a TPA certificate of authority or license denied or revoked for cause by any jurisdiction, or if the commissioner determines that any of the grounds set forth in section 14 of this chapter exists with respect to the TPA.

(f) A license issued under this section shall continue in force until renewed, expired, surrendered, suspended, revoked or otherwise terminated.

(g) Any license referred to in subsection (f) of this section is considered expired if the commissioner does not receive the renewal application as required in section 13 of this chapter by June 30 of the renewal year.

(h) An individual may not qualify for licensure under this section.

(i) A TPA licensed or applying for licensure under this section shall notify the commissioner within thirty days of any material change in its contact person for the TPA or other fact or circumstance affecting its qualification for a license in this state.

(j) A TPA licensed or applying for a license under this section shall maintain a surety bond with the State of Wyoming as obligee for its use and benefit to cover persons in this state who have remitted premiums, plan contributions, or insurance charges or other monies to the TPA in the course of the TPA's business. The bond shall be the greater of the following amounts:

(i) One hundred thousand dollars ($100,000); or

(ii) Ten percent (10%) of the aggregate total amount of funds handled in this state, not to exceed one million dollars ($1,000,000) unless a larger amount is deemed by the commissioner to be necessary for the protection of the protection of the payor's policyholders or members in this state.

(k) For the purposes of fixing the amount of the bond described in paragraph (j) of this section, the amount of funds handled shall be determined by the total funds handled by the TPA within the borders of and on behalf of the citizens of Wyoming during the preceding year. If no funds were handled during the preceding year the amount of funds reasonably estimated to be handled during the current licensing year by the TPA. Such bond or deposit shall provide protection to the payor's policyholders or members in this state against loss by reason of acts of fraud or dishonesty and negligence by the TPA.

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 13 License Renewal

(a) Each TPA licensed under section 12 shall file a license renewal application on or before June 30 of the renewal year, or within such extension of time as the commissioner for good cause may grant. The renewal application shall include an audited financial statement performed by an independent certified public accountant for the preceding two (2) fiscal years. An audited financial report prepared on a consolidated basis shall include a columnar consolidating or combining worksheet that shall be filed with the report and include the following:

(i) Amounts shown on the consolidated audited financial report shall be shown on the worksheet;

(ii) Amounts for each entity shall be stated separately; and

(iii) Explanations of consolidating and eliminating entries shall be included. The renewal application shall be in the form and contain such matters as the commissioner prescribes and shall be verified by at least two (2) officers of the TPA.

(b) The renewal shall include the complete names and addresses of all payors with which the TPA had agreements, and funds handled on behalf of Wyoming citizens for each during the two (2) preceding fiscal years.

(c) The renewal shall include the verification of the bond amount required by section 12 of this chapter and a copy of the bond itself.

(d) The renewal shall include an updated appointment verification for all payors with which the TPA has current agreements.

(e) At the time of filing its renewal, the TPA shall pay a filing fee as required by W.S. § 26-4-101.

History

• Effective 2022-11-02

Wyo. Code R. 044.0002.4.11022022 § 14 Grounds for Denial, Suspension or Revocation of Licensure

(a) The commissioner may, deny, suspend or revoke the license of a TPA if, after notice and opportunity for hearing pursuant to Chapter 32 of the Wyoming Insurance Regulations, the commissioner finds that the TPA:

(i) Has a negative net worth;

(ii) Is using such methods or practices in the conduct of its business so as to render its further transaction of business in this state hazardous or injurious to insured persons or the public;

(iii) Has failed to pay any judgment rendered against it in this state within sixty (60) days after the judgment has become final;

(iv) Has violated any lawful rule or order of the commissioner or any provision of the insurance laws of this state;

(v) Has refused to produce its accounts, records and files for examination or investigation by the commissioner;

(vi) Has, without just cause, refused to pay proper claims or perform services arising under its contracts or has, without just cause, caused covered individuals to accept less than the amount due them or caused covered individuals to employ attorneys or bring suit against the TPA or a payor which it represents to secure full payment or settlement of such claims;

(vii) Is required pursuant to this chapter to have a license and fails at any time to meet any qualification for which issuance of a license could have been refused had the failure then existed and been known to the commissioner, unless the commissioner issued a license with knowledge of the ground for disqualification and had the authority to waive it;

(viii) Has one or more of the individuals responsible for the conduct of its affairs has been convicted of, or has entered a plea of guilty or nolo contendere to, any felony, without regard to whether adjudication was withheld;

(ix) Is under suspension or revocation in another state; or

(x) Has failed to file a timely renewal application pursuant to section 13.

(b) If the commissioner finds that sufficient grounds exist for the suspension or revocation of a license issued under this section the commissioner may, in lieu of or in addition to the suspension or revocation, impose a fine upon the TPA pursuant to W.S. § 26-1-107.

(c) The provisions of this section are in addition to and not instead of any other enforcement provisions contained in the Wyoming Insurance Code [title 26].

History

• Effective 2022-11-02

Chapter 10 Coordination of Benefits

Wyo. Code R. 044.0002.10.09132023 Coordination of Benefits

CHAPTER 10

COORDINATION OF BENEFITS

Section 1. Authority.

(a) These regulations are promulgated pursuant to W.S. §§ 26‑2‑110, 26-18-121, and 26‑19‑101, et seq.

Section 2. Definitions and Procedures.

(a) "Plan" means any plan providing benefits or services for or on account of medical or dental care or treatment.

(i) "Plan" includes:

(A) Group and non-group insurance contracts and subscriber contracts;

(B) Uninsured arrangements of group or group-type coverage;

(C) Group and non-group coverage through closed panel plans;

(D) Group-type contracts;

(E) Medicare or other governmental benefits, as permitted by law, except as provided in Paragraph (ii)(H) of this Subsection. That part of the definition of plan may be limited to the hospital, medical, and surgical benefits of the governmental program; and

(F) Group and non-group insurance contracts and subscriber contracts that pay or reimburse for the cost of dental care.

(ii) "Plan" does not include:

(A) Hospital indemnity coverage benefits or other fixed indemnity coverage;

(B) Accident only coverage;

(C) Specified disease or specified accident coverage;

(D) Limited benefit health coverage;

(E) School accident-type coverages that cover students for accidents only, including athletic injuries, either on a twenty-four-hour basis or on a "to and from school" basis;

(F) Benefits provided in long-term care insurance policies for non‑medical services; for example, personal care, adult day care, homemaker services, assistance with activities of daily living, respite care and custodial care or for contracts that pay a fixed daily benefit without regard to expenses incurred or the receipt of services;

(G) Medicare supplement policies;

(H) A state plan under Medicaid; or

(I) A governmental plan, which, by law, provides benefits that are in excess of those of any private insurance plan or other non-governmental plan.

(b) The term "Plan" shall be construed separately with respect to each policy, contract, or other arrangement for benefits or services and separately with respect to that portion of any such policy, contract, or other arrangement which reserves the right to take the benefits or services of other plans into consideration in determining its benefits and that portion which does not.

(c) The definition of a "Plan" within the Coordination of Benefits provision of a group contract shall enumerate the types of coverage which the insurer may consider in determining whether overinsurance exists with respect to a specific claim. Such definition:

(i) Shall not include individual or family policies, or individual or family subscriber contracts, except as provided in this Subsection.

(ii) May include all group policies or group subscriber contracts as well as such group‑type contracts as are not available to the general public and can be obtained and maintained only because of the covered person's membership in or connection with a particular organization or group. Such group‑type contracts may be included in the definition, at the option of the insurer, whether or not individual policy forms are utilized and whether the group‑type coverage is designated as "franchise" or "blanket" or in some other fashion.

(iii) Shall not include group or group‑type hospital indemnity benefits written on a non‑expense incurred basis unless they are characterized as reimbursement type benefits and are designed or administered so as to give the insured the right to elect indemnity type benefits, in lieu of such reimbursement type benefits, at the time of claim.

(iv) School accident type coverages written on either an individual, group, blanket, or franchise basis shall not be taken into consideration in coordination of benefits.

(v) If "Medicare" or similar governmental benefits are included in the definition of a "Plan," such benefits shall be considered without expanding any of the definitions of this provision beyond the hospital, medical, and surgical benefits as may be provided by the governmental program.

(vi) A plan may not coordinate or design benefits so that the benefits payable are altered solely on the basis that:

(A) another plan exists; or

(B) the claimant is or could have been covered under another plan; or

(C) the claimant has elected an option under another plan providing a lower level of benefits than another option for which the claimant was eligible.

(vii) Shall not include any policy providing coverage for a specified disease.

(d) "Allowable Expense" means any necessary, reasonable and customary item of expense at least a portion of which is covered under at least one of the plans covering the person for whom claim is made.

(e) When a plan provides benefits in the form of services rather than cash payments, the reasonable cash value of each service rendered shall be deemed to be both an allowable expense and a benefit paid.

Section 3. Order of Benefit Determination. Each plan determines its order of benefits using the first of the following rules that applies:

(a) Non-Dependent or Dependent

(i) Subject to Subparagraph (A) of this paragraph, the plan that covers the person other than as a dependent, for example as an employee, member, subscriber, policyholder or retiree, is the primary plan and the plan that covers the person as a dependent is the secondary plan.

(A) If the person is a Medicare beneficiary, and, as a result of the provisions of Title XVIII of the Social Security Act and implementing regulations, Medicare is:

(I) Secondary to the plan covering the person as a dependent; and

(II) Primary to the plan covering the person as other than a dependent (e.g. a retired employee),

(B) Then the order of benefits is reversed so that the plan covering the person as an employee, member, subscriber, policyholder or retiree is the secondary plan and the other plan covering the person as a dependent is the primary plan.

(b) Dependent Child Covered Under More Than One Plan

(i) Unless there is a court decree stating otherwise, plans covering a dependent child shall determine the order of benefits as follows:

(A) For a dependent child whose parents are married or are living together, whether or not they have ever been married:

(I) The plan of the parent whose birthday falls earlier in the calendar year is the primary plan; or

(II) If both parents have the same birthday, the plan that has covered a parent longest is the primary plan.

(B) For a dependent child whose parents are divorced or separated or are not living together, whether or not they have ever been married:

(I) If a court decree states that one of the parents is responsible for the dependent child's health care expenses or health care coverage and the plan of that parent has actual knowledge of those terms, that plan is primary. If the parent with responsibility has no health care coverage for the dependent child's health care expenses, but that parent's spouse does, that parent's spouse's plan is the primary plan. This item shall not apply with respect to any plan year during which benefits are paid or provided before the entity has actual knowledge of the court decree provision;

(II) If a court decree states that both parents are responsible for the dependent child's health care expenses or health care coverage, the provisions of Subparagraph (A) of this paragraph shall determine the order of benefits;

(III) If a court decree states that the parents have joint custody without specifying that one parent has responsibility for the health care expenses or health care coverage of the dependent child, the provisions of Subparagraph (A) of this paragraph shall determine the order of benefits; or

(IV) If there is no court decree allocating responsibility for the child's health care expenses or health care coverage, the order of benefits for the child are as follows:

(1.) The plan covering the custodial parent;

(2.) The plan covering the custodial parent's spouse;

(3.) The plan covering the non-custodial parent; and then

(4.) The plan covering the non-custodial parent's spouse.

(C) For a dependent child covered under more than one plan of individuals who are not the parents of the child, the order of benefits shall be determined, as applicable, under Subparagraph (A) or (B) of this paragraph as if those individuals were parents of the child.

(D) For a dependent child who has coverage under either or both parents' plans and also has his or her own coverage as a dependent under a spouse's plan, the rule in subsection (e) applies.

(E) In the event the dependent child's coverage under the spouse's plan began on the same date as the dependent child's coverage under either or both parents' plans, the order of benefits shall be determined by applying the birthday rule in Subparagraph (A) of this paragraph to the dependent child's parent(s) and the dependent's spouse.

(c) Active Employee or Retired or Laid-Off Employee

(i) The plan that covers a person as an active employee - meaning an employee who is neither laid off nor retired or as a dependent of an active employee - is the primary plan. The plan covering that same person as a retired or laid-off employee or as a dependent of a retired or laid-off employee is the secondary plan.

(ii) If the other plan does not have this rule, and as a result, the plans do not agree on the order of benefits, this rule is ignored.

(iii) This rule does not apply if the rule in Subsection (a) of this Section can determine the order of benefits.

(d) COBRA or State Continuation Coverage

(i) If a person whose coverage is provided pursuant to COBRA or under a right of continuation pursuant to state or other federal law is covered under another plan, the plan covering the person as an employee, member, subscriber or retiree or covering the person as a dependent of an employee, member, subscriber or retiree is the primary plan and the plan covering that same person pursuant to COBRA or under a right of continuation pursuant to state or other federal law is the secondary plan.

(ii) If the other plan does not have this rule, and if, as a result, the plans do not agree on the order of benefits, this rule is ignored.

(iii) This rule does not apply if the rule in Subsection (a) of this Section can determine the order of benefits.

(e) Longer or Shorter Length of Coverage

(i) If the preceding rules do not determine the order of benefits, the plan that covered the person for the longer period of time is the primary plan and the plan that covered the person for the shorter period of time is the secondary plan.

(ii) To determine the length of time a person has been covered under a plan, two successive plans shall be treated as one if the covered person was eligible under the second plan within twenty-four (24) hours after coverage under the first plan ended.

(iii) The start of a new plan does not include:

(A) A change in the amount or scope of a plan's benefits;

(B) A change in the entity that pays, provides or administers the plan's benefits; or

(C) A change from one type of plan to another, such as, from a single employer plan to a multiple employer plan.

(iv) The person's length of time covered under a plan is measured from the person's first date of coverage under that plan. If that date is not readily available for a group plan, the date the person first became a member of the group shall be used as the date from which to determine the length of time the person's coverage under the present plan has been in force.

(f) If none of the preceding rules determines the order of benefits, the allowable expenses shall be shared equally between the plans.

(g) If none of the preceding rules determines the order of benefits, the allowable expenses shall be shared equally between the plans. If the plans cannot agree on the order of benefits within forty-five (45) calendar days after the plans have received all of the information needed to pay the claim, the plans shall immediately pay the claim in equal shares and determine their relative liabilities following payment, except that no plan shall be required to pay more than it would have paid had it been the primary plan.

Section 4. Procedure to be Followed by Secondary Plan to Calculate Benefits and Pay a Claim.

In determining the amount to be paid by the secondary plan on a claim, should the plan wish to coordinate benefits, the secondary plan shall calculate the benefits it would have paid on the claim in the absence of other health care coverage and apply that calculated amount to any allowable expense under its plan that is unpaid by the primary plan. The secondary plan may reduce its payment by the amount so that, when combined with the amount paid by the primary plan, the total benefits paid or provided by all plans for the claim do not exceed 100 percent of the total allowable expense for that claim. In addition, the secondary plan shall credit to its plan deductible any amounts it would have credited to its deductible in the absence of other health care coverage.

Section 5. Right of Recovery.

Whenever payments for allowable expenses have been made by an insurer in excess of the maximum amount required by its contract requirements, the insurer shall have the right to recover excess payments as the insurer shall determine from among: any person to whom payments were made, any other insurers, or any other organizations. Coordination of Benefits differs from subrogation. Provisions for one may be included in health care benefits contracts without compelling the inclusion or exclusion of the other.

Section 6. Notice to Covered Persons.

A plan shall, in its explanation of benefits provided to covered persons, include the following language: "If you are covered by more than one health benefit plan, you should file all your claims with each plan."

Section 7. Effective Date.

This regulation shall become effective upon filing with the Secretary of State. All policy and contract forms subject to this regulation which were issued prior to its effective date shall be brought into compliance with the requirements of this regulation at the next anniversary date or renewal date of the group policy or contract.

History

• Effective 2023-09-13

Chapter 11 Rules Governing Filing of Forms

Wyo. Code R. 044.0002.11.09162025 Rules Governing Filing of Forms

CHAPTER 11

RULES GOVERNING FILING OF FORMS

Section 1. Authority. These rules and regulations are promulgated pursuant to W.S. §§ 26-2-110, 26-5-104 through 26-5-107, 26‑14‑109, 26‑15‑110, and 16‑3‑101 et seq.

Section 2. Applicability. These rules shall apply to all insurers or advisory organizations required to submit form filings pursuant to W.S. §§ 26‑14‑109 and 26‑15‑110. These rules shall not apply to any assigned risk program.

Section 3. Submission of Filings.

(a) The filing required by W.S. § 26‑15‑110 may be made by an insurance company, or on behalf of an insurance company by a registered advisory organization, in accordance with these rules. No advisory organization may make any filings on its own behalf.

(i) Any insurance company may make individual form filings directly with the Department.

(ii) Any advisory organization may make individual filings on behalf of a single insurance company by submitting the form for filing together with an affidavit from the insurance company which states the advisory organization is authorized to make the form filing on behalf of the insurance company and that the insurance company will make the form available for use in Wyoming under the company's underwriting standards.

(iii) No form is considered filed by a reference to some other approved form of another insurer or an advisory organization. All form filings must be complete in and of themselves.

(b) Pursuant to W.S. § 26‑15‑110(d), the Commissioner may issue an order exempting companies and advisory organizations from the requirements of this section. Exemption orders will remain in effect until withdrawn by the Commissioner.

Section 4. Alternative Filing Procedures.

(a) An advisory organization may submit a form to the Commissioner for conditional approval. No form will be considered filed unless it is adopted for use by one or more admitted insurance companies by one of the following two methods:

(i) First Alternative Method. After a form is submitted by an advisory organization for conditional approval and the advisory organization is advised that the form is conditionally approved, any admitted insurance company may adopt the form for use in Wyoming by submitting a certificate executed by an authorized company official that the company is adopting the form identified by the system approved under paragraph (c) of this Section for use in Wyoming; and that the form will be offered in Wyoming.

(ii) Second Alternative Method. An insurance company which is a member or subscriber of an advisory organization may adopt all or substantially all forms of the advisory organization which are or become conditionally approved in this state by filing a single certificate executed by an authorized company official that the company is adopting all forms conditionally approved except those the company specifically identifies to the Wyoming Insurance Department in writing within 60 days of the date of conditional approval notification to the advisory organization. The certificate shall attest that the insurance company will make the form available for use in Wyoming under the company's underwriting standards for the insurance offered under each form, until withdrawn or unless accepted within 60 days as provided here.

(b) Deviations from conditionally approved advisory organization forms must be individually submitted for department approval in accordance with W.S. § 26‑15‑110 and Section 3 of this regulation.

(c) No advisory organization shall be eligible to submit forms for conditional approval until the advisory organization shall have established an easily accessible system of referencing the forms as they are adopted by each admitted insurance company in a manner approved by the Commissioner. No insurance company may adopt a form submitted by an advisory organization for conditional approval until that company has identified to the Commissioner's satisfaction those forms actually being used or that will be used in Wyoming by the insurance company.

Section 5. Availability of Filed Forms. Companies shall offer to Wyoming residents any forms which it filed with the Wyoming Insurance Department. Failure to make the form available, under applicable underwriting standards, will be deemed an unfair trade practice in violation of W.S. §§ 26‑13‑102, 26‑13‑104, and 26‑13‑116. An insurer may withdraw any form for use in Wyoming at any time. Nothing contained here shall authorize midterm cancellation of any issued policy form.

Section 6. Annual Forms Listing. On or before June 1 each year, each insurance company shall submit a list which sufficiently identifies each form it filed for approval, delivered, or issued for delivery in Wyoming in the previous calendar year.

Section 7. Company Forms File. Each insurance company shall maintain a file, accessible to the Commissioner, containing a copy of each form available for use in Wyoming. Each insurance company and advisory organization shall submit a copy of any form available for use in Wyoming within 10 days after a request by the Commissioner.

Section 8. Updates To Forms Required. Any previously approved insurance form containing language that conflicts with any statutory or regulatory requirements due to statutory or regulatory changes subsequent to approval, must be updated and filed for approval pursuant to W.S. § 26-15-110 before further delivery or issuance for delivery in Wyoming.

History

• Effective 2025-09-16

Chapter 12 Regulation Governing Replacement of Life Insurance Policies and Annuities

Wyo. Code R. 044.0002.12.02122013 Regulation Governing Replacement of Life Insurance Policies and Annuities

CHAPTER 12

REGULATION GOVERNING REPLACEMENT OF LIFE INSURANCE POLICIES AND ANNUITIES

Section 1. Authority

These rules and regulations governing the replacement of life insurance policies and annuities in the State of Wyoming supplement the provisions of W.S. 26-13-102, W.S. 26-13-103, W.S. 26-13-104, W.S. 26-13-105, W.S. 26-13-106, W.S. 26-13-107, W.S. 26-15-109, and W.S. 26-15-110. They are promulgated by authority of and pursuant to the Wyoming Administrative Procedure Act (W.S. 16-3-101 through W.S.16-3-115) and Wyoming Insurance Code (W.S. 26-2-110 and W.S. 26-2-125).

Section 2. Purpose

The purpose of this Regulation is:

(a) To regulate the activities of insurers, and producers with respect to the replacement of existing life insurance and annuities.

(b) To protect the interests of life insurance and annuity purchasers by establishing minimum standards of conduct to be observed in replacement transactions by:

(i) Assuring that purchasers receive information with which a decision can be made in his or her own best interest;

(ii) Reducing the opportunity for misrepresentation and incomplete disclosures; and

(iii) Establishing penalties for failure to comply with requirements of this Regulation.

(c) To declare that failure to comply with the provisions of this Regulation will be deemed an unfair method of competition and an unfair trade practice.

Section 3. Definitions

(a) "Replacement" means any transaction in which new life insurance or a new annuity is to be purchased, and it is known or should be known to the proposing producer or to the proposing insurer if there is no producer, that by reason of such transaction, existing life insurance or annuity has been or is to be:

(i) Lapsed, forfeited, surrendered, or otherwise terminated;

(ii) Converted to reduced paid-up insurance, continued as extended term insurance, or otherwise reduced in value by the use of nonforfeiture benefits or other policy values;

(iii) Amended so as to effect either a reduction in benefits or in the term for which coverage would otherwise remain in force or for which benefits would be paid;

(iv) Reissued with any reduction in cash value; or

(v) Pledged as collateral or subjected to borrowing, whether in a single loan or under a schedule of borrowing over a period of time for amounts in the aggregate exceeding twenty-five percent (25%) of the loan value set forth in the policy.

(b) "Conservation" means any attempt by the existing insurer or its producer to dissuade a policy owner from the replacement of existing life insurance or annuity. Conservation does not include routine administrative procedures such as late payment reminders, late payment offers or reinstatement offers.

(c) "Direct-Response Sales" means any sale of life insurance or annuity where the insurer does not utilize a producer in the sale or delivery of the policy.

(d) "Existing Insurer" means the insurance company whose policy is or will be changed or terminated in such a manner as described within the definition of "replacement."

(e) "Existing Life Insurance or Annuity" means any life insurance or annuity in force, including life insurance under a binding or conditional receipt or a life insurance policy or annuity that is within an unconditional refund period.

(f) "Replacing Insurer" means the insurance company that issues or proposes to issue a new policy or contract which is a replacement of existing life insurance or annuity.

(g) "Registered Contract" means variable annuities, investment annuities, variable life insurance under which the death benefits and cash values vary in accordance with unit values of investments held in a separate account, or any other contracts issued by life insurance companies which are registered with the Federal Securities and Exchange Commission.

(h) "Sales Charge" is defined as any initial charge or fee assessed to the consumer for the purchase of an insurance product. This includes but is not limited to the following terms: front-end loads, separate commission charges, initial premium charge/load, and purchase fees. It does not include contingent deferred sales charges (CDSC) as this charge would be considered a surrender charge, monthly administrative fees, annual contract charges, mortality and expense charges (M&E), premium taxes, or fees on investments in the separate account.

(i) "Surrender Charge" is defined as a charge or fee assessed to the consumer for the surrender, sale, cancellation, termination, transfer, or exchange of an insurance product prior to the maturity or completion of the surrender period stated in the policy.

(j) "Surrender Period" is defined as the amount of time a policyholder must wait in order to receive a withdrawal from an insurance product without a "surrender charge."

Section 4. Exemptions

Unless otherwise specifically included, this Regulation shall not apply to transactions involving:

(a) Credit life insurance;

(b) Group life insurance or group annuities;

(c) An application to the existing insurer that issued the existing life insurance and a contractual change or a conversion privilege is being exercised;

(d) Proposed life insurance that is to replace life insurance under a binding or conditional receipt issued by the same company; and

(e) Transactions where the replacing insurer and the existing insurer are the same, or are subsidiaries or affiliates under common ownership or control; provided, however, producers proposing replacement shall comply with the requirements of Section 5(a).

Section 5. Duties of Producers

(a) Each producer who initiates the application shall submit to the insurer to which an application for life insurance or annuity is presented, with or as part of each application:

(i) A statement signed by the applicant as to whether replacement of existing life insurance or annuity is involved in the transaction; and

(ii) A signed statement as to whether the producer knows replacement is or may be involved in the transaction.

(b) Where a replacement is involved, the producer shall:

(i) Present to the applicant, not later than at the time of taking the application, a "Replacement Notice" in the form as described in Exhibit A, or other substantially similar form approved by the Commissioner. The Notice shall be signed by both the applicant and the producer and left with the applicant. The "Replacement Notice" shall include any applicable surrender charges of the policy being replaced, any sales charges applicable to the policy being purchased, and any surrender periods and/or charges applicable to the new policy being purchased.

(ii) Obtain with or as part of each application a list of all existing life insurance and/or annuity to be replaced and properly identified by name of insurer, the insured and contract number. If a contract number has not been assigned by the existing insurer, alternative identification, such as an application or receipt number, shall be listed.

(iii) Leave with the applicant the original or a copy of written or printed communications used for presentation to the applicant.

(iv) Submit to the replacing insurer with the application a copy of the Replacement Notice provided pursuant to Section 5(b)(i).

(c) Each producer who uses written or printed communications in a conversation shall leave with the applicant the original or a copy of such materials used.

Section 6. Duties of All Insurers

Each insurer shall:

(a) Inform its field representatives or other personnel responsible for compliance with this Regulation of the requirements of this Regulation.

(b) Require with or as a part of each completed application for life insurance or annuity a statement signed by the applicant as to whether such proposed insurance or annuity will replace existing life insurance or annuity.

Section 7. Duties of Insurers That Use Producers

Each insurer that uses a producer in a life insurance or annuity sale shall:

(a) Require with or as part of each completed application for life insurance or annuity, a statement signed by the producer as to whether he or she knows replacement is or may be involved in the transaction.

(b) Where a replacement is involved:

(i) Require from the producer with the application for life insurance or annuity a list of all the applicant's existing life insurance or annuity to be replaced and a copy of the Replacement Notice provided the applicant pursuant to Section 5(b)(i). Such existing life insurance or annuity shall be identified by name of insurer, insured and contract number. If a number has not been assigned by the existing insurer, alternative identification, such as an application or receipt number, shall be listed.

(ii) Send to each existing insurer a written communication advising of the replacement or proposed replacement and the identification information obtained pursuant to Section 7(b)(i). This written communication shall be made within three (3) working days of the date the application is received in the replacing insurer's home or regional office, or the date the proposed policy or contract is issued, whichever is sooner.

(c) The replacing insurer shall maintain evidence of the "Replacement Notice," all written communications with respect to replacement, and a replacement register, cross indexed by replacing producer and existing insurer to be replaced. Evidence that all requirements were met shall be maintained for at least three years or until the conclusion of the next succeeding regular examination by the Insurance Department of its state of domicile, whichever is later.

(d) The replacing insurer shall provide in its policy or in a separate written notice which is delivered with the policy that the applicant has a right to an unconditional refund of all premiums paid, which right may be exercised within a period of thirty (30) days commencing from the date of delivery of the policy. In the case of a variable or market value adjustment policy or contract, a payment of the cash surrender value provided under the policy or contract plus the fees and other charges deducted from the gross premiums or considerations or imposed under such policy or contract.

Section 8. Duties of Insurers to Direct Response Sales

Each insurer shall:

(a) Inform its personnel responsible for compliance with this Regulation of the requirements of this Regulation;

(b) Require with or as a part of each completed application for insurance a statement signed by the applicant as to whether such proposed insurance will replace existing insurance;

(c) Where a replacement is proposed by an insurer in the solicitation of a direct-response sale or it is known by the insurer on the date of application that a replacement will occur:

(i) Provide the applicant or prospective applicant with or as part of the application the "Replacement Notice" (Exhibit A), or other substantially similar form approved by the commissioner, with the request that the applicant properly complete, sign and return a copy of the Notice with the application. In these instances the insurer may delete the references to the producer, including the producer's signature, and references not applicable to the product being sold or replaced, without having to obtain approval of the form from the commissioner. The "Replacement Notice" shall include any applicable surrender charges of the new policy being replaced, any sales charges applicable to the policy being purchased, and any surrender periods and/or charges applicable to the new policy being purchased.

(ii) Send to the existing insurer at its home office within three (3) working days of the date the Notice is received, a copy of the Notice advising of the replacement or proposed replacement of existing insurance. Forwarding of the Notice is not required if the replacing insurer and existing insurer are one and the same in name and direct management control;

(iii) Maintain copies of the Notice, all written communications with respect to replacement, and a replacement register, cross-indexed by existing insurer to be replaced, for at least three (3) years or until the conclusion of the next regular examination by the Insurance Department of its state of domicile, whichever is later;

(iv) Provide the applicant with a right to an unconditional refund of all premiums paid, which right may be exercised within a thirty (30) day period of delivery of the policy or contract.

(d) Where no replacement is proposed by an insurer in the solicitation of a direct-response sale and a Replacement Notice was not included with or as part of the application and returned to the insurer, but it is indicated on the application that a replacement might occur and the insurer plans to issue a policy:

(i) Suspend the application process for no longer than ten (10) days;

(ii) Provide the applicant with the Replacement Notice within three (3) days after receipt of the application;

(iii) Request that the applicant properly complete, sign and return a copy of the Notice within five (5) days; and

(iv) Continue the process as outlined in Sections 8(c)(ii) through 8(c)(iv). However, the insurer may continue the application process after ten (10) days from receipt of application even if a copy of the Notice has not been received.

Section 9. Penalties

(a) A violation of this Regulation shall occur if a producer or insurer recommends the replacement or conservation of an existing policy by use of a substantially inaccurate presentation or comparison of an existing contract's premiums and benefits or dividends and values, if any. Any insurer, producer, representative, officer or employee of such insurer failing to comply with the requirements of this Regulation shall be subject to such penalties as may be appropriate under the Insurance Code.

(b) Patterns of action by policy owners who purchase replacing policies from the same producer, after indicating on applications that replacement is involved, shall be deemed prima facie evidence of the producer's knowledge that replacement was intended in connection with the sale of those policies, and such patterns of action shall be deemed prima facie evidence of the producer's intent to violate this Regulation.

(c) This Regulation does not prohibit the use of additional material other than that which is required that is not in violation of this Regulation or any other statute or regulation.

Section 10. Severability

If any section or portion of a section of this Regulation, or the applicability thereof to any person or circumstance, is held invalid by a court, the remainder of this Regulation, or the applicability of such provision to other persons, shall not be affected thereby.

Section 11. Effective Date

This Regulation shall become effective upon filing with the Secretary of State.

Exhibit A

REPLACEMENT NOTICE

ASK QUESTIONS -- IT'S YOUR MONEY -- GET THE FACTS

Whether it is to your advantage to replace or change your existing insurance or annuity program, only you can decide. It is in your best interest to obtain adequate information in order to compare relatively short and long range costs and benefits before a final decision is made.

The producer or insurance company assisting you with this new purchase must notify your existing producer or company so that they may prepare a detailed, current statement concerning your existing program for your comparison. Statements and illustrations should not, however, be used as the sole basis to compare policies or contracts. We want you to understand the effects of replacements before you make your purchase decision, and ask that you review the statements listed under "Items to Consider."

EXISTING INSURANCE WHICH MAY BE REPLACED OR CHANGED

Full Name of

Insurance Company

Including Home        Policy or Contract

Office Location Number* Insured

---

---

---

Surrender Charge of Policy Being Replaced % and $_____

Sales Charge of Policy Being Purchased (if applicable) $_______________

New Surrender Period and Surrender Charges of Policy Being Purchased.

| YEARS | | | | | | | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | %CHARGE | | | | | | | | | | |

| YEARS | | | | | | | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | %CHARGE | | | | | | | | | | |

• If a number has not been assigned by the existing insurer, indicate alternative identification, such as an application or receipt number.

ITEMS TO CONSIDER

1. Due to a possible change in insurability status (health, occupation or high risk recreational activities) you might be denied new coverage, or the premium may be higher than a standard premium.

2. The Incontestability and Suicide Clause time periods would probably begin anew in a new policy. This could possibly result in a claim being denied that might otherwise have been paid under an existing policy or contract.

3. Your present insurance company may be able to modify your existing plan on terms which may be more favorable for you than completely replacing it with a new policy or contract.

4. Don't terminate or alter your existing policy until after the new policy has been delivered to you and accepted by you.

5. If you terminate your existing policy, you may incur surrender charges and/or penalties. The new policy you are purchasing may have a new surrender charge period and/or sales charges.

6. There may be tax consequences in replacing an existing policy. Is there a benefit from favorable "grandfathered" treatment of the old policy under the federal tax code? Is this transaction a "tax free" exchange? See your tax advisor for specific tax advice regarding the proposed transaction.

7. Take your time in making your decision about purchasing the new policy. Gather all information about the new policy and compare it to your old policy. Remember, you do not have to make a decision during the first meeting with your sales person.

8. REMEMBER: Following receipt of a new life insurance policy or annuity contract you should immediately examine its contents. If you are not satisfied with it for any reason, you have the right to return it within the thirty (30) day "examination period" to the insurer at its home office or branch office or to the producer through whom it was purchased, for a full refund of premium. If you do return the policy or contract, you should request a dated receipt indicating that it was returned.

DID YOU READ THE "ITEMS TO CONSIDER"?

---

Applicant's Signature Date Producer's Signature Date

---

Applicant's Name (printed) Producer's Name (printed) and License No.

---

Address Address

---

City, State, Zip Code City, State, Zip Code

---

Telephone Number Telephone Number

History

• Effective 2013-02-12

Chapter 13 Health Maintenance Organizations

Wyo. Code R. 044.0002.13.12311996 Health Maintenance Organizations

CHAPTER 13

REGULATION GOVERNING HEALTH MAINTENANCE ORGANIZATIONS

Section 1. Authority

These rules and regulations governing health maintenance organizations are promulgated by au- thority of and pursuant to the Wyoming Administrative Procedure Act and Sections 26-2-110, and 26-34- 120 of the Wyoming Insurance Code.

Section 2. Purpose

The purpose of these rules and regulations is to implement Chapter 34 of the Wyoming Insurance Code.

Section 3. Standards

(a) The health maintenance organization shall develop and institute health care services which assure the enrollees adequate medical care which is available and accessible in accordance with the enroll- ees’ plan.

(b) A progressive, preventive health program is required which is developed according to the prevailing health factors predominate in the enrollee population.

(c) In reviewing material submitted, the commissioner will recognize that there are differences between the practices and procedures of a group practice and that of an individual practice arrangement, that either arrangement can be utilized in an HMO setting and that these differences will necessarily affect the structure and operation of an HMO.

Section 4. Definitions

Terms used shall have the same meaning as defined by Sections 26-1-102 and 26-34-102 of the Wyoming Insurance Code and are herein clarified accordingly. Terms used herein, which are not defined by the Wyoming Insurance Code, are defined as follows:

(a) “Inpatient medical care” shall include, but is not limited to, medical and surgical care re- ceived in a hospital environment;

(b) “Outpatient services” means those services which may be rendered in, but are not limited to clinics, private offices, and hospital based outpatient services as a minimum, and may include but are not limited to surgery centers, radiation therapy centers, and nursing homes;

(c) ”Medical director” means a physician licensed to practice in the State of Wyoming; and

(d) “Certification” means approval by a branch of the Federal government to perform reim- bursable services.

Section 5. Organization

(a) The HMO will be organized in a manner which allows attainment of its stated mission which as a minimum, shall be to provide and/or to cause to be provided:

(i) Emergency care;

(ii) Inpatient hospital and medical-surgical care; and

(iii) Outpatient services.

(b) A governing body, person, or persons legally responsible for the operation of the HMO shall provide for the following:

(i) A copy of the agreement, contract, or policy which the HMO proposes to issue to subscribers which describes the scope of the health care services it renders as permitted by law to enrollees either directly by a medical staff or through arrangements with others;

(ii) The names of all physicians and providers giving their license number, if required by the Department of Health and Social Services, Division of Health and Medical Services, business ad- dress, specialty where applicable, certification of eligibility, and medical or hospital staff privileges of hospitals used or by which the HMO has a contractual agreement;

(iii) The maintenance of a list of the above information;

(iv) The appointment of a chief executive officer either full-time or part-time in accor- dance with the demands of that office;

(v) The appointment of a medical director either full-time or part-time in accordance with the demands of that office. The medical direction may serve as the chief of the medical staff. Medical staff bylaws, rules, or regulations, are required to include provisions for the delivery of health services by physicians and professional health care providers, licensed or duly authorized to practice in the State of Wyoming. Other providers, as required, to support the medical staff must be available in order to assure that the enrollee receives health care services with continuity and without unreasonable periods of delay; and

(vi) An ongoing procedure and program to monitor effectively the quality of the health care requirements set forth herein. The treatment outcome shall include, but is not limited to, a procedure for peer review.

Section 6. Facilities and Environment

(a) Facilities owned and/or operated by the HMO shall have sufficient equipment for examina- tion and treatment in accordance with enrollee contracts.

(b) If all or part of the HMO services are to be performed by contract with providers of service, the following shall pertain:

(i) Said providers of service shall be licensed or registered according to applicable state and local laws;

(ii) Said providers of service which have no licensure requirements may be certified for participation in a Federal program. In the event that the providers are not certified or licensed pursuant to State or Federal law, then an acceptable quality control program must be maintained; and

(iii) Said services being contracted must be clearly identifiable listing the name and lo- cation of the facility or facilities of the contract providers and listing the services offered at each location and the service hours.

Section 7. Services

The requirements of this section are applicable to the categories of services listed as available under the health care plan. The HMO may wish to provide such services directly or arrange for their provision according to the specific requirement of the plan, provided the commissioner may waive or modify such requirements if inapplicable to a particular HMO’s operation.

(a) Emergency service must be provided on a twenty-four (24) hour basis.

(b) Inpatient hospital and medical care which shall mean acute care hospital services, includ- ing, but not limited to, a semi-private room with customary furnishings and equipment, meals (including special diets as medically necessary), general nursing care, use of operating room and related facilities, intensive care unit and services, drugs, medications, biologicals, anesthesia and oxygen services, diagnos- tic laboratory and x-ray services, special duty nursing as medically necessary, physical therapy, respiratory therapy, administration of blood and blood products, and other diagnostic, therapeutic and rehabilitative services as appropriate, and coordinated discharge planning including the planning of such continuing care as may be necessary, both medically and as a means of preventing possible early rehospitalization and which shall be available on a twenty-four (24) hour basis.

(c) Outpatient services:

(i) Ambulatory outpatient services shall be provided, which shall include diagnostic and treatment services, physical therapy, speech therapy, occupational therapy services as appropriate, and those hospital services which can reasonably be provided on an ambulatory basis. Such services may be provided at a hospital, any other appropriate licensed facility, or any appropriate facility which is not required by law to be licensed, if the professionals delivering such services are licensed to practice, are certified, or practice under the authority of the plan, medical group, or individual practice association or other authority authorized by applicable Wyoming law.

(ii) The outpatient services shall, as a minimum, have an ongoing preventive health program which shall include, under a physician’s or other appropriate licensed provider’s supervision:

(A) Reasonable health appraisal examinations on a periodic basis;

(B) A variety of voluntary family planning services;

(C) Prenatal care;

(D) Vision and hearing testing for persons through age sixteen (16);

(E) Immunizations for children in accordance with the recommendations of the American Academy of Pediatrics and immunizations for adults as recommended by the U.S. Public Health Service;

(F) Venereal disease tests;

(G) Cytology examinations on a reasonable periodic basis; and

(H) Effective health education services, including information regarding personal health behavior and health care, and recommendations regarding the optimal use of health care services provided by the plan or health care organizations affiliated with the plan.

(iii) Diagnostic laboratory services shall be available by either of the following meth- ods:

(A) If provided in house by the HMO, laboratory services shall be under the direction of a qualified physician and shall participate successfully in all proficiency testing programs offered by the Department of Health and Social Services in those specialties in which the HMO laboratory performs examinations; or

(B) If provided by service contract, the laboratory service may be certified as an independent laboratory in the Medicare Program, or it must maintain an acceptablequality control pro- gram.

(iv) Diagnostic and therapeutic radiological services must be provided by the HMO as specified in the plan. The services may be offered by contract and shall be under the direction of a qualified physician.

(v) Pharmacy services:

(A) The plan of pharmacy services provided by the HMO shall assure quality and accessibility.

(B) Pharmacy services to enrollees shall be provided either directly by a licensed staff pharmacist or pharmacy through arrangements with qualified pharmacies, pharmacists, or by a quali- fied service agency.

(C) The plan of pharmacy services provided by a service agency shall be by contract with an agency administrator capable of performing drug utilization review and claims process- ing, and shall assure quality and accessibility.

(vi) Other services shall be available in accordance with those specified in the plan.

Section 8. Accessibility of Services

(a) Within each service area of a plan, basic health care services and specialized health care services shall be readily available and accessible to each of the plan’s enrollees.

(b) The location of facilities providing the primary health care services of the plan shall be within reasonable proximity of the business or personal residences of enrollees, and so located as to not result in unreasonable barriers to accessibility.

(c) Hours of operation and provision for after-hour services shall be reasonable.

(d) Emergency health care services shall be available and accessible within the service area twenty-four (24) hours a day, seven (7) days a week.

(e) The ratio of enrollees to staff, including health professionals, administrative and other sup- porting staff, directly or through referrals, shall be such as to reasonably assure that all services offered by the plan will be accessible to enrollees on an appropriate basis without delays detrimental to the health of the enrollees.

(f) A plan shall provide accessibility to medically required specialists who are certified or eligible for certification by the appropriate specialty board, through staffing, contracting, orreferral.

Section 9. Medical Records

(a) Medical records shall be maintained by HMO or the appropriate physician and provider of service.

(b) Arrangements shall be made for the sharing of pertinent medical records between physi- cians and providers within the HMO, while assuring the records’ confidentiality.

Section 10. Statistical Information

The HMO will compile, develop, evaluate, and report statistics relating to the cost of operation, the pattern of utilization of services, the accessibility, and availability of the services. Sufficient information shall be maintained to support continuity and adequate quality of care to the enrollees.

(a) The HMO shall maintain a membership file which shall include:

(i) Name of the individual;

(ii) Name and address of the subscriber;

(iii) Family number;

(iv) Individual’s identification number;

(v) Date of birth;

(vi) Sex;

(vii) Coverage or method of payment;

(viii) Insurance certificate number or contract number;

(ix) Entry date and reason, if available;

(x) Exit date and reason, if available;

(xi) Date of most recent verification of information; and

(xii) Such other information as the commissioner or the administrator may require.

Section 11. Annual Statement

On or before March 1 of each year, each authorized health maintenance organization shall file with the commissioner, with a copy to the administrator, a full and true statement of its financial condition, transactions and affairs as of December 31 immediately preceding. The statement shall be in the general form and context of, and require information as called for by, the form of annual statement for health maintenance organizations as prescribed by the National Association of Insurance Commissioners, to- gether with any modification the commissioner may require. The statement shall be verified by the oath of the organization’s president or vice president and secretary or actuary as applicable.

Section 12. Complaint Investigation

A complaint investigation procedure shall be implemented which assures:

(a) A mechanism through which written enrollee complaints may be filed and presented by the enrollee or his authorized representative;

(b) The source of the complaint, and the date filed;

(c) A written review of the complaint;

(d) Provision for informal discussions, consultations or conferences between the complainant and a person of authority to resolve or recommend the resolution of the complaint within thirty (30) days;

(e) A description of the conclusions and results; and

(f) Maintenance of a file for all written complaints for annual review by the commissioner or the administrator.

Section 13. Reimbursement for Emergency Care

The HMO will provide a mechanism to provide for the assurance of reimbursement for emergency care during periods of time the enrollee is out of the HMO service area as specified in their plan.

Section 14. Licensing and Regulations of Agents; General

No person may hold himself out to be an HMO agent or perform the acts of an HMO agent within this state unless such person:

(a) Has a valid disability agent’s license authorizing him to write disability insurancesubject to all applicable provisions of Chapter 9 of the Wyoming Insurance Code pertaining to disability agents.

(b) Has an appointment by an HMO with a valid Wyoming Certificate of Authority.

Section 15. Penalties

Any violation of these regulations shall be punishable under the provisions of Sections 26-1-107, 26-34-118, and 26-34-123 of the Wyoming Insurance Code.

Section 16. Effective Date

These regulations shall be effective immediately upon filing with the Secretary of State’s office.

STATEMENT OF PRINCIPAL REASONS

FOR

Amendments to Chapter 13 of Wyoming Insurance Department Regulation

Regulation Governing Health Maintenance Organizations

The purpose of these regulations is to implement Chapter 34 of the Wyoming Insurance Code; “The Health Maintenance Organization Act of 1995.”

The primary purpose of these amendments is to correct citings in Section 1. Authority, to the Wyoming Insurance Code which have no applicability to the Regulation. W.S. § 26-34- 103(e) refers to the commissioner promulgating rules and regulations exempting from the filing require- ments under certificate of authority and W.S. § 26-34-115. refers to uncovered expenditures insolvency deposit. Nothing in the Regulation promulgates rules affecting these two areas.

Section 14. Certificate of need is eliminated in its entirety as the certificate of need process was repealed in 1986.

Subsequent sections are renumbered, accordingly. Additional amendments to this Chapter are to change the chapter numbering and the chapter pagi- nation.

Presently the Chapter is designated by the Roman number symbol “XIII.” It will be amended to be designated by the Arabic number symbol “13.”

Pagination of the chapter will be amended from the present continuous and sequential numbering from chapter-to-chapter, to chapter-specific numbering. As an example, each page will be designated first by a chapter number and then page number, as in 13-1, 13-2, 13-3, etc. Amending the method by which the pages are numbered will allow for simpler amendments in the future, and for easier reader identifica- tion of the chapter and pages with which they are concerned.

History

• Effective 1996-12-31

Chapter 14 Cancellation and Nonrenewal of Automobile Liability Policies

Wyo. Code R. 044.0002.14.09162025 Cancellation and Nonrenewal of Automobile Liability Policies

CHAPTER 14

CANCELLATION AND NONRENEWAL OF AUTOMOBILE LIABILITY POLICIES

Section 1. Authority.

(a) These rules are promulgated by the Insurance Commissioner pursuant to W.S. §§ 26-2-109, 26-2-110, 26-35-201 et seq., and 16-3-101 to 16-3-115.

Section 2. Notice of Right Under Assigned Risk Plan.

(a) When automobile liability coverage is either canceled or nonrenewed by an insurer, the insurer shall notify the policyholder of his possible eligibility for automobile insurance through the automobile assigned risk plan or Wyoming automobile insurance plan. The notification shall accompany or be included in the notice of cancellation or nonrenewal by these rules.

(b) This section shall not apply to cancellation or nonrenewal for nonpayment of premium.

History

• Effective 2025-09-16

Chapter 15 Risk Retention

Wyo. Code R. 044.0002.15.12092016 Risk Retention

CHAPTER 15

REGULATION GOVERNING RISK RETENTION

Section 1. Authority

These rules and regulations governing risk retention and purchasing groups are adopted pursuant to W.S. §§ 26‑2‑110 and 26-36-101 et seq.

Section 2. Definitions

As used in these rules and regulations:

(a) "authorized" and "admitted" means an insurer authorized by a subsisting certificate of authority issued by the commissioner to transact insurance in this state;

(b) "liability insurance coverage" means liability insurance policy or endorsement forms under which a liability risk retention group or liability insurer may undertake to indemnify a liability risk retention group or liability purchasing group member;

(c) "unauthorized" and "non‑admitted" means not authorized to transact insurance in this state by a subsisting certificate of authority issued by the commissioner.

Section 3. REGISTRATION, NOTICE AND INFORMATIONAL FILINGS

(a) Foreign Liability Risk Retention Group Registration

(i) Any risk retention group chartered in a state other than Wyoming, before offering liability insurance on any risk located, resident or to be performed in this state, shall register with the commissioner, on forms the commissioner designates, sworn to by the president or chief executive officer and the secretary of the risk retention group pursuant to W.S. § 26‑36‑105.

(b) Purchasing Group Notice of Intent

(i) Any purchasing group which intends to do business in this state, before soliciting any member to insure through the group any risk located, resident or to be performed in this state, shall furnish notice of its intent to do business to the commissioner, sworn to by the party who, under the organizational plan of the group, has authority to bind the group by signature, on forms the commissioner designates, providing such information and documentation as the commissioner shall require pursuant to W.S. § 26‑36‑109.

(c) Appointment of Commissioner as Agent for Service of Process

(i) Any risk retention group filing its registration or risk purchasing group filing its notice of intent to do business unless otherwise exempted under W.S. § 26‑36‑109(b), shall submit to the commissioner, contemporaneously with filing its registration or notice of intent, a statement of registration irrevocably appointing the commissioner as its agent for the purpose of receiving legal documents and service of process, in the form designated by the commissioner.

(d) Updates and Amendments

(i) Any registered risk retention group or risk purchasing group shall notify the commissioner in writing within thirty (30) days of any changes to the information contained on the registration form or notice of intent form. The commissioner may request additional information and documentation as necessary. No such request shall delay the effective date of the notice.

(ii) On or before March 1 of each year, each registered risk retention group and risk purchasing group shall file a sworn affidavit by the party authorized to file a registration or notice of intent to do business, certifying to the commissioner the accuracy of the information on file or as amended, and as to its continued intent to be registered and do business.

Section 4. ELIGIBILITY AND CONDITIONS FOR PROCUREMENT

(a) Group Location

For the purposes of Section Four of these rules and regulations a liability purchasing group shall be deemed located or situated in the state where it is domiciled.

(b) Direct Production

Any registered risk retention group in this state which utilizes brokers or agents in soliciting, negotiating, procuring or providing liability insurance for its members located or resident in this state shall do so only through brokers or agents licensed in this state. Nothing herein shall be construed to prevent a risk retention group from soliciting, negotiating, procuring or providing liability insurance for its members located or resident in this state directly through its officers, directors, owners, partners, trustees, or full‑time salaried employees not licensed as a broker or agent in this state.

(i) Any registered purchasing group in this state which utilizes brokers or agents in soliciting, negotiating, procuring, or providing liability insurance for its members located or resident in this state shall do so only through brokers or agents licensed in this state. Nothing herein shall be construed to prevent a purchasing group from soliciting, negotiating, procuring or providing liability insurance for its members located or resident in this state through an insurer admitted in the state in which the purchasing group is located on a direct basis through the purchasing group's officers, directors, owners, partners, trustees, or full‑time salaried employees not licensed as a broker or agent in this state.

Section 5. TAXES

(a) Liability Risk Retention Group Taxes

Each risk retention group shall file with the commissioner a report of all premiums paid to it for risks insured by it located, resident or to be performed within or properly allocated to this state in a form the commissioner prescribes and requires pursuant to the provisions of W.S. § 26‑4‑103 and W.S. § 26-36-105(d).

(b) Purchasing Group Taxes

Premium taxes and taxes on premiums paid for coverage of risks resident or located in this state by a purchasing group or any member of the purchasing groups shall be:

(i) Imposed at the same rate and subject to the same interest, fines and penalties as that applicable to premium taxes and taxes on premiums paid for similar coverage from a similar insurance source by other insureds; and

(ii) Paid first by such insurance source, and if not by such source by the agent or broker for the purchasing group, and if not by such agent or broker then by the purchasing group, and if not by such purchasing group then by each of its members.

Section 6. Tax Delinquency

If an insurer, liability risk retention group or risk retention broker agent does not pay the tax on or before March 31 of the year in which due, in accordance with the Wyoming Risk Retention Act and these rules and regulations, the tax is delinquent, and the commissioner may enforce payment thereof by the seizure, distraint and sale of any of the insurer's, the liability risk retention group's or the risk retention broker agent's property within Wyoming.

Section 7. EFFECTIVE DATE

These rules and regulations become effective upon filing with the Secretary of State.

History

• Effective 2016-12-09

Chapter 16 Governing Insurance Company Appointments of Producers

Wyo. Code R. 044.0002.16.12092016 Governing Insurance Company Appointments of Producers

CHAPTER 16

CHAPTER 16

REGULATION GOVERNING

INSURANCE COMPANY APPOINTMENTS OF PRODUCERS

Section 1. Authority

These regulations governing the company appointments of producers are promulgated pursuant to the authority granted by W.S. §§ 26‑2‑110, 26-9-213 and 26‑9‑217.

Section 2. Definitions

(a) "Appointment" means a notification filed with the insurance department that an insurer has established an agency relationship with a producer.

(b) "Appointment continuation" means continuation of a company's existing appointment based on payment of the required fee without submission of an appointment form.

(c) For purposes of this regulation, "producer" means insurance producer as defined by W.S. § 26-1-102(xxxv), and includes title agents as defined in W.S. § 26‑23‑303(a)(xix).

(d) "Termination for cause" means an insurer has ended its agency relationship with a producer for one of the reasons set forth in W.S. § 26‑9‑211(a) or that the producer has been found by a court, governmental body or self-regulatory organization authorized by law to have engaged in any of the activities set forth in W.S. § 26‑9‑211(a).

Section 3. Producer Appointment

(a) Prior to submitting a notice of appointment, the appointing insurer shall verify that the producer is licensed and qualified to sell all products the producer sells for that insurer.

(b) Each insurer appointing a title agent in Wyoming shall, at the time the request for title agent license is submitted, file with the commissioner a notice of producer appointment in a form acceptable to the commissioner.

(c) An insurer may file a notice of appointment electronically by accessing links to vendors through the Department's website. If an insurer cannot file a request electronically, then the insurer may file a paper form.

Section 4. Continuation and Termination

(a) Annually, each insurer will receive notice of the amount owed for continuation of appointments pursuant to W.S. §§ 26-9-213(e) and 26-4-101(a). The amount owed may not be altered or amended. Annually, on or before March 31, each insurer shall pay the amount owed for the continuation of appointment fee. Failure to pay the amount owed for the continuation of appointment fee on or before March 31 as required shall result in the termination of the insurer's producer appointments.

(b) Each insurer terminating a producer appointment for any reason shall file with the commissioner a notice of producer appointment termination. The notice of termination should be filed electronically by accessing links to the vendors through the department's website. An insurer may file a paper form if they cannot file electronically.

(c) If any insurer terminates a producer appointment for cause, it must submit a completed Termination for Cause form and supporting documentation in accordance with W.S. § 26‑9‑214.

Section 5. Effective Date

(a) These rules and regulations shall become effective upon filing with the Secretary of State.

History

• Effective 2016-12-09

Chapter 17 Mortality Tables

Wyo. Code R. 044.0002.17.01082015 Mortality Tables

CHAPTER 17

MORTALITY TABLES

Section 1. Authority

This rule is promulgated by the Commissioner of Insurance pursuant to W.S. 26-6-206 and W.S. 26-2-110 of the Wyoming Insurance Code and the Wyoming Administrative Procedure Act.

Section 2. Purpose

The purpose of this rule is to recognize the following mortality tables for use in determining the minimum standard of valuation for annuity and pure endowment contracts: the 1983 Table "a," the 1983 Group Annuity Mortality (1983 GAM) Table, the 2012 Individual Annuity Reserving (2012 IAR) Table, and the 1994 Group Annuity Reserving (1994 GAR) Table.

Section 3. Definitions

(a) As used in this rule "1983 Table ‘a'" means that mortality table developed by the Society of Actuaries Committee to Recommend a New Mortality Basis for Individual Annuity Valuation and adopted as a recognized mortality table for annuities in June 1982 by the National Association of Insurance Commissioners. [See 1982 Proceedings of the NAIC II, page 454.]

(b) As used in this rule "1983 GAM Table" means that mortality table developed by the Society of Actuaries Committee on Annuities and adopted as a recognized mortality table for annuities in December 1983 by the National Association of Insurance Commissioners. [See 1984 Proceedings of the NAIC I, pages 414 to 415.]

(c) As used in this rule "1994 GAR Table" means that mortality table developed by the Society of Actuaries Group Annuity Valuation Table Task Force and shown on pages 866- 867 of Volume XLVII of the Transactions of the Society of Actuaries (1995).

(d) As used in this rule, "Period table" means a table of mortality rates applicable to a given calendar year (the Period).

(e) As used in this rule, "Generational mortality table" means a mortality table containing a set of mortality rates that decrease for a given age from one year to the next based on a combination of a Period table and a projection scale containing rates of mortality improvement.

(f) As used in this rule "2012 IAR Table" means that Generational mortality table developed by the Society of Actuaries Committee on Life Insurance Research and containing 2012+n rates, qx , derived from a combination of the 2012 IAM Period Table and Projection Scale G2, using the methodology stated in Section 5.

(g) As used in this rule, "2012 Individual Annuity Mortality Period Life (2012 IAM Period) Table" means the Period table containing loaded mortality rates for calendar year 2012. This table contains rates, qx²⁰¹² , developed by the Society of Actuaries Committee on Life Insurance Research and is shown in Appendices 1-2.

(h) As used in this rule, "Projection Scale G2 (Scale G2)" is a table of annual rates, G2x, of mortality improvement by age for projecting future mortality rates beyond calendar year 2012. This table was developed by the Society of Actuaries Committee on Life Insurance Research and is shown in Appendices 3-4.

Section 4. Individual Annuity or Pure Endowment Contracts

(a) Except as provided in Subsections B and C of this section, the 1983 Table "a" is recognized and approved as an individual annuity mortality table for valuation and, at the option of the company, may be used for purposes of determining the minimum standard of valuation for any individual annuity or pure endowment contract issued on or May 20, 1981.

(b) Except as provided in Subsection C of this section, the 1983 Table "a" shall be used for determining the minimum standard of valuation for any individual annuity or pure endowment contract issued on or after October 18, 1985.

(c) Except as provided in Subsection D of this section, the 2012 IAR Mortality Table shall be used for determining the minimum standard of valuation for any individual annuity or pure endowment contract issued on or after January 1, 2015.

(d) The 1983 Table "a" without projection is to be used for determining the minimum standards of valuation for an individual annuity or pure endowment contract issued on or after January 1, 2015, solely when the contract is based on life contingencies and is issued to fund periodic benefits arising from:

(i) Settlements of various forms of claims pertaining to court settlements or out of court settlements from tort actions;

(ii) Settlements involving similar actions such as worker's compensation claims; or

(iii) Settlements of long term disability claims where a temporary or life annuity has been used in lieu of continuing disability payments.

Section 5. Application of the 2012 IAR Mortality Table

In using the 2012 IAR Mortality Table, the mortality rate for a person age x in year (2012 + n) is calculated as follows:

2012+𝑛 2012 𝑛 𝑞𝑥 = 𝑞𝑥 (1 − 𝐺2𝑥) 2012+n

The resulting qx shall be rounded to three decimal places per 1,000, e. g., 0.741 deaths per 1,000. Also, the rounding shall occur according to the formula above, starting at the 2012 period table rate.

2012 For example, for a male age 30, qx = 0.741.

2013 qx = 0.741 * (1 – 0.010) ^ 1 = 0.73359, which is rounded to 0.734.

2014 qx = 0.741 * (1 – 0.010) ^ 2 = 0.7262541, which is rounded to 0.726.

2014 2013 method leading to incorrect rounding would be to calculate qx as qx * (1 – 0.010), or

2013 2014 0.734 * 0.99 = 0.727. It is incorrect to use the already rounded qx to calculate qx .

Section 6. Group Annuity or Pure Endowment Contracts

(a) Except as provided in Subsections B and C of this section, the 1983 GAM Table and the 1983 Table "a" are recognized and approved as group annuity mortality tables for valuation and, at the option of the company, any one of these tables may be used for purposes of valuation for an annuity or pure endowment purchased on or after May 1, 1981 under a group annuity or pure endowment contract.

(b) Except as provided in Subsection C of this section, the 1983 GAM Table shall be used for determining the minimum standard of valuation for any annuity or pure endowment purchased on or after December 31, 1996 under a group annuity or pure endowment contract.

(c) The 1994 GAR Table is recognized and approved as group annuity mortality tables for valuation and shall be used for determining the minimum standard of valuation for any annuity or pure endowment purchased on or after January 1, 2015 under a group annuity or pure endowment contract.

Section 7. Application of the 1994 GAR Table

In using the 1994 GAR Table, the mortality rate for a person age x in year (1994 + n) is calculated as follows:

1994+𝑛 1994 𝑛 𝑞𝑥 = 𝑞𝑥 (1 − 𝐴𝐴𝑥)

1994 where the 𝑞𝑥 and 𝐴𝐴𝑥 are as specified in the 1994 GAR Table.

Section 8. Severability

If any provision of this rule or its application to any person or circumstances is for any reason held to be invalid, the remainder of the regulation and the application of its provisions to other persons or circumstances shall not be affected.

Section 9. Effective Date

The effective date of this rule is January 1, 2015 for new policies.

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APPENDIX I

2012 IAM Period Table

Female, Age Nearest Birthday

| AGE | 1000∙𝑞x2012 | AGE | 1000∙𝑞𝑥2012 | AGE | 1000∙𝑞𝑥2012 | AGE | 1000∙𝑞𝑥2012 | | --- | --- | --- | --- | --- | --- | --- | --- | | 0 | 1.621 | 30 | 0.300 | 60 | 3.460 | 90 | 88.377 | | 1 | 0.405 | 31 | 0.321 | 61 | 3.916 | 91 | 97.491 | | 2 | 0.259 | 32 | 0.338 | 62 | 4.409 | 92 | 107.269 | | 3 | 0.179 | 33 | 0.351 | 63 | 4.933 | 93 | 118.201 | | 4 | 0.137 | 34 | 0.365 | 64 | 5.507 | 94 | 130.969 | | 5 | 0.125 | 35 | 0.381 | 65 | 6.146 | 95 | 146.449 | | 6 | 0.117 | 36 | 0.402 | 66 | 6.551 | 96 | 163.908 | | 7 | 0.110 | 37 | 0.429 | 67 | 7.039 | 97 | 179.695 | | 8 | 0.095 | 38 | 0.463 | 68 | 7.628 | 98 | 196.151 | | 9 | 0.088 | 39 | 0.504 | 69 | 8.311 | 99 | 213.150 | | 10 | 0.085 | 40 | 0.552 | 70 | 9.074 | 100 | 230.722 | | 11 | 0.086 | 41 | 0.600 | 71 | 9.910 | 101 | 251.505 | | 12 | 0.094 | 42 | 0.650 | 72 | 10.827 | 102 | 273.007 | | 13 | 0.108 | 43 | 0.697 | 73 | 11.839 | 103 | 295.086 | | 14 | 0.131 | 44 | 0.740 | 74 | 12.974 | 104 | 317.591 | | 15 | 0.156 | 45 | 0.780 | 75 | 14.282 | 105 | 340.362 | | 16 | 0.179 | 46 | 0.825 | 76 | 15.799 | 106 | 362.371 | | 17 | 0.198 | 47 | 0.885 | 77 | 17.550 | 107 | 384.113 | | 18 | 0.211 | 48 | 0.964 | 78 | 19.582 | 108 | 400.000 | | 19 | 0.221 | 49 | 1.051 | 79 | 21.970 | 109 | 400.000 | | 20 | 0.228 | 50 | 1.161 | 80 | 24.821 | 110 | 400.000 | | 21 | 0.234 | 51 | 1.308 | 81 | 28.351 | 111 | 400.000 | | 22 | 0.240 | 52 | 1.460 | 82 | 32.509 | 112 | 400.000 | | 23 | 0.245 | 53 | 1.613 | 83 | 37.329 | 113 | 400.000 | | 24 | 0.247 | 54 | 1.774 | 84 | 42.830 | 114 | 400.000 | | 25 | 0.250 | 55 | 1.950 | 85 | 48.997 | 115 | 400.000 | | 26 | 0.256 | 56 | 2.154 | 86 | 55.774 | 116 | 400.000 | | 27 | 0.261 | 57 | 2.399 | 87 | 63.140 | 117 | 400.000 | | 28 | 0.270 | 58 | 2.700 | 88 | 71.066 | 118 | 400.000 | | 29 | 0.281 | 59 | 3.054 | 89 | 79.502 | 119 | 400.000 | | 120 | 1000.000 | | | | | | |

APPENDIX II

2012 IAM Period Table

Male, Age Nearest Birthday

| AGE | 1000∙𝑞𝑥2012 | AGE | 1000∙𝑞𝑥2012 | AGE | 1000∙𝑞𝑥2012 | AGE | 1000∙𝑞𝑥2012 | | --- | --- | --- | --- | --- | --- | --- | --- | | 0 | 1.605 | 30 | 0.741 | 60 | 5.096 | 90 | 109.993 | | 1 | 0.401 | 31 | 0.751 | 61 | 5.614 | 91 | 123.119 | | 2 | 0.275 | 32 | 0.754 | 62 | 6.169 | 92 | 137.168 | | 3 | 0.229 | 33 | 0.756 | 63 | 6.759 | 93 | 152.171 | | 4 | 0.174 | 34 | 0.756 | 64 | 7.398 | 94 | 168.194 | | 5 | 0.168 | 35 | 0.756 | 65 | 8.106 | 95 | 185.260 | | 6 | 0.165 | 36 | 0.756 | 66 | 8.548 | 96 | 197.322 | | 7 | 0.159 | 37 | 0.756 | 67 | 9.076 | 97 | 214.751 | | 8 | 0.143 | 38 | 0.756 | 68 | 9.708 | 98 | 232.507 | | 9 | 0.129 | 39 | 0.800 | 69 | 10.463 | 99 | 250.397 | | 10 | 0.113 | 40 | 0.859 | 70 | 11.357 | 100 | 268.607 | | 11 | 0.111 | 41 | 0.926 | 71 | 12.418 | 101 | 290.016 | | 12 | 0.132 | 42 | 0.999 | 72 | 13.675 | 102 | 311.849 | | 13 | 0.169 | 43 | 1.069 | 73 | 15.150 | 103 | 333.962 | | 14 | 0.213 | 44 | 1.142 | 74 | 16.860 | 104 | 356.207 | | 15 | 0.254 | 45 | 1.219 | 75 | 18.815 | 105 | 380.000 | | 16 | 0.293 | 46 | 1.318 | 76 | 21.031 | 106 | 400.000 | | 17 | 0.328 | 47 | 1.454 | 77 | 23.540 | 107 | 400.000 | | 18 | 0.359 | 48 | 1.627 | 78 | 26.375 | 108 | 400.000 | | 19 | 0.387 | 49 | 1.829 | 79 | 29.572 | 109 | 400.000 | | 20 | 0.414 | 50 | 2.057 | 80 | 33.234 | 110 | 400.000 | | 21 | 0.443 | 51 | 2.302 | 81 | 37.533 | 111 | 400.000 | | 22 | 0.473 | 52 | 2.545 | 82 | 42.261 | 112 | 400.000 | | 23 | 0.513 | 53 | 2.779 | 83 | 47.441 | 113 | 400.000 | | 24 | 0.554 | 54 | 3.011 | 84 | 53.233 | 114 | 400.000 | | 25 | 0.602 | 55 | 3.254 | 85 | 59.855 | 115 | 400.000 | | 26 | 0.655 | 56 | 3.529 | 86 | 67.514 | 116 | 400.000 | | 27 | 0.688 | 57 | 3.845 | 87 | 76.340 | 117 | 400.000 | | 28 | 0.710 | 58 | 4.213 | 88 | 86.388 | 118 | 400.000 | | 29 | 0.727 | 59 | 4.631 | 89 | 97.634 | 119 | 400.000 | | 120 | 1000.000 | | | | | | |

APPENDIX III

Projection Scale G2

Female, Age Nearest Birthday

| AGE | 𝐺2𝑥 | AGE | 𝐺2𝑥 | AGE | 𝐺2𝑥 | AGE | 𝐺2𝑥 | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | 0 | 0.010 | 30 | 0.010 | 60 | 0.013 | 90 | 0.006 | | | 1 | 0.010 | 31 | 0.010 | 61 | 0.013 | 91 | 0.006 | | | 2 | 0.010 | 32 | 0.010 | 62 | 0.013 | 92 | 0.005 | | | 3 | 0.010 | 33 | 0.010 | 63 | 0.013 | 93 | 0.005 | | | 4 | 0.010 | 34 | 0.010 | 64 | 0.013 | 94 | 0.004 | | | 5 | 0.010 | 35 | 0.010 | 65 | 0.013 | 95 | 0.004 | | | 6 | 0.010 | 36 | 0.010 | 66 | 0.013 | 96 | 0.004 | | | 7 | 0.010 | 37 | 0.010 | 67 | 0.013 | 97 | 0.003 | | | 8 | 0.010 | 38 | 0.010 | 68 | 0.013 | 98 | 0.003 | | | 9 | 0.010 | 39 | 0.010 | 69 | 0.013 | 99 | 0.002 | | | 10 | 0.010 | 40 | 0.010 | 70 | 0.013 | 100 | 0.002 | | | 11 | 0.010 | 41 | 0.010 | 71 | 0.013 | 101 | 0.002 | | | 12 | 0.010 | 42 | 0.010 | 72 | 0.013 | 102 | 0.001 | | | 13 | 0.010 | 43 | 0.010 | 73 | 0.013 | 103 | 0.001 | | | 14 | 0.010 | 44 | 0.010 | 74 | 0.013 | 104 | 0.000 | | | 15 | 0.010 | 45 | 0.010 | 75 | 0.013 | 105 | 0.000 | | | 16 | 0.010 | 46 | 0.010 | 76 | 0.013 | 106 | 0.000 | | | 17 | 0.010 | 47 | 0.010 | 77 | 0.013 | 107 | 0.000 | | | 18 | 0.010 | 48 | 0.010 | 78 | 0.013 | 108 | 0.000 | | | 19 | 0.010 | 49 | 0.010 | 79 | 0.013 | 109 | 0.000 | | | 20 | 0.010 | 50 | 0.010 | 80 | 0.013 | 110 | 0.000 | | | 21 | 0.010 | 51 | 0.010 | 81 | 0.012 | 111 | 0.000 | | | 22 | 0.010 | 52 | 0.011 | 82 | 0.012 | 112 | 0.000 | | | 23 | 0.010 | 53 | 0.011 | 83 | 0.011 | 113 | 0.000 | | | 24 | 0.010 | 54 | 0.011 | 84 | 0.010 | 114 | 0.000 | | | 25 | 0.010 | 55 | 0.012 | 85 | 0.010 | 115 | 0.000 | | | 26 | 0.010 | 56 | 0.012 | 86 | 0.009 | 116 | 0.000 | | | 27 | 0.010 | 57 | 0.012 | 87 | 0.008 | 117 | 0.000 | | | 28 | 0.010 | 58 | 0.012 | 88 | 0.007 | 118 | 0.000 | | | 29 | 0.010 | 59 | 0.013 | 89 | 0.007 | 119 | 0.000 | | | 120 | 0.000 | | | | | | | |

APPENDIX IV

Projection Scale G2

Male, Age Nearest Birthday

| AGE | 𝐺2𝑥 | AGE | 𝐺2𝑥 | AGE | 𝐺2𝑥 | AGE | 𝐺2𝑥 | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | 0 | 0.010 | 30 | 0.010 | 60 | 0.015 | 90 | 0.007 | | | 1 | 0.010 | 31 | 0.010 | 61 | 0.015 | 91 | 0.007 | | | 2 | 0.010 | 32 | 0.010 | 62 | 0.015 | 92 | 0.006 | | | 3 | 0.010 | 33 | 0.010 | 63 | 0.015 | 93 | 0.005 | | | 4 | 0.010 | 34 | 0.010 | 64 | 0.015 | 94 | 0.005 | | | 5 | 0.010 | 35 | 0.010 | 65 | 0.015 | 95 | 0.004 | | | 6 | 0.010 | 36 | 0.010 | 66 | 0.015 | 96 | 0.004 | | | 7 | 0.010 | 37 | 0.010 | 67 | 0.015 | 97 | 0.003 | | | 8 | 0.010 | 38 | 0.010 | 68 | 0.015 | 98 | 0.003 | | | 9 | 0.010 | 39 | 0.010 | 69 | 0.015 | 99 | 0.002 | | | 10 | 0.010 | 40 | 0.010 | 70 | 0.015 | 100 | 0.002 | | | 11 | 0.010 | 41 | 0.010 | 71 | 0.015 | 101 | 0.002 | | | 12 | 0.010 | 42 | 0.010 | 72 | 0.015 | 102 | 0.001 | | | 13 | 0.010 | 43 | 0.010 | 73 | 0.015 | 103 | 0.001 | | | 14 | 0.010 | 44 | 0.010 | 74 | 0.015 | 104 | 0.000 | | | 15 | 0.010 | 45 | 0.010 | 75 | 0.015 | 105 | 0.000 | | | 16 | 0.010 | 46 | 0.010 | 76 | 0.015 | 106 | 0.000 | | | 17 | 0.010 | 47 | 0.010 | 77 | 0.015 | 107 | 0.000 | | | 18 | 0.010 | 48 | 0.010 | 78 | 0.015 | 108 | 0.000 | | | 19 | 0.010 | 49 | 0.010 | 79 | 0.015 | 109 | 0.000 | | | 20 | 0.010 | 50 | 0.010 | 80 | 0.015 | 110 | 0.000 | | | 21 | 0.010 | 51 | 0.011 | 81 | 0.014 | 111 | 0.000 | | | 22 | 0.010 | 52 | 0.011 | 82 | 0.013 | 112 | 0.000 | | | 23 | 0.010 | 53 | 0.012 | 83 | 0.013 | 113 | 0.000 | | | 24 | 0.010 | 54 | 0.012 | 84 | 0.012 | 114 | 0.000 | | | 25 | 0.010 | 55 | 0.013 | 85 | 0.011 | 115 | 0.000 | | | 26 | 0.010 | 56 | 0.013 | 86 | 0.010 | 116 | 0.000 | | | 27 | 0.010 | 57 | 0.014 | 87 | 0.009 | 117 | 0.000 | | | 28 | 0.010 | 58 | 0.014 | 88 | 0.009 | 118 | 0.000 | | | 29 | 0.010 | 59 | 0.015 | 89 | 0.008 | 119 | 0.000 | | | 120 | 0.000 | | | | | | | |

History

• Effective 2015-01-08

Chapter 18 Regulation Governing Consultants

Wyo. Code R. 044.0002.18.01272016 Regulation Governing Consultants

CHAPTER 18

REGULATION GOVERNING CONSULTANTS

Section 1. Authority

These regulations governing consultants are promulgated by the authority of and pursuant to the Wyoming Administrative Procedure Act, W.S. §§ 16-3-101 through 16-3-115, W.S. § 26-2-110, W.S. § 26-9-217 and W.S. § 26-9-220.

Section 2. Definitions

(a) As used in these regulations "Consultant" means any person who, for a fee, engages in the business of offering to another person any advice, counsel, opinion or service with respect to insurance needs, insurance risks, or concerning the benefits, coverages or provisions under any policy of insurance that could be issued in this state, or involving the advantages or disadvantages of any such policy of insurance, or any formal plan of managing pure risk and is not compensated by an insurer, or insurance producer for the advice given.

(i) Consultants as defined in this section shall include:

(A) A public adjustor or

(B) Any other person who, for compensation as an independent contractor, or as the employee of an independent contractor, or for fee or commission, on behalf of the insured investigates and negotiates settlement of claims arising under insurance contracts or who is engaged in the business of advising insureds with respect to the benefits or advantages promised under insurance contracts that could be or have been issued in this state.

(ii) Consultants, as defined in this section shall not include: A licensed attorney;

(A) Any licensed insurance producer who gives advice incidental to the normal course of insurance business and does not charge a fee other than commissions received from the insurance written; or

(B) Any person who gives incidental advice in the normal course of a business or professional activity, other than insurance consulting, if neither that person nor that person's employer receives compensation, direct or indirect, on account of any insurance transaction that results from that advice.

Section 3. Qualifications

(a) In addition to the requirements contained in W.S. § 26-9-220, to be licensed as a consultant the applicant shall:

(i) Be at least 18 years old;

(ii) Be a resident of Wyoming or of another state which permits residents of Wyoming to act as consultants in that state;

(iii) Not have committed any act that is grounds for denial, suspension or revocation set forth in W.S. § 26-9-211; and

(iv) Have and maintain an office accessible to the public and keep therein the usual and customary records pertaining to transactions under the license except that this provision does not prohibit maintenance of the office in the licensee's home.

Section 4. Effective Date

This regulation becomes effective immediately upon filing with the Secretary of State.

History

• Effective 2016-01-27

Chapter 19 After Market Parts Regulation

Wyo. Code R. 044.0002.19.07132017 § 1 Authority

These regulations are promulgated pursuant to W.S. §§ 16‑3‑101 et seq., 26‑2‑110, and 26‑13‑101 et seq.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.19.07132017 § 2 Definitions

For the purpose of these regulations, the following definitions shall apply:

(a) "Insurer" includes an insurance company and any person authorized to represent the insurer with respect to a claim who is acting within the scope of the person's authority.

(b) "Non‑Original Equipment Manufacturer" (Non‑OEM) means any manufacturer other than the original equipment manufacturer of the part. "Part" means parts which generally constitute the exterior of a motor vehicle, including inner and outer panels. "Part" does not mean tires, windshields, or windows.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.19.07132017 § 3 Identification

No insurer shall directly or indirectly require the use of any non-OEM part that does not carry sufficient permanent identification so as to identify its manufacturer. Such identification shall be accessible to the extent possible after installation.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.19.07132017 § 4 Like Kind and Quality

No insurer shall directly or indirectly require the use of any non-OEM part unless the non-OEM part is at least equal in quality to the original part in terms of fit and performance. The cost of any modifications which may become necessary when making the repair shall be considered as a factor in determining the quality of the non-OEM part.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.19.07132017 § 5 Consent

(a) No insurer shall directly or indirectly require the use of non‑OEM parts nor shall any insurer accept any estimate or authorize any repair unless the consumer is advised that he or she is not required to accept non‑OEM parts in the repair of the vehicle and consents in writing to the use of those parts before repairs are made.

(b) No insurer shall directly or indirectly require the consumer to pay any difference in price if the consumer elects to use OEM parts in the repair of the vehicle.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.19.07132017 § 6 Disclosure

The insurer must disclose to the claimant in writing, either on the estimate or on a separate document attached to the estimate, the following information in no smaller print than 10 point type:

THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AUTOMOBILE PARTS NOT MADE BY THE ORIGINAL MANUFACTURER. PARTS USED IN THE REPAIR OF YOUR VEHICLE BY OTHER THAN THE ORIGINAL MANUFACTURER ARE REQUIRED TO BE AT LEAST OF EQUAL QUALITY IN TERMS OF FIT AND PERFORMANCE TO THE ORIGINAL MANUFACTURER PARTS THEY ARE REPLACING.

(a) All Non-OEM parts to be installed on the vehicle shall be clearly identified on the estimate of such repair.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.19.07132017 § 7 Effective Date

This regulation shall become effective upon filing with the Secretary of State.

History

• Effective 2017-07-13

Chapter 20 Regulation Governing Continuing Education

Wyo. Code R. 044.0002.20.10032022 § 1 Authority

This regulation is promulgated pursuant to W. S. §§ 26-2-110 and 26-9-231.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 2 Definitions

Terms used in this Chapter have the following meanings:

(a) "Certificate of completion" means a document signed by the instructor (or other designated person) of a certified course which signifies satisfactory completion of the course and reflects hours of credit earned.

(b) "Certified course" means an educational presentation offered in a class, seminar, independent study, or similar form of instruction involving insurance fundamentals, insurance-related law, insurance policies, claims and coverages, insurance needs and product changes, insurance risk management, etc., which is approved by the commissioner pursuant to Section 9 of this Regulation.

(c) "Classroom" means an organized setting where a group of persons are physically located and instructed.

(d) "Contact hours" means the number of hours of instruction or participation in the classroom, webinar, or self-study program.

(e) "Ethics" means instruction in the customs among members of the insurance profession involving their moral and professional duties toward one another, toward clients, toward insureds, and toward insurers. It may include, but is not limited to, fiduciary responsibility, commingling funds, paying and accepting commissions, unfair claims practices, professionalism, policy replacement consideration, handling or supervising the affairs or funds of another and conflicts of interest.

(f) "Good cause" means reasons for not timely complying with the requirements of this regulation including disability, death of an immediate family member, natural disaster or other extenuating circumstances.

(g) "Licensee" means persons who are required to be licensed under the Wyoming insurance code including resident insurance producers, title agents, adjusters, and designated Wyoming home state non-resident adjusters.

(h) "Carry-over credit hour" means a credit hour earned during the one hundred twenty (120) days before the licensing continuation date in excess of the twenty-four (24) hours of continuing education required per two (2) year licensing period, which may be applied to the next continuing education period. Any carry-over credit hours may not count as ethics hours.

(i) "Disinterested third party" means someone who is not:

(i) A minor;

(ii) A relative of the licensee;

(iii) An immediate supervisor or subordinate of the licensee; or

(iv) A person with an economic or other interest in ensuring the successful outcome of a competency examination.

(j) "Self-study program" means a course that involves book study, video study, computer based training, or other means of training and education where a qualified instructor is not present. Self-study programs must include an examination, which is to be monitored by a disinterested third-party.

(k) "Webinar" means any course offered by live video conference or webcast if the technology allows for communication between and among the participants and their instructor and the participant's attendance and participation are monitored. Participation shall be verified by the instructor, who shall ask no fewer than three (3) polling questions every hour.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 3 Basic Requirement

Licensees shall complete twenty-four (24) contact hours of continuing education within each two (2) year licensing period. Of the twenty-four (24) required hours, at least three (3) shall be approved ethics hours. Licensees may be allowed up to twelve (12) carry-over credit hours to count toward their twenty-four (24) hours of required continuing education.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 4 Exceptions

The following exceptions may be made to the continuing education rules:

(a) Upon written request received by the Department on or before the end of the licensing period, the commissioner may grant an extension for good cause shown by the licensee.

(b) A non-resident licensee residing in a state or district requiring continuing education requirements which meet or exceed Wyoming's requirements, need only comply with the resident state's requirements.

(c) A non-resident adjuster residing in a state or district having continuing education requirements, shall complete the resident state's requirements.

(d) A non-resident adjuster residing in another state or district not having continuing education requirements who has designated Wyoming as a home state nonresident adjuster shall:

(i) Complete the necessary hours of continuing education to meet Wyoming's requirement as determined by the commissioner; and

(ii) Complete the reporting requirement of section 8 of this regulation.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 5 Program Requirements

(a) All continuing education courses are subject to review and certification by the commissioner. They must be submitted to the Department in accordance with Section 9 of this regulation on forms approved by the commissioner.

(b) A specific course will qualify as an acceptable continuing education program if it is a formal course of learning or online course study which contributes directly to the professional competence of a licensee.

(c) To qualify for credit, the following standards must be met:

(i) Course development:

(A) The course must have significant intellectual or practical content to enhance and improve the insurance knowledge and professional competence of participants.

(B) The course must be developed by persons who are qualified in the subject matter and instructional design.

(C) The course content must be current.

(D) The course must have a method for measuring the student's successful completion of course material and for evaluating the learning experience.

(ii) Course presentation:

(A) Instructors must be qualified, both with respect to course content and teaching methods. Instructors will be considered qualified if, through formal training or experience, they have obtained sufficient knowledge to instruct the course competently.

(B) The number of participants and physical facilities must be consistent with the teaching method specified.

(C) All courses must include some means for evaluating course quality.

(iii) The following courses do not qualify as acceptable continuing education:

(A) Any course used to prepare for taking an insurance licensing examination, or taken before licensure.

(B) Committee service on professional organizations.

(C) Computer science courses.

(D) Motivation, psychology, prospecting, recruiting, time management or sales training courses.

(E) Securities courses, other than variable annuities courses.

(F) Courses on communications skills, personnel management, or supportive office skills.

(G) Any program not in accordance with this regulation.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 6 Measurement of Credit

(a) Professional education courses shall be credited for continuing education purposes in full hours only. The number of hours shall be equivalent to the actual number of contact hours. Each hourly period must include at least fifty (50) minutes of continuous instruction or participation. For this purpose, a one-day program will be granted eight (8) hours credit if the total lapsed time is approximately eight (8) hours and the contact time is at least four hundred (400) minutes. The approved credit hours shall be determined by the commissioner.

(b) University or college upper-division credit or noncredit courses shall be evaluated as follows:

(i) For credit courses, each semester system credit shall not account for more than five (5) hours toward the continuing education requirement. Each quarter system credit shall not account for more than three (3) hours. The final number of credits shall be determined by the commissioner.

(ii) For non-credit courses, the number of credits will be determined by the commissioner, but not to exceed the amount allowed for credit courses.

(c) A licensee, whether an instructor or student, may not receive credit for attendance at the same course more than once every forty-eight (48) months.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 7 Reporting and Fees

(a) Each sponsor shall submit the electronic course certification for continuing education and before expiration of licensee's renewal date.

(b) The sponsor shall retain the original certificate of completion for each educational course as evidence of the licensee's completion of the program or course for the most recent two (2) year period. The certificates of completion shall be kept in an electronic form approved by the commissioner.

(c) The Department may audit the electronic course certificates submitted by sponsors. If the continuing education electronic filing submitted by the sponsor is not approved, the Department will notify the sponsor of the basis for rejection.

(d) The licensee bears the burden of establishing that a particular course for which credit is claimed is acceptable and meets the continuing education requirements set forth in this regulation.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 8 Programs of Study -- Certification by Commissioner

(a) All courses shall be certified by the commissioner before being acceptable for continuing education credit. A course must be certified in advance of presentation and an approved electronic application for certification must be submitted to the commissioner by the sponsor sixty (60) days before the course. All correspondence courses or individual study programs must be approved and certified in accordance with Section 6 before being offered to licensees for continuing education credit.

(b) Any sponsor intending to provide classes, seminars, or other forms of instruction as certified courses shall apply electronically on forms approved by the commissioner including the fees outlined in W.S. §26-4-101, and furnish for the commissioner's approval a subject matter outline, the presentation method, the instructor qualifications, and other information supporting the request for approval.

(c) The outline shall include a statement of the method used to determine whether the licensee satisfactorily completed the approved course. The method may be a written examination, a written report by the licensee, certification by the providing organization of the licensee's program attendance or completion, or other method approved by the commissioner as appropriate for the subject.

(d) Upon receiving the application, the commissioner will certify or deny the course or program as qualifying for credit and indicate the number of hours of credit awarded for approved subjects. The commissioner will furnish a written explanation of the reason for any denial of the application. Upon certification, the course will be given a course identification number which shall be used on all certificates of completion and verification forms.

(e) Program certification will be effective for up to two (2) years, or until any material changes are made in the program, after which it must be resubmitted to the commissioner. Certification may be resubmitted without revisions no more than three (3) times. Courses previously certified may be submitted by referencing the previous course certification number and outlining any material changes to the course.

(f) If any course has not been certified by the commissioner before it is presented, the course may be advertised or presented as "continuing education credits have been applied for" but shall not be represented or advertised in any manner as "approved" for continuing education credit. No course may be advertised as "continuing education credits have been applied for" until a completed application for certification has been submitted to the commissioner.

(g) Any recognized national program may be filed within sixty (60) days after it is given and will be approved for the number of contact hours spent, up to the number of hours credited for passage of the national examination. This exception applies only to CIC Institutes and classroom study of the following courses: Chartered Financial Consultant (ChFC); Certified Insurance Counselor (CIC); Chartered Property and Casualty Underwriter (CPCU); Registered Health Underwriter (RHU); Chartered Life Underwriter (CLU); Life Underwriter Training Council Fellow (LUTCF); Certified Employee Benefit Specialist (CEBS); Certified Financial Planner (CFP); Fellow of the Life Management Institute (FLMI); Registered Employee Benefits Counselor (REBC); Health Insurance Associate (HIA); Associate in Claims (AIC); Associate in Risk Management (ARM); Associate in Underwriting (AU); Certification in Long Term Care (CTLC); Registered Professional Liability Underwriting (RPLUS); Certified Insurance Service Representative (CISR), Associates in Loss Control Management (ALCM), Fraternal Insurance Counselor (FIC); Life Office Management Association (LOMA); and similar courses specifically accepted by the Department.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 9 Proof of Completion -- Sponsor Responsibilities

(a) Upon completing a class, program, or course of study, the instructor or sponsor shall:

(i) Provide a certificate of completion to the commissioner in electronic form for the individuals who have satisfactorily completed the class, program, or course of study; and

(ii) Certify to the commissioner an electronic roster of all attendees specifying whether satisfactory completion was based on attendance, written report, or examination.

(b) Sponsors shall be responsible for, but not limited to, the following:

(i) Ensuring compliance with all laws and rules pertaining to insurance education. During the approved program, if the sponsor finds that a student is reading unrelated materials, sleeping, talking excessively or is otherwise disruptive or inattentive, the sponsor may take whatever action it feels is appropriate, including refusing to grant the student any credit for attendance;

(ii) Notifying the commissioner of any material change of course instructors or course content;

(iii) Ensuring licensees are provided with current, accurate information and classroom facilities conducive to a sound learning environment;

(iv) Evaluating courses and instructors. The commissioner may request written evaluations of courses and instructors, either by licensees or coordinators;

(v) Investigating complaints relating to course offerings and instructors, and forwarding all written complaints to the Department;

(vi) Maintaining accurate records relating to course offerings, instructors, and licensee attendance for a period of two (2) years from the date the course was completed;

(vii) Providing instructors and licensees the name and telephone number of the coordinator.

(viii) Notifying the commissioner fifteen (15) days in advance of any changes in course offering dates and subsequent offering dates of an approved course; and

(ix) Appointing one (1) person to act as coordinator of the course and contact person.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 10 Loss of Certification: Action Against Sponsors

(a) The commissioner may suspend a course certification if:

(i) The course teaching method or program content no longer meets the standards of this regulation, or has been significantly changed without notice to the commissioner for re-approval; or

(ii) The instructor, coordinator, or sponsor had certified to the commissioner that a licensee had completed the program in accordance with course standards when in fact the licensee had not done so;

(iii) Licensees who have satisfactorily completed the program in accordance with course standards were not certified by the sponsor, coordinator, or instructor (unless the certificate of completion was refused pursuant to Section 9(b)(i));

(iv) The instructor or sponsor is not qualified as defined by the standards of this regulation, has had an insurance license revoked, or lacks necessary education or experience in the subject matter of the course; or

(v) There is other good and just cause why certification should be suspended. The commissioner reserves the right to audit courses without the sponsor's approval. The commissioner may at any time after notice and opportunity for hearing withdraw approval of any course. Licensees who attended a course before the commissioner withdraws approval will be granted credit for hours in actual attendance.

(b) The commissioner will reinstate a suspended certification when the sponsor provides proof satisfactory to the commissioner that the conditions responsible for the suspension have been corrected.

(c) The commissioner may institute an administrative or other action against a sponsor upon finding any one or more of the following:

(i) Advertising that a course is certified before the sponsor obtains certification. Included within the meaning of "certified" are such notations as "____ hours CECs," "will be worth ____ hours" or "approved for credit in Wyoming";

(ii) Submitting a course outline with material inaccuracies, including out-of-date information or topic content;

(iii) Presenting non-approved material during a certified course;

(iv) Failing to present a course for the full time specified in the request form submitted to the Department.

(d) Upon finding that a sponsor has violated this regulation, the commissioner may enter an Order barring certification of a sponsor's courses, either for a set period of time or indefinitely. The commissioner may also impose any penalty provided by W.S. § 26-1-107.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 11 Credit for Individual Study Programs

(a) In determining whether credit is allowed for specific correspondence programs, individual study programs, online courses, or webinars, the commissioner will determine the equivalency of the program to a comparable seminar or a comparable course for credit in an accredited educational institution.

(b) The individual study program must require each producer to enroll in the course before having access to course material.

(c) All approved correspondence courses, online courses, and independent study courses shall include a monitored examination which requires a score of seventy (70) percent or better, or an equivalent scaled score, to earn a certificate of completion. For each approved course, the sponsor shall maintain a pool of tests sufficient to maintain the integrity of the testing process. A written explanation of test security and administration methods shall accompany the course examination materials. The examinations shall be administered, graded, and the results recorded by the sponsor to which approval was originally granted. The sponsor shall retain completed tests. The examination administration shall be monitored by a disinterested third party.

(d) All correspondence courses, online courses, webinars or individual study courses must be submitted by the sponsor which compiles or publishes the course materials and must be approved by the commissioner prior to being offered to licensees for continuing education credit. Any course approval is not transferable to any other entity.

(e) Credit will be allowed only in the licensing period in which the course is completed, and must be reported during the same licensing period.

(f) Online courses shall prevent access to the course exam before the examinee reviews the course materials.

(g) Online courses shall prevent downloading any course exam.

(h) Online courses shall provide review questions at the end of each unit or chapter and prevent access to the final exam until each set of questions are answered correctly at a seventy (70) percent rate.

(i) Correspondence programs, individual study programs, and online courses shall provide a monitor affidavit containing specific monitor duties and responsibilities printed for monitor's use to direct the taking of the final exam. A monitor shall complete the affidavit after the exam is completed.

(j) Webinars do not require a comprehensive final examination.

(k) Webinar providers shall monitor attendance and determine when a participant is inactive or not fully participating.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 12 Credit for Service as Lecturer, Discussion Leader, or Speaker

One (1) hour of continuing education credit will be awarded for each hour completed as an instructor or discussion leader, provided the course is certified by the commissioner.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 13 Credit for Breakfast, Luncheon, or Dinner Meetings

Courses, seminars, or programs presented in connection with breakfast, luncheon, or dinner meetings qualify for continuing education credit only if they are meetings of recognized insurance organizations, meet the requirements of this regulation, and are certified in advance.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 14 Licensee's Failure to Meet Requirements

(a) If a sponsor does not submit a completed verification form showing compliance with this regulation as set forth in Section 8, or if a licensee has not met the continuing education requirements and has not been granted an extension of time within which to comply, the licensee's license shall not be renewed until the person demonstrates to the commissioner's satisfaction that he has complied with all requirements of W.S. § 26-9-231.

(b) If the Department denies a request for extension to meet the continuing education requirements, the licensee's license will lapse thirty (30) days after the date the denial is mailed to the licensee, unless the licensee provides proof of compliance with the continuing education requirements before the license lapses.

(c) The commissioner may immediately institute an administrative or other action pursuant to W.S. § 26-9-211 against any licensee who submits a false or fraudulent certificate of compliance or reporting form.

History

• Effective 2022-10-03

Wyo. Code R. 044.0002.20.10032022 § 15 Effective Date

This regulation shall be effective January 1, 2023.

20-1

History

• Effective 2022-10-03

Chapter 21 Rules Governing Advertisements of Accident and Sickness Insurance

Wyo. Code R. 044.0002.21.07162019 § 1 Authority

These regulations are promulgated pursuant to Wyoming Statutes §§ 26-2-110 and 26‑13‑101 et seq.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 2 Applicability

(a) These regulations shall apply to individual and group accident and sickness insurance "advertisement," as defined in Section 3(b), (h), (i), and (j) unless otherwise specified in this regulation, which the insurer knows or reasonably should know, is intended for presentation, distribution, or dissemination in Wyoming when the presentation, distribution, or dissemination is made either directly or indirectly by or on behalf of an insurer or producer as those terms are defined in the Wyoming Insurance Code.

(b) Every insurer shall establish, and at all times maintain, a system of control over, and be responsible for the content, form, and method of dissemination of all its policy advertisements regardless of by whom written, created, designed, or presented.

(c) Advertising materials shall be identified by form numbers or other identifying means sufficient to distinguish an advertisement from any other advertising materials, policies, applications, or other materials used by the insurer.

(d) The requirements of these regulations shall also apply to health maintenance organizations.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 3 Definitions

As used in these rules and regulations:

(a) "Accident and sickness insurance policy" means a policy, plan, certificate, contract, agreement, statement of coverage, rider, or endorsement providing accident or sickness benefits or medical surgical or hospital benefits on an indemnity, reimbursement, service, or prepaid basis, except when issued in connection with insurance other than life insurance and annuities. An accident and sickness insurance policy includes a Medicare supplement insurance policy.

(i) "Accident and sickness insurance policy" does not apply to disability income insurance, waiver of premium, and double indemnity benefits included in life insurance, endowment, or annuity contracts containing only provisions that:

(A) Provide additional benefits in case of death, dismemberment, or loss of sight by accident; or

(B) Operate to safeguard the contracts against lapse or to give a special surrender value, special benefit, or an annuity in the event the insured or annuitant becomes totally and permanently disabled as defined by the contract or supplemental contract.

(b) "Advertisement" means:

(i) Printed and published material, audio visual material, and descriptive literature of an insurer used in direct mail, newspapers, magazines, radio scripts, TV scripts, websites, and other Internet displays or communications, other forms of electronic communications, social media, billboards, and similar displays;

(ii) Descriptive literature and sales aids of all kinds issued by an insurer or producer for presentation to members of the insurance-buying public, such as circulars, leaflets, booklets, depictions, illustrations, form letters, and lead-generating devices of all kinds;

(iii) Prepared sales talks, presentations, and material for use by producers, whether prepared by the insurer or the producer;

(iv) Advertising material included with policies delivered and material used to solicit renewals and reinstatements; and

(v) All media communications by producers to the general public and specific members of the general public.

(vi) The definition of advertisement does not include:

(A) Material used solely for training and educating an insurer's employees or producers;

(B) Material used in-house by insurers;

(C) Communications within an insurer's own organization not intended for dissemination to the public;

(D) Individual communications of a personal nature with current policyholders other than material urging the policyholders to increase or expand coverages;

(E) Correspondence between a prospective group or blanket policyholder and an insurer in the course of negotiating a group or blanket contract;

(F) Material ordered by a court to be disseminated to policyholders; or

(G) A general announcement from a group or blanket policyholder to eligible individuals on an employment or membership list regarding a contract or program having been written or arranged; provided the announcement clearly indicates it is preliminary to issuing a booklet and the announcement does not describe the specific contract or program benefits nor advantages of purchasing the contract or program. This does not prohibit a sponsor's general endorsement of the program.

(c) "Certificate" means a statement of the coverage and provisions of a group accident and sickness insurance policy which has been delivered or issued for delivery in Wyoming and includes riders, endorsements, and enrollment forms, if attached.

(d) "Exception" means any provision in a policy whereby coverage for a specified hazard is entirely excluded; it is a statement of a risk not assumed under the policy.

(e) "Insurer" means an individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyds, fraternal benefit society, hospital service corporation, prepaid health plan, and any other legal entity defined as an insurer in the Wyoming insurance code and engaged in advertising itself or an accident and sickness insurance policy.

(f) "Institutional advertisement" means an advertisement whose sole purpose is promoting the reader's, viewer's, or listener's interest in accident and sickness insurance, or promoting the insurer as a seller of accident and sickness insurance.

(g) "Invitation to contract" means an advertisement that is neither an invitation to inquire nor an institutional advertisement.

(h) "Invitation to inquire" means:

(i) An advertisement aimed at creating a desire to inquire about accident and sickness insurance, limited to a brief description of the loss for which benefits are payable but may contain:

(A) The dollar amount of benefits payable; and

(B) The period of time during which benefits are payable.

(ii) An invitation to inquire may not refer to cost.

(iii) An invitation to inquire shall contain a provision in the following or substantially similar form:

"This policy has [exclusions] [limitations] [reduction of benefits] [terms under which the policy may be continued in force or discontinued]. For costs and complete details of the coverage, call [or write] your insurance agent of the company [whichever is applicable]."

(i) "Lead generating device" means any communication directed to the public, regardless of form, content, or stated purpose, intended to result in compiling or qualifying a list containing names and other personal information to solicit Wyoming residents to purchase accident and sickness insurance.

(j) "Limitation" means a provision restricting policy coverage other than an exception or reduction.

(k) "Limited benefit health coverage" is insurance offered and marketed as supplemental health insurance and not as a substitute for hospital or medical insurance or major medical expense insurance.

(l) "Person" as defined by W.S. § 26-1-102(a)(xx).

(m) "Producer" means an insurance producer as defined by W.S. § 26-1-102(a)(xxxv).

(n) "Prominently" or "conspicuously" means presented in a manner noticeably set apart from other information or images in the advertisement.

(o) "Reduction" means a provision reducing the benefit amount; a risk of loss is assumed but payment upon occurrence of the loss is limited to some amount or period less than would be otherwise payable and such reduction has not been used.

Section 4. Method of Disclosure of Required Information.

(a) All information, exceptions, limitations, reductions, and other restrictions required to be disclosed by this regulation shall be set out conspicuously and in close conjunction to the statements to which the information relates or under appropriate captions of such prominence that it shall not be minimized, rendered obscure, presented in an ambiguous fashion, or intermingled with the context of the advertisement so as to be confusing or misleading. This regulation permits, but is not limited to, use of either of the following methods of disclosure:

(i) In the description of the related benefits or in a paragraph set out in close conjunction with the description of the policy benefits; or

(ii) Disclosure not in conjunction with the provisions describing policy benefits but under appropriate captions of such prominence that the information shall not be minimized, rendered obscure, or otherwise made to appear unimportant. The phrase "under appropriate captions" means the title must accurately describe the captioned material. Appropriate captions include the following: "Exceptions," "Exclusions," "Conditions Not Covered," and "Exceptions and Reductions." Use of captions such as the following are prohibited because they do not provide adequate notice of the significance of the material: "Extent of Coverage," "Only these Exclusions," or "Minimum Limitations."

Section 5. Form and Content of Advertisements.

(a) The format and content of accident or sickness insurance policy advertisements shall be sufficiently complete and clear to avoid deception or the capacity or tendency to mislead or deceive. Format means the arrangement of text and captions.

(b) Distinctly different advertisements are required for publication in different media, such as newspapers or magazines of general circulation as compared to scholarly, technical, or business journals, and newspapers. Where an advertisement consists of more than one piece of material, each piece of material must independently conform to the disclosure requirements.

(c) Whether an advertisement has the capacity or tendency to mislead or deceive shall be determined by the Commissioner from the overall impression the advertisement may be reasonably expected to create within the segment of the public to which it is directed.

(d) Advertisements shall be truthful and not misleading in fact or implication. Words or phrases, the meaning of which is clear only by implication or familiarity with insurance terminology, shall not be used.

(e) An insurer shall clearly identify its accident and sickness insurance policy as an insurance policy. A policy trade name shall be followed by the words "insurance policy" or similar words clearly identifying that an insurance policy or health benefits product (in the case of health maintenance organizations, prepaid health plans, and other direct services organizations) is being offered.

(f) An insurer, producer, or other person shall not solicit a Wyoming resident to purchase accident and sickness insurance in connection with or as the result of using advertisement by the person or any other persons, where the advertisement:

(i) Contains any misleading representations or misrepresentations, or is otherwise untrue, deceptive, or misleading regarding the information imparted, the status, character, or representative capacity of the person, or the true purpose of the advertisement; or

(ii) Otherwise violates the provisions of this regulation.

(g) An insurer, producer, or other person shall not solicit Wyoming residents to purchase accident and sickness insurance using a true or fictitious name that is deceptive or misleading regarding the status, character, or proprietary or representative capacity of the person, or the true purpose of the advertisement.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 6 Advertisements of Benefits Payable, Losses Covered or Premiums Payable

(a) Covered Benefits:

(i) The use of deceptive words, phrases, or illustrations in accident and sickness insurance advertisements is prohibited.

(ii) An advertisement that fails to state clearly the type of insurance coverage being offered is prohibited.

(iii) An advertisement shall not omit information or use words, phrases, statements, references, or illustrations if the omission or use has the capacity, tendency, or effect of misleading or deceiving purchasers or prospective purchasers as to the nature or extent of any policy benefit payable, loss covered, or premium payable. The fact the policy offered is made available to a prospective insured for inspection prior to consummation of the sale or an offer is made to refund the premium if the purchaser is not satisfied, does not remedy misleading statements.

(iv) An advertisement shall not contain or use words or phrases such as "all," "full," "complete," "comprehensive," "unlimited," "up to," "as high as," "this policy will help fill some of the gaps Medicare and your present insurance leave out," "this policy will help replace your income," (when used to express loss of time benefits), or similar words and phrases, in a manner that exaggerates any benefits beyond the policy's terms.

(v) An advertisement of a hospital or other similar facility confinement benefit referencing direct payment of the benefit to the policyholder is prohibited unless, in making the reference, the advertisement includes a statement that the benefits may be paid directly to the hospital or other health care facility if the policyholder assigns their benefits. An advertisement of medical and surgical expense benefits shall comply with this regulation. Phrases such as "you collect," "you get paid," "pays you," or other words or phrases of similar import may be used so long as the advertisement indicates it is payable to the insured or someone designated by the insured.

(vi) An advertisement for limited benefit health coverage or coverage of only certain types of loss is prohibited if:

(A) The advertisement refers to a total benefit maximum limit payable under the policy in any headline, lead-in, or caption without also in the same headline, lead-in, or caption specifying the applicable daily limits and other internal limits;

(B) The advertisement states a total benefit limit without stating the periodic benefit payment, if any, and the length of time the periodic benefit would be payable to reach the total benefit limit; or

(C) The advertisement prominently displays a total benefit limit that would not, as a general rule, be payable under an average claim.

(vii) Section 6(a)(vi) does not apply to individual major medical expense coverage, individual basic medical expense coverage, or disability income insurance.

(viii) Advertisements emphasizing total amounts payable under hospital, medical, or surgical accident and sickness insurance coverage or other benefits in a policy, such as benefits for private duty nursing, are prohibited unless the actual amounts payable per day for the indemnity or benefits are stated.

(ix) Advertisements examples of benefits payable under a policy shall not use examples in a way that implies the maximum payable benefit under the policy will be paid when less than maximum benefits are paid in an average claim.

(x) When an advertisement sets forth a range of benefit levels, it shall be clear the insured will receive only the benefit level written or printed in the policy selected and issued. Language implying the insured may select the benefit level at the time of filing claims is prohibited.

(xi) Language in an advertisement implying the amount of benefits payable under a loss-of-time policy may be increased at the time of claim or disability according to the needs of the insured is prohibited.

(xii) Advertisements for policies with modest premiums due to limited coverage or limited amounts of benefits shall not describe premiums as "low," "low cost," "budget," or use qualifying words of similar import. The use of words such as "only" and "just" in conjunction with statements of premium amounts when used to imply a bargain is prohibited.

(xiii) Advertisements stating or implying premiums will not be changed in the future are prohibited unless the advertised policies expressly provide that the premiums will not be changed in the future.

(xiv) An advertisement for a policy that does not require the premium to accompany the application shall not overemphasize that fact and shall clearly indicate under what circumstances coverage will become effective.

(xv) An advertisement exaggerating the effects of statutorily mandated benefits or required policy provisions or implying the provisions are unique to the advertised policy is prohibited.

(xvi) An advertisement implying that a common type of policy or a combination of common benefits is "new," "unique," "a bonus," "a breakthrough," or is otherwise unusual is prohibited. The addition of a novel method of premium payment to an otherwise common plan of insurance does not render it new.

(xvii) Language in an advertisement stating or implying that each member under a family contract is covered as to the maximum benefits advertised where that is not the fact is prohibited.

(xviii) An advertisement containing statements such as "anyone can apply," or "anyone can join," other than with respect to a guaranteed issue policy for which administrative procedures exist to assure the policy is issued within a reasonable period of time after the application is received by the insurer, is prohibited.

(xix) An advertisement stating or implying immediate coverage of a policy is prohibited unless administrative procedures exist so the policy is issued within fifteen (15) working days after the insurer receives the completed application.

(xx) An advertisement containing statements such as "here is all you do to apply," "simply," or "merely" to refer to the act of applying for a policy that is not a guaranteed issue policy is prohibited unless it refers to the fact that the application is subject to acceptance of approval by the insurer.

(xxi) An advertisement of accident and sickness insurance sold by direct response shall not state or imply that because no insurance agent will call and no commissions will be paid to agents that it is a low cost plan, or use other similar words or phrases because the cost of advertising and servicing the policies is a substantial cost in the marketing by direct response.

(xxii) Applications, request forms for additional information, and similar related materials are prohibited if they resemble paper currency, bonds, stock certificates, etc., or use any name, service mark, slogan, symbol, or device in a manner implying the insurer or the policy advertised is connected with a government agency, such as the Social Security Administration or the Department of Health and Human Services.

(xxiii) An advertisement implying in any manner that the prospective insured may realize a profit from obtaining hospital, medial, or surgical insurance coverage is prohibited.

(xxiv) An advertisement using words such as "extra," "special," or "added" to describe a benefit in the policy is prohibited. No advertisement of a benefit for which payment is conditioned upon confinement in a hospital or similar facility shall use words or phrases such as "tax free," "extra cash," "extra income," "extra pay," or substantially similar words or phrases because these words and phrases have the capacity, tendency, or effect of misleading the public into believing the policy advertised will, in some way, enable them to make a profit from being hospitalized.

(xxv) An advertisement of a hospital or other similar facility confinement benefit shall not advertise that the amount of the benefit is payable on a monthly or weekly basis when, in fact, the amount of the benefit payable is based upon a daily pro rata basis relating to the number of days of confinement unless the statements of the monthly or weekly benefit amounts are juxtaposed with equally prominent statements of the benefit payable on a daily basis. The term "juxtaposed" means side by side or immediately above or below. When the policy contains a limit on the number of days of coverage provided, such limit must appear in the advertisement.

(xxvi) An advertisement of a policy covering only one disease or a list of specified diseases shall not imply coverage beyond the policy terms. Synonymous terms shall not be used to refer to any disease so as to imply broader coverage than is the fact.

(xxvii) An advertisement that is an invitation to contract for a specified disease policy that provides lesser benefit amounts for a particular subtype of disease, shall clearly disclose the subtype and its benefits. This provision shall not apply to institutional advertisements.

(xxviii) An advertisement of a specified disease policy providing expense benefits shall not use the term "actual" when the policy only pays up to a limited amount for expenses. Instead, the term "charges" or substantially similar language should be used which does not create the misleading impression that there is full coverage for expenses.

(xxix) An advertisement describing any benefits which vary by age shall disclose that fact.

(xxx) An advertisement using a phrase such as "no age limit" if benefits or premiums vary by age or if age is an underwriting factor shall disclose that fact.

(xxxi) A television, radio, mail, or newspaper advertisement, or lead-generating device designed to produce leads either by use of a coupon, a request to write or to call the company, or a subsequent advertisement prior to contact shall include information disclosing that an agent may contact the applicant.

(xxxii) Advertisements, applications, requests for additional information, and similar materials are prohibited if they state or imply that the recipient has been individually selected to be offered insurance or has had his or her eligibility for the insurance individually determined in advance when the advertisement is directed to all persons in a group or to all persons whose names appear on a mailing list.

(xxxiii) An advertisement, including invitations to inquire or invitations to contract, shall not employ devices designed to create undue fear or anxiety in those to whom they are directed. Examples of prohibited devices are:

(A) Using phrases such as "cancer kills somebody every two minutes" and "total number of accidents" without reference to the total population from which the statistics are drawn;

(B) Exaggerating the importance of diseases rarely or seldom found in the class of persons to whom the policy is offered;

(C) Using phrases such as "the finest kind of treatment," implying that the treatment would be unavailable without insurance;

(D) Reproducing newspaper articles, magazine articles, information from the Internet, or other similar published material containing irrelevant facts and figures;

(E) Using images unduly emphasizing automobile accidents, disabled persons or persons confined in beds who are in obvious distress, persons receiving hospital or medical bills, or persons being evicted from their homes due to their medical bills.

(F) Using phrases such as "financial disaster," "financial distress," "financial shock," or another phrase implying financial ruin is likely without insurance. Using such phrases is only permissible in advertising major medical expense coverage, individual basic medical expense coverage, or disability income coverage, and only if the phrase does not dominate the advertisement;

(G) Using phrases or devices that unduly excite fear of dependence upon relatives or charity; and

(H) Using phrases or devices implying that long sicknesses or hospital stays are common among the elderly.

(b) Exceptions, Reductions and Limitations:

(i) An advertisement shall not contain descriptions of policy limitations, exceptions, or reductions, worded in a positive manner implying it is a benefit, such as describing a waiting period as a "benefit builder" or stating "even pre-existing conditions are covered after two years." Words and phrases used in an advertisement describing the policy limitations, exceptions, and reductions shall fairly and accurately describe the negative features of the limitations, exceptions, and reductions of the offered policy.

(ii) An advertisement that is an invitation to contract shall disclose exceptions, reductions, and limitations affecting the basic policy provisions.

(iii) An advertisement subject to the requirements of the preceding paragraph shall prominently disclose when a policy contains a waiting, elimination, probationary, or similar time period between the effective date of the policy and the effective date of coverage under the policy, or a time period between the date a loss occurs and the date benefits begin to accrue for the loss.

(iv) An advertisement shall not use the words "only," "just," "merely," "minimum," "necessary," or similar words or phrases to describe applicability of any exceptions, reductions, limitations, or exclusions such as: "This policy is subject to the following minimum exceptions and reductions."

(v) An advertisement that is an invitation to contract that fails to disclose the amount of any deductible or the percentage of any coinsurance factor is prohibited.

(vi) An advertisement for loss-of-time coverage that is an invitation to contract which sets forth a range of amounts of benefit levels is prohibited unless it also states eligibility for the benefits is based upon condition of health, income, or other economic conditions, or other underwriting standards of the insurer if that is the fact.

(vii) An advertisement that refers to "hospitalization for injury or sickness" omitting the word "covered" when the policy excludes certain sicknesses or injuries, or that refers to "whenever you are hospitalized," "when you go to the hospital," or "while you are confined in the hospital" omitting the phrase "for covered injury or sickness," if the policy excludes certain injuries or sickness, is prohibited. Continued reference to "covered injury or sickness" is not necessary where the advertisement has prominently disclosed this fact and where the description of sicknesses or injuries not covered is prominently set forth.

(viii) An advertisement that fails to disclose that the definition of "hospital" does not include certain facilities providing institutional care such as a nursing home, convalescent home, or extended care facility, when the facilities are excluded under the policy's definition of hospital is prohibited.

(ix) The term "confining sickness" or "homebound status" shall be explained in an advertisement containing the term.

(x) An advertisement that fails to disclose any waiting or elimination periods for specific benefits is prohibited.

(xi) An advertisement for a policy providing benefits for specified illnesses only, such as cancer, or for specified accidents only, such as automobile accidents, or other policies providing benefits that are limited in nature shall clearly and conspicuously in prominent type state the limited nature of the policy. The statement shall be worded in language identical to, or substantially similar to, the following: "THIS IS A LIMITED POLICY," "THIS POLICY PROVIDES LIMITED BENEFITS," "THIS IS A CANCER ONLY POLICY," "THIS IS A MEDICARE SUPPLEMENT POLICY," or "THIS IS AN AUTOMOBILE ACCIDENT ONLY POLICY."

(c) Pre-Existing Conditions:

(i) An advertisement that is an invitation to contract shall, in negative terms, disclose the extent to which any loss is not covered if the cause of loss is traceable to a condition existing prior to the policy's effective date. The term "pre-existing condition" shall not be used without an appropriate definition or description complying with Wyoming Statutes.

(ii) Under no circumstance shall the definition of "preexisting condition" be based upon "prudent person" or similar language, meaning the average layperson would have sought treatment or advice for the given condition or symptom. Preexisting conditions shall only relate to conditions for which medical advice, diagnosis, care, or treatment was actually recommended or received.

(iii) When an accident and sickness insurance policy does not cover losses resulting from preexisting conditions, an advertisement of the policy shall not state or imply that the applicant's physical condition or medical history will not affect issuance of the policy or payment of a claim under the policy. The phrase "no health questions" or words of similar import shall not be used if the policy excludes preexisting conditions. Use of a phrase such as "guaranteed issue or "automatic issue," if the policy excludes preexisting conditions for a certain period, must be accompanied by a statement disclosing that fact in a manner that does not minimize, render obscure, or otherwise make it appear unimportant and is otherwise consistent with Section 4.

(iv) When an advertisement contains an application form to be completed by the applicant and returned by mail, the application form shall contain a question or statement reflecting the pre-existing condition provisions of the policy immediately preceding a blank space for the applicant's signature. The application form shall contain a question or statement substantially as follows:

"I understand the policy applied for will not pay benefits for any loss incurred during the first twelve (12) months after the issue date on account of disease or physical conditions for which medical advice, diagnosis, care, or treatment was actually recommended or received in the last six (6) months."

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 7 Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability, and Termination

(a) An advertisement that is an invitation to contract shall disclose provisions relating to renewability, cancellability, and termination and any modification of benefits, losses covered, or premiums because of age or for other reasons, in a manner which shall not minimize or render obscure the qualifying conditions.

(b) Advertisements of non-renewable accident and sickness insurance policies shall state renewability of the contract at the company's option in language substantially similar to the following: "This policy is renewable at the option of the company," or "The company has the right to refuse renewal of this policy," or "Renewable at the option of the insurer."

(c) Advertisements of insurance policies that are guaranteed renewable, or renewable at the option of the company, shall disclose that the insurer has the right to increase premium rates if the policy so states.

(d) Qualifying conditions constituting limitations on the permanent nature of coverage shall be disclosed in advertisements of policies which are guaranteed renewable, or renewable at the option of the company. Examples of qualifying conditions include (1) age limits, (2) reservation of a right to increase premiums, and (3) establishment of lifetime maximum limits.

(i) Provisions for reducing benefits at stated ages shall be set forth. For example, a policy may contain a provision reducing benefits fifty percent (50%) after age sixty (60) although it is renewable to age sixty-five (65). Provisions for eliminating certain hazards at any specific ages or after the policy has been in force for a specified period of time shall also be set forth.

(ii) An advertisement for a policy providing for step-rated premium rates based upon the policy year or the insured's attained age shall disclose the rate increases and the times or ages at which the premiums increase.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 8 Standards for Marketing

(a) An insurer, directly or through its producers, shall:

(i) Establish marketing procedures assuring any policy comparison by its producers will be fair and accurate;

(ii) Establish marketing procedures assuring excessive insurance is not sold or issued, except in the case of group major medical expense coverage and disability income coverage; and

(iii) Establish auditable procedures for verifying compliance with this subsection.

(b) In addition to the practices prohibited in Wyoming Statute § 26-13-101 et seq., the following acts and practices are prohibited:

(i) High Pressure Tactics. Employing marketing methods that effectually induce insurance purchases, or tends to induce insurance purchases, through force, fright, threat (explicit or implied), or undue pressure to purchase or recommend the purchase of insurance; and

(ii) Cold Lead Advertising. Using, directly or indirectly, any marketing method which fails to disclose in a conspicuous manner that a purpose of the marketing method is soliciting insurance and contact will be made by an insurance producer or insurance company.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 9 Testimonials or Endorsements by Third Parties

(a) Testimonials and endorsements used in advertisements shall be genuine, represent the current opinion of the author, applicable to the policy advertised, and accurately reproduced. In using a testimonial or endorsement, the insurer makes as its own all of the statements contained in it, and the advertisement, including the statement, is subject to all provisions of this regulation. When a testimonial or endorsement is used more than one year after originally given, a written confirmation to continue using the testimonial or endorsement must be obtained.

(b) A person shall be deemed a "spokesperson" if the person making the testimonial or endorsement:

(i) Has a financial interest in the insurer or a related entity as a stockholder, director, officer, employee, or otherwise;

(ii) Has been formed by the insurer or, is owned or controlled by the insurer, its employees, or the person or persons who own or control the insurer;

(iii) Is any person in a policy-making position affiliated with the insurer in any of the above described capacities; or

(iv) Is in any way directly or indirectly compensated for making a testimonial or endorsement.

(c) The fact of a financial interest or the proprietary or representative capacity of a spokesperson shall be disclosed in an advertisement in the introductory portion of the testimonial or endorsement. If a spokesperson is directly or indirectly compensated for making a testimonial or endorsement, the fact shall be disclosed in the advertisement by language substantially as follows: "Paid Endorsement" or words of similar import in a type style and size at least equal to that used for the spokesperson's name or the body of the testimonial or endorsement, whichever is larger. In the case of television or radio advertising, the required disclosure shall be in the introductory portion of the advertisement and shall be given prominence.

(d) The disclosure requirements shall not apply where the sole financial interest or compensation of a spokesperson for all testimonials or endorsements made on behalf of the insurer consists of payment of union scale wages required by union rules and if the payment is actually the scale for TV or radio performances.

(e) An advertisement shall not state or imply that an insurer or accident and sickness insurance policy has been approved or endorsed by any individual, group of individuals, society, association, or other organizations, unless that is the fact, and unless any proprietary relationship between an organization and the insurer is disclosed. An advertisement must disclose if the entity making the endorsement or testimonial has been formed by the insurer or is owned or controlled by the insurer or the person or persons who own or control the insurer. If the insurer or an officer of the insurer formed or controls the association, or holds any policy-making position in the association, that fact must be disclosed.

(f) When a testimonial refers to benefits received under an accident and sickness insurance policy, the specific claim data, including claim number, date of loss, and other pertinent information shall be retained by the insurer for inspection for a period of four (4) years or until the insurer files their next regular report of examination, whichever is the longer period of time. Use of testimonials that do not correctly reflect present practices of the insurer or that are not applicable to the policy or benefit being advertised is not permissible.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 10 Use of Statistics

(a) An advertisement relating to dollar amounts of claims paid, number of persons insured, or similar statistical information relating to an insurer or policy shall not use irrelevant facts, and shall not be used unless it accurately reflects all current and relevant facts. The advertisement shall not imply that the statistics are derived from the policy advertised unless that is the fact.

(i) An advertisement shall specifically identify the accident and sickness insurance policy to which statistics relate and where statistics are given which are applicable to a different policy, it shall be stated clearly that the data do not relate to the policy being advertised.

(ii) An advertisement using statistics describing an insurer, such as assets, corporate structure, financial standing, age, product lines, or relative position in the insurance business, may be irrelevant and, if used at all, shall be used with extreme caution. As a specific example, an advertisement for accident and sickness insurance referring to the amount of life insurance the company has in force or the amounts paid out in life insurance benefits is not permissible unless the advertisement clearly indicates the amount paid out for each line of insurance.

(b) An advertisement shall not represent or imply that insurer's claim settlements are "liberal" or "generous" or use words of similar import, or that claim settlements are or will be beyond the actual terms of the policy. An unusual amount paid for a unique claim for the policy advertised is misleading and shall not be used.

(c) The source of any statistics used in an advertisement shall be identified in the advertisement.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 11 Identification of Plan or Number of Policies

(a) An advertisement that uses the word "plan" without prominently identifying it as an accident and sickness insurance policy is prohibited.

(b) When a choice of the benefits amount is referred to, an advertisement that is an invitation to contract shall disclose that the amount of benefits provided depends upon the plan selected and the premium varies with the amount of the benefits selected.

(c) When an advertisement that is an invitation to contract refers to various benefits contained in two (2) or more policies, other than group master policies, the advertisement shall disclose that the benefits are provided only through a combination of policies.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 12 Disparaging Comparisons and Statements

(a) An advertisement shall not directly or indirectly make unfair or incomplete comparisons of policies or benefits or comparisons of non-comparable policies of other insurers, and shall not disparage competitors, their policies, services, or business methods, and shall not disparage or unfairly minimize competing methods of marketing insurance.

(b) An advertisement shall not contain statements such as "no red tape" or "here is all you do to receive benefits."

(c) Advertisements stating or implying that competing insurance coverages customarily contain certain exceptions, reductions, or limitations not contained in the advertised policies are prohibited unless the exceptions, reductions, or limitations are contained in a substantial majority of the competing coverages.

(d) Advertisements stating or implying that an insurer's premiums are lower or its loss ratios are higher because its organizational structure differs from that of competing insurers are prohibited.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 13 Jurisdictional Licensing and Status of Insurer

(a) An advertisement intended to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond those limits.

(b) An advertisement shall not create the impression directly or indirectly that the insurer, its financial condition or status, or the payment of its claims, or the merits, desirability, or advisability of its policy forms or kinds of plans of insurance are approved, endorsed, or accredited by any division or agency of the State of Wyoming or the federal government. Terms such as "official," or words of similar import, used to describe any policy or application form are prohibited because of the potential for deceiving or misleading the public.

(c) An advertisement shall not imply that approval, endorsement, or accreditation of policy forms or advertising has been granted by any division or agency of the state of Wyoming or the federal government. Approval of either policy forms or advertising shall not be used by an insurer to imply or state that a governmental agency has endorsed or recommended the insurer, its policies, advertising or its financial condition.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 14 Identity of Insurer

(a) The name of the actual insurer shall be stated in all of its advertisements. The form number or numbers of the policy advertised shall be stated in an advertisement that is an invitation to contract. An advertisement shall not use a trade name, any insurance group designation, name of the parent company of the insurer, name of a particular division of the insurer, service mark, slogan, symbol, or other device that, without disclosing the name of the actual insurer, would have the capacity and tendency to mislead or deceive as to the true identity of the insurer.

(b) An advertisement shall not use any combination of words, symbols, or physical materials whose content, phraseology, shape, color or other characteristics are so similar to combinations of words, symbols, or physical materials used by agencies of the federal government or of the state of Wyoming, or otherwise appear to be of such a nature that it tends to confuse or mislead prospective insureds into believing the solicitation is in some manner connected with an agency of the municipal, state, or federal government.

(c) Advertisements, envelopes or stationery that employ words, letters, initials, symbols, or other devices similar to those used in governmental agencies or by other insurers are not permitted if they may lead the public to believe:

(i) That the advertised coverages are somehow provided by or endorsed by the governmental agencies or the other insurers; or

(ii) That the advertiser is the same as, is connected with, or is endorsed by the governmental agencies or the other insurers.

(d) An advertisement shall not use the name of a state or political subdivision of a state in a policy name or description.

(e) An advertisement in the form of envelopes or stationery of any kind may not use any name, service mark, slogan, symbol, or any device in a manner implying that the insurer, the policy advertised, or that any agent who may call upon the consumer in response to the advertisement is connected with a governmental agency, such as the Social Security Administration.

(f) An advertisement may not incorporate the word "Medicare" in the plan or policy title advertised unless, wherever it appears, the word is qualified by language differentiating it from Medicare. The advertisement, however, shall not use the phrase "[ ] Medicare Department of the [ ] Insurance Company," or language of similar import.

(g) An advertisement may not imply that the reader may lose a right or privilege or benefit under federal, state, or local law if he or she fails to respond to the advertisement.

(h) Use of letters, initials, or symbols of the corporate name or trademark having the tendency or capacity to mislead or deceive the public as to the true identity of the insurer is prohibited unless the true, correct, and complete name of the insurer is in close conjunction and in the same size type as the letters, initials, or symbols of the corporate name or trademark.

(i) The use of the name of an agency or "[ ] Underwriters" or "[ ] Plan" in a type, size, and location with the capacity and tendency to mislead or deceive as to the true identity of the insurer is prohibited.

(j) The use of an address so as to mislead or deceive as to true identity of the insurer, its location, or licensing status is prohibited.

(k) An insurer shall not use, in the trade name of its insurance policy any terminology or words so similar to the name of a governmental agency or governmental program as to have the tendency to confuse, deceive, or mislead prospective purchasers.

(l) Advertisements used or created by agents, producers, brokers, or solicitors of an insurer shall have prior written approval of the insurer before they may be used.

(m) An agent who makes contact with a consumer, as a result of acquiring that consumer's name from a lead-generating device, shall disclose that fact in the initial contact with the consumer. An agent or insurer may not use names produced from lead-generating devices that do not comply with the requirements of this regulation.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 15 Group or Quasi-Group Implications

(a) An advertisement of a particular policy shall not state or imply that prospective insureds become group or quasi-group members covered under a group policy and as members enjoy special rates or underwriting privileges, unless that is the fact.

(b) Solicitations of a particular class, such as governmental employees, by use of advertisements which state or imply that their occupational status entitles them to reduced rates on a group or other basis when in fact the policy being advertised is sold only on an individual basis at regular rates is prohibited.

(c) Advertisements indicating that a particular coverage or policy is exclusively for "preferred risks," a particular segment of the population, or that a particular segment of the population is an acceptable risk when the distinctions are not maintained in issuing policies are prohibited.

(d) An advertisement to join an association, trust, or discretionary group that is also an invitation to contract for insurance coverage shall clearly disclose that the applicant will be purchasing both membership in the association, trust, or discretionary group and insurance coverage. The insurer shall solicit insurance coverage on a separate and distinct application requiring a separate signature. The separate and distinct applications required need not be on separate documents or contained in a separate mailing. The insurance program shall be presented so as not to conceal the fact that prospective members are purchasing insurance as well as applying for membership, if that is the case. Similarly, it is prohibited to use terms such as "enroll" or "join" to imply group or blanket insurance coverage when that is not the fact.

(e) Advertisements for group or franchising plans providing a common benefit or a common combination of benefits shall not imply that the insurance coverage is tailored or designed specifically for that group, unless that is the fact.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 16 Introductory, Initial or Special Offers

(a) An advertisement of an individual policy shall not directly or by implication represent that a contract or combination of contracts is an introductory, initial, or special offer, that applicants will receive substantial advantages not available at a later date, or that the offer is available only to a specified group of individuals, unless that is the fact. An advertisement shall not contain phrases describing an enrollment period as "special," "limited," or similar words or phrases when the insurer uses the enrollment periods as the usual method of marketing accident and sickness insurance.

(b) An enrollment period included in limited health benefit plans during which a particular insurance product may be purchased on an individual basis shall not be offered within Wyoming unless there has been a lapse of not less than twenty-four (24) months between the close of the immediately preceding enrollment period for the same product and the opening of the new enrollment period. The advertisement shall indicate the date by which the applicant must mail the application, which shall not be less than ten (10) days and not more than forty (40) days from the date the enrollment period is advertised for the first time. This regulation applies to all advertising media, i.e., mail, newspapers, the Internet, radio, television, magazines and periodicals, by any one insurer. It is inapplicable to solicitations of employees or members of a particular group or association otherwise eligible under specific provisions of the Insurance Code for group, blanket, or franchise insurance. The phrase "any one insurer" includes all affiliated companies of a group of insurance companies under common management or control.

(i) The phrase "a particular insurance product" means an insurance policy providing substantially different benefits than those contained in any other policy. Different terms of renewability; an increase or decrease in the dollar amounts of benefits; and an increase or decrease in any elimination period or waiting period from those available during an enrollment period for another policy are not sufficient to constitute the product being offered as a different product eligible for concurrent or overlapping enrollment periods.

(c) Any statement or implication to the effect that only a specific number of policies will be sold or that a time is fixed for the discontinuance of the sale of the particular policy advertised because of special advantages available in the policy is prohibited, unless that is the fact.

(d) An advertisement shall not offer a policy utilizing a reduced initial premium rate in a manner that overemphasizes the availability and amount of the initial reduced premium. When an insurer charges an initial premium that differs in amount from the amount of the renewal premium payable on the same mode, the advertisement shall not display the amount of the reduced initial premium either more frequently or more prominently than the renewal premium, and both the initial reduced premium and the renewal premium must be stated in juxtaposition in each portion of the advertisement where the initial reduced premium appears.

(e) Special awards, such as a "safe driver's award," shall not be used in connection with advertisements of accident and sickness insurance.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 17 Statements About an Insurer

An advertisement shall not contain statements which are untrue in fact, or by implication misleading, with respect to the assets, corporate structure, financial standing, age, or relative position of the insurer in the insurance business. An advertisement shall not contain a recommendation by any commercial rating system unless it clearly indicates the purpose of the recommendation and the limitations of the scope and extent of the recommendations.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 18 Enforcement Procedures

(a) Each insurer shall maintain at its home or principal office a complete file containing every advertisement of its individual policies and typical advertisements of its blanket, franchise, and group policies disseminated in this or any other state, whether or not licensed in another state, with a notation attached to each advertisement indicating the manner and extent of distribution and the form number of any policy advertised. The file shall be subject to regular and periodical inspection by the Commissioner. All advertisements shall be maintained in a file for a period of either four (4) years or until the filing of the next regular report on examination of the insurer, whichever is the longer period of time. The provisions of this paragraph shall also apply to all insurer-approved agency advertisement.

(b) Each insurer required to file an annual statement shall file with the Commissioner by March 1 of each year a certificate of compliance executed by an authorized officer of the insurer stating that, to the best of the officer's knowledge, information, and belief, the advertisements disseminated by the insurer during the preceding statement year complied with the provisions of this regulation and the insurance laws of Wyoming as implemented and interpreted by this regulation.

History

• Effective 2019-07-16

Wyo. Code R. 044.0002.21.07162019 § 19 Filing of Advertising Material

At the Commissioner's discretion and request, any insurer or agent may be required to submit all or any part of their advertisements to the Department for review and approval prior to use.

History

• Effective 2019-07-16

Chapter 22 Closed Blocks of Business

Wyo. Code R. 044.0002.22.12092016 Closed Blocks of Business

CHAPTER 22

REGULATION GOVERNING CLOSED BLOCKS OF BUSINESS

Section 1. Authority

This regulation governing closed blocks of business is promulgated by the authority of and pursuant to the Wyoming Insurance Code W.S. §§ 26‑2‑110 and 26‑39‑101 et. seq.

Section 2. Definitions

"Like Insureds" for the purposes of W.S. § 26‑39‑103 shall mean those insureds who:

(a) Are of the same underwriting risk classification as designated or approved by the Wyoming Insurance Commissioner; and

(b) Are insured under disability insurance policies providing the same type of coverage. Each of the following coverages shall be deemed a type of coverage:

(i) Hospital‑surgical expense coverage;

(ii) Major medical expense coverage;

(iii) Hospital indemnity coverage;

(iv) Disability income coverage;

(v) Accident only coverage;

(vi) Specified disease coverage;

(vii) Medicare supplement coverage;

(viii) Mortgage disability coverage;

(ix) Long‑term care coverage;

(x) Short‑term non‑renewable coverage; and

(xi) Such other coverages as designated or approved by the Commissioner.

Section 3. Closed Blocks

An insurer will be presumed to have closed a block of business in Wyoming pursuant to W.S. § 26‑39‑102(a)(ii), if the insurer has not marketed or sold a new contract in Wyoming in that block of business during the preceding calendar year.

Section 4. Reporting Requirements

On or before March 1 of each year, any insurer who has sold an individual group or blanket disability contract or certificate, excluding credit disability insurance as defined in W.S. § 26‑21‑102(a)(ii), in Wyoming in the past calendar year shall submit a report containing the following information:

(a) A listing for the preceding calendar year of all blocks of business which still have Wyoming insureds as policy or certificate holders within each block as well as an indication as to whether each block has been closed according to the standard set forth in Section 3 of this regulation;

(b) A listing of the number of insureds on the first and last days of the reporting year in each block, and the number of insureds added or canceled from that block during reporting year.

(c) Such other information as the Insurance Commissioner deems necessary.

Section 5. Effective Date

This regulation becomes effective immediately upon filing with the Secretary of State.

History

• Effective 2016-12-09

Chapter 23 Regulation Governing Uninsured Motorist Endorsements

Wyo. Code R. 044.0002.23.05152025 § 1 Authority

These rules and regulations supplement W.S. §§ 26-2-110 and W.S. § 26-15-101 et. seq. of the Wyoming Insurance Code and the Wyoming Uninsured Motorists' Act W.S. § 31-10-101, et. seq.

History

• Effective 2025-05-15

Wyo. Code R. 044.0002.23.05152025 § 2 "Other" Insurance Clauses

If an insured holds more than one policy of uninsured motorists insurance or is entitled to recover under more than one policy of uninsured motorists insurance, for which separate premiums have been paid, the extent of this coverage will be the combined coverages under all policies, and actual damages sustained by the insured will be recoverable to the full extent of the combined limits of all such policies. Such recovery, however, will not exceed the minimum requirements for coverage under W.S. § 31‑9‑102, as to all other policies except the primary policy. The primary policy shall be construed to mean that policy which provides the coverage for the insured automobile involved in the accident. Payment under the policy may only be reduced when total proven or undisputed damages incurred by the insured do not exceed the policy limits of the uninsured motorists coverage.

History

• Effective 2025-05-15

Wyo. Code R. 044.0002.23.05152025 § 3 Reduction of Uninsured Motorists Coverage by Sums Paid Under Automobile Medical Coverage, Bodily Injury Coverage, and Worker's Compensation

(a) Benefits payable under uninsured motorists coverage shall not reduce or be reduced by payments made under any other section of the policy, including, but not limited to, sums paid under automobile medical coverage and bodily injury liability coverage, where actual damages exceed the policy limits of the uninsured motorists coverage. Payment under the policy may only be reduced when total proven or undisputed damages incurred by the insured do not exceed the policy limits of the uninsured motorists coverage.

(b) Benefits payable under uninsured motorists coverage shall not be reduced by amounts paid under Worker's Compensation.

History

• Effective 2025-05-15

Wyo. Code R. 044.0002.23.05152025 § 4 Hit‑and‑Run Coverage

(a) Uninsured motorist endorsements that provide coverage against bodily injury inflicted by a hit‑and‑run motorist shall not restrict such coverage to injuries which result from actual physical contact with the hit‑and‑run vehicle.

(b) If a policy contains language requiring the insured to report a hit‑and‑run accident to a police officer or the Department of Motor Vehicles within a specific timeframe after the accident, the policy shall also include the phrase, "or as soon thereafter as is practicable under the circumstances."

(c) If a policy contains language requiring an insured to file with the insurer a statement or oath within a specific timeframe after the accident the policy shall also include the phrase "after request for the same is made by the insurer."

History

• Effective 2025-05-15

Wyo. Code R. 044.0002.23.05152025 § 5 Defining an Uninsured Automobile

(a) The definition of an uninsured automobile shall not include a provision that states the unauthorized use of a motor vehicle owned by a federal, state or local governmental agency is excluded.

(b) Any uninsured motorists coverage that excludes from the uninsured automobile definition any land motor vehicle or trailer while located for use as a residence or premises shall be amended to read "This exclusion shall not apply to mobile recreational vehicles while being used for normal and ordinary purposes."

History

• Effective 2025-05-15

Wyo. Code R. 044.0002.23.05152025 § 6 Consent to Sue Clause

Uninsured motorists coverage shall not contain any policy language which requires the insured to obtain written consent of the insurer to initiate an action against an uninsured motorist. The insurer shall be entitled to a copy of the complaint and summons.

History

• Effective 2025-05-15

Wyo. Code R. 044.0002.23.05152025 § 7 Mandatory Arbitration Clause

Uninsured motorists coverage shall not contain a mandatory arbitration clause. An arbitration clause shall not require that the decision is binding on the parties without the right of appeal unless the parties agree to be so bound by a separate written agreement.

History

• Effective 2025-05-15

Wyo. Code R. 044.0002.23.05152025 § 8 Benefits in Excess of Damages

Payments shall not be required under uninsured motorists coverage which would result in duplicate payment for the same elements of loss or payment in excess of damages sustained.

History

• Effective 2025-05-15

Chapter 24 Private Passenger Liability Policies

Wyo. Code R. 044.0002.24.12311996 Private Passenger Liability Policies

CHAPTER 24

REGULATION GOVERNING PRIVATE PASSENGER LIABILITY POLICIES

Section 1. Authority

These rules and regulations governing the policy provisions of the Liability Section of private passenger automobile policies marketed in the State of Wyoming supplement Section 26-15-113 of the Wyoming Insurance Code. They are promulgated by authority of and pursuant to the Wyoming Admin- istrative Procedures Act (16-3-101 et seq.) and to Sections 26-2-110 and 26-2-125 of the Wyoming Insurance Code.

Section 2. Purpose

The purpose of this regulation is to lessen a gap in coverage that exists when the named insured, in the course of his employment in a business other than the automobile business, negligently injures a fellow employee while driving (1) certain non-owned vehicles, the use of which is otherwise insured, or (2) the owned motor vehicle. The above situations are excluded from many automobile liability policies issued in this state. These exclusions were intended to avoid duplication of benefits to an injured party under the liability contract and the Workmen’s Compensation Law. The State of Wyoming Workmen’s Compensation Act is captive for hazardous occupations, but excludes non-hazardous occupations—thus gap in coverage is possible.

Section 3. Applicability

These rules shall apply to the Bodily Injury Liability coverage of any private passenger automo- bile insurance policy issued in the State of Wyoming.

Section 4. Definitions

Types of vehicles which are not peculiar to business or industry and might reasonably be styled as family type vehicles shall not be excluded from the coverage afforded for non-owned auto. Such vehicles take the form of vans, panel deliveries, pickups, etc. If the policy language distinguishes between different types of vehicles such as “private passenger” and “utility”or definitions of similar import; the van—panel delivery—pickup type must be included in the definition which affords non- owned coverage. A suggested demarcation might be between 10,000 and 10,001 pounds of gross ve- hicle weight. This of course, need not affect the automobile business exclusion.

Section 5. Minimum Coverage

Consistent with the Wyoming Safety Responsibility Act, any private passenger automobile policy which provides Bodily Injury Liability coverage may not exclude the named insured from suchcoverage for bodily injury to a fellow employee of the named insured injured in the course of such employment in a business other than the automobile business and arising out of the use by the named insured of:

(a) The owned motor vehicle, or

(b) A non-owned private passenger or utility automobile the use of which is otherwise covered by the policy. Liability coverage may be excluded from the above described situations for those injuries which are required to be compensated, under any Workmen’s Compensation Law.

History

• Effective 1996-12-31

Chapter 25 Information Practices

Wyo. Code R. 044.0002.25.02212018 § 1 Authority

These rules and regulations are authorized by the Wyoming Public Records Act (W.S. § 16-4-201 et. seq.).

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.25.02212018 § 2 Incorporation by Reference

(a) For any code, standard, rule, or regulation incorporated by reference in these rules:

(i) The Department of Insurance has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond this chapter's effective date; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department of Insurance and is available for public inspection and copying at cost at the same location.

(b) Each rule incorporated by reference in these rules is further identified as follows:

(i) The Wyoming Department of Administration and Information's regulation, Chapter 2: Uniform Procedures, Fees, Costs, and Charges for Inspecting, Copying, and Producing Public Records effective September 6, 2016, is incorporated by reference.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.25.02212018 § 3 Effective Date

These rules become effective upon filing with the Secretary of State.

History

• Effective 2018-02-21

Chapter 26 Regulation Governing Adjustment of Damages to Dwelling Roofs Under Homeowners' Policies

Wyo. Code R. 044.0002.26.07312025 § 1 Authority

These rules and regulations governing the adjustment of roof damage under Homeowners' Policies marketed in the State of Wyoming are promulgated pursuant to W.S. §§16-3-101 through 16-3-106, 26‑2‑110, 26‑2‑125, and 26-13-124.

History

• Effective 2025-07-31

Wyo. Code R. 044.0002.26.07312025 § 2 Definitions

(a) "Adjustment" means the investigation and negotiation of settlements relative to insurance claims or the application of the factual circumstances of an insurance claim to the insurance policy provisions, or both, arising under property and casualty insurance contracts.

(b) "Facet" means one continuous side of a roof that has many sides.

(c) "Obsolete" means a roofing product which is no longer manufactured or available for use, and for which there is no roofing product of similar like, kind and quality currently available.

(d) "Roofing product" means the specific construction material used to cover the roof of the insured property. The roofing product on the insured property shall be identified by the manufacturer, material composition, hazard rating, installation method, color, warranty, construction style, dimension, and model number.

History

• Effective 2025-07-31

Wyo. Code R. 044.0002.26.07312025 § 3 Adjustment Practices

(a) If an insured loss causes damage to all facets of the roof of a covered property, the entire roof shall be replaced.

(b) Unless consent is given pursuant to Section 4(a) of this regulation, if the roofing product existing on the insured property at the time of loss is obsolete and there is partial damage, i.e., damage to one or more facets of the roof but not the entire roof, it shall be construed that the full roof has been damaged and adjustment shall be made on that basis.

(c) Adjustment of a roof claim shall include, but not be limited to, investigation into all usual and customary aspects of a roofing claim and shall include identification of the specific roofing product on the insured property.

(i) Investigation to determine the roofing product existing on the insured property may include photographic documentation of the roofing material, but photographic documentation of the roofing product in and of itself is insufficient to meet the requirement of a reasonable investigation required by Wyo. Stat. 26-13-124.

(ii) No insurer shall depreciate the cost of labor associated with the installation and tear-off of roofing products when adjusting a roofing claim.

History

• Effective 2025-07-31

Wyo. Code R. 044.0002.26.07312025 § 4 Consent of the insured

(a) Pursuant to Subsection 3(b) of this regulation, if the insured consents in writing in advance, and the roofing product is obsolete, a different roofing product may be used in the repair or replacement of damaged facets of the roof of an insured property to the insured's satisfaction.

(i) Consent provided pursuant to Subsection (a) of this section shall only be valid so long as the insurer who seeks repair or replacement of one or more facets, but less than replacement of the entire roof, fully disclosed any known effect of the repair or replacement on underwriting standards, on value of the property, on future insurability, and on any existing roof warranty.

(b) Any consent provided by the insured pursuant to this Section must be retained by the insurer for not less than five (5) years and be made available for inspection by the Commissioner upon request.

History

• Effective 2025-07-31

Wyo. Code R. 044.0002.26.07312025 § 5 Effective Date

This regulation shall become effective upon filing with the Secretary of State.

History

• Effective 2025-07-31

Chapter 28 Regulation Governing Perpetual Care Trust Funds for Privately Owned Cemeteries

Wyo. Code R. 044.0002.28.05162023 Regulation Governing Perpetual Care Trust Funds for Privately Owned Cemeteries

CHAPTER 28

REGULATION GOVERNING PERPETUAL CARE TRUST FUNDS FOR

PRIVATELY OWNED CEMETERIES

Section 1. Authority. These regulations govern perpetual care trust funds for any cemetery organized by any individual, group of individuals, corporation or association and are promulgated pursuant to W.S. §§16%u20113%u2011101 et seq., 26%u20112%u2011109, 26%u20112%u2011110, 35-8-101, et seq., 35-8-404, and 35-8-407. These regulations do not apply to cemeteries formed by municipal corporations and duly organized cemetery districts.

Section 2. Definitions. Unless otherwise stated, the definitions found in W.S. §§ 26-1-102, 33-16-502, and 35-8-401 shall apply.

(a) "Buyer" means any person, including individuals who are employees or officers of a corporation owning the disposition site, who purchases or receives a disposition site.

(b) "Disposition site" means any structure, lot, or other physical location used for the final disposition of a deceased human body.

(c) "Lot" or "grave" means a space of ground in a cemetery intended to be used for the permanent disposition of a deceased human body.

(d) "Perpetual care" refers to the general maintenance of the cemetery including: the cutting and trimming of lawn, shrubs, and trees at reasonable intervals; keeping all places where interments have been made in proper order; keeping in repair the drains, waterlines, roads, buildings, fences, and other structures consistent with a well%u2011maintained cemetery. It shall also include overhead expenses necessary for such purposes, including maintenance of machinery, tools and equipment for such care, compensation of employees, payment of reasonable and necessary insurance premiums, reasonable payments for employees' pension and other benefit plans, and the maintenance of necessary records of lot ownership, transfers and burials. It also includes the administration of endowed care funds in those instances wherein those administering such funds fail or refuse to act.

(e) "Privately owned cemetery" means any cemetery organized by any person except municipal corporations and duly organized cemetery districts.

(f) "Seller" means an individual, group of individuals, corporation, or association who represent(s) themself(ves) as a privately owned cemetery to convey privately owned disposition site ownership.

Section 3. Perpetual Care Trust Fund.

(a) Each seller shall establish a perpetual care trust fund before the advertisement or sale of disposition sites. All income and interest from the fund shall be used exclusively for perpetual care. The trust fund shall be irrevocable and deposited in Wyoming at a licensed bank, trust company, or federal savings and loan association and shall be invested as required herein.

(b) The deposit into the perpetual care trust fund shall be made by the seller not later than thirty (30) days after the close of the month in which any payment was received for the purchase of any disposition site. If payments are received in installments, the applicable pro rata share of each payment shall be deposited.

(c) A seller must deposit with the trustee an initial sum of ten thousand dollars ($10,000) or more in cash. When deposits in the trust fund have reached $20,000, the seller may withdraw deposits at the rate of one thousand dollars ($1,000) for each additional two thousand dollars ($2,000) added to the fund. No funds may be withdrawn from the Perpetual Care Trust Fund without the written authorization of the Commissioner or his designee.

Section 4. Bond. Every seller shall post with the Commissioner a surety bond in an amount of not less than five percent (5%) of all amounts received from all buyers or their representatives, whether deposited or invested. The bond amount shall be determined as of December 31st of the preceding year, or such greater amount which the seller may wish to post, but in no event less than $10,000. The bond amount of may not be reduced without the prior written approval of the Commissioner. The State of Wyoming shall be named as the obligee in the bond for the benefit of the buyers, their heirs, legatees, or assigns who are damaged by the loss of any monies paid to the seller after their receipt by the seller. This bond may consist of cash, demand deposits, savings accounts, certificates of deposit, corporate surety bond, or other such security as the Commissioner shall require.

Section 5. Investment of Perpetual Care Trust Fund. The seller shall limit his deposits to obligations of the United States or of any states thereof; obligations and stock of federal government agencies; demand deposits, savings accounts, certificates of deposit, or shares of savings and loan associations, provided that the seller may invest, notwithstanding the limitations of this section, funds in an amount not to exceed in the aggregate the amount of the seller's bond posted in accordance with Section 4, in such types of investments that prudent investors would acquire or retain for their own account. The seller shall be strictly accountable for the corpus of the funds to the buyer and the Commissioner.

Section 6. Treatment of Consumer.

(a) No privately owned cemetery shall limit disposition site sales based on sex, race, religion, or other protected classes.

(b) Whenever a seller conveys ownership in a disposition site, the seller shall execute and deliver to the buyer a written statement that specifically states:

(i) The nature and the extent of the perpetual care to be provided;

(ii) That such care shall be provided from the income and interest of the perpetual care trust fund;

(iii) That the perpetual care trust fund has been established in conformity with these regulations and the laws of Wyoming; and

(iv) That not less than the amounts required by statute have been set aside and deposited in trust.

(c) A master copy of all written documents provided by sellers to buyers or potential buyers, including installment contracts, sales promotions, coupons or certificates, warranty deeds, advertising, descriptions of solicitation practices, and any other materials used in the sale of disposition sites shall be delivered to the Commissioner. All materials shall be approved by the Commissioner before use.

Section 7. Inspection of Cemetery. The Commissioner may inspect privately owned cemeteries to determine if proper perpetual care is being taken. If proper perpetual care is not being taken, the Commissioner may require deposit of additional corpus into the perpetual care trust fund, and/or implement procedures for more efficient use of perpetual care income.

Section 8. Cemetery Records. All records of a privately owned cemetery must be maintained in the county in which the cemetery is located. These records shall include a detailed map of the cemetery, accurate records of each disposition site sold, and detailed records of deposits and investments of the perpetual care trust fund. These records shall be kept in perpetuity.

Section 9. Annual Report. On or before March 1st of each year, each seller shall file an annual report containing the information required by the Commissioner on the Privately Owned Cemetery Annual Report Form available on the Wyoming Department of Insurance website.

Section 10. Examination. The seller shall make available to the Commissioner for examination all books, records, and accounts pertaining to the sale of disposition sites and deposits into the perpetual care trust fund. The Commissioner, or his designee, may require the attendance and examination under oath of any person whose testimony may be required. The cost of any examination may be charged to the cemetery.

Section 11. Exceptions.

(a) The provisions of Sections 3 through 10 of this regulation do not apply to any privately owned cemetery being maintained or managed pursuant to a valid contract with a municipal corporation or duly organized cemetery district so long as the contract remains in effect.

(b) Any privately owned cemetery seeking an exemption pursuant to the provisions of this section shall provide to the commissioner a copy of the current cemetery maintenance contract with the municipal corporation or cemetery district at the time the exemption is requested, and within thirty (30) days of any renewal or amendment of the cemetery maintenance contract. Any exemption granted pursuant to this section shall be at the sole discretion of the commissioner.

(c) Any privately owned cemetery who is granted an exemption pursuant to the provisions of this section shall make all records pertaining to the maintenance of the cemetery available to the commissioner for review upon reasonable advance notice during the cemetery's regular working hours, including but not limited to perpetual care fund records, plot sale information, and any other records required generally of privately owned cemeteries pursuant to this regulation.

(d) Any exemption granted pursuant to the provisions of this section may be revoked by the commissioner after notice and the opportunity for a hearing pursuant to the provisions of the Wyoming Administrative Procedures Act, W.S. § 16-3-101 et seq., and any applicable rules and regulations of the Department of Insurance.

Section 12. Effective Date. This regulation shall become effective upon filing with the Secretary of State.

History

• Effective 2023-05-16

Chapter 29 Managing General Agents

Wyo. Code R. 044.0002.29.12311996 Managing General Agents

CHAPTER 29

MANAGING GENERAL AGENTS

Section 1. Authority

These regulations are promulgated by authority of the Wyoming Insurance Code, W.S. 26-2- 110(a) and 26-1-102(a)(xviii) and provisions of the Wyoming Administrative Procedure Act W.S. 16-3- 101 et seq.

Section 2. Scope

These regulations shall apply to those individuals, firms or corporations who fall within the definition of managing general agent pursuant to W.S. 26-1-102(a)(xviii).

Section 3. Purpose

The purpose of these regulations is to protect the interest of the public by requiring managing general agents to file with the Insurance Department copies of their management contracts.

Section 4. Management Contracts

As used in these regulations management contracts shall include all agreements or contracts under which any individual, firm or corporation is appointed by one (1) or more insurers as an indepen- dent contractor for the principal purpose of exercising general supervision over the business of the insurer in all or part of Wyoming. Such contracts shall expressly grant the Managing General Agent authority to appoint agents for the insurers and to terminate those appointments.

Section 5. Certificate of Registration; Required

No insurer shall transact the business of insurance in this state through a managing general agent unless such agent has been registered and appointed by the insurer with the insurance department and the commissioner has issued a certificate of registration to said agent.

Section 6. Certificate of Registration; Filing

(a) Every insurer transacting the business of insurance in this state through a managing general agent shall register and appoint said agent with the insurance department on forms provided by the insurance department. In registering and appointing a managing general agent the insurer shall certify to the commissioner that:

(i) the managing general agent is competent, trustworthy, financiallyresponsible and of good reputation;

(ii) the managing general agent is the insurer’s representative and is authorized to perform those functions which are set forth in the management contract; and

(iii) the insurer agrees that any violation of the Wyoming Insurance Code, any lawful rule or final order of the commissioner or any final judgment or decree made by any court committed by the managing general agent while acting within its apparent scope of authority for the insurer shall be deemed to be a violation of said code by the insurer.

(b) Every insurer transacting business through a managing general agent shall file with the commissioner a copy of the management contract in conjunction with the filing of the registration form.

(c) After completion of the registration, if the commissioner finds the managing general agent meets the requirements of the Wyoming Insurance Code and these regulations, he shall promptly issue to the managing general agent a certificate of registration and shall provide a copy of said certifi- cate to the insurer.

Section 7. Certificate of Registration; Continuation

(a) A certificate of registration issued under these regulations shall continue in force until expired, suspended, revoked or otherwise terminated, if the insurer’s written request for continuation is received by the commissioner on or before March 31 annually.

(b) Any certificate of registration referred to in subsection (a) of this section is considered expired if the commissioner does not receive the request for continuation by midnight March 31.

Section 8. Exception

In the event that the managing general agent is licensed as a resident or nonresident agent or broker in this state, then such agent shall be exempt from the requirements of Sections 5, 6, and 7 of these regulations.

Section 9. Violations

Any individual, firm or corporation who shall violate any of the provisions of these Managing General Agent Regulations, or file any false or fraudulent management contract as required by these regulations shall be punishable in accordance with W.S. 26-1-107.

Section 10. Severability

If any provision of these rules and regulations or the application thereof to any person or circum- stance is for any reason held to be invalid, the remainder of these rules and regulations and the applica- tion of such provision to other persons and circumstances shall not be affected thereby.

Section 11. Effective Date

These regulations become effective immediately upon filing with the Secretary of State.

CERTIFICATE OF REGISTRATION

This application, made pursuant to Wyoming Insurance Department Regulations, is submitted for the purpose of registering a managing general agent for

_____________________________________________________________________________________ Insurer

of _________________________________________________________________________________ Street Address

_____________________________________________________________________________________ City, State and Zip Code

1. Name of Managing General Agent _________________________________________________

2. Principal administrative office address ______________________________________________

---

3. Managing General Agent’s telephone number ________________________________________

4. List names, addresses and titles of all officers if a corporation, partners if a partnership and proprietor if a sole proprietorship.

---

---

---

---

---

5. Is it understood that, by filing this registration with the insurance commissioner, the insurer agrees that any violation of the Wyoming Insurance Code, any lawful rule or final order of the commis- sioner or any final judgment or decree made by any court committed by the managing general agent, while acting within its apparent scope of authority for the insurer shall be deemed to be a violation of said code by the insurer? ( ) Yes ( ) No I, _________________________________________________________________, on behalf of Name __________________________________________________________________________________ , Insurer certify that the Managing General Agent designated herein is competent, trustworthy, financially respon- sible and of good reputation. Attached hereto is a copy of the management contract between the insurer listed above and the Managing General Agent.

__________________________________________ Signature

__________________________________________ Title

ACKNOWLEDGMENT:

State of _______________________

County of ______________________

The foregoing instrument was acknowledged before me this ______ day of ________________________ ________, 19. Witness my hand and official seal.

__________________________________________ Notary Public

My commission expires __________________________________________

History

• Effective 1996-12-31

Chapter 31 Policy Fee - Premium Regulations

Wyo. Code R. 044.0002.31.12092016 Policy Fee - Premium Regulations

CHAPTER 31

POLICY FEE‑‑PREMIUM REGULATION

Section 1. Authority

This regulation is promulgated by authority of W.S. §§ 26‑2‑110, 26-3-102, 26-4-103 and 16-3-101 et. seq.

Section 2. Applicability

This regulation shall apply to all direct insurance written in this State.

Section 3. Definition of Policy Fee

A policy fee means any sum of money by whatever name called that is directly or indirectly, collected from an insured, by an insurer or its insurance agent or broker as a consideration for insurance, which sum of money is added to the premium the insured would otherwise pay. A policy fee shall not be interpreted to include the cost of medical examinations required by a life insurer pursuant to W.S. § 26‑13‑121(b), nor shall it include sums collected for taxes by surplus lines brokers.

Section 4. Premium Tax

Any policy fee collected or charged shall be included in an insurer's premium income and the appropriate premium tax shall be paid pursuant to W.S. §§ 26-3-102 and 26-4-103. Such tax shall be paid by the insurer and shall not be charged to any individual insured, agent or broker.

Section 5. Effective Date

This regulation shall become effective upon filing with the Secretary of State.

History

• Effective 2016-12-09

Chapter 32 Practice & Procedure Before the Department of Insurance, State of WY

Wyo. Code R. 044.0002.32.02212018 Practice & Procedure Before the Department of Insurance, State of WY

Chapter 32

RULES OF PRACTICE AND PROCEDURE FOR

CONTESTED CASES

Section 1. Authority and Applicability.

These rules apply to contested cases and other proceedings before the as appropriate, and are promulgated pursuant to W.S. §§ 26‑2‑108 through 26‑2‑111, and 16-3-101 et seq.

Section 2. Incorporation by Reference.

(a) The rules below, adopted on December 7, 2016 and effective March 1, 2017, are incorporated by reference and can be found at: http://www.courts.state.wy.us/Supreme/CourtRules.

(i) Rule 26, Wyoming Rules of Civil Procedure.

(ii) Rule 28 through 36, Wyoming Rules of Civil Procedure.

(iii) Rule 37, except 37(b)(1) and 37(b)(2), Wyoming Rules of Civil Procedure.

Section 3. Definitions.

The following definitions are applicable to this Chapter. Terms not defined herein shall use the definitions set forth and contained in the Wyoming Insurance Code and the Administrative Procedure Act.

(a) "Attorney" means an attorney licensed to practice law in the State of Wyoming, or an attorney who is licensed to practice law in another state and who is associated with an attorney licensed to practice law in the State of Wyoming.

(b) "Contested case" means a proceeding in which legal rights, duties, or privileges of a party are required by law to be determined by an agency after an opportunity for hearing.

(c) "Department" or "agency" means the Wyoming Department of Insurance.

(d) "Hearing" means any proceeding in which the Petitioner and Respondent have the opportunity to present arguments to a Hearing Officer regarding a contested case brought pursuant to W.S. §§ 26-2-108 to 26-2-111, or W.S. §§ 16-3-107 to 16-3-113. The term "hearing" does not apply to informal appearances before the commissioner or his designee, including those matters arising under W.S. §§ 16-3-102 to 16-3-106.

(e) "Hearing officer" means a hearing examiner from the Office, an attorney who has been retained by the agency to preside over a contested case, an officer of the Department who has been designated to preside over a contested case, or any other person who is statutorily authorized to preside over a contested case.

(f) "Office" means the Office of Administrative Hearings.

(g) "Petitioner" means the person or entity seeking relief through the contested case proceeding.

(h) "Representative" means an individual other than an attorney who is authorized to function in a representative capacity on behalf of a party to a contested case.

(i) "Respondent" means the person or entity against whom relief is being sought through the contested case proceeding.

(j) "Wyoming Administrative Procedure Act" means Wyoming Statute §§ 16-3-101 through -115.

Section 4. Informal Proceedings and Alternative Dispute Resolution.

(a) Nothing in these rules shall be construed so as to prevent the Department from establishing informal procedures for resolving a contested case or from establishing procedures which are intended to occur prior to the Department's referral for or the initiation of a contested case.

(b) Parties to a contested case are encouraged to resolve the contested case through settlement, informal conference, mediation, arbitration, or other means throughout the duration of a contested case.

(c) With the consent of all parties, the hearing officer may assign a contested case to another hearing officer on limited assignment for the purpose of nonbinding alternative dispute resolution methods, including settlement conference and mediation. Such settlement conference or mediation shall be conducted in accordance with the procedures prescribed by the hearing officer conducting the settlement conference or mediation.

Section 5. Commencement of Hearings.

The following procedures shall be followed for contested cases before the Department:

(a) All contested case hearings shall commence by filing a written petition, complaint, notice, order, or notice to show cause.

(b) The petition, complaint, order, notice, or notice to show cause shall contain all information required by Section 14(a), and set forth, in ordinary and concise language, a statement of the nature of the contested case.

(i) Unless otherwise provided for in the notice, order, complaint, or petition the Respondent(s) shall be allowed twenty (20) days from the date of the certificate of service to file an answer or responsive pleading with the Department.

(ii) If any Respondent fails to answer or otherwise appear within the time allowed, and provided that all rules of service have been followed, the Respondent(s), shall be in default. Any allegations of the complaint, petition, or order, or notice to show cause may be taken as true and an order of the commissioner entered accordingly.

(c) All other matters brought to hearing pursuant to the Wyoming Insurance Code, any other lawful rule, regulation, or order of the commissioner, shall be commenced by filing a Notice of Hearing setting forth the reasons and authority of said hearing and indicating the date, time, and place of said hearing.

Section 6. Referral to Office.

(a) Upon referral to the Office to conduct a contested case, the agency shall transmit to the Office copies of appropriate agency documents reflecting the disputed agency action or inaction and the basis thereof, including any written challenge(s) initiating the contested case and a reference to applicable law.

(b) The agency shall submit a transmittal sheet, on a form provided by the Office, sufficiently identifying the contested case, including:

(i) the name of the agency;

(ii) the names of the known parties and their attorneys or representatives;

(iii) a concise statement of the nature of the contested case;

(iv) notification of any time limits for the setting of a hearing or entry of a decision, location requirements, and anticipated special features or unique requirements; and

(v) certification by an authorized officer of the agency that all parties have been properly served with a true and complete copy of the transmittal form.

Section 7. Referral to Hearing Officer Other than the Office.

When the agency refers a contested case to a hearing officer other than the Office, or when the agency retains a contested case, the agency shall comply with any referral requirements of that hearing officer.

Section 8. Designation and Authority of Hearing Officer; Recusal.

(a) The Department may refer, assign, or designate a hearing officer to preside over any contested case, unless otherwise provided by law. When appropriate under applicable law or at the Department's request, the hearing officer may provide a recommended decision.

(b) Upon referral for contested case by the agency that will not be present for the hearing, a hearing officer shall conduct a contested case and may enter proposed findings of fact and conclusions of law or may provide a complete record of the contested case to the agency for entry of a final decision.

(c) At any time while a contested case is pending, a hearing officer may withdraw from a contested case by filing written notice of recusal. From and after the date the written notice of recusal is entered, the recused hearing officer shall not participate in the contested case.

(d) Upon motion of any party, recusal of a hearing officer shall be for cause. Whenever the grounds for such motion become known, any party may move for a recusal of a hearing officer on the ground that the hearing officer:

(i) has been engaged as counsel in the action prior to being appointed as hearing officer;

(ii) has an interest in the outcome of the action;

(iii) is related by consanguinity to a party;

(iv) is a material witness in the action;

(v) is biased or prejudiced against the party or the party's attorney or representative; or

(vi) any other grounds provided by law.

(e) A motion for recusal shall be supported by an affidavit or affidavits of any person or persons, stating sufficient facts to show the existence of grounds for the motion. Prior to a hearing on the motion, any party may file counter-affidavits. The motion shall be heard by the hearing officer or, at the discretion of the hearing officer, by another hearing officer. If the motion is granted, the hearing officer shall immediately designate another hearing officer to preside over the contested case.

(f) A hearing officer shall not be subject to a voir dire examination by any party.

Section 9. Appearances and Withdrawals.

(a) A party, whether it be an individual, corporation, partnership, governmental organization, or other entity may appear through an attorney or representative. An individual may represent himself/herself. An individual or entity seeking to intervene in a contested case under Rule 24 of the Wyoming Rules of Civil Procedure, may appear through an attorney or representative prior to a ruling on the motion to intervene.

(b) Prior to withdrawing from a contested case, an attorney shall file a motion to withdraw. The motion for an attorney's withdrawal shall include a statement indicating the manner in which notification was given to the client and setting forth the client's last known address and telephone number. The hearing officer shall not grant the motion to withdraw unless the attorney has made reasonable efforts to give actual notice to the client that:

(i) the attorney wishes to withdraw;

(ii) the client has the burden of keeping the hearing officer informed of the address where notices, pleadings, or other papers may be served;

(iii) the client has the obligation to prepare, or to hire another attorney or representative to prepare, for the contested case and the dates of proceedings;

(iv) the client may suffer an adverse determination in the contested case if the client fails or refuses to meet these burdens;

(v) the pleadings and papers in the case shall be served upon the client at the client's last known address; and

(vi) the client has the right to object within 15 days of the date of notice.

(c) Prior to withdrawing from a contested case, a representative shall provide written notice of withdrawal to the hearing officer and the agency.

(d) The filing of an answer or other appearance by an attorney constitutes his appearance for the party for whom the pleading is filed. Any person appearing before the commissioner, or hearing officer, at a hearing in a representative capacity shall be precluded from examining or cross‑examining any witness unless such representative is a Wyoming licensed attorney, or a non‑resident attorney granted pro hac vice status or a representative of the Department designated by the commissioner. This rule shall not be construed to prohibit any person from representing himself. Any person appearing must abide by the Wyoming Rules of Civil Procedure and the Wyoming Rules of Evidence so far as they are applicable under these rules and the Wyoming Administrative Procedure Act.

Section 10. Ex Parte Communications.

Except as authorized by law, a party or a party's attorney or representative shall not communicate with the hearing officer in connection with any issue of fact or law concerning any pending contested case, except upon notice and opportunity for all parties to participate. Should ex parte communication occur, the hearing officer shall advise all parties of the communication as soon as possible thereafter and, if requested, shall allow any party an opportunity to respond prior to ruling on the issue.

Section 11. Filing and Service of Papers

(a) In all contested cases, the parties shall file all original documents, pleadings, and motions with the Department, as applicable, with true and correct copies of the particular document, pleading, or motion properly served on all other parties and the hearing officer, accompanied by a certificate of service. The Department shall maintain the complete original file, and all parties and the hearing officer shall be provided copies of all contested case documents, pleadings, and motions contained therein.

(b) Filing and service under this rule shall be made either by hand delivery or by U.S. mail transmittal to the last address of record. The Department permits filing and service by e-mail or facsimile. Parties wishing to file by means other than those described in this Section shall obtain preapproval from the hearing officer.

(c) Service by mail shall be deemed to have been served as stated in W.S. 26-2-126(c).

Section 12. Computation of Time.

In computing any period of time prescribed or allowed by these rules, by order or by any applicable statutes or regulations, the day of the act, event, or default from which the designated period of time begins to run shall not be included. The last day of the period so computed shall be included, unless it is a Saturday, a Sunday, or a legal holiday, or, when the act to be done is the filing of a paper, a day on which weather or other conditions have made agency offices inaccessible, in which event the period runs until the end of the following day which is not one of the aforementioned days.

Section 13. Motions and Motion Practice.

The hearing officer shall establish all filing deadlines in the Notice of Hearing, Pretrial Order or in accordance with W.S. Title 26 and the applicable Wyoming Rules of Civil Procedure.

Section 14. Setting Hearings, Other Proceedings, and Location of Hearings.

(a) The hearing officer or the agency, as applicable, shall assign a docket number to each contested case. All papers, pleadings, motions, and orders filed thereafter shall contain:

(i) a conspicuous reference to the assigned docket number;

(ii) a caption setting forth the title of the contested case and a brief designation describing the document filed;

(iii) the name, address, telephone number, and signature of the person who prepared the document; and

(iv) an e-mail address and/or fax number to allow for electronic service, unless otherwise ordered.

(b) The hearing officer shall set the course of proceedings, which may include, but is not limited to, scheduling informal conferences, confidentiality issues, summary disposition deadlines, motion practice, settlement conferences, and the evidentiary hearing.

(c) Prehearing conferences may be held at the discretion of the hearing officer. Any party may request a prehearing conference to address issues such as discovery, motion deadlines, scheduling orders, or status conferences.

(d) At the hearing officer's discretion, and unless otherwise provided by the agency, telephone or videoconference calls may be used to conduct any proceeding. At the discretion of the hearing officer, parties or their witnesses may be allowed to participate in any hearing by telephone or videoconference.

(e) The hearing officer shall determine the location for proceedings.

Section 15. Consolidation.

A party may seek consolidation of two or more contested cases by filing a motion to consolidate in each case sought to be consolidated. If consolidation is ordered, and unless otherwise ordered by the hearing officer, all subsequent filings shall be in the case first filed, and all previous filings related to the consolidated cases shall be placed together under that case number. Consolidation may be ordered on a hearing officer's own motion.

Section 16. Continuances, Extensions of Time, and Duty to Confer.

(a) A motion for a continuance of any scheduled hearing shall be in writing, state the reasons for the motion, and be filed and served on all parties and the hearing officer. A request for a continuance filed less than five days before a scheduled hearing shall be granted only upon a showing of good cause.

(b) A motion for an extension of time for performing any act prescribed or allowed by these rules or by order of the hearing officer shall be filed and served on all parties and the hearing officer prior to the expiration of the applicable time period. A motion for extension of time shall be granted only upon a showing of good cause.

(c) A moving party shall make reasonable efforts to contact all parties, representatives, and attorneys before filing a motion for continuance or extension of time. A motion for continuance or extension of time shall include a statement concerning efforts made to confer with the other party(s) and position(s) on the motion.

Section 17. Discovery.

(a) The taking of depositions and discovery shall be in accordance with the Notice of Hearing, Pretrial Order or in accordance with W.S. Title 26.

(b) Unless the hearing officer orders otherwise, parties shall not file discovery requests, answers, and deposition notices with the hearing officer.

Section 18. Subpoenas.

(a) Any party may request the hearing officer to issue a subpoena to compel the attendance of a witness or for the production of documents. Requests for the issuance of a subpoena shall be accompanied by a completed subpoena, which shall conform to Rule 45 of the Wyoming Rules of Civil Procedure.

(b) Witnesses who are summoned to appear at a hearing are entitled to the same fees as are paid for witnesses in the district courts of the State of Wyoming. Costs may be awarded to the prevailing party at the discretion of the Hearing Officer; but costs against the State of Wyoming, its officers or agencies, shall be imposed only to the extent permitted by law.

Section 19. Summary Disposition.

Wyoming Rules of Civil Procedure, Rules 12(b)(6), 52(c), 56.1, and 56, apply to contested cases.

Section 20. Prehearing Procedures.

(a) Unless otherwise ordered by the hearing officer, each party to a contested case shall file and serve on all other parties and the hearing officer a prehearing disclosure statement setting forth:

(i) a complete list of all witnesses who will or may testify, together with information on how that witness may be contacted and a brief description of the testimony the witness is expected to give in the case. If a deposition is to be offered into evidence, the original shall be filed with the agency, with a copy provided to the hearing officer,

(ii) a statement of the specific claims, defenses, and issues which the party asserts are before the hearing officer for hearing;

(iii) a statement of the burden of proof to be assigned in the contested case with reference to specific regulatory, statutory, constitutional, or other authority established by relevant case law;

(iv) a statement identifying stipulated facts. If the parties are unable to stipulate to facts, the parties shall indicate what efforts have been made to stipulate to facts and the reasons facts cannot be stipulated; and

(v) a complete list and copies of all documents, statements, etc., which the party will or may introduce into evidence.

(b) Parties shall file and serve prehearing disclosure statements on or before the date established by the hearing officer.

(c) The information provided in a prehearing disclosure statement shall be binding on each party throughout the course of the contested case unless modified for good cause.

(d) Additional witnesses or exhibits may be added only if the need to do so was not reasonably foreseeable at the time of filing of the prehearing disclosure statement, it would not unfairly prejudice other parties, and good cause is shown.

(e) The hearing officer may modify the requirements of a prehearing disclosure statement.

(f) Failure to file a prehearing disclosure statement may result in the hearing officer's striking of witnesses, exhibits, claims and defenses, or dismissal of the contested case.

(g) If a prehearing order is entered, the prehearing order shall control the course of the hearing.

Section 21. Burden of Proof.

The hearing officer shall assign the burden of proof in accordance with applicable law.

Section 22. Evidence.

(a) The hearing officer shall rule on the admissibility of evidence in accordance with the following:

(i) evidence of the type commonly relied upon by reasonably prudent persons in the conduct of their serious affairs shall be admissible. Irrelevant, immaterial, or unduly repetitious evidence shall be excluded;

(ii) evidence may be offered through witness testimony or in documentary form;

(iii) testimony shall be given under oath administered by the hearing officer. Deposition testimony and other prefiled testimony may be submitted as evidence, provided the testimony is given under oath administered by an appropriate authority, and is subject to cross‑examination by all parties;

(iv) the rules of privilege recognized by Wyoming law shall be given effect; and

(v) a hearing officer may take administrative notice of judicially cognizable facts, provided the parties are properly notified of any material facts noticed.

(b) Each party shall have the opportunity to cross-examine witnesses, in accordance with Section 9(d). The hearing officer may allow cross-examination on matters not covered on direct examination.

(c) The hearing officer, agency staff, or other persons delegated to do so by the hearing officer, when applicable, may ask questions of any party or witness.

Section 23. Contested Case Hearing Procedure.

(a) The hearing officer shall conduct the contested case and shall have discretion to direct the order of the proceedings.

(b) Unless otherwise provided by law, and at the hearing officer's discretion, the party with the burden of proof shall be the first to present evidence. All other parties shall be allowed to cross-examine witnesses in an orderly fashion. When that party rests, other parties shall then be allowed to present their evidence. Rebuttal and surrebuttal evidence shall be allowed only at the discretion of the hearing officer.

(c) The hearing officer shall have discretion to allow opening statements and closing arguments.

(d) Hearings shall be conducted in accordance with the following order of procedure unless otherwise modified by the Hearing Officer after notice to the parties:

(i) The Hearing Officer shall announce that the hearing is convened upon the call of the docket number, title of the matter and case to be heard, and shall note for the record all subpoenas issued and all appearances of record, including counsels of record.

(ii) The Petitioner shall then proceed to present his evidence. Witnesses may be cross‑examined by the Respondent or Respondents. All exhibits offered by and on behalf of the Petitioner shall be marked by letters of the alphabet beginning with "A".

(iii) The Respondent or Respondents shall, in the order of answers or appearances made, be heard in the same manner as the Petitioner's evidence, witnesses and exhibits have been heard and presented. Each Respondent's exhibits shall be marked separately so as to identify the respective Respondents and numbered commencing with the number "1".

(iv) All persons testifying at any hearing before the Hearing Officer shall be administered the following by the Hearing Officer:

(A) "Do you swear (or affirm) to tell the truth, the whole truth and nothing but the truth?

(e) Disrespectful, disorderly or contemptuous conduct, refusal to comply with directions, continued use of dilatory tactics, or refusal to adhere to reasonable standards of orderly and ethical conduct, at any pre‑hearing or hearing, shall constitute grounds for immediate exclusion from the hearing or pre-hearing.

(f) In all matters before the commissioner, or his designee, the commissioner may request the Attorney General of the State of Wyoming, or a representative of his staff, to be present to assist and advise the commissioner, his designee, or the Department.

(g) After all proceedings have been concluded, the Hearing Officer shall dismiss and excuse all witnesses and declare the hearing closed. Either party who wishes to file written briefs of law and proposed findings of fact and conclusions of law and order may do so.

Section 24. Default.

Unless otherwise provided by law, a hearing officer may enter an order of default or an order affirming agency action for a party's failure to appear at a lawfully noticed hearing.

Section 25. Settlements.

Parties shall promptly notify the hearing officer of all settlements, stipulations, agency orders, or any other action eliminating the need for a hearing. When the contested case has settled, the agency may enter an order, on its own motion, dismissing the case.

Section 26. Expedited Hearing.

(a) At the hearing officer's discretion, a contested case may be heard as an expedited hearing upon the motion of any party. Expedited hearings may include summary suspensions under Wyoming Statute § 16-3-113(c), and other emergency proceedings authorized by law.

(b) An expedited hearing shall be decided on written arguments, evidence, and stipulations submitted by the parties. A hearing officer may permit oral arguments upon the request of any party.

(c) The hearing officer may require an evidentiary hearing in any case in which it appears that facts material to a decision in the case cannot be properly determined by an expedited hearing.

Section 27. Recommended Decision.

In those contested cases where the hearing officer makes a recommended decision, the hearing officer shall file the recommended decision with the agency and serve copies of the recommended decision on all parties to the contested case. Unless otherwise ordered, parties shall have ten days to file written exceptions to the hearing officer's recommended decision. Written exceptions shall be filed with the agency and served on all parties.

Section 28. Final Decision.

(a) A final decision entered by a hearing officer shall be in writing, filed with the agency, and served upon all parties to the contested case. A final decision entered by the agency shall be served upon all parties and the hearing officer.

(b) A final decision shall include findings of fact and conclusions of law, separately stated. When the hearing officer allows the parties to submit a proposed final order, the parties shall forward the original to the agency and serve copies of the proposed order on all other parties and the hearing officer.

(c) A hearing officer or agency may at any time prior to judicial review, correct clerical errors in final decisions or other parts of the record. A party may move that clerical errors or other parts of the record be corrected. During the pendency of judicial review, such errors may be corrected only with leave of the court having jurisdiction.

(d) If the Hearing Officer is not the commissioner, the Hearing Officer shall, immediately following the full and complete hearing, prepare and forward to the commissioner recommended findings of fact and conclusions of law.

(i) If upon reviewing the recommended findings of fact and conclusions of law the commissioner finds them to be sufficient to meet the requirements of the law, the commissioner shall enter a decision and order adopting the same which shall then be distributed in accordance with this Section.

(ii) If upon reviewing the recommended findings of fact and conclusions of law the commissioner determines they are not sufficient to meet the requirements of the law, he may remand the matter for additional or more complete findings of fact and conclusions of law.

Section 29. Record of Proceeding.

(a) Hearings in all contested cases or as otherwise required by law, including all testimony, shall be reported or preserved, verbatim by any appropriate means determined by the Hearing Officer. The compensation of a reporter shall be paid by the party or parties requesting such reporter. If a transcript of testimony is required by the Hearing Officer, the cost thereof shall be paid by the Department, or as otherwise provided by law. The Hearing Officer may direct any party or parties to assume the cost of the transcript if transcribed at his or their request. This rule shall not be construed to prohibit any party in any public hearing from providing for a reporting or preservation of the proceedings thereof, provided the same is produced at his expense.

(b) Compensation of Reporter.

(i) The reporter shall be paid by the party or parties requesting such reporter.

(A) If a transcript of testimony is required by the Hearing Officer, the cost thereof shall be paid by the Department, or as otherwise provided by law.

(B) The Hearing Officer may direct any party or parties to assume the cost of the transcript if transcribed at his or their request.

(c) This rule shall not be construed to prohibit any party in any public hearing from providing for a reporting or preservation of the proceedings thereof, provided the same is produced at his expense.

(d) Transcript in the event of appeal:

(i) In case of an appeal to the district court, the party appealing shall obtain and file a transcript of the testimony and all other evidence offered at the hearing.

(ii) The transcript must be verified by the oath of the person who transcribed the testimony as a true and correct transcript of the testimony and other evidence in the case.

(iii) The compensation for the person preparing the transcript and all other costs involved in the appeal shall be paid by the party filing the appeal.

Section 30. Effective Date.

These regulations shall become effective upon filing with the Secretary of State.

History

• Effective 2018-02-21

Chapter 33 Unfair Trade Practices Regulation

Wyo. Code R. 044.0002.33.02212018 § 1 Authority

This regulation is promulgated pursuant to W.S. §§ 16-3-101 through 16-3-115, 26‑2‑110, 26-9-217, and 26-13-101 et seq.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.33.02212018 § 2 Unfair Discrimination

The following are acts or practices which constitute unfair discrimination between individuals or risks of the same class and essentially the same hazard. This regulation is not exclusive and other acts not herein specified may also be deemed to be violations:

(a) Refusing to issue, refusing to renew, cancelling, mandating increased deductibles or limiting the amount of insurance coverage on a property or casualty risk, by whatever means direct or indirect, because of the geographic location of the risk, unless it is:

(i) For a business purpose which is not a mere pretext for unfair discrimination, or

(ii) Required by law or regulatory mandate.

(b) Refusing to issue, refusing to renew, cancelling, mandating increased deductibles or limiting the amount of insurance coverage on a residential property risk, or the personal property contained therein, by whatever means direct or indirect, because of the age of the residential property, unless it is:

(i) For a business purpose which is not a mere pretext for unfair discrimination, or

(ii) Required by law.

(c) Refusing to insure, refusing to continue to insure, limiting the amount, extent or kind of coverage available to an individual, or charging an individual a different rate for the same coverage solely because of blindness or partial blindness, except where the refusal, limitation, or rate differential is based on sound actuarial principles or is related to actual or reasonably anticipated experience.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.33.02212018 § 3 Prohibited Uses of Senior-Specific Certifications and Professional Designations

(a) An insurance producer or consultant may not use a senior-specific certification or professional designation that indicates or implies in such a way as to mislead a purchaser or prospective purchaser that the insurance producer or consultant has special certification or training in advising or servicing seniors in connection with the solicitation, sale or purchase of an annuity, accident and health, or life insurance product, or in the provision of advice as to the value of or the advisability of purchasing or selling an annuity, accident and health, or life insurance product, either directly or indirectly through publications or writings, or by issuing or promulgating analyses or reports related to an annuity, accident and health, or life insurance product.

(b) The prohibited use of senior-specific certifications or professional designations is an untrue, deceptive, misleading, dishonest, or untrustworthy act or practice and includes, but is not limited to, the following:

(i) Use of a certification or professional designation by an insurance producer who has not actually earned or is otherwise ineligible to use the certification or designation;

(ii) Use of a nonexistent or self-conferred certification or professional designation;

(iii) Use of a certification or professional designation that indicates or implies a level of occupational qualifications obtained through education, training or experience that the insurance producer using the certification or designation does not have; and

(iv) Use of a certification or professional designation obtained from a certifying or designating organization that:

(A) Is primarily engaged in the business of instruction in sales or marketing;

(B) Does not have reasonable standards or procedures for assuring the competency of its certificants or designees;

(C) Does not have reasonable standards or procedures for monitoring and disciplining its certificants or designees for improper or unethical conduct; or

(D) Does not have reasonable continuing education requirements for its certificants or designees in order to maintain the certificate or designation.

(c) There is a rebuttable presumption that a certifying or designating organization is not disqualified solely for purposes of subsection (b)(iv) when the certification or designation issued from the organization does not primarily apply to sales or marketing and when the organization or the certification or designation in question has been accredited by:

(i) The American National Standards Institute (ANSI);

(ii) The National Commission for Certifying Agencies; or

(iii) Any organization that is on the U.S. Department of Education's list entitled "Accrediting Agencies Recognized for Title IV Purposes."

(d) In determining whether a combination of words or an acronym standing for a combination of words constitutes a certification or professional designation indicating or implying that a person has special certification or training in advising or servicing seniors, factors to be considered shall include:

(i) Use of one or more words such as "senior," "retirement," "elder," or like words combined with one or more words such as "certified," "registered," "chartered," "advisor," "specialist," "consultant," "planner," or like words, in the name of the certification or professional designation; and

(ii) The manner in which those words are combined.

(e) For purposes of this regulation, a job title within an organization that is licensed or registered by a state or federal financial services regulatory agency is not a certification or professional designation, unless it is used in a manner that would confuse or mislead a reasonable consumer, when the job title:

(i) Indicates seniority or standing within the organization; or

(ii) Specifies an individual's area of specialization within the organization.

For purposes of subsection (e), financial services regulatory agency includes, but is not limited to, an agency that regulates insurers, insurance producers, broker-dealers, investment advisers, or investment companies as defined under the federal Investment Company Act of 1940.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.33.02212018 § 4 Adjustment of Physical Damage Claims

(a) This section applies to the adjustment of physical damage claims under all motor vehicle policies issued in the State of Wyoming including, but not limited to, private passenger automobiles, recreational vehicles, commercial vehicles, motorcycles, or any other risk insured as a motor vehicle or trailer.

(b) Insurers shall adjust personal property losses, be it first or third party claims, by utilizing one of the following options:

(i) Pay for the loss in its entirety in money based on an appraisal of the damage sustained by insured's vehicle;

(ii) Repair the damaged property; or

(iii) Replace the damaged property.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.33.02212018 § 5 Department Inquiries

(a) All persons shall respond to Department inquiries, including, but not limited to, document and information requests during market conduct and financial examinations, investigations of complaints, and any other formal or informal investigation or examination conducted for the purpose of determining compliance with Wyoming law shall be as follows:

(i) Unless another time period is specified by statute, regulation or by the Department either electronically or in another written form, a complete and accurate response to any inquiry from the Division shall be provided within twenty (20) calendar days from the date of the inquiry.

(ii) "Complete and accurate response" means a written response that includes all of the information, documents and explanation requested in the Department's inquiry. If the requested information is not available the response shall include a detailed explanation of why it cannot be provided.

(iii) If additional time is required to respond to any Department inquiry, the person shall submit a written request for an extension of time to the commissioner. The request for an extension of time shall:

(A) Be made no later than 5:00 PM Mountain Time on the business day prior to the response due date;

(B) Include a specific period of time for the extension; and

(C) State in detail the reasons necessitating the extension.

(iv) An extension may be granted, at the discretion of the commissioner, for good cause shown. When a request for an extension is granted, the person shall provide a complete and accurate response within the new time period granted. If an extension is not granted, or the person requesting the extension does not receive written confirmation from the commissioner that the extension is granted, the original response due date applies.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.33.02212018 § 6 Effective Date

This regulation shall become effective upon filing with the Secretary of State.

History

• Effective 2018-02-21

Chapter 34 Cancer Insurance Regulations

Wyo. Code R. 044.0002.34.12311996 Cancer Insurance Regulations

CHAPTER 34

CANCER INSURANCE REGULATION

Section 1. Authority

These regulations governing the advertisement and sale of cancer insurance in the State of Wyoming supplement the provisions of W.S. 26-13-101 et seq., W.S. 26-15-101 et seq., and W.S. 26- 18-101 et seq. They are promulgated by authority of and pursuant to the Wyoming Administrative Procedure Act (W.S. 16-3-101 et seq.) and the Wyoming Insurance Code (W.S. 26-2-110).

Section 2. Purpose

The purpose of these rules is to provide for the approval of all advertising materials used in the sale and marketing of cancer insurance in the State of Wyoming, to prohibit certain illegal and unethical practices in the advertising of cancer insurance, to assure truthful and adequate disclosure of all material and relevant information in the sale and advertising of cancer insurance, to provide for certain minimum benefits to ensure that the benefits provided in the policy are reasonably related to the premium charged for the coverage, to prohibit certain limitations, restrictions, and reductions used in the policy forms to ensure that cancer policies do not contain any exceptions and conditions which deceptively affect the risk purported to be assumed in the general coverage of the contract, and to prohibit certain policy provisions which tend to mislead, deceive and injure the insuring public.

Section 3. Applicability

These rules shall apply to any advertisement for cancer insurance and to any cancer policy, as those terms are hereinafter defined, which any insurer intends to distribute, disseminate, issue, circulate or deliver in the State of Wyoming.

Section 4. Definitions

(a) For the purposes of these rules an “advertisement” shall include (1) printed and published material, audio-visual material and descriptive literature of an insurer used in direct mail, newspapers, magazines, radio scripts, television scripts, billboards and similar displays; (2) descriptive literature and sales aids of all kinds issued by an insurer, agent or broker for presentation to members of the insurance buying public, including but not limited to circulars, leaflets, booklets, depictions, illustrations, and form letters; and (3) prepared sales talks, presentations and material for use by agents, brokers and solicitors.

(b) “Cancer policy” for the purposes of these rules shall include any policy or contract of disability insurance (as defined by W.S. 26-5-103) which provides benefits for loss caused by the dis- ease of cancer only.

(c) “Stated benefit” cancer policy for the purposes of these rules shall mean a policy which pays a stated benefit amount to the insured without regard to the actual amount of loss or expenses incurred by the insured, such amount being determined in accordance with the coverages afforded in the policy and by reference to periodic benefit tables contained therein.

(d) “Expense reimbursement” cancer policy for the purposes of these rules shall mean a policy which wholly or partially reimburses the insured for specified costs associated with the diagnosis and treatment of cancer and the medical care of cancer patients in accordance with the policy provisions.

(e) “Department of Insurance” for the purposes of these rules shall mean the Wyoming Insurance Department.

(f) “Insurer” for the purpose of these rules shall include an individual, corporation, associa- tion, partnership, reciprocal exchange, interinsurer, Lloyds, fraternal benefit society, health maintenance organization, and any other legal entity which is defined as an insurer in the Wyoming Insurance Code and is engaged in the advertisement and marketing of a cancer policy as hereinabove defined.

(g) “Exception” for the purpose of these rules shall mean any provision in a policy whereby coverage for a specified hazard is entirely eliminated; it is a statement of a risk not assumed under the policy.

(h) “Reduction” for the purpose of these rules shall mean any provision which reduces the amount of the benefit; a risk of loss is assumed but payment upon the occurrence of such loss is limited to some amount or period less than would be otherwise payable had such reduction not been used.

(i) “Limitation” for the purpose of these rules shall mean any provision which restricts coverage under the policy other than an exception or a reduction.

PART 1. Advertising

Section 1. Approval of Advertising

(a) All advertisements for previously approved cancer policies shall be filed with the Depart- ment of Insurance prior to being utilized for the purpose of solicitation within the State of Wyoming and on or before the effective date of these rules.

(b) No cancer policies shall henceforth be submitted for approval to the Department of Insurance unless all advertisements, as defined in these rules, which the insurer intends to use to facili- tate the marketing, solicitation or sale of such policies in the State of Wyoming are also filed.

Section 2. Prohibited Practices

(a) No advertisement, as defined in these rules, shall be used to facilitate the marketing, solicitation and sale of cancer policies in the State of Wyoming if the purpose of the advertisement, when read in its entire context, is to induce or create fear in prospective policyholders.

(b) No advertisement, as defined in these rules, shall contain any statistics which purport to represent or show:

(i) the frequency with which cancer will strike certain areas of the body or certain organs of the body;

(ii) that cancer insurance is a “bargain” or words of similar import that detract from the limited nature of cancer coverage;

(iii) the frequency with which cancer will strike an average family or the average individual including, but not limited to, such statements that “cancer will strike one out of every four living Americans” or “cancer will strike two of every three families over the years”;

(iv) a comparison of the death rate of cancer with that of any other cause of death, including automobile accidents or war;

(v) an estimation of the number of deaths which will result from cancer during any particular time period, the number of people who will be hospitalized for any particular period of time, or the number of people who will discover they have cancer in a particular time period;

(vi) the cost of cancer, including the overall expense of cancer treatment, the average cost per victim, the average cost per day or the rate at which such costs are increasing;

(c) The Department of Insurance may disapprove or withdraw approval previously given to any advertisements used to facilitate the marketing, solicitation or sale of such policies in the State of Wyoming if the Department finds any such advertisement to violate the provisions of this regulation, Chapter 13 of the Wyoming Insurance Code, Chapter 21 of the Wyoming Insurance Department regula- tions, or if such advertisements are otherwise found to be presently or prospectively hazardous or injuri- ous to the Wyoming insurance buying public. If the Department of Insurance disapproves any such advertising or withdraws approval previously given, the Department shall issue an order specifying in what respects the advertisement fails to meet the requirements of the Wyoming Insurance Code or the regulations promulgated by the Department of Insurance.

(d) No cancer advertisements, as defined by these rules, shall use words or phrases which are calculated to arouse fear, alarm, anxiety, dread, shock, fright, panic, including suchwords as “strike,” “kill,” “cripple,” or “maim.”

(e) No cancer advertisements, as defined by these rules, shall give undue prominence to the word “cancer” through the use of color, printed configurations or the size or type of print, nor shall any symbols, insignias, or characterizations be used which connote death, sickness, pain, suffering, disease, disablement, or hardship, including grave markers, skull and crossbones, the use of an “X” superim- posed over one who is portrayed to be a future victim of cancer, pictures or characterizations of bedrid- den cancer patients, or pictures or characterizations depicting grief, sorrow or the mourning of a victim of cancer, or pictures or characterizations of surgeons, doctors, nurses or any hospital personnel which are intended to depict medical treatment for the disease of cancer.

Section 3. Outline of Coverage

All materials advertising cancer insurance within the State of Wyoming shall contain an outline of benefits, exclusions, and conditions of coverage. Such outline must specify:

(a) any applicable waiting period;

(b) the period of time within which the policy can be returned for a full refund;

(c) all exceptions, limitations, reductions and conditions of coverage; and

(d) a summarization of all benefits provided by the policy.

Section 4. Maximum or Lifetime Benefits

(a) No insurer shall advertise a maximum lifetime liability per person or a maximum lifetime liability for any expense reimbursement or stated policy benefit if the policy in question establishes a maximum benefit on a “per day,” “per visit,” “per confinement,” “per trip,” “per month,” “per opera- tion,” or “per loss” basis for any benefit under the policy including, but not limited to, coverage for costs and expenses associated with hospital confinement, drugs and medicine, convalescence, surgery, attend- ing physicians, radiation and chemotherapy, anesthesia, blood and plasma, ambulance services, or transportation expenses.

(b) No insurer shall advertise a maximum lifetime liability per person or a maximum lifetime liability for any policy benefit which is unreasonably related to the lifetime benefits otherwise obtain- able.

(c) No insurer shall advertise a maximum monthly indemnity benefit without also advertis- ing the daily pro-rated indemnity benefit.

PART 2.  Limitations and Restrictions on Coverage

Section 1. Insured to Have Thirty Days in Which to Return Policy

No cancer policy shall contain any provision which restricts the right of the insured to return his policy for full premium refund to less than thirty days.

Section 2. Policy Not to Be Canceled by Class

No cancer policy shall contain any provision by which the insurer reserves the right to cancel all like policies of a class or form number.

Section 3. Waiting Period Not to Exceed Thirty Days

No cancer policy shall contain any provision which establishes a waiting period in excess of thirty days from the effective date of the policy or thirty days from the insurer’s receipt of premium, whichever shall first occur.

Section 4. Certification Not Required

No cancer policy shall contain a provision which requires, as a prerequisite to an insurer’s liabil- ity under such policy, any board certification of any pathologist, radiologist, chemotherapist, or any physician involved in the diagnosis, treatment or care of the insured, as long as the pathologist, radiolo- gist, chemotherapist, or physician has otherwise been duly licensed as a doctor of medicine and is in good standing in the medical community.

Section 5. Coverage Not to Depend on Diagnosis Being Made in Hospital

No cancer policy shall contain any provision under which the coverage is made to depend upon the diagnosis of cancer being made while the insured is confined in a hospital.

Section 6. Insurer Liable for Losses Incurred Prior to Diagnosis of Cancer

Provided that the positive diagnosis of cancer has not been made before thirty days of the effec- tive date of the policy and provided further that the policy claimant can substantiate by the weight of the evidence that all costs and expenses for which claim is made were proximately caused by the disease of cancer, no cancer policy shall contain any provision which eliminates, reduces, restricts or otherwise limits the insurer’s liability for (i) any loss incurred prior to the date the positive diagnosis of cancer was made; or (ii) any loss incurred after the policy was issued but prior to the elapse of thirty days thereof.

Section 7. Coverage Not to Be Cut off Subsequent to Expiration of Waiting Period

No policy of cancer insurance shall contain any provision which establishes a “cut-off” period or otherwise reduces, restricts, limits or eliminates the insurer’s liability for losses proximately caused by the disease of cancer anytime subsequent to thirty days after the effective date of the policy.

Section 8. Benefits Not to Be Reduced on Account of Age

No cancer policy shall reduce, restrict, limit or eliminate the benefits offered by the policy on account of the insured’s age. The risk of cancer, to the extent it can be associated with the age of the insured, shall be recognized, if at all, by an increase or decrease of benefits otherwise available under the policy.

Section 9. Benefits Not to Be Denied Because Loss Was Incurred Outside of U.S.

No cancer policy shall contain any provision which restricts the insurer’s liability to losses incurred within the United States or within the United States and Canada.

Section 10. Benefits Not to Be Denied Because Loss Was Not Incurred in Hospital

No cancer policy shall contain any provision which reduces, restricts, limits or eliminates any policy benefits solely because the costs or expenses for which claim is submitted were not incurred while the insured was confined in a hospital.

Section 11. Maximum or Lifetime Benefits

(a) If any expense reimbursement or stated benefit cancer policy sets, prescribes or estab- lishes a maximum lifetime liability per person for all benefits or a maximum lifetime liability for any individual benefit or benefits, the insurer shall not establish a maximum payment or indemnity for any benefit on a “per day,” “per visit,” “per confinement,” “per trip,” “per month,” or “per loss” basis. Subject only to such maximum lifetime liability per person or the maximum lifetime liability for any individual benefit, the insurer’s liability for any benefit under the policy shall then be limited only by the reasonable and customary charges of the area or community where covered services are provided.

(b) No such expense reimbursement cancer policy or stated benefit policy shall contain a maximum lifetime liability per person or a maximum lifetime liability for any policy benefit which is unreasonably related to the lifetime benefits otherwise obtainable.

(c) No stated benefit cancer policy shall provide for a monthly indemnity benefit without also conspicuously stating the daily indemnity benefit.

PART 3.  Minimum Benefits—Extended Benefits

Section 1. Cancer Defined

No policy of cancer insurance issued in the State of Wyoming shall define cancer in such a manner as to exclude leukemia or Hodgkin’s disease.

Section 2. Policy Must Designate Limited Coverage

No policy of cancer insurance shall be offered in the State of Wyoming unless it states promi- nently and conspicuously that such policy is a limited policy and is not designed to pay for all medical costs associated with the disease of cancer.

Section 3. Policy to Cover All Losses Caused by Cancer

No expense reimbursement policy of cancer insurance shall exclude from coverage any pre- scribed or necessary medical costs or expenses proximately caused by the disease of cancer or its diag- nosis and treatment, nor shall any insurer attempt to circumvent this section by providing that the insurer’s liability under the policy only extends to losses resulting from “definitive cancer treatment” or “direct extension, metastatic spread or recurrence” or words of similar import.

Section 4. Radiation and Chemotherapy Benefits

No expense reimbursement cancer policy shall provide benefits for any type of radiation therapy without also providing the same benefits for chemotherapy or any other therapy prescribed by a doctor of medicine and designed to destroy or to arrest the uncontrolled spread of cancer cells, including the use of drugs to alter immunological responses or in the case of leukemia, the use of marrow transplants.

Section 5. Private Nursing Benefit

If any expense reimbursement policy provides benefits for nursing services, no such policy shall deny such coverage if such services have been prescribed and are deemed medically necessary by a duly licensed doctor of medicine.

Section 6. Ambulance Benefits

An insurer’s liability for ambulance benefits under an expense reimbursement policy of cancer insurance shall not be made to depend on the duration of the insured’s stay in a hospital, provided that hospital confinement was intended when the ambulance services were utilized.

Section 7. Government Hospital Confinement Benefit

(a) If any expense reimbursement cancer policy issued in the State of Wyoming excludes from coverage a hospital confinement benefit for a facility contracted for or operated by the United States Government for the treatment of members or veterans of the armed services, the application for such policy shall contain a question asking whether the applicant is a member or ex-member of the armed services and shall advise the applicant that coverage for benefits received from a hospital con- tracted for or operated by the United States Government has been excluded.

(b) If any expense reimbursement cancer policy offers a Government Hospital Confinement benefit, such benefits thereunder shall not be reduced for hospital confinement below the benefits speci- fied for non-governmental hospitals without a corresponding reduction in premium.

(c) No expense reimbursement cancer policy shall offer a Government Hospital Confinement benefit to members or ex-members of the armed forces while excluding any or all other benefits of the policy ordinarily available to non-members of the armed services without a corresponding reduction in premium rates. If the policy only provides a hospital confinement benefit for members or ex-members of the armed forces, the policy shall prominently and conspicuously so state.

Section 8. Extended Benefits

No policy of cancer insurance shall contain any provision for the payment of extended benefits when such benefits can only be obtained by confinement in a hospital for a period in excess of twelve consecutive days, nor shall any insurer provide for extended benefits which require confinement in a hospital for any unreasonable length of time.

PART 4.  Minimum Loss Ratios

Section 1. Previously Approved Policies

The previous approval of any expense reimbursement or stated benefit cancer policy shall not be continued past July 1, 1980, unless on or prior thereto proper and adequate certification is submitted to the Department of Insurance for each policy approved showing that the benefits in relation to premium charged have or will produce a minimum sixty (60) percent loss ratio over a five year period of time. Such certifications shall be submitted annually thereafter. If the certification shows in any year for which it has been filed that any previously approved cancer policy has produced or will produce less than a sixty (60) percent loss ratio over a five year period of time, such policy may be withdrawn from use and refiled within thirty days from the time the certification was submitted to reflect necessary premium adjustments or changes in policy benefits.

Section 2. Subsequently Filed Policies

No cancer policy filed with the Department of Insurance subsequent to the effective date of these rules, be it an expense reimbursement or stated benefit policy, shall be approved for use in the State of Wyoming unless proper and adequate certification is submitted along with the policy filed showing that benefits in relation to the premium charged are designed to produce a minimum loss ratio of not less than sixty (60) percent over a given year period of time. Such certifications shall be made annually thereafter in accordance with the provisions of Section 1 of this Part. If subsequent to the approval of a cancer policy, such certification shows in any year for which it was filed that the policy has produced or will produce less than a sixty (60) percent loss ratio over a five year period of time, it may be withdrawn and refiled in accordance with the provisions of Section 1 of this Part.

Section 3. Policies May Be Otherwise Disapproved

Nothing in these rules shall be construed to otherwise prohibit the Department of Insurance from disapproving or withdrawing previous approval of any expense reimbursement or stated benefit cancer policy form in accordance with the provisions of W.S. 26-15-111.

PART 5.  Miscellaneous

Section 1. Severability

If any section or portion of a section of these rules (including Part I, Part II, and Part III), or the applicability thereof to any person or circumstance is held invalid by a court of law, the remainder of the rules, or the applicability of such provision to other persons or circumstances, shall not be affected thereby.

Section 2. Effective Date

These rules shall become effective on August 1, 1980.

History

• Effective 1996-12-31

Chapter 35 Medicare Supplement Insurance

Wyo. Code R. 044.0002.35.06042025 § 1 Purpose

The purpose of this regulation is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement policies; to facilitate public understanding and comparison of such policies; to eliminate provisions contained in such policies which may be misleading or confusing in connection with the purchase of such policies or with the settlement of claims; and to provide for full disclosures in the sale of accident and sickness insurance coverages to persons eligible for Medicare.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 2 Authority

This regulation is issued pursuant to the authority vested in the commissioner under Wyoming Statute §§ 26-2-110 and 26-38-201, et seq.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 3 Applicability and Scope

(a) Except as otherwise specifically provided in Sections 7, 13, 14, 17 and 22, this regulation shall apply to:

(i) All Medicare supplement policies delivered or issued for delivery in this state on or after the effective date of this regulation; and

(ii) All certificates issued under group Medicare supplement policies, which certificates have been delivered or issued for delivery in this state.

(b) This regulation shall not apply to a policy or contract of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees or former employees, or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 4 Definitions

For purposes of this regulation:

(a) "Applicant" means:

(i) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits, and

(ii) In the case of a group Medicare supplement policy, the proposed certificate holder.

(b) "Bankruptcy" means when a Medicare Advantage organization that is not an issuer has filed, or has had filed against it, a petition for declaration of bankruptcy and has ceased doing business in the state.

(c) "Certificate" means any certificate delivered or issued for delivery in this state under a group Medicare supplement policy.

(d) "Certificate form" means the form on which the certificate is delivered or issued for delivery by the issuer.

(e) "Continuous period of creditable coverage" means the period during which an individual was covered by creditable coverage, if during the period of the coverage the individual had no breaks in coverage greater than sixty three (63) days.

(f) Creditable coverage, for the purposes of this regulation, means:

(i) With respect to an individual, coverage of the individual provided under any of the following:

(Medicare);

(A) A group health plan;

(B) Health insurance coverage;

(C) Part A or Part B of Title XVIII of the Social Security Act

(D) Title XIX of the Social Security Act (Medicaid), other than

coverage consisting solely of benefits under section 1928;

(E) Chapter 55 of Title 10 United States Code (CHAMPUS);

(F) A medical care program of the Indian Health Service or of a tribal

organization;

(G) A state health benefits risk pool;

(H) A health plan offered under chapter 89 of Title 5 United States

Code (Federal Employees Health Benefits Program);

(I) A public health plan as defined in federal regulation; and

(J) A health benefit plan under Section 5(e) of the Peace Corps Act (22 United States Code 2504(e)).

(ii) "Creditable coverage" shall not include one or more, or any combination of, the following:

combination thereof;

(A) Coverage only for accident or disability income insurance, or any

(B) Coverage issued as a supplement to liability insurance;

(C) Liability insurance, including general liability insurance and

automobile liability insurance;

(D) Workers' compensation or similar insurance;

(E) Automobile medical payment insurance;

(F) Credit-only insurance;

(G) Coverage for on-site medical clinics; and

(H) Other similar insurance coverage, specified in federal regulations,

under which benefits for medical care are secondary or incidental to other insurance benefits.

(iii) "Creditable coverage" shall not include the following benefits if they are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of the plan:

(A) Limited scope dental or vision benefits;

(B) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; and

(C) Such other similar, limited benefits as are specified in federal

regulations.

(iv) "Creditable coverage" shall not include the following benefits if offered

as independent, non-coordinated benefits:

(A) Coverage only for a specified disease or illness; and

(B) Hospital indemnity or other fixed indemnity insurance.

(v) "Creditable coverage" shall not include the following if it is offered as a separate policy, certificate or contract of insurance:

(A) Medicare supplemental health insurance as defined under section 1882(g)(1) of the Social Security Act;

(B) Coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code; and

(C) Similar supplemental coverage provided to coverage under a

group health plan.

(g) "Employee welfare benefit plan" means a plan, fund or program of employee benefits as defined in 29 U.S.C. Section 1002 (Employee Retirement Income Security Act).

(h) "Insolvency" means when an issuer, licensed to transact the business of insurance in this state, has had a final order of liquidation entered against it with a finding of insolvency by a court of competent jurisdiction in the issuer's state of domicile.

(i) "Issuer" includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this state Medicare supplement policies or certificates.

(j) "Medicare" means the "Health Insurance for the Aged Act," Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

(k) "Medicare Advantage plan" means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:

(i) Coordinated care plans that provide health care services, including but not limited to health maintenance organization plans (with or without a point-of-service option), plans offered by provider-sponsored organizations, and preferred provider organization plans;

(ii) Medical savings account plans coupled with a contribution into a Medicare Advantage plan medical savings account; and

(iii) Medicare Advantage private fee-for-service plans.

(l) "Medicare supplement policy" means a group or individual policy of [accident and sickness] insurance or a subscriber contract [of hospital and medical service associations or health maintenance organizations], other than a policy issued pursuant to a contract under Section 1876 of the federal Social Security Act (42 U.S.C. Section 1395 et. seq.) or an issued policy under a demonstration project specified in 42 U.S.C. § 1395ss(g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare. "Medicare supplement policy" does not include Medicare Advantage plans established under Medicare Part C, Outpatient Prescription Drug plans established under Medicare Part D, or any Health Care Prepayment Plan (HCPP) that provides benefits pursuant to an agreement under §1833(a)(1)(A) of the Social Security Act.

(m) "Pre-Standardized Medicare supplement benefit plan," "Pre-Standardized benefit plan" or "Pre-Standardized plan" means a group or individual policy of Medicare supplement insurance issued prior to July 30, 1992.

(n) "1990 Standardized Medicare supplement benefit plan," "1990 Standardized benefit plan" or "1990 plan" means a group or individual policy of Medicare supplement insurance issued on or after July 30, 1992 and with an effective date for coverage prior to June 1, 2010 and includes Medicare supplement insurance policies and certificates renewed on or after that date which are not replaced by the issuer at the request of the insured.

(o) "2010 Standardized Medicare supplement benefit plan," "2010 Standardized benefit plan" or "2010 plan" means a group or individual policy of Medicare supplement insurance issued with an effective date for coverage on or after June 1, 2010.

(p) "Policy form" means the form on which the policy is delivered or issued for delivery by the issuer.

(q) "Secretary" means the Secretary of the United States Department of Health and Human Services.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 5 Policy Definitions and Terms

No policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy or certificate unless the policy or certificate contains definitions or terms that conform to the requirements of this section.

(a) "Accident," "accidental injury," or "accidental means" shall be defined to employ "result" language and shall not include words that establish an accidental means test or use words such as "external, violent, visible wounds" or similar words of description or characterization.

(i) The definition shall not be more restrictive than the following: "Injury or injuries for which benefits are provided means accidental bodily injury sustained by the insured

person which is the direct result of an accident, independent of disease or bodily infirmity or any other cause, and occurs while insurance coverage is in force."

(ii) The definition may provide that injuries shall not include injuries for which benefits are provided or available under any workers' compensation, employer's liability or similar law, or motor vehicle no-fault plan, unless prohibited by law.

(b) "Benefit period" or "Medicare benefit period" shall not be defined more restrictively than as defined in the Medicare program.

(c) "Convalescent nursing home," "extended care facility," or "skilled nursing facility" shall not be defined more restrictively than as defined in the Medicareprogram.

(d) "Health care expenses" means, for purposes of Section 14, expenses of health maintenance organizations associated with the delivery of health care services, which expenses are analogous to incurred losses of insurers.

(e) "Hospital" may be defined in relation to its status, facilities and available services or to reflect its accreditation by the Joint Commission on Accreditation of Hospitals, but not more restrictively than as defined in the Medicare program.

(f) "Medicare" shall be defined in the policy and certificate. Medicare may be substantially defined as "The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then Constituted or Later Amended," or "Title I, Part I of Public Law 89-97, as Enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof," or words of similar import.

(g) "Medicare eligible expenses" shall mean expenses of the kinds covered by Medicare Parts A and B, to the extent recognized as reasonable and medically necessary by Medicare.

(h) "Physician" shall not be defined more restrictively than as defined in the Medicare program.

(i) "Sickness" shall not be defined to be more restrictive than the following: "Sickness means illness or disease of an insured person which first manifests itself after the effective date of insurance and while the insurance is in force." The definition may be further modified to exclude sicknesses or diseases for which benefits are provided under any workers' compensation, occupational disease, employer's liability or similar law.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 6 Policy Provisions

(a) Except for permitted preexisting condition clauses as described in Section 7(a)(i), Section 8(a)(i), and Section 8.1(a)(i) of this regulation, no policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy if the policy or certificate contains limitations or exclusions on coverage that are more restrictive than those of Medicare.

(b) No Medicare supplement policy or certificate may use waivers to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.

(c) No Medicare supplement policy or certificate in force in the state shall contain benefits that duplicate benefits provided by Medicare.

(d) Outpatient Prescription Drug Policies.

(i) Subject to Sections 7(a)(iv), (v) and (vii), and 8(a)(iv) and (v) of this regulation, a Medicare supplement policy with benefits for outpatient prescription drugs in existence prior to January 1, 2006 shall be renewed for current policyholders who do not enroll in Part D at the option of the policyholder.

(ii) A Medicare supplement policy with benefits for outpatient prescription drugs shall not be issued after December 31, 2005.

(iii) After December 31, 2005, a Medicare supplement policy with benefits for outpatient prescription drugs may not be renewed after the policyholder enrolls in Medicare Part D unless:

(A) The policy is modified to eliminate outpatient prescription coverage for expenses of outpatient prescription drugs incurred after the effective date of the individual's coverage under a Part D plan and;

(B) Premiums are adjusted to reflect the elimination of outpatient prescription drug coverage at the time of Medicare Part D enrollment, accounting for any claims paid, if applicable.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 7 Minimum Benefit Standards for Pre-Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery Prior to July 30, 1992

No policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy or certificate unless it meets or exceeds the following minimum standards. These are minimum standards and do not preclude the inclusion of other provisions or benefits which are not inconsistent with these standards.

(a) General Standards. The following standards apply to Medicare supplement policies and certificates and are in addition to all other requirements of this regulation.

(i) A Medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than ninety (90) days from the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within ninety (90) days before the effective date of coverage.

(ii) A Medicare supplement policy or certificate shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.

(iii) A Medicare supplement policy or certificate shall provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible, co-payment, or coinsurance amounts. Premiums may be modified to correspond with such changes.

(iv) A "non-cancellable," "guaranteed renewable," or "non-cancellable and guaranteed renewable" Medicare supplement policy shall not:

(A) Provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than the nonpayment of premium; or

(B) Be cancelled or non-renewed by the issuer solely on the grounds of deterioration of health.

(v) Cancellation, termination, or non-renewal under this section.

(A) Except as authorized by the commissioner of this state, an issuer shall neither cancel nor non-renew a Medicare supplement policy or certificate for any reason other than nonpayment of premium or material misrepresentation.

(B) If a group Medicare supplement insurance policy is terminated by the group policyholder and not replaced as provided in Paragraph (v)(D), the issuer shall offer certificate holders an individual Medicare supplement policy. The issuer shall offer the certificate holder at least the following choices:

(I) An individual Medicare supplement policy currently offered by the issuer having comparable benefits to those contained in the terminated group Medicare supplement policy; and

(II) An individual Medicare supplement policy which provides only such benefits as are required to meet the minimum standards as defined in Section 8.1(b) of this regulation.

(C) If membership in a group is terminated, the issuer shall:

(I) Offer the certificate holder the conversion opportunities described in Subparagraph (b); or

(II) At the option of the group policyholder, offer the certificate holder continuation of coverage under the group policy.

(D) If a group Medicare supplement policy is replaced by another group Medicare supplement policy purchased by the same policyholder, the issuer of the replacement policy shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new group policy shall not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced.

(vi) Termination of a Medicare supplement policy or certificate shall be without prejudice to any continuous loss which commenced while the policy was in force, but the extension of benefits beyond the period during which the policy was in force may be

predicated upon the continuous total disability of the insured, limited to the duration of the policy benefit period, if any, or to payment of the maximum benefits. Receipt of Medicare Part D benefits will not be considered in determining a continuous loss.

(vii) If a Medicare supplement policy eliminates an outpatient prescription drug benefit as a result of requirements imposed by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the modified policy shall be deemed to satisfy the guaranteed renewal requirements of this subsection.

(b) Minimum Benefit Standards.

(i) Coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period;

(ii) Coverage for either all or none of the Medicare Part A inpatient hospital deductible amount;

(iii) Coverage of Part A Medicare eligible expenses incurred as daily hospital charges during use of Medicare's lifetime hospital inpatient reserve days;

(iv) Upon exhaustion of all Medicare hospital inpatient coverage including the lifetime reserve days, coverage of ninety percent (90%) of all Medicare Part A eligible expenses for hospitalization not covered by Medicare subject to a lifetime maximum benefit of an additional 365 days;

(v) Coverage under Medicare Part A for the reasonable cost of the first three

(3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations or already paid for under Part B;

(vi) Coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a prospective payment system, the co-payment amount, of Medicare eligible expenses under Part B regardless of hospital confinement, subject to a maximum calendar year out-of-pocket amount equal to the Medicare Part B deductible [$100];

(vii) Effective January 1, 1990, coverage under Medicare Part B for the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations), unless replaced in accordance with federal regulations or already paid for under Part A, subject to the Medicare deductible amount.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 8 Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 30, 1992 and with an Effective Date for Coverage Prior to June 1, 2010

The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state on or after July 30, 1992 and with an effective date for coverage prior to June 1, 2010. No policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit standards.

(a) General Standards. The following standards apply to Medicare supplement policies and certificates and are in addition to all other requirements of this regulation.

(i) A Medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than ninety (90) days from the effective date of coverage because it involved a preexisting condition. The policy or certificate may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within ninety (90) days before the effective date of coverage.

(ii) A Medicare supplement policy or certificate shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.

(iii) A Medicare supplement policy or certificate shall provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible, co- payment, or coinsurance amounts. Premiums may be modified to correspond with such changes.

(iv) No Medicare supplement policy or certificate shall provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than the nonpayment of premium.

(v) Each Medicare supplement policy shall be guaranteed renewable.

(A) The issuer shall not cancel or non-renew the policy solely on the ground of health status of the individual.

(B) The issuer shall not cancel or non-renew the policy for any reason other than nonpayment of premium or material misrepresentation.

(C) If the Medicare supplement policy is terminated by the group policyholder and is not replaced as provided under Section 8(a)(v)(E), the issuer shall offer certificate holders an individual Medicare supplement policy which (at the option of the certificate holder):

group policy, or

(I) Provides for continuation of the benefits contained in the

(II) Provides for benefits that otherwise meet the

requirements of this subsection.

(D) If an individual is a certificate holder in a group Medicare supplement policy and the individual terminates membership in the group, the issuer shall:

(I) Offer the certificate holder the conversion opportunity described in Section 8(a)(v)(C), or

(II) At the option of the group policyholder, offer the certificate holder continuation of coverage under the group policy.

(E) If a group Medicare supplement policy is replaced by another

group Medicare supplement policy purchased by the same policyholder, the issuer of the replacement policy shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new policy shall not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced.

(F) If a Medicare supplement policy eliminates an outpatient prescription drug benefit as a result of requirements imposed by the Medicare Prescription Drug, Improvement and Modernization Act of 2003, the modified policy shall be deemed to satisfy the guaranteed renewal requirements of this paragraph.

(vi) Termination of a Medicare supplement policy or certificate shall be without prejudice to any continuous loss which commenced while the policy was in force, but the extension of benefits beyond the period during which the policy was in force may be conditioned upon the continuous total disability of the insured, limited to the duration of the policy benefit period, if any, or payment of the maximum benefits. Receipt of Medicare Part D benefits will not be considered in determining a continuous loss.

(vii) Suspension.

(A) A Medicare supplement policy or certificate shall provide that benefits and premiums under the policy or certificate shall be suspended at the request of the policyholder or certificate holder for the period (not to exceed twenty-four (24) months) in which the policyholder or certificate holder has applied for and is determined to be entitled to medical assistance under Title XIX of the Social Security Act, but only if the policyholder or certificate holder notifies the issuer of the policy or certificate within ninety (90) days after the date the individual becomes entitled to assistance.

(B) If suspension occurs and if the policyholder or certificate holder loses entitlement to medical assistance, the policy or certificate shall be automatically reinstituted (effective as of the date of termination of entitlement) as of the termination of entitlement if the policyholder or certificate holder provides notice of loss of entitlement within ninety (90) days after the date of loss and pays the premium attributable to the period, effective as of the date of termination of entitlement.

(C) Each Medicare supplement policy shall provide that benefits and premiums under the policy shall be suspended (for any period that may be provided by federal regulation) at the request of the policyholder if the policyholder is entitled to benefits under Section 226 (b) of the Social Security Act and is covered under a group health plan (as defined in Section 1862 (b)(1)(A)(v) of the Social Security Act). If suspension occurs and if the policyholder or certificate holder loses coverage under the group health plan, the policy shall be automatically reinstituted (effective as of the date of loss of coverage) if the policyholder provides notice of loss of coverage within ninety (90) days after the date of the loss.

(D) Reinstitution of coverages.

(I) Shall not provide for any waiting period with respect to treatment of preexisting conditions;

(II) Shall provide for resumption of coverage that is

substantially equivalent to coverage in effect before the date of suspension. If the suspended Medicare supplement policy provided coverage for outpatient prescription drugs, reinstitution of the policy for Medicare Part D enrollees shall be without coverage for outpatient prescription drugs and shall otherwise provide substantially equivalent coverage to the coverage in effect before the date of suspension; and

(III) Shall provide for classification of premiums on terms at least as favorable to the policyholder or certificate holder as the premium classification terms that would have applied to the policyholder or certificate holder had the coverage not been suspended.

(viii) If an issuer makes a written offer to the Medicare Supplement policyholders or certificate holders of one or more of its plans, to exchange during a specified period from his or her [1990 Standardized plan] (as described in Section 9 of this regulation) to a [2010 Standardized plan] (as described in Section 9.1 of this regulation), the offer and subsequent exchange shall comply with the following requirements:

(A) An issuer need not provide justification to the commissioner if the insured replaces a 1990 Standardized policy or certificate with an issue age rated 2010 Standardized policy or certificate at the insured's original issue age and duration. If an insured's policy or certificate to be replaced is priced on an issue age rate schedule at the time of such offer, the rate charged to the insured for the new exchanged policy shall recognize the policy reserve buildup, due to the pre-funding inherent in the use of an issue age rate basis, for the benefit of the insured. The method proposed to be used by an issuer must be filed with the commissioner according to Section 15(c).

(B) The rating class of the new policy or certificate shall be the class closest to the insured's class of the replaced coverage.

(C) An issuer may not apply new pre-existing condition limitations or a new incontestability period to the new policy for those benefits contained in the exchanged 1990 Standardized policy or certificate of the insured, but may apply pre-existing condition limitations of no more than ninety (90) days to any added benefits contained in the new 2010 Standardized policy or certificate not contained in the exchanged policy.

(D) The new policy or certificate shall be offered to all policyholders or certificate holders within a given plan, except where the offer or issue would be in violation of state or federal law.

(b) Standards for Basic (Core) Benefits Common to Benefit Plans A to J. Every issuer shall make available a policy or certificate including only the following basic "core" package of benefits to each prospective insured. An issuer may make available to prospective insureds any of the other Medicare Supplement Insurance Benefit Plans in addition to the basic core package, but not in lieu of it.

(i) Coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period;

(ii) Coverage of Part A Medicare eligible expenses incurred for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used;

(iii) Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of one hundred percent (100%) of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

(iv) Coverage under Medicare Parts A and B for the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations;

(v) Coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a prospective payment system, the co-payment amount, of Medicare eligible expenses under Part B regardless of hospital confinement, subject to the Medicare Part B deductible;

(c) Standards for Additional Benefits. The following additional benefits shall be included in Medicare Supplement Benefit Plans "B" through "J" only as provided by Section 9 of this regulation.

(i) Medicare Part A Deductible: Coverage for all of the Medicare Part A inpatient hospital deductible amount per benefit period.

(ii) Skilled Nursing Facility Care: Coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A.

(iii) Medicare Part B Deductible: Coverage for all of the Medicare Part B deductible amount per calendar year regardless of hospital confinement.

(iv) Eighty Percent (80%) of the Medicare Part B Excess Charges: Coverage for eighty percent (80%) of the difference between the actual Medicare Part B charge as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge.

(v) One Hundred Percent (100%) of the Medicare Part B Excess Charges: Coverage for all of the difference between the actual Medicare Part B charge as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge.

(vi) Basic Outpatient Prescription Drug Benefit: Coverage for fifty percent (50%) of outpatient prescription drug charges, after a $250 calendar year deductible, to a maximum of $1,250 in benefits received by the insured per calendar year, to the extent not covered by Medicare. The outpatient prescription drug benefit may be included for sale or issuance in a Medicare supplement policy until January 1, 2006.

(vii) Extended Outpatient Prescription Drug Benefit: Coverage for fifty percent (50%) of outpatient prescription drug charges, after a $250 calendar year deductible to a maximum of $3,000 in benefits received by the insured per calendar year, to the extent not covered by Medicare. The outpatient prescription drug benefit may be included for sale or issuance in a Medicare supplement policy until January 1, 2006.

(viii) Medically Necessary Emergency Care in a Foreign Country: Coverage to the extent not covered by Medicare for eighty percent (80%) of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, which care would have been covered by Medicare if provided in the United States and which care began during the first sixty (60) consecutive days of each trip outside the United States, subject to a calendar year deductible of $250, and a lifetime maximum benefit of $50,000. For purposes of this benefit, "emergency care" shall mean care needed immediately because of an injury or an illness of sudden and unexpected onset.

(ix) Preventive Medical Care Benefit.

(A) Coverage for the following preventive health services is not

covered by Medicare:

(I) An annual clinical preventive medical history and physical

examination that may include tests and services from Subparagraph (B) and patient education to address preventive health care measures;

(II) Preventive screening tests or preventive services, the selection and frequency of which is determined to be medically appropriate by the attending physician.

(B) Reimbursement shall be for the actual charges up to one hundred percent (100%) of the Medicare-approved amount for each service, as if Medicare were to cover the service as identified in American Medical Association Current Procedural Terminology (AMA CPT) codes, to a maximum of $120 annually under this benefit. This benefit shall not include payment for any procedure covered by Medicare.

(x) At-Home Recovery Benefit. Coverage for services to provide short term, at-home assistance with activities of daily living for those recovering from an illness, injury or surgery.

(A) For purposes of this benefit, the following definitions shall apply:

(I) "Activities of daily living" include, but are not limited to bathing, dressing, personal hygiene, transferring, eating, ambulating, assistance with drugs that are normally self-administered, and changing bandages or other dressings.

(II) "Care provider" means a duly qualified or licensed home health aide or homemaker, personal care aide or nurse provided through a licensed home health care agency or referred by a licensed referral agency or licensed nurses' registry.

(III) "Home" shall mean any place used by the insured as a place of residence, provided that the place would qualify as a residence for home health care services covered by Medicare. A hospital or skilled nursing facility shall not be considered the insured's place of residence.

(IV) "At-home recovery visit" means the period of a visit required to provide at home recovery care, without limit on the duration of the visit, except each consecutive four (4) hours in a twenty-four-hour period of services provided by a care provider is one visit.

(B) Coverage Requirements and Limitations.

(I) At-home recovery services provided must be primarily services which assist in activities of daily living.

(II) The insured's attending physician must certify that the specific type and frequency of at-home recovery services are necessary because of a condition for which a home care plan of treatment was approved by Medicare.

(III) Coverage is limited to:

(1.) No more than the number and type of at-home recovery visits certified as necessary by the insured's attending physician. The total number of at-home recovery visits shall not exceed the number of Medicare approved home health care visits under a Medicare approved home care plan of treatment;

(2.) The actual charges for each visit up to a maximum

reimbursement of $40 per visit;

home;

this section;

(3.) $1,600 per calendar year;

(4.) Seven (7) visits in any one week;

(5.) Care furnished on a visiting basis in the insured's (6.) Services provided by a care provider as defined in

(7.) At-home recovery visits while the insured is

covered under the policy or certificate and not otherwise excluded;

(8.) At-home recovery visits received during the period the insured is receiving Medicare approved home care services or no more than eight (8) weeks after the service date of the last Medicare approved home health care visit.

(C) Coverage is excluded for:

(I) Home care visits paid for by Medicare or other

government programs; and

(II) Care provided by family members, unpaid volunteers or

providers who are not care providers.

(d) Standards for Plans K and L.

(i) Standardized Medicare supplement benefit plan "K" shall consist of the

following:

(A) Coverage of one hundred percent (100%) of the Part A hospital

coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period;

(B) Coverage of one hundred percent (100%) of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period;

(C) Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of one hundred percent (100%) of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

(D) Medicare Part A Deductible: Coverage for fifty percent (50%) of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of- pocket limitation is met as described in Subparagraph (J);

(E) Skilled Nursing Facility Care: Coverage for fifty percent (50%) of the coinsurance amount for each day used from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A until the out-of-pocket limitation is met as described in Subparagraph (J);

(F) Hospice Care: Coverage for fifty percent (50%) of cost sharing for all Part A Medicare eligible expenses and respite care until the out-of-pocket limitation is met as described in Subparagraph (j);

(G) Coverage for fifty percent (50%), under Medicare Part A or B, of the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations until the out-of-pocket limitation is met as described in Subparagraph (J);

(H) Except for coverage provided in Subparagraph (I) below, coverage for fifty percent (50%) of the cost sharing otherwise applicable under Medicare Part B after the policyholder pays the Part B deductible until the out-of-pocket limitation is met as described in Subparagraph (J) below;

(I) Coverage of one hundred percent (100%) of the cost sharing for Medicare Part B preventive services after the policyholder pays the Part B deductible; and

(J) Coverage of one hundred percent (100%) of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B of

$4000 in 2006, indexed each year by the appropriate inflation adjustment specified by the

Secretary of the U.S. Department of Health and Human Services.

(ii) Standardized Medicare supplement benefit plan "L" shall consist of the

following:

(A) The benefits described in Paragraphs (i)(A), (B), (C) and (I);

(B) The benefit described in Paragraphs (i)(D), (E), (F), (G) and

(H), but substituting seventy-five percent (75%) for fifty percent (50%); and

(C) The benefit described in Paragraph (i)(J), but substituting $2000

for $4000.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 8 1 Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage on or After June 1, 2010

The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective date for coverage on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered, or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit standards. No issuer may offer any 1990 Standardized Medicare supplement benefit plan for sale on or after June 1, 2010. Benefit standards applicable to Medicare supplement policies and certificates issued with an effective date for coverage prior June 1, 2010 remain subject to the requirements of Section 8.

(a) General Standards. The following standards apply to Medicare supplement policies and certificates and are in addition to all other requirements of this regulation.

(i) A Medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than ninety (90) days from the effective date of coverage because it involved a preexisting condition. The policy or certificate may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within ninety (90) days before the effective date of coverage.

(ii) A Medicare supplement policy or certificate shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.

(iii) A Medicare supplement policy or certificate shall provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible, co- payment, or coinsurance amounts. Premiums may be modified to correspond with such changes.

(iv) No Medicare supplement policy or certificate shall provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than the nonpayment of premium.

(v) Each Medicare supplement policy shall be guaranteed renewable.

(A) The issuer shall not cancel or non-renew the policy solely on the ground of health status of the individual.

(B) The issuer shall not cancel or non-renew the policy for any reason other than nonpayment of premium or material misrepresentation.

(C) If the Medicare supplement policy is terminated by the group policyholder and is not replaced as provided under Section 8.1(a)(v)(E) of this regulation, the issuer shall offer certificate holders an individual Medicare supplement policy which (at the option of the certificate holder):

(I) Provides for continuation of the benefits contained in the

group policy; or

(II) Provides for benefits that otherwise meet the

requirements of this Subsection.

(D) If an individual is a certificate holder in a group Medicare supplement policy and the individual terminates membership in the group, the issuer shall:

(I) Offer the certificate holder the conversion opportunity described in Section 8.1(a)(v)(C) of this regulation; or

(II) At the option of the group policyholder, offer the certificate holder continuation of coverage under the group policy.

(E) If a group Medicare supplement policy is replaced by another group Medicare supplement policy purchased by the same policyholder, the issuer of the replacement policy shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new policy shall not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced.

(vi) Termination of a Medicare supplement policy or certificate shall be without prejudice to any continuous loss which commenced while the policy was in force, but the extension of benefits beyond the period during which the policy was in force may be conditioned upon the continuous total disability of the insured, limited to the duration of the policy benefit period, if any, or payment of the maximum benefits. Receipt of Medicare Part D benefits will not be considered in determining a continuous loss.

(vii) Suspension.

(A) A Medicare supplement policy or certificate shall provide that benefits and premiums under the policy or certificate shall be suspended at the request of the policyholder or certificate holder for the period (not to exceed twenty-four (24) months) in which the policyholder or certificate holder has applied for and is determined to be entitled to medical assistance under Title XIX of the Social Security Act, but only if the policyholder or certificate holder notifies the issuer of the policy or certificate within ninety (90) days after the date the individual becomes entitled to assistance.

(B) If suspension occurs and if the policyholder or certificate holder loses entitlement to medical assistance, the policy or certificate shall be automatically reinstituted (effective as of the date of termination of entitlement) as of the termination of entitlement if the policyholder or certificate holder provides notice of loss of entitlement within

ninety (90) days after the date of loss and pays the premium attributable to the period, effective as of the date of termination of entitlement.

(C) Each Medicare supplement policy shall provide that benefits and premiums under the policy shall be suspended (for any period that may be provided by federal regulation) at the request of the policyholder if the policyholder is entitled to benefits under Section 226 (b) of the Social Security Act and is covered under a group health plan (as defined in Section 1862 (b)(1)(A)(v) of the Social Security Act). If suspension occurs and if the policyholder or certificate holder loses coverage under the group health plan, the policy shall be automatically reinstituted (effective as of the date of loss of coverage) if the policyholder provides notice of loss of coverage within ninety (90) days after the date of the loss.

(D) Reinstitution of coverages.

(I) Shall not provide for any waiting period with respect to treatment of preexisting conditions;

(II) Shall provide for resumption of coverage that is substantially equivalent to coverage in effect before the date of suspension; and

(III) Shall provide for classification of premiums on terms at least as favorable to the policyholder or certificate holder as the premium classification terms that would have applied to the policyholder or certificate holder had the coverage not been suspended.

(b) Standards for Basic (Core) Benefits Common to Medicare Supplement Insurance Benefit Plans A, B, C, D, F, F with High Deductible, G, M and N. Every issuer of Medicare supplement insurance benefit plans shall make available a policy or certificate including only the following basic "core" package of benefits to each prospective insured. An issuer may make available to prospective insureds any of the other Medicare Supplement Insurance Benefit Plans in addition to the basic core package, but not in lieu of it.

(i) Coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period;

(ii) Coverage of Part A Medicare eligible expenses incurred for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used;

(iii) Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of one hundred percent (100%) of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

(iv) Coverage under Medicare Parts A and B for the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations;

(v) Coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a prospective payment system, the co-payment amount, of Medicare eligible expenses under Part B regardless of hospital confinement, subject to the Medicare Part B deductible;

(vi) Hospice Care: Coverage of cost sharing for all Part A Medicare eligible hospice care and respite care expenses.

(c) Standards for Additional Benefits. The following additional benefits shall be included in Medicare supplement benefit Plans B, C, D, F, F with High Deductible, G, M, and N as provided by Section 9.1 of this regulation.

(i) Medicare Part A Deductible: Coverage for one hundred percent (100%) of the Medicare Part A inpatient hospital deductible amount per benefit period.

(ii) Medicare Part A Deductible: Coverage for fifty percent (50%) of the Medicare Part A inpatient hospital deductible amount per benefit period.

(iii) Skilled Nursing Facility Care: Coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A.

(iv) Medicare Part B Deductible: Coverage for one hundred percent (100%) of the Medicare Part B deductible amount per calendar year regardless of hospital confinement.

(v) One Hundred Percent (100%) of the Medicare Part B Excess Charges: Coverage for all of the difference between the actual Medicare Part B charges as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge.

(vi) Medically Necessary Emergency Care in a Foreign Country: Coverage to the extent not covered by Medicare for eighty percent (80%) of the billed charges for Medicare- eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, which care would have been covered by Medicare if provided in the United States and which care began during the first sixty (60) consecutive days of each trip outside the United States, subject to a calendar year deductible of $250, and a lifetime maximum benefit of $50,000. For purposes of this benefit, "emergency care" shall mean care needed immediately because of an injury or an illness of sudden and unexpected onset.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 9 Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 30, 1992 and with an Effective Date for Coverage Prior to June 1, 2010

(a) An issuer shall make available to each prospective policyholder and certificate holder a policy form or certificate form containing only the basic core benefits, as defined in Section 8(b) of this regulation.

(b) No groups, packages or combinations of Medicare supplement benefits other than those listed in this section shall be offered for sale in this state, except as may be permitted in Section 9(g) and in Section 10 of this regulation.

(c) Benefit plans shall be uniform in structure, language, designation and format to the standard benefit plans "A" through "L" listed in this subsection and conform to the definitions in Section 4 of this regulation. Each benefit shall be structured in accordance with the format provided in Sections 8(b) and 8(c), or 8(d) and list the benefits in the order shown in this subsection. For purposes of this section, "structure, language, and format" means style, arrangement and overall content of a benefit.

(d) An issuer may use, in addition to the benefit plan designations required in Subsection (c), other designations to the extent permitted by law.

(e) Make-up of benefit plans:

(i) Standardized Medicare supplement benefit plan "A" shall be limited to the basic (core) benefits common to all benefit plans, as defined in Section 8(b) of this regulation.

(ii) Standardized Medicare supplement benefit plan "B" shall include only the following: The core benefit as defined in Section 8(b) of this regulation, plus the Medicare Part A deductible as defined in Section 8(c)(i).

(iii) Standardized Medicare supplement benefit plan "C" shall include only the following: The core benefit as defined in Section 8(b) of this regulation, plus the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible and medically necessary emergency care in a foreign country as defined in Sections 8(c)(i), (ii), (iii) and (viii) respectively.

(iv) Standardized Medicare supplement benefit plan "D" shall include only the following: The core benefit (as defined in Section 8(b) of this regulation), plus the Medicare Part A deductible, skilled nursing facility care, medically necessary emergency care in an foreign country and the at-home recovery benefit as defined in Sections 8(c)(i), (ii), (viii) and (x) respectively.

(v) Standardized Medicare supplement benefit plan "E" shall include only the following: The core benefit as defined in Section 8(b) of this regulation, plus the Medicare Part A deductible, skilled nursing facility care, medically necessary emergency care in a foreign country and preventive medical care as defined in Sections 8(c)(i), (ii), and (ix) respectively.

(vi) Standardized Medicare supplement benefit plan "F" shall include only the following: The core benefit as defined in Section 8(b) of this regulation, plus the Medicare Part A deductible, the skilled nursing facility care, the Part B deductible, one hundred percent (100%) of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in Sections 8(c)(i), (ii), (iii), (v) and (viii) respectively.

(vii) Standardized Medicare supplement benefit high deductible plan "F" shall include only the following: 100% of covered expenses following the payment of the annual high deductible plan "F" deductible. The covered expenses include the core benefit as defined in Section 8(b) of this regulation, plus the Medicare Part A deductible, skilled nursing facility care, the Medicare Part B deductible, one hundred percent (100%) of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in Sections

8(c)(i), (ii), (iii), (v) and (viii) respectively. The annual high deductible plan "F" deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement plan "F" policy, and shall be in addition to any other specific benefit deductibles. The annual high deductible Plan "F" deductible shall be $1500 for 1998 and 1999, and shall be based on the calendar year. It shall be adjusted annually thereafter by the Secretary to reflect the change in the Consumer Price Index for all urban consumers for the twelve-month period ending with August of the preceding year, and rounded to the nearest multiple of $10.

(viii) Standardized Medicare supplement benefit plan "G" shall include only the following: The core benefit as defined in Section 8(b) of this regulation, plus the Medicare Part A deductible, skilled nursing facility care, eighty percent (80%) of the Medicare Part B excess charges, medically necessary emergency care in a foreign country, and the at-home recovery benefit as defined in Sections 8(c)(i), (ii), (iv), (viii), and (x) respectively.

(ix) Standardized Medicare supplement benefit plan "H" shall consist of only the following: The core benefit as defined in Section 8(b) of this regulation, plus the Medicare Part A deductible, skilled nursing facility care, basic prescription drug benefit and medically necessary emergency care in a foreign country as defined in Sections 8(c)(i), (ii), (vi) and (viii) respectively. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005.

(x) Standardized Medicare supplement benefit plan "I" shall consist of only the following: The core benefit as defined in Section 8(b) of this regulation, plus the Medicare Part A deductible, skilled nursing facility care, one hundred percent (100%) of the Medicare Part B excess charges, basic prescription drug benefit, medically necessary emergency care in a foreign country and at-home recovery benefit as defined in Sections 8(c)(i), (ii), (iv), (viii), and

(x) respectively. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005.

(xi) Standardized Medicare supplement benefit plan "J" shall consist of only the following: The core benefit as defined in Section 8(b) of this regulation, plus the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible, one hundred percent (100%) of the Medicare Part B excess charges, extended prescription drug benefit, medically necessary emergency care in a foreign country, preventive medical care and at-home recovery benefit as defined in Sections 8(c)(i), (ii), (iii), (v), (vi), (viii), (ix), and (x) respectively. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005.

(xii) Standardized Medicare supplement benefit high deductible plan "J" shall consist of only the following: 100% of covered expenses following the payment of the annual high deductible plan "J" deductible. The covered expenses include the core benefit as defined in Section 8(b) of this regulation, plus the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible, one hundred percent (100%) of the Medicare Part B excess charges, extended outpatient prescription drug benefit, medically necessary emergency care in a foreign country, preventive medical care benefit and at-home recovery benefit as defined in Sections 8(c)(i), (ii), (iii), (v), (vi), (viii), (ix), and (x) respectively. The annual high deductible plan "J" deductible shall consist of out- of-pocket expenses, other than premiums, for services

covered by the Medicare supplement plan "J" policy, and shall be in addition to any other specific benefit deductibles. The annual deductible shall be $1500 for 1998 and 1999, and shall be based on a calendar year. It shall be adjusted annually thereafter by the Secretary to reflect the change in the Consumer Price Index for all urban consumers for the twelve-month period ending with August of the preceding year, and rounded to the nearest multiple of $10. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005.

(f) Make-up of two Medicare supplement plans mandated by The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA);

(i) Standardized Medicare supplement benefit plan "K" shall consist of only those benefits described in Section 8 (d)(i).

(ii) Standardized Medicare supplement benefit plan "L" shall consist of only those benefits described in Section 8(d)(ii).

(g) New or Innovative Benefits: An issuer may, with the prior approval of the commissioner, offer policies or certificates with new or innovative benefits in addition to the benefits provided in a policy or certificate that otherwise complies with the applicable standards. The new or innovative benefits may include benefits that are appropriate to Medicare supplement insurance, new or innovative, not otherwise available, cost- effective, and offered in a manner that is consistent with the goal of simplification of Medicare supplement policies. After December 31, 2005, the innovative benefit shall not include an outpatient prescription drug benefit.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 9 1 Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates with an Effective Date for Coverage on or After June 1, 2010

The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective date for coverage on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit plan standards. Benefit plan standards applicable to Medicare supplement policies and certificates issued with an effective date for coverage before June 1, 2010 remain subject to the requirements of Section 8.

(a) Policy or Certificate Form.

(i) An issuer shall make available to each prospective policyholder and certificate holder a policy form or certificate form containing only the basic (core) benefits, as defined in Section 8.1(b) of this regulation.

(ii) If an issuer makes available any of the additional benefits described in Section 8.1(c), or offers standardized benefit Plans K or L (as described in Sections 9.1(e)(viii) and (ix) of this regulation), then the issuer shall make available to each prospective policyholder and certificate holder, in addition to a policy form or certificate form with only the basic (core) benefits as described in subsection (a)(i) above, a policy form or certificate form containing either standardized benefit Plan C (as described in Section 9.1(e)(iii) of this regulation) or

standardized benefit Plan F (as described in 9.1(e)(v) of this regulation).

(b) No groups, packages or combinations of Medicare supplement benefits other than those listed in this Section shall be offered for sale in this state, except as may be permitted in Section 9.1(f) and in Section 10 of this regulation.

(c) Benefit plans shall be uniform in structure, language, designation and format to the standard benefit plans listed in this Subsection and conform to the definitions in Section 4 of this regulation. Each benefit shall be structured in accordance with the format provided in Sections 8.1(b) and 8.1(c) of this regulation; or, in the case of plans K or L, in Sections 9.1(e)(viii) or (ix) of this regulation and list the benefits in the order shown. For purposes of this Section, "structure, language, and format" means style, arrangement and overall content of a benefit.

(d) In addition to the benefit plan designations required in Subsection (c) of this section, an issuer may use other designations to the extent permitted by law.

(e) Make-up of 2010 Standardized Benefit Plans:

(i) Standardized Medicare supplement benefit Plan A shall include only the following: The basic (core) benefits as defined in Section 8.1(b) of this regulation.

(ii) Standardized Medicare supplement benefit Plan B shall include only the following: The basic (core) benefit as defined in Section 8.1(b) of this regulation, plus one hundred percent (100%) of the Medicare Part A deductible as defined in Section 8.1(c)(i) of this regulation.

(iii) Standardized Medicare supplement benefit Plan C shall include only the following: The basic (core) benefit as defined in Section 8.1(b) of this regulation, plus one hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, one hundred percent (100%) of the Medicare Part B deductible, and medically necessary emergency care in a foreign country as defined in Sections 8.1(c)(i), (iii), (iv) and (vi) of this regulation, respectively.

(iv) Standardized Medicare supplement benefit Plan D shall include only the following: The basic (core) benefit (as defined in Section 8.1(b) of this regulation), plus one hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country as defined in Sections 8.1(c)(i), (iii) and

(vi) of this regulation, respectively.

(v) Standardized Medicare supplement [regular] Plan F shall include only the following: The basic (core) benefit as defined in Section 8.1(b) of this regulation, plus one hundred percent (100%) of the Medicare Part A deductible, the skilled nursing facility care, one hundred percent (100%) of the Medicare Part B deductible, one hundred percent (100%) of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in Sections 8.1(c)(i), (iii), (iv), (v), and (vi), respectively.

(vi) Standardized Medicare supplement Plan F with High Deductible shall include only the following: one hundred percent (100%) of covered expenses following the

payment of the annual deductible set forth in Subparagraph (B).

(A) The basic (core) benefit as defined in Section 8.1(b) of this regulation, plus one hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, one hundred percent (100%) of the Medicare Part B deductible, one hundred percent (100%) of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in Sections 8.1(c)(i), (iii), (iv), (v), and (vi) of this regulation, respectively.

(B) The annual deductible in Plan F With High Deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by [regular] Plan F, and shall be in addition to any other specific benefit deductibles. The basis for the deductible shall be $1,500 and shall be adjusted annually from 1999 by the Secretary of the U.S. Department of Health and Human Services to reflect the change in the Consumer Price Index for all urban consumers for the twelve-month period ending with August of the preceding year, and rounded to the nearest multiple of ten dollars ($10).

(vii) Standardized Medicare supplement benefit Plan G shall include only the following: The basic (core) benefit as defined in Section 8.1(b) of this regulation, plus one hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, one hundred percent (100%) of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in Sections 8.1(c)(i), (iii), (v), and (vi), respectively. Effective January 1, 2020, the standardized benefit plans described in Section 9.2(a)(iv) of this regulation (Redesignated Plan G High Deductible) may be offered to any individual who was eligible for Medicare prior to January 1, 2020.

(viii) Standardized Medicare supplement Plan K is mandated by The Medicare Prescription Drug, Improvement and Modernization Act of 2003, and shall include only the following:

(A) Part A Hospital Coinsurance 61st through 90th days: Coverage of one hundred percent (100%) of the Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period;

(B) Part A Hospital Coinsurance, 91st through 150th days: Coverage of one hundred percent (100%) of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period;

(C) Part A Hospitalization After 150 Days: Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of one hundred percent (100%) of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

(D) Medicare Part A Deductible: Coverage for fifty percent (50%) of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-

pocket limitation is met as described in Subparagraph (J);

(E) Skilled Nursing Facility Care: Coverage for fifty percent (50%) of the coinsurance amount for each day used from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A until the out-of-pocket limitation is met as described in Subparagraph (J);

(F) Hospice Care: Coverage for fifty percent (50%) of cost sharing for all Part A Medicare eligible expenses and respite care until the out-of-pocket limitation is met as described in Subparagraph (J);

(G) Blood: Coverage for fifty percent (50%), under Medicare Part A or B, of the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations until the out-of-pocket limitation is met as described in Subparagraph (J);

(H) Part B Cost Sharing: Except for coverage provided in Subparagraph (I), coverage for fifty percent (50%) of the cost sharing otherwise applicable under Medicare Part B after the policyholder pays the Part B deductible until the out-of-pocket limitation is met as described in Subparagraph (J);

(I) Part B Preventive Services: Coverage of one hundred percent (100%) of the cost sharing for Medicare Part B preventive services after the policyholder pays the Part B deductible; and

(J) Cost Sharing After Out-of-Pocket Limits: Coverage of one hundred percent (100%) of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B of $4000 in 2006, indexed each year by the appropriate inflation adjustment specified by the Secretary of the U.S. Department of Health and Human Services.

(ix) Standardized Medicare supplement Plan L is mandated by The Medicare Prescription Drug, Improvement and Modernization Act of 2003, and shall include only the following:

(A) The benefits described in Paragraphs 9.1(e)(viii)(A), (B), (C) and (I);

(B) The benefit described in Paragraphs 9.1(e)(viii)(D), (E), (F), (G) and (H), but substituting seventy-five percent (75%) for fifty percent (50%); and

(C) The benefit described in Paragraph 9.1(e)(viii)(J), but substituting

$2000 for $4000.

(x) Standardized Medicare supplement Plan M shall include only the following: The basic (core) benefit as defined in Section 8.1(b) of this regulation, plus fifty percent (50%) of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country as defined in Sections 8.1(c)(ii), (iii) and (vi) of this regulation, respectively.

(xi) Standardized Medicare supplement Plan N shall include only the following: The basic (core) benefit as defined in Section 8.1(b) of this regulation, plus one

hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country as defined in Sections 8.1(c)(i), (iii) and

(vi) of this regulation, respectively, with co-payments in the following amounts:

(A) the lesser of twenty dollars ($20) or the Medicare Part B coinsurance or co-payment for each covered health care provider office visit (including visits to medical specialists); and

(B) the lesser of fifty dollars ($50) or the Medicare Part B coinsurance or co-payment for each covered emergency room visit, however, this co-payment shall be waived if the insured is admitted to any hospital and the emergency visit is subsequently covered as a Medicare Part A expense.

(f) New or Innovative Benefits. An issuer may, with the prior approval of the commissioner, offer policies or certificates with new or innovative benefits, in addition to the standardized benefits provided in a policy or certificate that otherwise complies with the applicable standards. The new or innovative benefits shall include only benefits that are appropriate to Medicare supplement insurance, are new or innovative, are not otherwise available, and are cost-effective. Approval of new or innovative benefits must not adversely impact the goal of Medicare supplement simplification. New or innovative benefits shall not include an outpatient prescription drug benefit. New or innovative benefits shall not be used to change or reduce benefits, including a change of any cost-sharing provision, in any standardized plan.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 9 2. Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or After January 1, 2020

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state to individuals newly eligible for Medicare on or after January 1, 2020. No policy or certificate that provides coverage of the Medicare Part B deductible may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate to individuals newly eligible for Medicare on or after January 1, 2020. All policies must comply with the following benefit standards. Benefit plan standards applicable to Medicare supplement policies and certificates issued to individuals eligible for Medicare before January 1, 2020, remain subject to the requirements of Section 8 of this regulation.

(a) Benefit Requirements. The standards and requirements of Section 9.1 shall apply to all Medicare supplement policies or certificates delivered or issued for delivery to individuals newly eligible for Medicare on or after January 1, 2020, with the following exceptions:

(i) Standardized Medicare supplement benefit Plan C is redesignated as Plan D and shall provide the benefits contained in Section 9.1 (e)(iii) of this regulation but shall not provide coverage for one hundred percent (100%) or any portion of the Medicare Part B deductible.

(ii) Standardized Medicare supplement benefit Plan F is redesignated as Plan

G and shall provide the benefits contained in Section 9.1 (e)(v) of this regulation but shall not provide coverage for one hundred percent (100%) or any portion of the Medicare Part B deductible.

(iii) Standardized Medicare supplement benefit plans C, F, and F with High Deductible may not be offered to individuals newly eligible for Medicare on or after January 1, 2020.

(iv) Standardized Medicare supplement benefit Plan F With High Deductible is redesignated as Plan G With High Deductible and shall provide the benefits contained in Section 9.1 (e)(vi) of this regulation but shall not provide coverage for one hundred percent (100%) or any portion of the Medicare Part B deductible; provided further that, the Medicare Part B deductible paid by the beneficiary shall be considered an out-of-pocket expense in meeting the annual high deductible.

(v) The reference to Plans C or F contained in Section 9.1(a)(ii) is deemed a reference to Plans D or G for purposes of this section.

(b) Applicability to Certain Individuals. This Section 9.2, applies to only individuals that are newly eligible for Medicare on or after January 1, 2020:

(i) by reason of attaining age 65 on or after January 1, 2020; or

(ii) by reason of entitlement to benefits under part A pursuant to section 226(b) or 226A of the Social Security Act, or who is deemed to be eligible for benefits under section 226(a) of the Social Security Act on or after January 1, 2020.

(c) Guaranteed Issue for Eligible Persons. For purposes of Section 12(e), in the case of any individual newly eligible for Medicare on or after January 1, 2020, any reference to a Medicare supplement policy C or F (including F With High Deductible) shall be deemed to be a reference to Medicare supplement policy D or G (including G With High Deductible), respectively that meet the requirements of this Section 9.2(a).

(d) Applicability to Waivered States. In the case of a State described in Section 1882(p)(6) of the Social Security Act ("waivered" alternative simplification states) MACRA prohibits the coverage of the Medicare Part B deductible for any Medicare supplement policy sold or issued to an individual that is newly eligible for Medicare on or after January 1, 2020.

(e) Offer of Redesignated Plans to Individuals Other Than Newly Eligible. On or after January 1, 2020, the standardized benefit plans described in subparagraph (a)(iv), above may be offered to any individual who was eligible for Medicare prior to January 1, 2020 in addition to the standardized plans described in section 9.1(e) of this regulation.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 10 Medicare Select Policies and Certificates

(a) This section shall apply to Medicare Select policies and certificates, as defined in this section. No policy or certificate may be advertised as a Medicare Select policy or certificate unless it meets the requirements of this section.

(b) For the purposes of this section:

(i) "Complaint" means any dissatisfaction expressed by an individual concerning a Medicare Select issuer or its network providers.

(ii) "Grievance" means dissatisfaction expressed in writing by an individual insured under a Medicare Select policy or certificate with the administration, claims practices, or provision of services concerning a Medicare Select issuer or its network providers.

(iii) "Medicare Select issuer" means an issuer offering, or seeking to offer, a Medicare Select policy or certificate.

(iv) "Medicare Select policy" or "Medicare Select certificate" mean respectively a Medicare supplement policy or certificate that contains restricted network provisions.

(v) "Network provider" means a provider of health care, or a group of providers of health care, which has entered into a written agreement with the issuer to provide benefits insured under a Medicare Select policy.

(vi) "Restricted network provision" means any provision which conditions the payment of benefits, in whole or in part, on the use of network providers.

(vii) "Service area" means the geographic area approved by the commissioner within which an issuer is authorized to offer a Medicare Select policy.

(c) The commissioner may authorize an issuer to offer a Medicare Select policy or certificate, pursuant to this section and Section 4358 of the Omnibus Budget Reconciliation Act (OBRA) of 1990 if the commissioner finds that the issuer has satisfied all of the requirements of this regulation.

(d) A Medicare Select issuer shall not issue a Medicare Select policy or certificate in this state until its plan of operation has been approved by the commissioner.

(e) A Medicare Select issuer shall file a proposed plan of operation with the commissioner in a format prescribed by the commissioner. The plan of operation shall contain at least the following information:

(i) Evidence that all covered services that are subject to restricted network provisions are available and accessible through network providers, including a demonstration that:

(A) Services can be provided by network providers with reasonable promptness with respect to geographic location, hours of operation and after- hour care. The hours of operation and availability of after-hour care shall reflect usual practice in the local area. Geographic availability shall reflect the usual travel times within the community.

(B) The number of network providers in the service area is sufficient, with respect to current and expected policyholders, either:

(I) To deliver adequately all services that are subject to a restricted network provision; or

(II) To make appropriate referrals.

(C) There are written agreements with network providers describing specific responsibilities.

(D) Emergency care is available twenty-four (24) hours per day and seven (7) days per week

(E) In the case of covered services that are subject to a restricted network provision and are provided on a prepaid basis, there are written agreements with network providers prohibiting the providers from billing or otherwise seeking reimbursement from or recourse against any individual insured under a Medicare Select policy or certificate. This paragraph shall not apply to supplemental charges or coinsurance amounts as stated in the Medicare Select policy or certificate.

(ii) A statement or map providing a clear description of the service area.

(iii) A description of the grievance procedure to be utilized.

(iv) A description of the quality assurance program, including:

(A) The formal organizational structure;

(B) The written criteria for selection, retention and removal of network providers; and

(C) The procedures for evaluating quality of care provided by network providers, and the process to initiate corrective action when warranted.

(v) A list and description, by specialty, of the network providers.

(vi) Copies of the written information proposed to be used by the issuer to comply with Subsection (i).

(vii) Any other information requested by the commissioner.

(f) A Medicare Select issuer shall file:

(i) Any proposed changes to the plan of operation, except for changes to the list of network providers, with the commissioner prior to implementing the changes. Changes shall be considered approved by the commissioner after thirty (30) days unless specifically disapproved.

(ii) An updated list of network providers shall be filed with the commissioner at least quarterly.

(g) A Medicare Select policy or certificate shall not restrict payment for covered services provided by non-network providers if:

(i) The services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury or a condition; and

(ii) It is not reasonable to obtain services through a network provider.

(h) A Medicare Select policy or certificate shall provide payment for full coverage under the policy for covered services that are not available through network providers.

(i) A Medicare Select issuer shall make full and fair disclosure in writing of the provisions, restrictions and limitations of the Medicare Select policy or certificate to each applicant. This disclosure shall include at least the following:

(i) An outline of coverage sufficient to permit the applicant to compare the coverage and premiums of the Medicare Select policy or certificate with:

(A) Other Medicare supplement policies or certificates offered by the

issuer; and

(B) Other Medicare Select policies or certificates.

(ii) A description (including address, phone number and hours of operation)

of the network providers, including primary care physicians, specialty physicians, hospitals and other providers.

(iii) A description of the restricted network provisions, including payments for coinsurance and deductibles when providers other than network providers are utilized. Except to the extent specified in the policy or certificate, expenses incurred when using out-of-network providers do not count toward the out-of-pocket annual limit contained in plans K and L.

(iv) A description of coverage for emergency and urgently needed care and other out-of-service area coverage.

(v) A description of limitations on referrals to restricted network providers and to other providers.

(vi) A description of the policyholder's rights to purchase any other Medicare supplement policy or certificate otherwise offered by the issuer.

(vii) A description of the Medicare Select issuer's quality assurance program and grievance procedure.

(j) Prior to the sale of a Medicare Select policy or certificate, a Medicare Select issuer shall obtain from the applicant a signed and dated form stating that the applicant has received the information provided pursuant to Subsection (i) of this section and that the applicant understands the restrictions of the Medicare Select policy or certificate.

(k) A Medicare Select issuer shall have and use procedures for hearing complaints and resolving written grievances from the subscribers. The procedures shall be aimed at mutual agreement for settlement and may include arbitration procedures.

(i) The grievance procedure shall be described in the policy and certificates and in the outline of coverage.

(ii) At the time the policy or certificate is issued, the issuer shall provide detailed information to the policyholder describing how a grievance may be registered with the issuer.

(iii) Grievances shall be considered in a timely manner and shall be transmitted to appropriate decision-makers who have authority to fully investigate the issue and take corrective action.

promptly.

(iv) If a grievance is found to be valid, corrective action shall be taken

(v) All concerned parties shall be notified about the results of a grievance.

(vi) The issuer shall report no later than each March 31st to the

commissioner regarding its grievance procedure. The report shall be in a format prescribed by the commissioner and shall contain the number of grievances filed in the past year and a summary of the subject, nature and resolution of such grievances.

(l) At the time of initial purchase, a Medicare Select issuer shall make available to each applicant for a Medicare Select policy or certificate the opportunity to purchase any Medicare supplement policy or certificate otherwise offered by the issuer.

(m) Lesser Benefit Considerations.

(i) At the request of an individual insured under a Medicare Select policy or certificate, a Medicare Select issuer shall make available to the individual insured the opportunity to purchase a Medicare supplement policy or certificate offered by the issuer which has comparable or lesser benefits and which does not contain a restricted network provision. The issuer shall make the policies or certificates available without requiring evidence of insurability after the Medicare Select policy or certificate has been in force for six (6) months.

(ii) For the purposes of this subsection, a Medicare supplement policy or certificate will be considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare Select policy or certificate being replaced. For the purposes of this paragraph, a significant benefit means coverage for the Medicare Part A deductible, coverage for at-home recovery services or coverage for Part B excess charges.

(n) Medicare Select policies and certificates shall provide for continuation of coverage in the event the Secretary of Health and Human Services determines that Medicare Select policies and certificates issued pursuant to this section should be discontinued due to either the failure of the Medicare Select Program to be reauthorized under law or its substantial amendment.

(i) Each Medicare Select issuer shall make available to each individual insured under a Medicare Select policy or certificate the opportunity to purchase any Medicare supplement policy or certificate offered by the issuer which has comparable or lesser benefits and which does not contain a restricted network provision. The issuer shall make the policies and certificates available without requiring evidence of insurability.

(ii) For the purposes of this subsection, a Medicare supplement policy or certificate will be considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare Select policy or certificate being replaced. For the purposes of this paragraph, a significant benefit means coverage for the Medicare Part A deductible, coverage for at-home recovery services or coverage for Part B excess charges.

(o) A Medicare Select issuer shall comply with reasonable requests for data made by

state or federal agencies, including the United States Department of Health and Human Services, for the purpose of evaluating the Medicare Select Program.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 11 Open Enrollment

(a) An issuer shall not deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this state, nor discriminate in the pricing of a policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant in the case of an application for a policy or certificate that is submitted prior to or during the six (6) month period beginning with the first day of the first month in which an individual is both 65 years of age or older and is enrolled for benefits under Medicare Part B. Each Medicare supplement policy and certificate currently available from an insurer shall be made available to all applicants who qualify under this subsection without regard to age.

(b) If an applicant:

(i) Qualifies under Subsection (a) and submits an application during the time period referenced in Subsection (a) and, as of the date of application, has had a continuous period of creditable coverage of at least six months, the issuer shall not exclude benefits based on a preexisting condition.

(ii) Qualifies under Subsection (a) and submits an application during the time period referenced in Subsection (a) and, as of the date of application, has had a continuous period of creditable coverage that is less than six months, the issuer shall reduce the period of any preexisting condition exclusion by the aggregate of the period of creditable coverage applicable to the applicant as of the enrollment date. The Secretary shall specify the manner of the reduction under this subsection.

(c) Except as provided in Subsection (b) and Sections 12 and 23, Subsection (a) shall not be construed as preventing the exclusion of benefits under a policy, during the first ninety

(90) days, based on a preexisting condition for which the policyholder or certificate holder received treatment or was otherwise diagnosed during the ninety (90) days before the coverage became effective.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 12 Guaranteed Issue for Eligible Persons

(a) Guaranteed Issue.

(i) Eligible persons are those individuals described in Subsection (b) who seek to enroll under the policy during the period specified in Subsection (c), and who submit evidence of the date of termination, disenrollment, or Medicare Part D enrollment with the application for a Medicare supplement policy.

(ii) With respect to eligible persons, an issuer shall not deny or condition the issuance or effectiveness of a Medicare supplement policy described in Subsection (e) that is offered and is available for issuance to new enrollees by the issuer, shall not discriminate in the pricing of such a Medicare supplement policy because of health status, claims experience, receipt of health care, or medical condition, and shall not impose an exclusion of benefits based

on a preexisting condition under such a Medicare supplement policy.

(b) Eligible Persons. An eligible person is an individual described in any of the following paragraphs:

(i) The individual is enrolled under an employee welfare benefit plan that provides health benefits that supplement the benefits under Medicare; and the plan terminates, or the plan ceases to provide all such supplemental health benefits to the individual;

(ii) The individual is enrolled with a Medicare Advantage organization under a Medicare Advantage plan under part C of Medicare, and any of the following circumstances apply, or the individual is 65 years of age or older and is enrolled with a Program of All-Inclusive Care for the Elderly (PACE) provider under Section 1894 of the Social Security Act, and there are circumstances similar to those described below that would permit discontinuance of the individual's enrollment with such provider if such individual were enrolled in a Medicare Advantage plan:

(A) The certification of the organization or plan has been terminated;

(B) The organization has terminated or otherwise discontinued providing the plan in the area in which the individual resides;

(C) The individual is no longer eligible to elect the plan because of a change in the individual's place of residence or other change in circumstances specified by the Secretary, but not including termination of the individual's enrollment on the basis described in Section 1851(g)(3)(B) of the federal Social Security Act (where the individual has not paid premiums on a timely basis or has engaged in disruptive behavior as specified in standards under Section 1856), or the plan is terminated for all individuals within a residence area;

(D) The individual demonstrates, in accordance with guidelines established by the Secretary, that:

(I) The organization offering the plan substantially violated a material provision of the organization's contract under this part in relation to the individual, including the failure to provide an enrollee on a timely basis medically necessary care for which benefits are available under the plan or the failure to provide such covered care in accordance with applicable quality standards; or

(II) The organization, or agent or other entity acting on the organization's behalf, materially misrepresented the plan's provisions in marketing the plan to the individual; or

(E) The individual meets such other exceptional conditions as the Secretary may provide.

(iii) Organization:

(A) The individual is enrolled with:

(I) An eligible organization under a contract under Section

1876 of the Social Security Act (Medicare cost);

(II) A similar organization operating under demonstration project authority, effective for periods before April 1, 1999;

(III) An organization under an agreement under Section 1833(a)(1)(A) of the Social Security Act (health care prepayment plan); or

(IV) An organization under a Medicare Select policy; and

(B) The enrollment ceases under the same circumstances that would permit discontinuance of an individual's election of coverage under Section 12(b)(ii).

(iv) The individual is enrolled under a Medicare supplement policy and the enrollment ceases because:

(A) Insolvency, bankruptcy, and involuntary termination.

(I) Of the insolvency of the issuer or bankruptcy of the non-

issuer organization; or

(II) Of other involuntary termination of coverage or

enrollment under the policy;

of the policy; or

(B) The issuer of the policy substantially violated a material provision

(C) The issuer, or an agent or other entity acting on the issuer's

behalf, materially misrepresented the policy's provisions in marketing the policy to the individual.

(v) Related Enrollments

(A) The individual was enrolled under a Medicare supplement policy and terminates enrollment and subsequently enrolls, for the first time, with any Medicare Advantage organization under a Medicare Advantage plan under part C of Medicare, any eligible organization under a contract under Section 1876 of the Social Security Act (Medicare cost), any similar organization operating under demonstration project authority, any PACE provider under Section 1894 of the Social Security Act or a Medicare Select policy; and

(B) The subsequent enrollment under subparagraph (a) is terminated by the enrollee during any period within the first twelve (12) months of such subsequent enrollment during which the enrollee is permitted to terminate such subsequent enrollment under Section 1851(e) of the federal Social Security Act); or

(vi) The individual, upon first becoming eligible for benefits under part A of Medicare at age 65, enrolls in a Medicare Advantage plan under part C of Medicare, or with a PACE provider under Section 1894 of the Social Security Act, and disenrolls from the plan or program by not later than twelve (12) months after the effective date of enrollment.

(vii) The individual who has postponed enrollment in Medicare Part B until after age 65 because he is working and enrolled in a group health insurance plan.

(viii) The individual enrolls in a Medicare Part D plan during the initial

enrollment period and, at the time of enrollment in Part D, was enrolled under a Medicare supplement policy that covers outpatient prescription drugs and the individual terminates enrollment in the Medicare supplement policy and submits evidence of enrollment in Medicare Part D along with the application for a policy described in Subsection (e)(iv).

(ix) The individual is enrolled in a Medicare Supplement policy, and, on or after June 1, 2025, voluntarily terminates enrollment and enrolls in another Medicare Supplement policy.

(c) Guaranteed Issue Time Periods.

(i) In the case of an individual described in Subsection (b)(i), the guaranteed issue period begins on the later of: (i) the date the individual receives a notice of termination or cessation of all supplemental health benefits (or, if a notice is not received, notice that a claim has been denied because of a termination or cessation); or (ii) the date that the applicable coverage terminates or ceases; and ends sixty-three (63) days thereafter;

(ii) In the case of an individual described in Subsection (b)(ii), (b)(iii), (b)(v) or (b)(vi) whose enrollment is terminated involuntarily, the guaranteed issue period begins on the date that the individual receives a notice of termination and ends sixty-three (63) days after the date the applicable coverage is terminated;

(iii) In the case of an individual described in Subsection (b)(iv)(A), the guaranteed issue period begins on the earlier of: (i) the date that the individual receives a notice of termination, a notice of the issuer's bankruptcy or insolvency, or other such similar notice if any, and (ii) the date that the applicable coverage is terminated, and ends on the date that is sixty-three (63) days after the date the coverage is terminated;

(iv) In the case of an individual described in Subsection (b)(ii), (b)(iv), (b)(v) or (b)(vi) who disenrolls voluntarily, the guaranteed issue period begins on the date that is sixty

(60) days before the effective date of the disenrollment and ends on the date that is sixty-three

(63) days after the effective date;

(v) In the case of an individual described in Subsection (b)(vii), the guaranteed issue period begins on the date the individual receives notice pursuant to Section 1882(v)(2)(B) of the Social Security Act from the Medicare supplement issuer during the sixty- day period immediately preceding the initial Part D enrollment period and ends on the date that is sixty-three (63) days after the effective date of the individual's coverage under Medicare Part D; and

(vi) In the case of an individual described in Subsection (b) but not described in the preceding provisions of this Subsection, the guaranteed issue period begins on the effective date of disenrollment and ends on the date that is sixty-three (63) days after the effective date.

(vii) In the case of an individual described in Section 12(b)(ix), the guaranteed issue period begins on the individual's birthday and ends sixty-three (63) days thereafter.

(d) Extended Medigap Access for Interrupted Trial Periods.

(i) In the case of an individual described in Subsection (b)(v) (or deemed to be so described, pursuant to this paragraph) whose enrollment with an organization or provider described in Subsection (b)(v)(A) is involuntarily terminated within the first twelve (12) months of enrollment, and who, without an intervening enrollment, enrolls with another such organization or provider, the subsequent enrollment shall be deemed to be an initial enrollment described in Section 12(b)(v);

(ii) In the case of an individual described in Subsection (b)(vi) (or deemed to be so described, pursuant to this paragraph) whose enrollment with a plan or in a program described in Subsection (b)(vi) is involuntarily terminated within the first twelve (12) months of enrollment, and who, without an intervening enrollment, enrolls in another such plan or program, the subsequent enrollment shall be deemed to be an initial enrollment described in Section 12(b)(vi); and

(iii) For purposes of Subsections (b)(v) and (b)(vi), no enrollment of an individual with an organization or provider described in Subsection (b)(v)(A), or with a plan or in a program described in Subsection (b)(vi), may be deemed to be an initial enrollment under this paragraph after the two-year period beginning on the date on which the individual first enrolled with such an organization, provider, plan or program.

(e) Products to Which Eligible Persons are Entitled. The Medicare supplement policy to which eligible persons are entitled under the following:

(i) Section 12(b)(i), (ii), (iii) and (iv) is a Medicare supplement policy which has a benefit package classified as Plan A, B, C, F (including F with a high deductible), K or L offered by any issuer.

(ii) Other Eligible Policies.

(A) Subject to Subparagraph (B), Section 12(b)(v) is the same Medicare supplement policy in which the individual was most recently previously enrolled, if available from the same issuer, or, if not so available, a policy described in Paragraph (i);

(B) After December 31, 2005, if the individual was most recently enrolled in a Medicare supplement policy with an outpatient prescription drug benefit, a Medicare supplement policy described in this subparagraph is:

(I) The policy available from the same issuer but modified to remove outpatient prescription drug coverage; or

(II) At the election of the policyholder, an A, B, C, F (including F with a high deductible), K or L policy that is offered by any issuer.

(iii) Section 12(b)(vi) shall include any Medicare supplement policy offered by

any issuer;

(iv) Section 12(b)(vii) is a Medicare supplement policy that has a benefit

package classified as Plan A, B, C, F (including F with a high deductible), K or L, and that is offered and is available for issuance to new enrollees by the same issuer that issued the individual's Medicare supplement policy with outpatient prescription drug coverage.

(v) Section 12(b)(ix) includes any comparable or lesser Medicare policy offered by any issuer. For the purposes of this Section, a Medicare supplement policy or certificate will be considered to have comparable or lesser benefits unless it contains one (1) or more significant benefits not included in the Medicare Supplement policy or certificate being replaced.

(f) Notification provisions.

(i) At the time of an event described in Subsection (b) of this section because of which an individual loses coverage or benefits due to the termination of a contract or agreement, policy, or plan, the organization that terminates the contract or agreement, the issuer terminating the policy, or the administrator of the plan being terminated, respectively, shall notify the individual of his or her rights under this section, and of the obligations of issuers of Medicare supplement policies under Subsection (a). Such notice shall be communicated contemporaneously with the notification of termination.

(ii) At the time of an event described in Subsection (a) of this section because of which an individual ceases enrollment under a contract or agreement, policy, or plan, the organization that offers the contract or agreement, regardless of the basis for the cessation of enrollment, the issuer offering the policy, or the administrator of the plan, respectively, shall notify the individual of his or her rights under this section, and of the obligations of issuers of Medicare supplement policies under Section 12(a). Such notice shall be communicated within ten working days of the issuer receiving notification of disenrollment.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 13 Standards for Claims Payment

(a) An issuer shall comply with section 1882(c)(3) of the Social Security Act (as enacted by section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA) 1987, Pub. L. No. 100-203) by:

(i) Accepting a notice from a Medicare carrier on dually assigned claims submitted by participating physicians and suppliers as a claim for benefits in place of any other claim form otherwise required and making a payment determination on the basis of the information contained in that notice;

(ii) Notifying the participating physician or supplier and the beneficiary of the payment determination;

(iii) Paying the participating physician or supplier directly;

(iv) Furnishing, at the time of enrollment, each enrollee with a card listing the policy name, number and a central mailing address to which notices from a Medicare carrier may be sent;

(v) Paying user fees for claim notices that are transmitted electronically or otherwise; and

(vi) Providing to the Secretary of Health and Human Services, at least annually, a central mailing address to which all claims may be sent by Medicare carriers.

(b) Compliance with the requirements set forth in Subsection (a) above shall be

certified on the Medicare supplement insurance experience reporting form.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 14 Loss Ratio Standards and Refund or Credit of Premium

(a) Loss Ratio Standards.

(i) Medicare Supplement Policy Form or Certificate Form.

(A) Shall not be delivered or issued for delivery unless the policy form or certificate form can be expected, as estimated for the entire period for which rates are computed to provide coverage, to return to policyholders and certificate holders in the form of aggregate benefits (not including anticipated refunds or credits) provided under the policy form or certificate form:

(I) At least seventy-five percent (75%) of the aggregate amount of premiums earned in the case of group policies; or

(II) At least sixty-five percent (65%) of the aggregate amount of premiums earned in the case of individual policies;

(B) Loss ratio standards shall be calculated on the basis of incurred claims experience or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis and earned premiums for the period and in accordance with accepted actuarial principles and practices. Incurred health care expenses where coverage is provided by a health maintenance organization shall not include:

(I) Home office and overhead costs;

(II) Advertising costs;

(III) Commissions and other acquisition costs;

(IV) Taxes;

(V) Capital costs;

(VI) Administrative costs; and

(VII) Claims processing costs.

(ii) All filings of rates and rating schedules shall demonstrate that expected claims in relation to premiums comply with the requirements of this section when combined with actual experience to date. Filings of rate revisions shall also demonstrate that the anticipated loss ratio over the entire future period for which the revised rates are computed to provide coverage can be expected to meet the appropriate loss ratio standards.

(iii) For purposes of applying Subsection (a)(i) of this section and Subsection (c)(iii) of Section 15 only, policies issued as a result of solicitations of individuals through the mails or by mass media advertising (including both print and broadcast advertising) shall be deemed to be individual policies.

(iv) For policies issued prior to July 6, 1992, expected claims in relation to premiums shall meet:

(A) The originally filed anticipated loss ratio when combined with the actual experience since inception;

(B) The appropriate loss ratio requirement from Subsection (a)(i)(A)(I) and (II) when combined with actual experience beginning with July 6, 1992 to date; and

(C) The appropriate loss ratio requirement from Subsection (a)(i)(A)(I) and (II) over the entire future period for which the rates are computed to provide coverage.

(b) Refund or Credit Calculation.

(i) An issuer shall collect and file with the commissioner by May 31 of each year the data contained in the applicable reporting form contained in Appendix A for each type in a standard Medicare supplement benefit plan.

(ii) If on the basis of the experience as reported the benchmark ratio since inception (ratio 1) exceeds the adjusted experience ratio since inception (ratio 3), then a refund or credit calculation is required. The refund calculation shall be done on a statewide basis for each type in a standard Medicare supplement benefit plan. For purposes of the refund or credit calculation, experience on policies issued within the reporting year shall be excluded.

(iii) For the purposes of this section, policies or certificates issued prior to the effective date of this rule, the issuer shall make the refund or credit calculation separately for all individual policies (including all group policies subject to an individual loss ratio standard when issued) combined and all other group policies combined for experience after the effective date of this amendment. The first report shall be due by May 31, 2011.

(iv) A refund or credit shall be made only when the benchmark loss ratio exceeds the adjusted experience loss ratio and the amount to be refunded or credited exceeds a de minimis level. The refund shall include interest from the end of the calendar year to the date of the refund or credit at a rate specified by the Secretary of Health and Human Services, but in no event shall it be less than the average rate of interest for thirteen-week Treasury notes. A refund or credit against premiums due shall be made by September 30 following the experience year upon which the refund or credit is based.

(c) Annual filing of Premium Rates. An issuer of Medicare supplement policies and certificates issued before or after the effective date of this amendment in this state shall file annually its rates, rating schedule and supporting documentation including ratios of incurred losses to earned premiums by policy duration for approval by the commissioner in accordance with the filing requirements and procedures prescribed by the commissioner. The supporting documentation shall also demonstrate in accordance with actuarial standards of practice using reasonable assumptions that the appropriate loss ratio standards can be expected to be met over the entire period for which rates are computed. The demonstration shall exclude active life reserves. An expected third-year loss ratio which is greater than or equal to the applicable percentage shall be demonstrated for policies or certificates in force less than three (3) years. As soon as practicable, but prior to the effective date of enhancements in Medicare benefits, every issuer of Medicare supplement policies or certificates in this state shall file with the commissioner, in accordance with the applicable filing procedures of this state:

(i) Premium Adjustments.

(A) Appropriate premium adjustments necessary to produce loss ratios as anticipated for the current premium for the applicable policies or certificates. The supporting documents necessary to justify the adjustment shall accompany the filing.

(B) An issuer shall make premium adjustments necessary to produce an expected loss ratio under the policy or certificate to conform to minimum loss ratio standards for Medicare supplement policies and which are expected to result in a loss ratio at least as great as that originally anticipated in the rates used to produce current premiums by the issuer for the Medicare supplement policies or certificates. No premium adjustment which would modify the loss ratio experience under the policy other than the adjustments described herein shall be made with respect to a policy at any time other than upon its renewal date or anniversary date.

(C) If an issuer fails to make premium adjustments acceptable to the commissioner, the commissioner may order premium adjustments, refunds or premium credits deemed necessary to achieve the loss ratio required by this section.

(ii) Any appropriate riders, endorsements or policy forms needed to accomplish the Medicare supplement policy or certificate modifications necessary to eliminate benefit duplications with Medicare. The riders, endorsements or policy forms shall provide a clear description of the Medicare supplement benefits provided by the policy or certificate.

(d) Public Hearings. The commissioner may conduct a public hearing to gather information concerning a request by an issuer for an increase in a rate for a policy form or certificate form issued before or after the effective date of this amendment if the experience of the form for the previous reporting period is not in compliance with the applicable loss ratio standard. The determination of compliance is made without consideration of any refund or credit for the reporting period. Public notice of the hearing shall be furnished in a manner deemed appropriate by the commissioner.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 15 Filing and Approval of Policies and Certificates and Premium Rates

(a) An issuer shall not deliver or issue for delivery a policy or certificate to a resident of this state unless the policy form or certificate form has been filed with and approved by the commissioner in accordance with filing requirements and procedures prescribed by the commissioner.

(b) An issuer shall file any riders or amendments to policy or certificate forms to delete outpatient prescription drug benefits as required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 only with the commissioner in the state in which the policy or certificate was issued.

(c) An issuer shall not use or change premium rates for a Medicare supplement policy or certificate unless the rates, rating schedule and supporting documentation have been filed with and approved by the commissioner in accordance with the filing requirements and procedures prescribed by the commissioner.

(d) Multiple Policy or Type.

(i) Except as provided in Paragraph (ii) of this subsection, an issuer shall not file for approval more than one form of a policy or certificate of each type for each standard Medicare supplement benefit plan.

(ii) An issuer may offer, with the approval of the commissioner, up to four (4) additional policy forms or certificate forms of the same type for the same standard Medicare supplement benefit plan, one for each of the following cases:

(A) The inclusion of new or innovative benefits;

(B) The addition of either direct response or agent marketing

methods;

reason of disability.

(C) The addition of either guaranteed issue or underwritten methods;

(D) The offering of coverage to individuals eligible for Medicare by

(iii) For the purposes of this section, a "type" means an individual policy, a group policy, an individual Medicare Select policy, or a group Medicare Select policy.

(e) Availability and Discontinuance.

(i) Except as provided in Paragraph (i)(A), an issuer shall continue to make available for purchase any policy form or certificate form issued after the effective date of this regulation that has been approved by the commissioner. A policy form or certificate form shall not be considered to be available for purchase unless the issuer has actively offered it for sale in the previous twelve (12) months.

(A) An issuer may discontinue the availability of a policy form or certificate form if the issuer provides to the commissioner in writing its decision at least thirty

(30) days prior to discontinuing the availability of the form of the policy or certificate. After receipt of the notice by the commissioner, the issuer shall no longer offer for sale the policy form or certificate form in this state.

(B) An issuer that discontinues the availability of a policy form or certificate form pursuant to Subparagraph (A) shall not file for approval a new policy form or certificate form of the same type for the same standard Medicare supplement benefit plan as the discontinued form for a period of five (5) years after the issuer provides notice to the commissioner of the discontinuance. The period of discontinuance may be reduced if the commissioner determines that a shorter period is appropriate.

(ii) The sale or other transfer of Medicare supplement business to another issuer shall be considered a discontinuance for the purposes of this subsection.

(iii) A change in the rating structure or methodology shall be considered a discontinuance under Paragraph (i) unless the issuer complies with the following requirements:

(A) The issuer provides an actuarial memorandum, in a form and manner prescribed by the commissioner, describing the manner in which the revised rating methodology and resultant rates differ from the existing rating methodology and existing rates.

(B) The issuer does not subsequently put into effect a change of rates or rating factors that would cause the percentage differential between the discontinued and subsequent rates as described in the actuarial memorandum to change. The commissioner may approve a change to the differential that is in the public interest.

(f) Combination of Forms or Certificates.

(i) Except as provided in Paragraph (ii), the experience of all policy forms or certificate forms of the same type in a standard Medicare supplement benefit plan shall be combined for purposes of the refund or credit calculation prescribed in Section 14(b)(iv).

(ii) Forms assumed under an assumption reinsurance agreement shall not be combined with the experience of other forms for purposes of the refund or credit calculation.

(g) An issuer shall not present for filing or approval a rate structure for its Medicare supplement policies or certificates issued after the effective date of the amendment of this regulation based upon a structure or methodology with any groupings of attained ages greater than one year. The ratio between rates for successive ages shall increase smoothly as age increases.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 16 Permitted Compensation Arrangements

(a) An issuer or other entity may provide commission or other compensation to an agent or other representative for the sale of a Medicare supplement policy or certificate only if the first year commission or other first year compensation is no more than 200 percent of the commission or other compensation paid for selling or servicing the policy or certificate in the second year or period.

(b) The commission or other compensation provided in subsequent (renewal) years must be the same as that provided in the second year or period and must be provided for no fewer than five (5) renewal years.

(c) No issuer or other entity shall provide compensation to its agents or other producers and no agent or producer shall receive compensation greater than the renewal compensation payable by the replacing issuer on renewal policies or certificates if an existing policy or certificate is replaced.

(d) For purposes of this section, "compensation" includes pecuniary or non- pecuniary remuneration of any kind relating to the sale or renewal of the policy or certificate including but not limited to bonuses, gifts, prizes, awards and finders fees.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 17 Required Disclosure Provisions

(a) General Rules.

(i) Medicare supplement policies and certificates shall include a renewal or continuation provision. The language or specifications of the provision shall be consistent with the type of contract issued. The provision shall be appropriately captioned and shall appear on the first page of the policy, and shall include any reservation by the issuer of the right to change premiums and any automatic renewal premium increases based on the policyholder's age.

(ii) Except for riders or endorsements by which the issuer effectuates a request made in writing by the insured, exercises a specifically reserved right under a Medicare supplement policy, or is required to reduce or eliminate benefits to avoid duplication of Medicare benefits, all riders or endorsements added to a Medicare supplement policy after date of issue or at reinstatement or renewal which reduce or eliminate benefits or coverage in the policy shall require a signed acceptance by the insured. After the date of policy or certificate issue, any rider or endorsement which increases benefits or coverage with a concomitant increase in premium during the policy term shall be agreed to in writing signed by the insured, unless the benefits are required by the minimum standards for Medicare supplement policies, or if the increased benefits or coverage is required by law. Where a separate additional premium is charged for benefits provided in connection with riders or endorsements, the premium charge shall be set forth in the policy.

(iii) Medicare supplement policies or certificates shall not provide for the payment of benefits based on standards described as "usual and customary," "reasonable and customary" or words of similar import.

(iv) If a Medicare supplement policy or certificate contains any limitations with respect to preexisting conditions, such limitations shall appear as a separate paragraph of the policy and be labeled as "Preexisting Condition Limitations."

(v) Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the policyholder or certificate holder shall have the right to return the policy or certificate within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the insured person is not satisfied for any reason.

(vi) Accident and sickness policies for Medicare-eligible persons.

(A) Issuers of accident and sickness policies or certificates which provide hospital or medical expense coverage on an expense incurred or indemnity basis to persons eligible for Medicare shall provide to those applicants a Guide to Health Insurance for People with Medicare in the form developed jointly by the National Association of Insurance Commissioners and CMS and in a type size no smaller than 12 point type. Delivery of the Guide shall be made whether or not the policies or certificates are advertised, solicited or issued as Medicare supplement policies or certificates as defined in this regulation. Except in the case of direct response issuers, delivery of the Guide shall be made to the applicant at the time of application and acknowledgement of receipt of the Guide shall be obtained by the issuer. Direct response issuers shall deliver the Guide to the applicant upon request but not later than at the time the policy is delivered.

(B) For the purposes of this section, "form" means the language, format, type size, type proportional spacing, bold character, and line spacing.

(b) Notice Requirements.

(i) As soon as practicable, but no later than thirty (30) days prior to the annual effective date of any Medicare benefit changes, an issuer shall notify its policyholders

and certificate holders of modifications it has made to Medicare supplement insurance policies or certificates in a format acceptable to the commissioner. The notice shall:

(A) Include a description of revisions to the Medicare program and a description of each modification made to the coverage provided under the Medicare supplement policy or certificate, and

(B) Inform each policyholder or certificate holder as to when any premium adjustment is to be made due to changes in Medicare.

(ii) The notice of benefit modifications and any premium adjustments shall be in outline form and in clear and simple terms so as to facilitate comprehension.

(iii) The notices shall not contain or be accompanied by any solicitation.

(c) MMA Notice Requirements. Issuers shall comply with any notice requirements of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

(d) Outline of Coverage Requirements for Medicare Supplement Policies.

(i) Issuers shall provide an outline of coverage to all applicants at the time application is presented to the prospective applicant and, except for direct response policies, shall obtain an acknowledgement of receipt of the outline from the applicant; and

(ii) If an outline of coverage is provided at the time of application and the Medicare supplement policy or certificate is issued on a basis which would require revision of the outline, a substitute outline of coverage properly describing the policy or certificate shall accompany the policy or certificate when it is delivered and contain the following statement, in no less than twelve (12) point type, immediately above the company name:

NOTICE: Read this outline of coverage carefully. It is not identical to the outline of coverage provided upon application and the coverage originally applied for has not been issued."

(iii) The outline of coverage provided to applicants pursuant to this section consists of four parts: a cover page, premium information, disclosure pages, and charts displaying the features of each benefit plan offered by the issuer. The outline of coverage shall be in the language and format prescribed below in no less than twelve (12) point type. All plans shall be shown on the cover page, and the plans that are offered by the issuer shall be prominently identified. Premium information for plans that are offered shall be shown on the cover page or immediately following the cover page and shall be prominently displayed. The premium and mode shall be stated for all plans that are offered to the prospective applicant. All possible premiums for the prospective applicant shall be illustrated.

(iv) The following items shall be included in the outline of coverage in the order prescribed below.

Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010

This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan "A" available. Some plans may not be available in your state.

Plans E, H, I, and J are no longer available for sale. [This sentence shall not appear after June 1, 2011.]

Basic Benefits:

 Hospitalization -Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.

 Medical Expenses -Part B coinsurance (generally 20% of Medicare-approved expenses) or co-payments for hospital outpatient services. Plans K, L and N require insureds to pay a portion of Part B coinsurance or co-payments.

 Blood -First three pints of blood each year.

 Hospice— Part A coinsurance

*Plan F also has an option called a high deductible plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year [$2000] deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed [$2000]. Out-of- pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan's separate foreign travel emergency deductible.

PREMIUM INFORMATION [Boldface Type]

We [insert issuer's name] can only raise your premium if we raise the premium for all policies like yours in this State. [If the premium is based on the increasing age of the insured, include information specifying when premiums will change.]

READ YOUR POLICY VERY CAREFULLY [Boldface Type]

This is only an outline describing your policy's most important features. The policy is your insurance contract. You must read the policy itself to understand all of the rights and duties of both you and your insurance company.

RIGHT TO RETURN POLICY [Boldface Type]

If you find that you are not satisfied with your policy, you may return it to [insert issuer's address]. If you send the policy back to us within 30 days after you receive it, we will treat the policy as if it had never been issued and return all of your payments.

POLICY REPLACEMENT [Boldface Type]

If you are replacing another health insurance policy, do NOT cancel it until you have actually received your new policy and are sure you want to keep it.

NOTICE [Boldface Type]

This policy may not fully cover all of your medical costs. [for agents:]

Neither [insert company's name] nor its agents are connected with Medicare.

[for direct response:]

[insert company's name] is not connected with Medicare.

This outline of coverage does not give all the details of Medicare coverage. Contact your local Social Security Office or consult Medicare and You for more details.

COMPLETE ANSWERS ARE VERY IMPORTANT [Boldface Type]

When you fill out the application for the new policy, be sure to answer truthfully and completely all questions about your medical and health history. The company may cancel your policy and refuse to pay any claims if you leave out or falsify important medical information. [If the policy or certificate is guaranteed issue, this paragraph need not appear.]

Review the application carefully before you sign it. Be certain that all information has been properly recorded.

[Include for each plan prominently identified in the cover page, a chart showing the services, Medicare payments, plan payments and insured payments for each plan, using the same language, in the same order, using uniform layout and format as shown in the charts below. No more than four plans may be shown on one chart. For purposes of illustration, charts for each plan are included in this regulation. An issuer may use additional benefit plan designations on these charts pursuant to Section 9.1D of this regulation.]

[Include an explanation of any innovative benefits on the cover page and in the chart, in a manner approved by the commissioner.]

Benefit Chart of Medicare Supplement Plans Sold on or after January 1, 2020

This chart shows the benefits included in each of the standard Medicare supplement plans. Some plans may not be available. Only applicants first eligible for Medicare before 2020 may purchase Plans C, F, and high deductible F.

Note: A ✔means 100% of the benefit is paid.

deductible

1 Plans F and G also have a high deductible option which require first paying a plan deductible of [$2180] before the plan begins to pay. Once the plan deductible is met, the plan pays 100% of covered services for the rest of the calendar year. High deductible plan G does not cover the Medicare Part B deductible. However, high deductible plans F and G count your payment of the Medicare Part B deductible toward meeting the plan deductible.

2 Plans K and L pay 100% of covered services for the rest of the calendar year once you meet the out-of-pocket yearly limit.

3 Plan N pays 100% of the Part B coinsurance, except for a co-payment of up to $20 for some office visits and up to a $50 co- payment for emergency room visits that do not result in an inpatient admission.

PLAN A

MEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD

• A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

HOSPITALIZATION*

Semiprivate room and board, general nursing and general nursing and miscellaneous services and supplies

First 60 days

61st thru 90th day

All but $[1068]

All but $[267] a day

$0

$[267] a day

$[1068](Part A deductible)

91st day and after:

—While using 60 lifetime reserve days

—Once lifetime reserve days are used:

All but $[534] a day

$0

$0

$[534] a day

100% of Medicare eligible expenses

$0

$0

$0**

—Additional 365 days

$0

All costs

—Beyond the additional 365 days

SKILLED NURSING FACILITY CARE*

You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital

First 20 days

21st thru 100th day 101st day and after

All approved amounts

All but $[133.50] a day

$0

$0

$0

$0

Up to $[133.50] a day All costs

$0

PLAN A

MEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD (cont.)

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

BLOOD

First 3 pints

Additional amounts

$0 100%

3 pints

$0

$0

$0

HOSPICE CARE

You must meet Medicare's requirements, including a doctor's certification of terminal illness.

All but very limited co- payment/ coinsurance for out- Patient drugs and inpatient respite care

Medicare co- payment/coinsurance

$0

** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN A

MEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR

• Once you have been billed $[135] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

MEDICAL EXPENSES— IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL

TREATMENT, such as Physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment,

First $[135] of Medicare Approved Amounts*

Remainder of Medicare Approved Amounts

$0

Generally 80%

$0

Generally 20%

$[135] (Part B deductible)

$0

Part B Excess Charges (Above Medicare Approved Amounts)

$0

$0

All costs

BLOOD

First 3 pints

Next $[135] of Medicare Approved Amounts* Remainder of Medicare Approved Amounts

$0

$0 80%

All costs

$0 20%

$0

$[135] (Part B deductible)

$0

CLINICAL LABORATORY SERVICES—TESTS FOR DIAGNOSTIC SERVICES

100%

$0

$0

PLAN A PARTS A & B

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

HOME HEALTH CARE

MEDICARE APPROVED SERVICES

Medically necessary skilled care services and medical supplies

100%

$0

$0

Durable medical equipment

—First $[135] of Medicare Approved Amounts*

$0

$0

$[135] (Part B Deductible)

—Remainder of Medicare Approved Amounts

80%

20%

$0

PLAN B

MEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD

• A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

HOSPITALIZATION*

Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

61st thru 90th day 91st day and after:

—While using 60 lifetime reserve days

All but $[1068]

All but $[267] a day

All but $[534] a day

$[1068](Part A deductible)

$[267] a day

$[534] a day

$0

$0

$0

—Once lifetime reserve days are used:

—Additional 365 days

—Beyond the additional 365 days

$0

$0

100% of Medicare eligible expenses

$0

$0**

All costs

SKILLED NURSING FACILITY CARE*

You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered Medicare-approved facility within 30 days after leaving the hospital

First 20 days

All approved amounts

$0

$0

21st thru 100th day

101st day and after

All but $[133.50] a day

$0

$0

$0

Up to $[133.50] a day

All costs

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

BLOOD

First 3 pints

Additional amounts

$0 100%

3 pints

$0

$0

$0

HOSPICE CARE

You must meet Medicare's requirements, including a doctor's certification of terminal illness

All but very limited co- payment/coinsurance for out-patient drugs and inpatient respite care

Medicare co- payment/ coinsurance

$0

** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN B

MEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR

• Once you have been billed $[135] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

MEDICAL EXPENSES— IN OR OUT OF THE HOSPITAL AND

OUTPATIENT HOSPITAL TREATMENT, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment,

First $[135] of Medicare Approved Amounts* Remainder of Medicare Approved Amounts

$0

Generally 80%

$0

Generally 20%

$[135] (Part B deductible)

$0

Part B Excess Charges (Above Medicare Approved Amounts)

$0

$0

All costs

BLOOD

First 3 pints

$0

All costs

$0

Next $[135] of Medicare Approved Amounts*

$0

$0

$[135] (Part B

Remainder of Medicare Approved Amounts

80%

20%

deductible)

$0

CLINICAL LABORATORY SERVICES—TESTS FOR DIAGNOSTIC SERVICES

100%

$0

$0

PLAN B PARTS A & B

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

HOME HEALTH CARE

MEDICARE APPROVED SERVICES

Medically necessary skilled care services and medical supplies

100%

$0

$0

Durable medical equipment

—First $[135] of Medicare Approved Amounts*

$0

$0

$[135] (Part B deductible)

—Remainder of Medicare Approved Amounts

80%

20%

$0

PLAN C

MEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD

• A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

HOSPITALIZATION*

Semiprivate room and board, general nursing and miscellaneous services and supplies

$[1068](Part A deductible)

$[267] a day

$[534] a day

100% of Medicare eligible expenses

$0

First 60 days

All but $[1068]

$0

61st thru 90th day

All but $[267] a day

$0

91st day and after:

All but $[534] a day

$0

—While using 60 lifetime reserve days

—Once lifetime reserve days are used:

—Additional 365 days

$0

$0**

—Beyond the additional 365 days

$0

All costs

SKILLED NURSING FACILITY CARE*

You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare- approved facility within 30 days after leaving the hospital

First 20 days

All approved amounts

$0

$0

21st thru 100th day 101st day and after

All but $[133.50] a day

$0

Up to $[133.50] a day

$0

$0

All costs

BLOOD

First 3 pints

Additional amounts

$0 100%

3 pints

$0

$0

$0

HOSPICE CARE

You must meet Medicare's requirements, including a doctor's certification of terminal illness.

All but very limited co-payment/ coinsurance for out- patient drugs and inpatient respite care

Medicare co- payment/ coinsurance

$0

** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN C

MEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR

• Once you have been billed $[135] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

MEDICAL EXPENSES— IN OR OUT OF THE HOSPITAL AND

OUTPATIENT HOSPITAL TREATMENT, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment,

First $[135] of Medicare Approved Amounts* Remainder of Medicare Approved Amounts

$0

Generally 80%

$[135] (Part B deductible) Generally 20%

$0

$0

Part B Excess Charges (Above Medicare Approved Amounts)

$0

$0

All costs

BLOOD

First 3 pints

Next $[135] of Medicare Approved Amounts*

Remainder of Medicare Approved Amounts

$0

$0

80%

All costs

$[135] (Part B deductible)

20%

$0

$0

$0

CLINICAL LABORATORY SERVICES—TESTS FOR DIAGNOSTIC SERVICES

100%

$0

$0

PARTS A & B

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

HOME HEALTH CARE

MEDICARE APPROVED SERVICES

Medically necessary skilled care services and medical supplies

100%

$0

$0

Durable medical equipment

First $[135] of Medicare Approved Amounts* Remainder of Medicare Approved Amounts

$0

80%

$[135](PartB

deductible)

20%

$0

$0

OTHER BENEFITS—NOT COVERED BY MEDICARE

FOREIGN TRAVEL—NOT COVERED BY MEDICARE

Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA

$0

$250

First $250 each calendar year

$0

80% to a lifetime

20% and amounts

Remainder of Charges

$0

maximum benefit of

over the $50,000

$50,000

lifetime maximum

PLAN D

MEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD

• A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

HOSPITALIZATION*

Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

61st thru 90th day

All but $[1068]

All but $[267] a day

$[1068] (Part A deductible)

$[267] a day

$0

$0

$0

91st day and after:

—While using 60 lifetime reserve days

—Once lifetime reserve days are used: Additional 365 days

—Beyond the additional 365 days

All but $[534] a day

$0

$0

$[534] a day 100% of Medicare eligible expenses

$0

$0**

All costs

SKILLED NURSING FACILITY CARE*

You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital

First 20 days

All approved amounts

$0

$0

21st thru 100th day

101st day and after

All but $[133.50] a day

$0

Up to $[133.50] a day

$0

$0

All costs

BLOOD

First 3 pints

Additional amounts

$0 100%

3 pints

$0

$0

$0

HOSPICE CARE

You must meet Medicare's requirements, including a doctor's certification of terminal illness

All but very limited co- payment/coinsurance for out-patient drugs and

Medicare co- payment/ coinsurance

$0

inpatient respite care

** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN D

MEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR

• Once you have been billed $[135] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

MEDICAL EXPENSES— IN OR OUT OF THE HOSPITAL AND

OUTPATIENT HOSPITAL TREATMENT, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment,

First $[135] of Medicare Approved Amounts* Remainder of Medicare Approved Amounts

$0

Generally 80%

$0

Generally 20%

$[135] (Part B deductible)

$0

Part B Excess Charges (Above Medicare Approved Amounts)

$0

$0

All costs

BLOOD

First 3 pints

$0

All costs

$0

Next $[135] of Medicare Approved Amounts*

$0

$0

$[135] (Part B

Remainder of Medicare Approved Amounts

80%

20%

deductible)

$0

CLINICAL LABORATORY SERVICES—TESTS FOR DIAGNOSTIC SERVICES

100%

$0

$0

(continued)

PLAN D PARTS A & B

SERVICES

MEDICARE PAYS

PLAN

YOU PAY

HOME HEALTH CARE

MEDICARE APPROVED SERVICES

Medically necessary skilled care services and medical supplies

—Durable medical equipment

100%

$0 80%

$0 PAYS

$0 20%

$0

$[135] (Part B deductible)

$0

First $[135] of Medicare Approved Amounts*

Remainder of Medicare Approved Amounts

OTHER BENEFITS—NOT COVERED BY MEDICARE

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

FOREIGN TRAVEL—NOT COVERED BY MEDICARE

Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA

First $250 each calendar year

$0

$0

$250

Remainder of charges

$0

80% to a

20% and amounts

lifetime

over the $50,000

maximum

lifetime maximum

benefit of

$50,000

PLAN F or HIGH DEDUCTIBLE PLAN F

MEDICARE (PART A) - HOSPITAL SERVICES - PER BENEFIT PERIOD

• A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

[**This high deductible plan pays the same benefits as Plan F after you have paid a calendar year [$2180] deductible. Benefits from the high deductible plan F will not begin until out-of- pocket expenses are [$2180]. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan's separate foreign travel emergency deductible.]

SERVICES

MEDICARE PAYS

AFTER YOU PAY

$[2180] DEDUCTIBLE, PLAN PAYS

IN ADDITION TO

$[2180] DEDUCTIBLE, YOU PAY

HOSPITALIZATION*

Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

All but $[1260]

$[1260] (Part A deductible)

$0

$[315] a day

61st thru 90th day

All but $[315] a

day

$0

91st day and after:

• While using 60 lifetime reserve days

$[630] a day

$0

• Once lifetime reserve days are used:

• Additional 365 days

• Beyond the additional 365 days

All but $[630] a

day

$0

$0

100% of Medicare eligible expenses

$0

$0*** All costs

PLAN F or HIGH DEDUCTIBLE PLAN F

MEDICARE (PART A) - HOSPITAL SERVICES - PER BENEFIT PERIOD (cont.)

SERVICES

MEDICARE PAYS

[AFTER YOU PAY

$[2180] DEDUCTIBLE,**] PLAN PAYS

[IN ADDITION TO $[2180] DEDUCTIBLE,**] YOU PAY

SKILLED NURSING

All approved amounts All but $[157.50] a day

$0

FACILITY CARE*

You must meet Medicare's

requirements, including

having been in a hospital for

at least 3 days and entered a

Medicare- approved facility

within 30 days after leaving

the hospital

First 20 days

$0

$0

21st thru 100th day

Up to $[157.50] a day

$0

101st day and after

$0

All costs

BLOOD

First 3 pints Additional amounts

$0 100%

3 pints

$0

$0

$0

HOSPICE CARE

You must meet Medicare's

All but very limited co-

Medicare co-

$0

requirements, including a

payment/

payment/

doctor's certification of

coinsurance for out-

coinsurance

terminal illness

patient drugs and

inpatient respite care

*** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would havepaid.

PLAN F or HIGH DEDUCTIBLE PLAN F

MEDICARE (PART B) - MEDICAL SERVICES - PER CALENDAR YEAR

*Once you have been billed $[185] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

[**This high deductible plan pays the same benefits as Plan F after you have paid a calendar year [$2180] deductible. Benefits from the high deductible plan F will not begin until out-of-pocket expenses are [$2180]. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan's separate foreign travel emergency deductible.]

SERVICES

MEDICARE PAYS

[AFTER YOU PAY

$[2180] DEDUCTIBLE,*] PLAN PAYS

[IN ADDITION TO

$[2180] DEDUCTIBLE,**

] YOU PAY

MEDICAL EXPENSES IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT,

such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment

First $[147] of Medicare Approved amounts*

$0

$[147] (Part B deductible)

$0

Remainder of Medicare Approved Amounts

Generally 80%

Generally 20%

$0

Part B excess charges (Above Medicare Approved Amounts)

$0

100%

$0

BLOOD

First 3 pints

Next $[185] of Medicare Approved amounts*

Remainder of Medicare Approved amounts

$0

$0

80%

All costs

$[147](Part B Deductible)

20%

$0

$0

$0

CLINICAL LABORATORY SERVICES—-TESTS FOR DIAGNOSTIC SERVICES

100%

$0

$0

PLAN F or HIGH DEDUCTIBLE PLAN F PARTS A & B

SERVICES

MEDICARE PAYS

[AFTER YOU PAY

$[2180] DEDUCTIBLE,**] PLAN PAYS

[IN ADDITION TO

$[2180] DEDUCTIBLE,**] YOU PAY

HOME HEALTH CARE MEDICARE APPROVED SERVICES

$0

$[147] (Part B deductible)

20%

Medically necessary skilled care services and medical supplies

100%

$0

Durable medical equipment

-First $[147] of Medicare Approved Amounts*

$0

$0

-Remainder of Medicare

— Approved Amounts

80%

$0

PLAN F or HIGH DEDUCTIBLE PLAN F OTHER BENEFITS - NOT COVERED BY MEDICARE

SERVICES

MEDICARE PAYS

[AFTER YOU PAY

$[2180]

DEDUCTIBLE,**] PLAN PAYS

[IN ADDITION TO

$[2180] DEDUCTIBLE,**] YOU PAY

FOREIGN TRAVEL - NOT COVERED BY MEDICARE

Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA

First $250 each calendar year

$0

$0

$250

Remainder of charges

$0

80% to a

lifetime maximum benefit of

$50,000

20% and

amounts over the $50,000 lifetime maximum

PLAN G or HIGH DEDUCTIBLE PLAN G

MEDICARE (PART A) - HOSPITAL SERVICES - PER BENEFIT PERIOD

• A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

[**This high deductible plan pays the same benefits as Plan G after you have paid a calendar year [$2180] deductible. Benefits from the high deductible plan G will not begin until out-of- pocket expenses are [$2180]. Out-of-pocket expenses for this deductible include expenses for the Medicare Part B deductible, and expenses that would ordinarily be paid by the policy. This does not include the plan's separate foreign travel emergency deductible.]

SERVICES

MEDICARE PAYS

[AFTER YOU PAY

$[2180] DEDUCTIBLE,**] PLAN PAYS

[IN ADDITION TO

$[2180] DEDUCTIBLE,**] YOU PAY

HOSPITALIZATION*

Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

All but $[1288]

$[1288] (Part A deductible)

$0

61st thru 90th day

All but $[322] a day

$[322] a day

$0

91st day and after:

— While using 60 lifetime reserve days

All but $[644] a day

$[644] a day

$0

— Once lifetime reserve days are used:

—Additional 365 days

$0

100% of Medicare eligible expenses

$0***

—Beyond the additional 365 days

$0

$0

All costs

PLAN G or HIGH DEDUCTIBLE PLAN G

MEDICARE (PART A) - HOSPITAL SERVICES - PER BENEFIT PERIOD

SERVICES

MEDICARE PAYS

[AFTER YOU PAY

$[2180] DEDUCTIBLE,**]

PLAN PAYS

[IN ADDITION TO $[2180] DEDUCTIBLE,**] YOU PAY

SKILLED NURSING FACILITY CARE*

You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare- approved facility within 30 days after leaving the hospital

First 20 days

All approved amounts

$0

$0

21st thru 100th day

All but $[161] a day

Up to $[161] a day

$0

101st day and after

$0

$0

All costs

BLOOD

First 3 pints Additional amounts

$0 100%

3 pints

$0

$0

$0

HOSPICE CARE

You must meet

All but very limited

Medicare co-

$0

Medicare's requirements,

co-payment/

payment/coinsur

including a doctor's

coinsurance for out-

ance

certification of terminal

patient drugs and

illness.

inpatient respite care

*** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN G or HIGH DEDUCTIBLE PLAN G

MEDICARE (PART B) - MEDICAL SERVICES - PER CALENDAR YEAR

*Once you have been billed $[166] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

[**This high deductible plan pays the same benefits as Plan G after you have paid a calendar year [$2180] deductible. Benefits from the high deductible plan G will not begin until out-of-pocket expenses are [$2180]. Out-of-pocket expenses for this deductible include expenses for the Medicare Part B deductible, and expenses that would ordinarily be paid by the policy. This does not include the plan's separate foreign travel emergency deductible.]

SERVICES

MEDICARE PAYS

[AFTER YOU PAY

$[2180]

DEDUCTIBLE,**] PLAN PAYS

[IN ADDITION TO

$[2180]

DEDUCTIBLE,**] YOU PAY

MEDICAL EXPENSES

—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL

TREATMENT, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment

First $[166] of Medicare Approved Amounts*

$0

$0

$166 (Unless Part B deductible has been met)

Remainder of Medicare Approved Amounts

Generally 80%

Generally 20%

$0

Part B Excess charges

(Above Medicare Approved Amounts)

$0

100%

$0

PLAN G or HIGH DEDUCTIBLE PLAN G

MEDICARE (PART B) - MEDICAL SERVICES - PER CALENDAR YEAR

SERVICES

MEDICARE PAYS

[AFTER YOU PAY

$[2180] DEDUCTIBLE,* *] PLAN PAYS

[IN ADDITION TO

$[2180] DEDUCTIBLE,**] YOU PAY

BLOOD

First 3 pints

$0

All costs

$0

Next $[166] of Medicare Approved Amounts*

$0

$0

$166 (Unless Part B deductible has been met)

Remainder of Medicare Approved Amounts

80%

20%

$0

CLINICAL LABORATORY SERVICES—TESTS FOR DIAGNOSTIC SERVICES

100%

$0

$0

PLAN G or HIGH DEDUCTIBLE PLAN G PARTS A & B

SERVICES

MEDICARE PAYS

[AFTER YOU PAY

$[2180] DEDUCTIBLE,]** PLAN PAYS

[IN ADDITION TO

$[2180] DEDUCTIBLE,]** YOU PAY

HOME HEALTH CARE MEDICARE APPROVED SERVICES

Medically necessary skilled care services and medical supplies

100%

$0

$0

Durable medical equipment

• First $[166] of Medicare Approved Amounts*

$0

$0

$166 (Unless Part B deductible has been met)

• Remainder of Medicare Approved Amounts

80%

20%

$0

PLAN G or HIGH DEDUCTIBLE PLAN G

OTHER BENEFITS - NOT COVERED BY MEDICARE

SERVICES

MEDICARE PAYS

[AFTER YOU PAY

$[2180] DEDUCTIBLE,]** PLAN PAYS

[IN ADDITION TO

$[2180] DEDUCTIBLE,]** YOU PAY

FOREIGN TRAVEL - NOT COVERED BY MEDICARE

Medically necessary Emergency care services Beginning during the first 60 days of each

trip outside the USA

First $250 each calendar year

$0

$0

$250

Remainder of charges

$0

80% to a lifetime maximum benefit of

$50,000

20% and amounts over the $50,000 lifetime maximum

PLAN K

• You will pay half the cost-sharing of some covered services until you reach the annual out-of- pocket limit of $[4620] each calendar year. The amounts that count toward your annual limit are noted with diamonds (♦) in the chart below. Once you reach the annual limit, the plan pays 100% of your Medicare co-payment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called "Excess Charges") and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.

MEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD

** A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY*

HOSPITALIZATION**

Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

61st thru 90th day

All but $[1068]

All but $[267] a day

$[534](50% of Part A deductible)

$[267] a day

$[534](50% of Part A deductible)♦

$0

91st day and after:

—While using 60 lifetime reserve days

All but $[534] a day

$[534] a day

$0

—Once lifetime reserve days are used:

—Additional 365 days

—Beyond the additional 365 days

$0

$0

100% of Medicare eligible expenses

$0

$0*** All costs

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY*

SKILLED NURSING FACILITY CARE**

You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital

First 20 days

All approved amounts.

$0

$0

21st thru 100th day

All but $[133.50] a day

Up to $[66.75] a day (50% of Part A coinsurance)

Up to $[66.75] a day (50% of Part A coinsurance)♦

101st day and after

$0

$0

All costs

BLOOD

First 3 pints

Additional amounts

$0 100%

50%

$0

50%♦

$0

HOSPICE CARE

You must meet Medicare's requirements, including a doctor's certification of terminal illness.

All but very limited

co-payment/coinsurance for outpatient drugs and inpatient respite care

50% of co-payment/ coinsurance

50% of Medicare co- payment/coinsurance♦

*** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN K

MEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR

**** Once you have been billed $[135] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY*

MEDICAL EXPENSES—

IN OR OUT OF THE HOSPITAL AND OUTPATIENT

HOSPITAL TREATMENT, such as Physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment,

First $[135] of Medicare Approved Amounts**** Preventive Benefits for Medicare covered services

Remainder of Medicare Approved Amounts

$0

Generally 80% or more of Medicare approved amounts

Generally 80%

$0

Remainder of Medicare approved amounts

Generally 10%

$[135] (Part B deductible)**** ♦ All costs above Medicare approved amounts

Generally 10% ♦

Part B Excess Charges (Above Medicare Approved Amounts)

$0

$0

All costs (and they dnot count toward annual out-of-

lpimocikt eotf [$4620])*

BLOOD

First 3 pints

$0

50%

50%♦

Next $[135] of Medicare Approved Amounts****

$0

$0

$[135] (Part B deductible)**** ♦

Remainder of Medicare Approved Amounts

Generally 80%

Generally 10%

Generally 10% ♦

CLINICAL LABORATORY SERVICES—TESTS FOR DIAGNOSTIC SERVICES

100%

$0

$0

• This plan limits your annual out-of-pocket payments for Medicare-approved amounts to $[4620] per year. However, this limit does NOT include charges from your provider that exceed Medicare- approved amounts (these are called "Excess Charges") and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.

PLAN K PARTS A & B

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY*

HOME HEALTH CARE

MEDICARE APPROVED SERVICES

Medically necessary skilled care services and medical supplies

100%

$0

$0

Durable medical equipment

—First $[135] of Medicare Approved Amounts*****

$0

$0

$[135] (Part B deductible) ♦

—Remainder of Medicare Approved Amounts

80%

10%

10%♦

*****Medicare benefits are subject to change. Please consult the latest Guide to Health Insurance for People with Medicare.

PLAN L

• You will pay one-fourth of the cost-sharing of some covered services until you reach the annual out-of-pocket limit of $[2310] each calendar year. The amounts that count toward your annual limit are noted with diamonds (♦) in the chart below. Once you reach the annual limit, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called "Excess Charges") and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.

MEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD

** A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY*

HOSPITALIZATION**

Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

61st thru 90th day 91st day and after:

—While using 60 lifetime reserve days

All but $[1068]

All but $[267] a day All but $[534] a day

$[808.50] (75% of

Part A deductible)

$[267] a day

$[534] a day

$[267] (25% of Part A deductible)♦

$0

$0

Once lifetime reserve days are used:

—Additional 365 days

$0

100% of Medicare

$0***

eligible expenses

—Beyond the additional 365 days

$0

$0

All costs

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY*

SKILLED NURSING FACILITY CARE**

You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital

$0

Up to $[33.38] a day♦ (25% of Part A coinsurance♦)

All costs

First 20 days

All approved amounts

$0

21st thru 100th day

All but $[133.50] a day

Up to $[100.13] a

101st day and after

$0

day (75% of Part A

coinsurance)

$0

BLOOD

First 3 pints

Additional amounts

$0 100%

75%

$0

25%♦

$0

HOSPICE CARE

You must meet Medicare's requirements, including a doctor's certification of terminal illness.

All but very limited co- payment/

coinsurance for outpatient drugs and

inpatient respite care

75% of co-payment/ coinsurance

25% of co-payment/ coinsurance ♦

*** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN L

MEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR

**** Once you have been billed $[135] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY*

MEDICAL EXPENSES—

IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL

TREATMENT, such as Physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment,

$[135] (Part B deductible)**** ♦ All costs above Medicare approved amounts

Generally 5% ♦

First $[135] of Medicare Approved Amounts**** Preventive Benefits for Medicare covered services

Remainder of Medicare Approved Amounts

$0

Generally 80% or more of Medicare approved amounts

Generally 80%

$0

Remainder of Medicare approved amounts

Generally 15%

Part B Excess Charges (Above Medicare Approved Amounts)

$0

$0

All costs (and they do not count toward annual out-of-

lpimocikt eotf [$2310])*

BLOOD

First 3 pints

$0

75%

25%♦

Next $[135] of Medicare Approved Amounts****

$0

$0

$[135] (Part B deductible) ♦

Remainder of Medicare Approved Amounts

Generally 80%

Generally 15%

Generally 5%♦

CLINICAL LABORATORY SERVICES—TESTS FOR DIAGNOSTIC SERVICES

100%

$0

$0

• This plan limits your annual out-of-pocket payments for Medicare-approved amounts to $[2310] per year. However, this limit does NOT include charges from your provider that exceed Medicare- approved amounts (these are called "Excess Charges") and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.

PLAN L PARTS A & B

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY*

HOME HEALTH CARE

MEDICARE APPROVED SERVICES

Medically necessary skilled care services and medical supplies

100%

$0

$0

—Durable medical equipment

First $[135] of Medicare Approved Amounts***** Remainder of Medicare Approved Amounts

$0

80%

$0

15%

$[135] (Part B deductible) ♦

5% ♦

*****Medicare benefits are subject to change. Please consult the latest Guide to Health Insurance for People with Medicare.

PLAN M

MEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD

• A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

HOSPITALIZATION*

Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

61st thru 90th day 91st day and after:

All but $[1068]

All but $[267] a day All but $[534] a day

$[534](50% of Part A deductible)

$[267] a day

$[534] a day

$[534](50% of Part A deductible)

$0

$0

—While using 60 lifetime reserve days

—Once lifetime reserve days are used:

—Additional 365 days

—Beyond the additional 365 days

$0

$0

100% of Medicare eligible expenses

$0

$0**

All costs

SKILLED NURSING FACILITY CARE*

You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital

First 20 days

21st thru 100th day 101st day and after

All approved amounts All but $[133.50] a day

$0

$0

Up to $[133.50] a day

$0

$0

$0

All costs

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

BLOOD

First 3 pints

Additional amounts

$0 100%

3 pints

$0

$0

$0

HOSPICE CARE

Medicare co-

$0

You must meet Medicare's requirements, including a

All but very limited

doctor's certification of terminal illness

co-payment/

cpoaiynmsuernatn/ce

coinsurance for

outpatient drugs and

inpatient respite care

** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN M

MEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR

• Once you have been billed $[135] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

MEDICAL EXPENSES—

IN OR OUT OF THE HOSPITAL AND OUTPATIENT

HOSPITAL TREATMENT, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment

—First $[135] of Medicare Approved Amounts* Remainder of Medicare Approved Amounts

$0

Generally 80%

$0

Generally 20%

$[135] (Part B deductible)

$0

Part B Excess Charges (Above Medicare Approved Amounts)

$0

$0

All costs

BLOOD

First 3 pints

$0

All costs

$0

Next $[135] of Medicare Approved Amounts*

$0

$0

$[135] (Part B deductible)

Remainder of Medicare

Approved Amounts

80%

20%

$0

CLINICAL LABORATORY SERVICES—TESTS FOR DIAGNOSTIC SERVICES

100%

$0

$0

PARTS A & B

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

HOME HEALTH CARE

MEDICARE APPROVED SERVICES

Medically necessary skilled care services and medical supplies

100%

$0

$0

—Durable medical equipment

First $[135] of Medicare Approved Amounts*

$0

$0

$[135](Part B

Remainder of Medicare Approved Amounts

80%

20%

deductible)

$0

OTHER BENEFITS—NOT COVERED BY MEDICARE

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

FOREIGN TRAVEL—

NOT COVERED BY MEDICARE

Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA

First $250 each calendar year

$0

$0

$250

Remainder of Charges

$0

80% to a lifetime maximum benefit of

$50,000

20% and amounts

over the $50,000 lifetime maximum

PLAN N

MEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD

• A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

HOSPITALIZATION*

Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

All but $[1068]

$[1068](Part A deductible)

$0

61st thru 90th day

All but $[267] a day

$[267] a day

$0

91st day and after:

—While using 60 lifetime reserve days

All but $[534] a day

$[534] a day

$0

—Once lifetime reserve days are used:

—Additional 365 days

$0

100% of Medicare eligible expenses

$0**

—Beyond the additional 365

days

$0

$0

All costs

SKILLED NURSING FACILITY CARE*

You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital

First 20 days

21st thru 100th day

All approved amounts

All but $[133.50] a

day

$0

Up to $[133.50] a day

$0

$0

All costs

101st day and after

$0

$0

BLOOD

First 3 pints

Additional amounts

$0 100%

3 pints

$0

$0

$0

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

HOSPICE CARE

You must meet Medicare's requirements, including a doctor's certification of terminal illness

All but very limited co-payment/ coinsurance for outpatient drugs aAndaindpatient respite care

Medicare co- cpoaiynmsuernatn/ce

$0

** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

PLAN N

MEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR

• Once you have been billed $[135] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

MEDICAL EXPENSES— IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL

TREATMENT, such as physician's services, iannpdaotiuetnptatient medical and surgical services and spuhpypsilcieasl,and speech therapy, diagnostic tests, durable medical equipment

First $[135] of Medicare Approved Amounts*

$0

$0

$[135] (Part B deductible)

Remainder of Medicare Approved Amounts

Generally 80%

Balance, other than up to [$20] per office visit and up to [$50] per emergency room visit. The co- payment of up to [$50] is waived if the insured is admitted taony hospital and the emergency visit is covered as a Medicare Part A expense.

up to [$20] per office visit and up to [$50] per emergency room visit. The co-payment of up to [$50] is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.

Part B Excess Charges (Above Medicare Approved Amounts)

$0

$0

All costs

BLOOD

First 3 pints

$0

All costs

$0

Next $[135] of Medicare Approved Amounts*

$0

$0

$[135] (Part B deductible)

Remainder of Medicare

Approved Amounts

80%

20%

$0

CLINICAL LABORATORY SERVICES—TESTS FOR

DIAGNOSTIC SERVICES

100%

$0

$0

PLAN N PARTS A & B

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

HOME HEALTH CARE MEDICARE APPROVED SERVICES

Medically necessary skilled care services and medical supplies

—Durable medical equipment

100%

$0

$0

First $[135] of Medicare Approved Amounts*

$0

$0

$[135] (Part B deductible)

Remainder of Medicare

Approved Amounts

80%

20%

$0

OTHER BENEFITS—NOT COVERED BY MEDICARE

SERVICES

MEDICARE PAYS

PLAN PAYS

YOU PAY

FOREIGN TRAVEL— NOT COVERED BY MEDICARE

Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA

First $250 each calendar year

$0

$0

$250

Remainder of Charges

$0

80% to a lifetime maximum benefit of

$50,000

20% and amounts over the $50,000 lifetime

maximum

(e) Notice Regarding Policies or Certificates Which Are Not Medicare Supplement Policies.

(i) Any accident and sickness insurance policy or certificate, other than a Medicare supplement policy, a policy issued pursuant to a contract under Section 1876 of the Federal Social Security Act (42 U.S.C. § 1395 et seq.), disability income policy; or other policy identified in Section 3(b) of this regulation, issued for delivery in this state to persons eligible for Medicare shall notify insureds under the policy that the policy is not a Medicare supplement policy or certificate. The notice shall either be printed or attached to the first page of the outline of coverage delivered to insureds under the policy, or if no outline of coverage is delivered, to the first page of the policy, or certificate delivered to insureds. The notice shall be in no less than twelve (12) point type and shall contain the following language:

"THIS [POLICY OR CERTIFICATE] IS NOT A MEDICARE SUPPLEMENT [POLICY OR CONTRACT]. If

you are eligible for Medicare, review the Guide to Health Insurance for People with Medicare available from the company."

(ii) Applications provided to persons eligible for Medicare for the health insurance policies or certificates described in Subsection (d)(i) shall disclose, using the applicable statement in Appendix C, the extent to which the policy duplicates Medicare. The disclosure statement shall be provided as a part of, or together with, the application for the policy or certificate.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 18 Requirements for Application Forms and Replacement Coverage

(a) Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, Medicare Advantage, Medicaid coverage, or another health insurance policy or certificate in force or whether a Medicare supplement policy or certificate is intended to replace any other accident and sickness policy or certificate presently in force. A supplementary application or other form to be signed by the applicant and agent containing such questions and statements may be used.

[Statements]

(i) You do not need more than one Medicare supplement policy.

(ii) If you purchase this policy, you may want to evaluate your existing health coverage and decide if you need multiple coverages.

(iii) You may be eligible for benefits under Medicaid and may not need a Medicare supplement policy.

(iv) If, after purchasing this policy, you become eligible for Medicaid, the benefits and premiums under your Medicare supplement policy can be suspended, if requested, during your entitlement to benefits under Medicaid for 24 months. You must request this suspension within 90 days of becoming eligible for Medicaid. If you are no longer entitled to Medicaid, your suspended Medicare supplement policy (or, if that is no longer available, a substantially equivalent policy) will be reinstituted if requested within 90 days of

losing Medicaid eligibility. If the Medicare supplement policy provided coverage for outpatient prescription drugs and you enrolled in Medicare Part D while your policy was suspended, the reinstituted policy will not have outpatient prescription drug coverage, but will otherwise be substantially equivalent to your coverage before the date of the suspension.

(v) If you are eligible for, and have enrolled in a Medicare supplement policy by reason of disability and you later become covered by an employer or union-based group health plan, the benefits and premiums under your Medicare supplement policy can be suspended, if requested, while you are covered under the employer or union-based group health plan. If you suspend your Medicare supplement policy under these circumstances, and later lose your employer or union-based group health plan, your suspended Medicare supplement policy (or, if that is no longer available, a substantially equivalent policy) will be reinstituted if requested within 90 days of losing your employer or union-based group health plan. If the Medicare supplement policy provided coverage for outpatient prescription drugs and you enrolled in Medicare Part D while your policy was suspended, the reinstituted policy will not have outpatient prescription drug coverage, but will otherwise be substantially equivalent to your coverage before the date of the suspension.

(vi) Counseling services may be available in your state to provide advice concerning your purchase of Medicare supplement insurance and concerning medical assistance through the state Medicaid program, including benefits as a Qualified Medicare Beneficiary (QMB) and a Specified Low-Income Medicare Beneficiary (SLMB).

[Questions]

If you lost or are losing other health insurance coverage and received a notice from your prior insurer saying you were eligible for guaranteed issue of a Medicare supplement insurance policy, or that you had certain rights to buy such a policy, you may be guaranteed acceptance in one or more of our Medicare supplement plans. Please include a copy of the notice from your prior insurer with your application. PLEASE ANSWER ALL QUESTIONS.

[Please mark Yes or No below with an "X"] To the best of your knowledge,

(1) (a) Did you turn age 65 in the last 6 months?

Yes No

(b) Did you enroll in Medicare Part B in the last 6 months?

Yes No

(c) If yes, what is the effective date?

(2) Are you covered for medical assistance through the state Medicaid program?

[NOTE TO APPLICANT: If you are participating in a "Spend-Down Program" and have not met your "Share of Cost," please answer NO to this question.]

Yes No

If yes,

(a) Will Medicaid pay your premiums for this Medicare supplement policy?

Yes No

(b) Do you receive any benefits from Medicaid OTHER THAN payments toward your Medicare Part B premium?

Yes No

(3) (a) If you had coverage from any Medicare plan other than original Medicare within the past sixty-three (63) days (for example, a Medicare Advantage plan, or a Medicare HMO or PPO), fill in your start and end dates below. If you are still covered under this plan, leave "END" blank.

START / / END / /

(a) If you are still covered under the Medicare plan, do you intend to replace your current coverage with this new Medicare supplement policy?

Yes No

(b) Was this your first time in this type of Medicare plan?

Yes No

(c) Did you drop a Medicare supplement policy to enroll in the Medicare plan?

Yes No

(4) (a) Do you have another Medicare supplement policy in force?

Yes No

(b) If so, with what company, and what plan do you have [optional for Direct Mailers]?

(c) If so, do you intend to replace your current Medicare supplement policy with this policy?

Yes No

(5) Have you had coverage under any other health insurance within the past sixty-three (63) days? (For example, an employer, union, or individual plan)

Yes No

(a) If so, with what company and what kind of policy?

(b) What are your dates of coverage under the other policy?

START / / END / /

(If you are still covered under the other policy, leave "END" blank.)

B. Agents shall list any other health insurance policies they have sold to the applicant.

(1) List policies sold which are still in force.

(2) List policies sold in the past five (5) years that are no longer in force.

C. In the case of a direct response issuer, a copy of the application or supplemental form, signed by the applicant, and acknowledged by the insurer, shall be returned to the applicant by the insurer upon delivery of the policy.

D. Upon determining that a sale will involve replacement of Medicare supplement coverage, any issuer, other than a direct response issuer, or its agent, shall furnish the applicant, prior to issuance or delivery of the Medicare supplement policy or certificate, a notice regarding replacement of Medicare supplement coverage. One copy of the notice signed by the applicant and the agent, except where the coverage is sold without an agent, shall be provided to the applicant and an additional signed copy shall be retained by the issuer. A direct response issuer shall deliver to the applicant at the time of the issuance of the policy the notice regarding replacement of Medicare supplement coverage.

E. The notice required by Subsection D above for an issuer shall be provided in substantially the following form in no less than twelve (12) point type:

NOTICE TO APPLICANT REGARDING REPLACMENT OF MEDICARE SUPPLEMENT INSURANCE

OR MEDICARE ADVANTAGE

[Insurance company's name and address]

SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE FUTURE.

According to [your application] [information you have furnished], you intend to terminate existing Medicare supplement or Medicare Advantage insurance and replace it with a policy to be issued by [Company Name] Insurance Company. Your new policy will provide thirty (30) days within which you may decide without cost whether you desire to keep the policy.

You should review this new coverage carefully. Compare it with all accident and sickness coverage you now have. If, after due consideration, you find that purchase of this Medicare supplement coverage is a wise decision, you should terminate your present Medicare supplement or Medicare Advantage coverage. You should evaluate the need for other accident and sickness coverage you have that may duplicate this policy.

STATEMENT TO APPLICANT BY ISSUER, AGENT [BROKER OR OTHER REPRESENTATIVE]:

I have reviewed your current medical or health insurance coverage. To the best of my knowledge, this Medicare supplement policy will not duplicate your existing Medicare supplement or, if applicable, Medicare Advantage coverage because you intend to terminate your existing Medicare supplement coverage or leave your Medicare Advantage plan. The replacement policy is being purchased for the following reason (check one):

Additional benefits.

No change in benefits, but lower premiums.

Fewer benefits and lower premiums.

My plan has outpatient prescription drug coverage and I am enrolling in Part D.

Disenrollment from a Medicare Advantage plan. Please explain reason for disenrollment. [optional only for Direct Mailers. ]

Other. (please specify)

1. Note: If the issuer of the Medicare supplement policy being applied for does not, or is otherwise prohibited from imposing pre-existing condition limitations, please skip to statement 2 below. Health conditions that you may presently have (preexisting conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.

2. State law provides that your replacement policy or certificate may not contain new preexisting conditions, waiting periods, elimination periods or probationary periods. The insurer will waive any time periods applicable to preexisting conditions, waiting periods, elimination periods, or probationary periods in the new policy (or coverage) for similar benefits to the extent such time was spent (depleted) under the original policy.

3. If, you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical and health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, review it carefully to be certain that all information has been properly recorded. [If the policy or certificate is guaranteed issue, this paragraph need not appear.]

Do not cancel your present policy until you have received your new policy and are sure that you want to keep it.

(Signature of Agent, Broker or Other Representative)* [Typed Name and Address of Issuer, Agent or Broker]

(Applicant's Signature)

(Date)

*Signature not required for direct response sales.

F. Paragraphs 1 and 2 of the replacement notice (applicable to preexisting conditions) may be deleted by an issuer if the replacement does not involve application of a new preexisting condition limitation.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 19 Filing Requirements for Advertising

An issuer shall provide a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio or television medium to the Commissioner of Insurance of this state for review or approval by the commissioner to the extent it may be required under state law.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 20 Standards for Marketing

(a) An issuer, directly or through its producers, shall:

(i) Establish marketing procedures to assure that any comparison of policies by its agents or other producers will be fair and accurate.

(ii) Establish marketing procedures to assure excessive insurance is not sold

or issued.

(iii) Display prominently by type, stamp or other appropriate means, on the

first page of the policy the following:

"Notice to buyer: This policy may not cover all of your medical expenses."

(iv) Inquire and otherwise make every reasonable effort to identify whether a prospective applicant or enrollee for Medicare supplement insurance already has accident and sickness insurance and the types and amounts of any such insurance.

(v) Establish auditable procedures for verifying compliance with this Subsection (a).

(b) In addition to the practices prohibited in W. S. § 26-13-101, et seq., the following acts and practices are prohibited:

(i) Twisting. Knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert an insurance policy or to take out a policy of insurance with another insurer.

(ii) High pressure tactics. Employing any method of marketing having the effect of or tending to induce the purchase of insurance through force, fright, threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance.

(iii) Cold lead advertising. Making use directly or indirectly of any method of marketing which fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance agent or insurance company.

(c) The terms "Medicare Supplement," "Medigap," "Medicare Wrap- Around" and words of similar import shall not be used unless the policy is issued in compliance with this regulation.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 21 Appropriateness of Recommended Purchase and Excessive Insurance

(a) In recommending the purchase or replacement of any Medicare supplement policy or certificate an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement.

(b) Any sale of a Medicare supplement policy or certificate that will provide an individual more than one Medicare supplement policy or certificate is prohibited.

(c) An issuer shall not issue a Medicare supplement policy or certificate to an individual enrolled in Medicare Part C unless the effective date of the coverage is after the termination date of the individual's Part C coverage.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 22 Reporting of Multiple Policies

(a) On or before March 1 of each year, an issuer shall report the following information for every individual resident of this state for which the issuer has in force more than one Medicare supplement policy or certificate:

(i) Policy and certificate number; and

(ii) Date of issuance.

(b) The items set forth above must be grouped by individual policyholder.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 23 Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies or Certificates

(a) If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing issuer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods and probationary periods in the new Medicare supplement policy or certificate for similar benefits to the extent such time was spent under the original policy.

(b) If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate which has been in effect for at least ninety (90) days, the replacing policy shall not provide any time period applicable to preexisting conditions, waiting periods, elimination periods and probationary periods for benefits similar to those contained in the original policy or certificate.

History

• Effective 2025-06-04

Wyo. Code R. 044.0002.35.06042025 § 24 Prohibition Against Use of Genetic Information and Requests for Genetic Testing

This Section applies to all policies with policy years beginning on or after May 21, 2009.

(a) An issuer of a Medicare supplement policy or certificate:

(i) shall not deny or condition the issuance or effectiveness of the policy or certificate (including the imposition of any exclusion of benefits under the policy based on a pre-existing condition) on the basis of the genetic information with respect to such individual; and

(ii) shall not discriminate in the pricing of the policy or certificate (including the adjustment of premium rates) of an individual on the basis of the genetic information with respect to such individual.

(b) Nothing in Subsection (a) shall be construed to limit the ability of an issuer, to the extent otherwise permitted by law, from:

(i) Denying or conditioning the issuance or effectiveness of the policy or certificate or increasing the premium for a group based on the manifestation of a disease or disorder of an insured or applicant; or

(ii) Increasing the premium for any policy issued to an individual based on the manifestation of a disease or disorder of an individual who is covered under the policy (in such case, the manifestation of a disease or disorder in one individual cannot also be used as genetic information about other group members and to further increase the premium for the group).

(c) An issuer of a Medicare supplement policy or certificate shall not request or require an individual or a family member of such individual to undergo a genetic test.

(d) Subsection (c) shall not be construed to preclude an issuer of a Medicare supplement policy or certificate from obtaining and using the results of a genetic test in making a determination regarding payment (as defined for the purposes of applying the regulations promulgated under part C of title XI and section 264 of the Health Insurance Portability and Accountability Act of 1996, as may be revised from time to time) and consistent with Subsection (a).

(e) For purposes of carrying out Subsection (d), an issuer of a Medicare supplement policy or certificate may request only the minimum amount of information necessary to accomplish the intended purpose.

(f) Notwithstanding Subsection (c), an issuer of a Medicare supplement policy may request, but not require, that an individual or a family member of such individual undergo a genetic test if each of the following conditions is met:

(i) The request is made pursuant to research that complies with part 46 of title 45, Code of Federal Regulations, or equivalent Federal regulations, and any applicable State or local law or regulations for the protection of human subjects in research.

(ii) The issuer clearly indicates to each individual, or in the case of a minor child, to the legal guardian of such child, to whom the request is made that -

(A) compliance with the request is voluntary; and

(B) non-compliance will have no effect on enrollment status or premium or contribution amounts.

(iii) No genetic information collected or acquired under this Subsection shall be used for underwriting, determination of eligibility to enroll or maintain enrollment status, premium rates, or the issuance, renewal, or replacement of a policy or certificate.

(iv) The issuer notifies the Secretary in writing that the issuer is conducting activities pursuant to the exception provided for under this Subsection, including a description of the activities conducted.

(v) The issuer complies with such other conditions as the Secretary may by regulation require for activities conducted under this Subsection.

(g) An issuer of a Medicare supplement policy or certificate shall not request, require, or purchase genetic information for underwriting purposes.

(h) An issuer of a Medicare supplement policy or certificate shall not request, require, or purchase genetic information with respect to any individual prior to such individual's enrollment under the policy in connection with such enrollment.

(i) If an issuer of a Medicare supplement policy or certificate obtains genetic information incidental to the requesting, requiring, or purchasing of other information concerning any individual, such request, requirement, or purchase shall not be considered a violation of Subsection (h) if such request, requirement, or purchase is not in violation of Subsection (g).

(j) For the purposes of this Section only:

(i) "Issuer of a Medicare supplement policy or certificate" includes third- party administrator, or other person acting for or on behalf of such issuer.

(ii) "Family member" means, with respect to an individual, any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of such individual.

(iii) "Genetic information" means, with respect to any individual, information about such individual's genetic tests, the genetic tests of family members of such individual, and the manifestation of a disease or disorder in family members of such individual. Such term includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by such individual or any family member of such individual. Any reference to genetic information concerning an individual or family member of an individual who is a pregnant woman, includes genetic information of any fetus carried by such pregnant woman, or with respect to an individual or family member utilizing reproductive technology, includes genetic information of any embryo legally held by an individual or family member. The term "genetic information" does not include

information about the sex or age of any individual.

(iv) "Genetic services" means a genetic test, genetic counseling (including obtaining, interpreting, or assessing genetic information), or genetic education.

(v) "Genetic test" means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites that detect genotypes, mutations, or chromosomal changes. The term "genetic test" does not mean an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes; or an analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition that could reasonably be detected by a health care professional with appropriate training and expertise in the field of medicine involved.

(vi) "Underwriting purposes" means:

(A) rules for, or determination of, eligibility (including enrollment and continued eligibility) for benefits under the policy;

(B) the computation of premium or contribution amounts under the

policy; policy; and

(C) the application of any pre-existing condition exclusion under the

(D) other activities related to the creation, renewal, or replacement

of a contract of health insurance or health benefits.

APPENDIX A

MEDICARE SUPPLEMENT REFUND CALCULATION FORM FOR CALENDAR YEAR

TYPE1_______________________________________________SMSBP2

For the State of Company Name NAIC Group Code NAIC Company Code Address Person Completing Exhibit Title Telephone Number

Line

(a)

Earned Premium3

(b)

Incurred Claims4

Current Year's Experience

a. Total (all policy years)

b. Current year's issues5

c. Net (for reporting purposes =

Past Yea1ras-' 1Ebxperience (all policy years)

Total Experience

(Net Current Year + Past Year)

Refunds Last Year (Excluding Interest)

Previous Since Inception (Excluding Interest)

Refunds Since Inception (Excluding Interest)

Benchmark Ratio Since Inception (see worksheet for Ratio 1)

Experienced Ratio Since Inception (Ratio 2)

Total Actual Incurred Claims (line 3, col. b)

Total Earned Prem. (line 3, col. a)-Refunds Since Inception

(line 6)

Life Years Exposed Since Inception

If the Experienced Ratio is less than the Benchmark Ratio, and there are more than 500 life years exposure, then proceed to calculation of refund.

Tolerance Permitted (obtained from credibility table)

Medicare Supplement Credibility Table

Life Years Exposed

Since Inception Tolerance

10,000 +

0.0%

5,000 -9,999

5.0%

2,500 -4,999

7.5%

1,000 -2,499

10.0%

500 - 999

15.0%

If less than 500, no credibility.

1 Individual, Group, Individual Medicare Select, or Group Medicare Select Only.

2 "SMSBP" = Standardized Medicare Supplement Benefit Plan - Use "P" for pre-standardized plans.

3 Includes Modal Loadings and Fees Charged

4 Excludes Active Life Reserves

5 This is to be used as "Issue Year Earned Premium" for Year 1 of next year's "Worksheet for Calculation of Benchmark Ratios"

MEDICARE SUPPLEMENT REFUND CALCULATION FORM FOR CALENDAR YEAR

TYPE1_______________________________________________SMSBP2

For the State of Company Name NAIC Group Code NAIC Company Code Address Person Completing Exhibit Title Telephone Number

Adjustment to Incurred Claims for Credibility Ratio 3 = Ratio 2 + Tolerance

If Ratio 3 is more than Benchmark Ratio (Ratio 1), a refund or credit to premium is not required. If Ratio 3 is less than the Benchmark Ratio, then proceed.

Adjusted Incurred Claims

[Total Earned Premiums (line 3, col. a)-Refunds Since Inception (line 6)] x Ratio 3 (line 11)

Refund =

Total Earned Premiums (line 3, col. a)-Refunds Since Inception (line 6)

-[Adjusted Incurred Claims (line 12)/Benchmark Ratio (Ratio 1)]

If the amount on line 13 is less than .005 times the annualized premium in force as of December 31 of the reporting year, then no refund is made. Otherwise, the amount on line 13 is to be refunded or credited, and a description of the refund or credit against premiums to be used must be attached to this form.

I certify that the above information and calculations are true and accurate to the best of my knowledge and belief.

Signature

Name - Please Type

Title - Please Type

Date

REPORTING FORM FOR THE CALCULATION OF BENCHMARK RATIO SINCE INCEPTION FOR GROUP POLICIES FOR CALENDAR YEAR

TYPE¹ SMSBP²

For the State of Company Name NAIC Group Code NAIC Company Code Address Person Completing Exhibit Title Telephone Number

(a)³

(b)4

(c)

(d)

(e)

(f)

(g)

(h)

(i)

(j)

(o)5

Year

Earned Premium

Factor

(b)x(c)

Cumulative Loss Ratio

(d)x(e)

Factor

(b)x(g)

Cumulative Loss Ratio

(h)x(i)

Policy Year Loss Ratio

1

2.770

0.507

0.000

0.000

0.46

2

4.175

0.567

0.000

0.000

0.63

3

4.175

0.567

1.194

0.759

0.75

4

4.175

0.567

2.245

0.771

0.77

5

4.175

0.567

3.170

0.782

0.80

6

4.175

0.567

3.998

0.792

0.82

7

4.175

0.567

4.754

0.802

0.84

8

4.175

0.567

5.445

0.811

0.87

9

4.175

0.567

6.075

0.818

0.88

10

4.175

0.567

6.650

0.824

0.88

11

4.175

0.567

7.176

0.828

0.88

12

4.175

0.567

7.655

0.831

0.88

13

4.175

0.567

8.093

0.834

0.89

14

4.175

0.567

8.493

0.837

0.89

15+6

4.175

0.567

8.684

0.838

0.89

Total:

(k):

(l):

(m):

(n):

Benchmark Ratio Since Inception: (l + n)/(k + m):

1 Individual, Group, Individual Medicare Select, or Group Medicare Select Only.

2 "SMSBP" = Standardized Medicare Supplement Benefit Plan - Use "P" for pre-standardized plans

3 Year 1 is the current calendar year - 1. Year 2 is the current calendar year - 2 (etc.) (Example: If the current year is 1991, then: Year 1 is 1990; Year 2 is 1989, etc.)

4 For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.

5 These loss ratios are not explicitly used in computing the benchmark loss ratios. They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet. They are shown here for informational purposes only.

6 To include the earned premium for all years prior to as well as the 15th year prior to the current year.

REPORTING FORM FOR THE CALCULATION OF BENCHMARK RATIO SINCE INCEPTION FOR INDIVIDUAL POLICIES FOR CALENDAR YEAR

TYPE¹ SMSBP² For the State of Company Name NAIC Group Code NAIC Company Code Address Person Completing Exhibit Title Telephone Number

(a)³

(b)4

(c)

(d)

(e)

(f)

(g)

(h)

(i)

(j)

(o)5

Year

Earned Premium

Factor

(b)x(c)

Cumulative Loss Ratio

(d)x(e)

Factor

(b)x(g)

Cumulative Loss Ratio

(h)x(i)

Policy Year Loss Ratio

1

2.770

0.442

0.000

0.000

0.40

2

4.175

0.493

0.000

0.000

0.55

3

4.175

0.493

1.194

0.659

0.65

4

4.175

0.493

2.245

0.669

0.67

5

4.175

0.493

3.170

0.678

0.69

6

4.175

0.493

3.998

0.686

0.71

7

4.175

0.493

4.754

0.695

0.73

8

4.175

0.493

5.445

0.702

0.75

9

4.175

0.493

6.075

0.708

0.76

10

4.175

0.493

6.650

0.713

0.76

11

4.175

0.493

7.176

0.717

0.76

12

4.175

0.493

7.655

0.720

0.77

13

4.175

0.493

8.093

0.723

0.77

14

4.175

0.493

8.493

0.725

0.77

15+6

4.175

0.493

8.684

0.725

0.77

Total:

(k):

(l):

(m):

(n):

Benchmark Ratio Since Inception: (l + n)/(k + m):

1 Individual, Group, Individual Medicare Select, or Group Medicare Select Only.

2 "SMSBP" = Standardized Medicare Supplement Benefit Plan - Use "P" for pre-standardized plans

3 Year 1 is the current calendar year - 1. Year 2 is the current calendar year - 2 (etc.) (Example: If the current year is 1991, then: Year 1 is 1990; Year 2 is 1989, etc.)

4 For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.

5 These loss ratios are not explicitly used in computing the benchmark loss ratios. They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet. They are shown here for informational purposes only.

6 To include the earned premium for all years prior to as well as the 15th year prior to the current year.

APPENDIX B FORM FOR REPORTING

MEDICARE SUPPLEMENT POLICIES

Company Name:

Address:

Phone Number:

Due March 1, annually

The purpose of this form is to report the following information on each resident of this state who has in force more than one Medicare supplement policy or certificate. The information is to be grouped by individual policyholder.

Policy and Date of

Certificate # Issuance

Signature

Name and Title (please type)

Date

APPENDIX C DISCLOSURE STATEMENTS

Instructions for Use of the Disclosure Statements for Health

Insurance Policies Sold to Medicare Beneficiaries that Duplicate

Medicare

1. Section 1882 (d) of the federal Social Security Act [42 U.S.C. 1395ss] prohibits the sale of a health insurance policy (the term policy includes certificate) to Medicare beneficiaries that duplicates Medicare benefits unless it will pay benefits without regard to a beneficiary's other health coverage and it includes the prescribed disclosure statement on or together with the application for the policy.

2. All types of health insurance policies that duplicate Medicare shall include one of the attached disclosure statements, according to the particular policy type involved, on the application or together with the application. The disclosure statement may not vary from the attached statements in terms of language or format (type size, type proportional spacing, bold character, line spacing, and usage of boxes around text).

3. State and federal law prohibits insurers from selling a Medicare supplement policy to a person that already has a Medicare supplement policy except as a replacement policy.

4. Property/casualty and life insurance policies are not considered health insurance.

5. Disability income policies are not considered to provide benefits that duplicate Medicare.

6. Long-term care insurance policies that coordinate with Medicare and other health insurance are not considered to provide benefits that duplicate Medicare.

7. The federal law does not preempt state laws that are more stringent than the federal requirements.

8. The federal law does not preempt existing state form filing requirements.

9. Section 1882 of the federal Social Security Act was amended in Subsection (d)(3)(A) to allow for alternative disclosure statements. The disclosure statements already in Appendix C remain. Carriers may use either disclosure statement with the requisite insurance product. However, carriers should use either the original disclosure statements or the alternative disclosure statements and not use both simultaneously.

[Original disclosure statement for policies that provide benefits for expenses incurred for an accidental injury only.]

This is not Medicare Supplement Insurance

This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses that result from accidental injury. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when it pays:

 hospital or medical expenses up to the maximum stated in the policy

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items and services

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Original disclosure statement for policies that provide benefits for specified limited services.]

This is not Medicare Supplement Insurance

This insurance provides limited benefits, if you meet the policy conditions, for expenses relating to the specific services listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when:

 any of the services covered by the policy are also covered by Medicare

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items and services

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Original disclosure statement for policies that reimburse expenses incurred for specified diseases or other specified impairments. This includes expense-incurred cancer, specified disease and other types of health insurance policies that limit reimbursement to named medical conditions.]

This is not Medicare Supplement Insurance

This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses only when you are treated for one of the specific diseases or health conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when it pays:

 hospital or medical expenses up to the maximum stated in the policy

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 hospice

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items and services

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Original disclosure statement for policies that pay fixed dollar amounts for specified diseases or other specified impairments. This includes cancer, specified disease, and other health insurance policies that pay a scheduled benefit or specific payment based on diagnosis of the conditions named in the policy.]

This is not Medicare Supplement Insurance

This insurance pays a fixed amount, regardless of your expenses, if you meet the policy conditions, for one of the specific diseases or health conditions named in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits because Medicare generally pays for most of the expenses for the diagnosis and treatment of the specific conditions or diagnoses named in the policy.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 hospice

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items and services

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Original disclosure statement for indemnity policies and other policies that pay a fixed dollar amount per day, excluding long-term care policies.]

This is not Medicare Supplement Insurance

This insurance pays a fixed dollar amount, regardless of your expenses, for each day you meet the policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when:

 any expenses or services covered by the policy are also covered by Medicare

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 hospice

 other approved items and services

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Original disclosure statement for policies that provide benefits upon both an expense-incurred and fixed indemnity basis.]

This is not Medicare Supplement Insurance

This insurance pays limited reimbursement for expenses if you meet the conditions listed in the policy. It also pays a fixed amount, regardless of your expenses, if you meet other policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when:

 any expenses or services covered by the policy are also covered by Medicare; or

 it pays the fixed dollar amount stated in the policy and Medicare covers the same event

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 hospice care

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items & services

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Original disclosure statement for other health insurance policies not specifically identified in the preceding statements.]

This is not Medicare Supplement Insurance

This insurance provides limited benefits if you meet the conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when it pays:

 the benefits stated in the policy and coverage for the same event is provided by Medicare

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 hospice

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items and services

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for policies that provide benefits for expenses incurred for an accidental injury only.]

Some health care services paid for by Medicare may also trigger the payment of benefits from this policy.

This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses that result from accidental injury. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for policies that provide benefits for specified limited services.]

Some health care services paid for by Medicare may also trigger the payment of benefits under this policy.

This insurance provides limited benefits, if you meet the policy conditions, for expenses relating to the specific services listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for policies that reimburse expenses incurred for specified diseases or other specified impairments. This includes expense-incurred cancer, specified disease and other types of health insurance policies that limit reimbursement to named medical conditions.]

Some health care services paid for by Medicare may also trigger the payment of benefits from this policy. Medicare generally pays for most or all of these expenses.

This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses only when you are treated for one of the specific diseases or health conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 hospice

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for policies that pay fixed dollar amounts for specified diseases or other specified impairments. This includes cancer, specified disease, and other health insurance policies that pay a scheduled benefit or specific payment based on diagnosis of the conditions named in the policy.]

Some health care services paid for by Medicare may also trigger the payment of benefits from this policy.

This insurance pays a fixed amount, regardless of your expenses, if you meet the policy conditions, for one of the specific diseases or health conditions named in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 hospice

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for indemnity policies and other policies that pay a fixed dollar amount per day, excluding long-term care policies.]

Some health care services paid for by Medicare may also trigger the payment of benefits from this policy.

This insurance pays a fixed dollar amount, regardless of your expenses, for each day you meet the policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 hospice

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for policies that provide benefits upon both an expense- incurred and fixed indemnity basis.]

Some health care services paid for by Medicare may also trigger the payment of benefits from this policy.

This insurance pays limited reimbursement for expenses if you meet the conditions listed in the policy. It also pays a fixed amount, regardless of your expenses, if you meet other policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 hospice care

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items & services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for other health insurance policies not specifically identified in the preceding statements.]

Some health care services paid for by Medicare may also trigger the payment of benefits from this policy.

This insurance provides limited benefits if you meet the conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

 hospitalization

 physician services

 hospice

 [outpatient prescription drugs if you are enrolled in Medicare Part D]

 other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Check the coverage in all health insurance policies you already have.

For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

For help in understanding your health insurance, contact your state insurance department or your state [health] insurance [assistance] program [SHIP].

History

• Effective 2025-06-04

Chapter 37 Long-Term Care Regulation

Wyo. Code R. 044.0002.37.03112003 Long-Term Care Regulation

CHAPTER 37

LONG-TERM CARE REGULATION

Section 1. Purpose

The purpose of this regulation is to implement Chapter 38 of the Wyoming Insurance Code, to promote the public interest, to promote the availability of long-term care insurance coverage, to protect applicants for long-term care insurance, as defined, from unfair or deceptive sales or enrollment practices, to facilitate public understanding and comparison of long-term care insurance coverages, and to facilitate flexibility and innovation in the development of long-term care insurance.

Section 2. Authority

This regulation is issued pursuant to the authority vested in the Wyoming Insurance Commissioner under W.S. 26-2-110 and W.S. 26-38-101 through W.S. 26-38-106 of the Wyoming Insurance Code and W.S. 16-3-101, et seq., of the Wyoming Administrative Procedure Act.

Section 3. Applicability and Scope

Except as otherwise specifically provided, this regulation applies to all long-term care insurance policies delivered or issued for delivery in this state on or after the effective date hereof, by insurers; fraternal benefit societies; nonprofit health, hospital and medical service corporations; prepaid health plans, health maintenance organizations and all similar organizations.

Section 4. Definitions

For purposes of this regulation, the terms "long-term care insurance," "group long-term care insurance," "commissioner," "applicant," "policy" and "certificate" shall have the meanings set forth in W.S.26-38-103 of the Wyoming Insurance Code.

Section 5. Policy Definitions

No long-term care insurance policy delivered or issued for delivery in this state shall use the terms set forth below, unless the terms are defined in the policy and the definitions satisfy the following requirements:

(a) "Activities of daily living" means at least bathing, continence, dressing, eating, toileting and transferring.

(b) "Acute condition" means that the individual is medically unstable. Such an individual requires frequent monitoring by medical professionals, such as physicians and registered nurses, in order to maintain his or her health status.

(c) "Adult day care" means a program for six (6) or more individuals, of social and health- related services provided during the day in a community group setting for the purpose of supporting frail, impaired elderly or other disabled adults who can benefit from care in a group setting outside the home.

(d) "Bathing" means washing oneself by sponge bath; or in either a tub or shower, including the task of getting into or out of the tub or shower.

(e) "Cognitive impairment" means a deficiency in a persons's short or long-term memory, orientation as to persons, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness.

(f) "Continence" means the ability to maintain control of bowel and bladder function; or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag) .

(g) "Dressing" means putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs.

(h) "Eating" means feeding oneself by getting food into the body from a receptacle (such as plate, cup or table) or by a feeding tube or intravenously.

(i) "Hands-on assistance" means physical assistance (minimal, moderate or maximal) without which the individual would not be able to perform the activity of daily living.

(j) "Home health care services" means medical and nonmedical services, provided to ill, disabled or infirm persons in their residences. Such services may include homemaker services, assistance with activities of daily living and respite care services.

(k) "Medicare" shall be defined as "The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then Constituted or Later Amended," or "Title I, Part I of Public Law 89-97, as Enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof," or words of similar import.

(l) "Mental or nervous disorder" shall not be defined to include more than neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder.

(m) "Personal care" means the provision of hands-on services to assist an individual with activities of daily living.

(n) "Skilled nursing care," "intermediate care," "personal care," "home care," and other services shall be defined in relation to the level of skill required, the nature of the care and the setting in which care must be delivered.

(o) "Toileting" means getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.

(p) "Transferring" means moving into or out of a bed or wheelchair.

(q) All providers of services, including but not limited to "nursing care facility," "skilled nursing facility," "extended care facility," "intermediate care facility," "convalescent nursing home," "personal care facility," and "home care agency" shall be defined in relation to the services and facilities required to be available and the licensure or degree status of those providing or supervising the services. The definition may require that the provider be appropriately licensed or certified.

Section 6. Policy Practices and Provisions

(a) Renewability. The terms "guaranteed renewable" and "noncancellable" shall not be used in any individual long-term care insurance policy without further explanatory language in accordance with the disclosure requirements of Section 7 of this regulation.

(i) No such policy issued to an individual shall contain renewal provisions less favorable to the insured than "guaranteed renewable." However, the Commissioner may authorize nonrenewal on a statewide basis, on terms and conditions deemed necessary by the Commissioner, to best protect the interests of the insureds, if the insurer demonstrates:

(A) That renewal will jeopardize the insurer's solvency: or

(B) That:

(I) The actual paid claims and expenses have substantially exceeded the premium and investment income associated with the policies; and

(II) The policies will continue to experience substantial and unexpected losses over their lifetime; and

(III) The projected loss experience of the policies cannot be significantly improved or mitigated through reasonable rate adjustments or other reasonable methods; and

(IV) The insurer has made repeated and good faith attempts to stabilize loss experience of the policies, including the timely filing for rate adjustments.

(ii) The term "guaranteed renewable" may be used only when the insured has the right to continue the long-term care insurance in force by the timely payment of premiums and when the insurer has no unilateral right to make any change in any provision of the policy or rider while the insurance is in force, and cannot decline to renew, except that rates may be revised by the insurer on a class basis.

(iii) The term "noncancellable" may be used only when the insured has the right to continue the long-term care insurance in force by the timely payment of premiums during which period the insurer has no right to unilaterally make any change in any provision of the insurance or in the premium rate.

(b) Limitations and Exclusions. No policy may be delivered or issued for delivery in this state as long-term care insurance if such policy limits or excludes coverage by type of illness, treatment, medical condition or accident, except as follows:

(i) Preexisting conditions or diseases;

(ii) Mental or nervous disorders; however, this shall not permit exclusion or limitation of benefits on the basis of Alzheimer's Disease;

(iii) Alcoholism and drug addiction;

(iv) Illness, treatment or medical condition arising out of:

(A) War or act of war (whether declared or undeclared);

(B) Participation in a felony, riot or insurrection;

(C) Service in the armed forces or units auxiliary thereto;

(D) Suicide (sane or insane), attempted suicide or intentionally self-inflicted injury; or

(E) Aviation (this exclusion applies only to non-fare-paying passengers).

(v) Treatment provided in a government facility (unless otherwise required by law), services for which benefits are available under Medicare or other governmental program (except Medicaid), any state or federal workers' compensation, employer's liability or occupational disease law, or any motor vehicle no-fault law, services provided by a member of the covered person's immediate family and services for which no charge is normally made in the absence of insurance.

(vi) Payment for services provided outside the United States.

(c) Extension of Benefits. Termination of long-term care insurance shall be without prejudice to any benefits payable for institutionalization if such institutionalization began while the long-term care insurance was in force and continues without interruption after termination. Such extension of benefits beyond the period the long-term care insurance was in force may be limited to the duration of the benefit period, if any, or to payment of the maximum benefits and may be subject to any policy waiting period, and all other applicable provisions of the policy.

Section 7. Required Disclosure Provisions

(a) Renewability. Individual long-term care insurance policies shall contain a renewability provision. Such provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state the duration, where limited, of renewability and the duration of the term of coverage for which the policy is issued and for which it may be renewed.

(b) Riders and endorsements. Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured under an individual long-term care insurance policy, all riders or endorsements added to an individual long-term care insurance policy after date of issue or at reinstatement or renewal which reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the individual insured. After the date of policy issue, any rider or endorsement which increases benefits or coverage with a concomitant increase in premium during the policy term must be agreed to in writing signed by the insured, except if the increased benefits or coverage are required by law. Where a separate additional premium is charged for benefits provided in connection with riders or endorsements, such premium charge shall be set forth in the policy, rider or endorsement.

(c) Payment of benefits. A long-term care insurance policy which provides for the payment of benefits based on standards described as "usual and customary," "reasonable and customary" or words of similar import shall include a definition of such terms and an explanation of such terms in its accompanying outline of coverage.

(d) Limitations. If a long-term care insurance policy or certificate contains any limitations with respect to preexisting conditions, such limitations shall appear as a separate paragraph of the policy or certificate and shall be labeled as "Preexisting Condition Limitations."

(e) Other limitations or conditions on eligibility for benefits. A long-term care insurance policy or certificate containing any limitations or conditions for eligibility shall set forth a description of such limitations or conditions, including any required number of days of confinement, in a separate paragraph of the policy or certificate and shall label such paragraph "Limitations or Conditions on Eligibility for Benefits."

(f) Disclosure of Tax Consequences. With regard to life insurance policies that provide an accelerated benefit for long-term care, a disclosure statement is required at the time of application for the policy or rider and at the time the accelerated benefit payment request is submitted, that receipt of these 37-5 accelerated benefits may be taxable, and that assistance should be sought from a personal tax advisor. The disclosure statement shall be prominently displayed on the first page of the policy rider and any other related documents. This subsection shall not apply to qualified long-term care insurance contracts.

(g) Benefit Triggers. Activities of daily living and cognitive impairment shall be used to measure an insured's need for long-term care and shall be described in the policy or certificate in a separate paragraph and shall be labeled "Eligibility for the Payment of Benefits." Any additional benefit triggers shall also be explained in this section. If these triggers differ for different benefits, explanation of the trigger shall accompany each benefit description. If an attending physician or other specified person must certify a certain level of functional dependency in order to be eligible for benefits, this, too, shall be specified.

(h) A qualified long-term care insurance contract shall include a disclosure statement in the policy and in the outline of coverage as contained in section 19(e) that the policy is intended to be a qualified long-term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986, as amended.

(i) A nonqualified long-term care insurance contract shall include a disclosure statement in the policy and in the outline of coverage as contained in section 19(e) that the policy is not intended to be qualified long-term care insurance contract.

Section 8. Prohibition Against Post-Claims Underwriting

(a) All applications for long-term care insurance policies or certificates except those which are guaranteed issue shall contain clear and unambiguous questions designed to ascertain the health condition of the applicant.

(b) (i) If an application for long-term care insurance contains a question which asks whether the applicant has had medication prescribed by a physician, it must also ask the applicant to list the medication that has been prescribed.

(ii) If the medications listed in such application were known by the insurer, or should have been known at the time of application, to be directly related to a medical condition for which coverage would otherwise be denied, then the policy or certificate shall not be rescinded for that condition.

(c) Except for policies or certificates which are guaranteed issue:

(i) The following language shall be set out conspicuously and in close conjunction with the applicant's signature block on an application for a long-term care insurance policy or certificate: Caution: If your answers on this application are incorrect or untrue, [company] has the right to deny benefits or rescind your policy.

(ii) The following language, or language substantially similar to the following, shall be set out conspicuously on the long-term care insurance policy or certificate at the time of delivery:

Caution: The issuance of this long-term care insurance [policy] [certificate] is based upon your responses to the questions on your application. A copy of your [application] [enrollment form] [is enclosed] [was retained by you when you applied]. If your answers are incorrect or untrue, the company has the right to deny benefits or rescind your policy. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of your answers are incorrect, contact the company at this address: [insert address]

(iii) Prior to issuance of a long-term care policy or certificate to an applicant age eighty (80) or older, the insurer shall obtain one of the following:

(A) A report of a physical examination;

(B) An assessment of functional capacity;

(C) An attending physician's statement; or

(D) Copies of medical records.

(d) A copy of the completed application or enrollment form (whichever is applicable) shall be delivered to the insured no later than at the time of delivery of the policy or certificate unless it was retained by the applicant at the time of application.

(e) Every insurer or other entity selling or issuing long-term care insurance benefits shall maintain a record of all policy or certificate rescissions, both state and countrywide, except those which the insured voluntarily effectuated and shall annually furnish this information to the Insurance Commissioner in the format prescribed by the National Association of Insurance Commissioners in Appendix A.

Section 9. Minimum Standards for Home Health Care Benefits in Long-Term Care Insurance Policies

(a) A long-term care insurance policy or certificate may not, if it provides benefits for home health care services, limit or exclude benefits:

(i) By requiring that the insured/claimant would need skilled care in a skilled nursing facility if home health care services were not provided;

(ii) By requiring that the insured/claimant first or simultaneously receive nursing and/or therapeutic services in a home or community setting before home health care services are covered;

(iii) By limiting eligible services to services provided by registered nurses or licensed practical nurses;

(iv) By requiring that a nurse or therapist provide services covered by the policy that can be provided by a home health aide, or other licensed or certified home care worker acting within the scope of his or her licensure or certification.

(v) By requiring that the insured/claimant have an acute condition before home health care services are covered.

(vi) By limiting benefits to services provided by Medicare-certified agencies or providers.

(b) Home health care coverage may be applied to the non-home health care benefits provided in the policy or certificate when determining maximum coverage under the terms of the policy or certificate.

Section 10. Requirement to Offer Inflation Protection

(a) No insurer may offer a long-term care insurance policy unless the insurer also offers to the policyholder the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations which are meaningful to account for reasonably anticipated increases in the costs of long-term care services covered by the policy. Insurers must offer to each policyholder, at the time of purchase, the option to purchase a policy with an inflation protection feature no less favorable than one of the following:

(i) Increases benefit levels annually [in a manner so that the increases are compounded annually];

(ii) Guarantees the insured individual the right to periodically increase benefit levels without providing evidence of insurability or health status so long as the option for the previous period has not been declined; or

(iii) Covers a specified percentage of actual or reasonable charges.

(b) Where the policy is issued to a group, the required offer in subsection (a) above shall be made to the group policyholder; except, if the policy is issued to a group defined in W.S. 26-38-103(D) other than to a continuing care retirement community, the offering shall be made to each proposed certificate holder.

(c) The offer in subsection (a) above shall not be required of expense incurred long-term care insurance policies.

(d) Insurers shall include the following information in or with the outline of coverage:

(i) A graphic comparison of the benefit levels of a policy that increases benefits over the policy period with a policy that does not increase benefits. The graphic comparison shall show benefit levels over at least a twenty (20) year period.

(ii) Any expected premium increases or additional premiums to pay for automatic or optional benefit increases. If premium increases or additional premiums will be based on the attained age of the applicant at the time of the increase, the insurer shall also disclose the magnitude of the potential premiums the applicant would need to pay at ages 75 and 85 for benefit increases. An insurer may use a reasonable hypothetical, or a graphic demonstration, for the purposes of this disclosure.

Section 11. Requirements for Replacement

(a) Question concerning replacement. Individual and direct response solicited long-term care insurance application forms shall include a question designed to elicit information as to whether the proposed insurance policy is intended to replace any other accident and sickness or long-term care insurance policy presently in force. A supplementary application or other form to be signed by the applicant containing such a question may be used.

(b) Solicitations other than direct response. Upon determining that a sale will involve replacement, an insurer; other than an insurer using direct response solicitation methods, or its agent; shall furnish the applicant, prior to issuance or delivery of the individual long-term care insurance policy, a notice regarding replacement of accident and sickness or long-term care coverage. One copy of such notice shall be retained by the applicant and an additional copy signed by the applicant shall be retained by the insurer. The required notice shall be provided in the following manner:

NOTICE TO APPLICANT REGARDING REPLACEMENT OF INDIVIDUAL ACCIDENT AND SICKNESS OR LONG-TERM CARE INSURANCE

According to [your application] [information you have furnished], you intend to lapse or otherwise terminate existing accident and sickness or long-term care insurance and replace it with an individual long-term care insurance policy to be issued by [company name] Insurance Company. Your new policy provides thirty (30) days within which you may decide, without cost, whether you desire to keep the policy. For your own information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.

1.  Health conditions which you may presently have (preexisting conditions), may not be immediately or fully covered under the new policy. This could result in denial or delay in payment of benefits under the   new policy, whereas a similar claim might have been payable under your present policy.

2.  You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interest to make sure   you understand all the relevant factors involved in replacing your present coverage.

3.  If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your   medical health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, reread it carefully to be certain that all information has been properly recorded.

The above "Notice to Applicant" was delivered to me on

---

(Date)

---

(Applicant's Signature)

(c) Direct response solicitations. Insurers using direct response solicitation methods shall deliver notice regarding replacement of accident and sickness or long-term care coverage to the applicant upon issuance of the policy. The required notice shall be provided in the following manner.

NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND SICKNESS OR LONG-TERM CARE INSURANCE

According to [your application] [information you have furnished], you intend to lapse or otherwise terminate existing accident and sickness or long-term care insurance and replace it with the long-term care insurance policy delivered herewith issued by [company name] Insurance Company. Your new policy provides thirty (30) days within which you may decide, without cost, whether you desire to keep the policy. For your own information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.

1.  Health conditions which you may presently have (preexisting conditions), may not be immediately or fully covered under the new policy. This could result in denial or delay in payment of benefits under the new policy, whereas a similar claim might have been payable under your present policy.

2.  You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interest to make sure you understand all the relevant factors involved in replacing your present coverage.

3.  [To be included only if the application is attached to the policy.] If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, read the copy of the application attached to your new policy and be sure that all questions are answered fully and correctly. Omissions or misstatements in the application could cause an otherwise valid claim to be denied. Carefully check the application and write to [company name and address] within thirty (30) days if any information is not correct and complete, or if any past medical history has been left out of the application.

---

(Company Name)

Section 12. Discretionary Powers of Commissioner

The Commissioner may, upon written request and after an administrative hearing, issue an order to modify or suspend a specific provision or provisions of this regulation with respect to a specific long-term care insurance policy or certificate upon a written finding that:

(a) The modification or suspension would be in the best interest of the insureds; and

(b) The purposes to be achieved could not be effectively or efficiently achieved without the modification or suspension; and

(c) (i) The modification or suspension is necessary to the development of an innovative and reasonable approach for insuring long-term care; or

(ii) The policy or certificate is to be issued to residents of a life care or continuing care retirement community or some other residential community for the elderly and the modification or suspension is reasonably related to the special needs or nature of such a community; or

(iii) The modification or suspension is necessary to permit long-term care insurance to be sold as part of, or in conjunction with, another insurance product.

Section 13. Loss Ratio

Benefits under individual long-term care insurance policies shall be deemed reasonable in relation to premiums provided the expected loss ratio is at least sixty percent, calculated in a manner which provides for adequate reserving of the long-term care insurance risk. In evaluating the expected loss ratio, due consideration shall be given to all relevant factors, including:

(a) Statistical credibility of incurred claims experience and earned premiums;

(b) The period for which rates are computed to provide coverage;

(c) Experienced and projected trends;

(d) Concentration of experience within early policy duration;

(e) Expected claim fluctuation;

(f) Experience refunds, adjustments or dividends;

(g) Renewability features;

(h) All appropriate expense factors;

(i) Interest;

(j) Experimental nature of the coverage;

(k) Policy reserves;

(l) Mix of business by risk classification; and

(m) Product features such as long elimination periods, high deductibles and high maximum limits.

Section 14. Filing Requirement

Prior to an insurer or similar organization offering group long-term care insurance to a resident of this state pursuant to W.S. 26-38-104, it shall file with the Commissioner evidence that the group policy or certificate thereunder has been approved by a state having statutory or regulatory long-term care insurance requirements substantially similar to those adopted in this state.

Section 15. Filing Requirements for Advertising

(a) Every insurer, health care service plan or other entity providing long-term care insurance or benefits in this state, shall provide a copy of any long-term care insurance advertisement intended for use in this state, whether through written, radio, television or Internet medium to the Commissioner of Insurance for review and approval by the Commissioner. In addition, all advertisements shall be retained by the insurer, health care service plan or other entity for at least three (3) years from the date the advertisement was first used.

(b) The Commissioner may exempt from these requirements any advertising form or material when, in the Commissioner's opinion, this requirement may not be reasonably applied.

Section 16. Nonforfeiture Benefit Requirement

(a) This section does not apply to life insurance policies or riders containing accelerated long- term care benefits.

(b) To comply with the requirement to offer a nonforfeiture benefit pursuant to W.S. 26-38- 109:

(i) A policy or certificate offered with nonforfeiture benefits shall have coverage elements, eligibility, benefit triggers and benefit length that are the same as coverage to be issued without nonforfeiture benefits. The nonforfeiture benefit included in the offer shall be the benefit described in subsection (e); and

(ii) The offer shall be in writing if the nonforfeiture benefit is not otherwise described in the Outline of Coverage or other materials given to the prospective policyholder.

(c) If the offer required to be made under W.S. 26-38-109 is rejected, the insurer shall provide the contingent benefit upon lapse as described in this section.

(d) (i) After rejection of the offer required under W.S. 26-38-109, for individual and group policies without nonforfeiture benefits issued after the effective date of this section, the insurer shall provide a contingent benefit upon lapse.

(ii) In the event a group policyholder elects to make the nonforfeiture benefit an option to the certificateholder, a certificate shall provide either the nonforfeiture benefit or the contingent benefit upon lapse.

(iii) The contingent benefit upon lapse shall be triggered every time an insurer increases the premium rate to a level which results in a cumulative increase of the annual premium equal to or exceeding the percentage of the insured's initial annual premium set forth below, based on the insured's issue age, and the policy certificate lapses within 120 days of the due date of the premium so increased. Unless otherwise required, policyholders shall be notified at least thirty (30) days prior to the due date of the premium reflecting the rate increase.

Triggers for a Substantial Premium Increase

| Issues Age | Percent Increase Over Intial Premium | | --- | --- | | 19 an under | 200% | | 30-34 | 190% | | 35-39 | 170% | | 40-44 | 150% | | 45-49 | 130% | | 50-54 | 110% | | 55-59 | 90% | | 60 | 70% | | 61 | 66% | | 62 | 62% | | 63 | 58% | | 64 | 54% | | 65 | 50% | | 66 | 48% | | 67 | 46% | | 68 | 44% | | 69 | 42% | | 70 | 40% | | 71 | 38% | | 72 | 36% | | 73 | 34% | | 74 | 32% | | 75 | 30% | | 76 | 28% | | 77 | 26% | | 78 | 24% | | 79 | 22% | | 80 | 20% | | 81 | 19% | | 82 | 18% | | 83 | 17% | | 84 | 16% | | 85 | 15% | | 86 | 14% | | 87 | 13% | | 88 | 12% | | 89 | 11% | | 90 and over | 10% |

(iv) On or before the effective date of a substantial premium increase as defined in paragraph (iii) above, the insurer shall:

(A) Offer to reduce policy benefits provided by the current coverage without the requirement of additional underwriting so that required premium payments are not increased;

(B) Offer to convert the coverage to a paid-up status with a shortened benefit period in accordance with the terms of subsection (e). This option may be elected at any time during the 120-day period referenced in subsection (d)(iii); and

(C) Notify the policyholder or certificateholder that a default or lapse at any time during the 120-day period referenced in subsection (d)(iii) shall be deemed to be the election of the offer to convert in subparagraph (B) above.

(e) Benefits continued as nonforfeiture benefits, including contingent benefits upon lapse, are described in this subsection:

(i) For purposes of this subsection, attained age rating is defined as a schedule of premiums starting from the issue date which increases age at least one percent per year prior to age fifty (50), and at least three percent (3%) per year beyond age fifty (50).

(ii) For purposes of this subsection, the nonforfeiture benefit shall be of a shortened benefit period providing paid-up long-term care insurance coverage after lapse. The same benefits (amounts and frequency in effect at the time of lapse, but not increased thereafter) will be payable for a qualifying claim, but the lifetime maximum dollars or days of benefits shall be determined as specified in paragraph (iii) below.

(iii) The standard nonforfeiture credit will be equal to 100 percent of the sum of all premiums paid, including the premiums paid prior to any changes in benefits. The insurer may offer additional shortened benefit period options, as long as the benefits for each duration equal or exceed the standard nonforfeiture credit for that duration. However, the minimum nonforfeiture credit shall not be less than thirty (30) times the daily nursing home benefit at the time of lapse. In either event, the calculation of the nonforfeiture credit is subject to the limitation in subsection (f).

(iv) (A) The nonforfeiture benefit shall begin not later than the end of the third year following the policy or certificate issue date. The contingent benefit upon lapse shall be effective during the first three (3) years as well as thereafter.

(B) Notwithstanding subparagraph (A), for a policy or certificate with attained age rating, the nonforfeiture benefit shall begin on the earlier of:

(I) The end of the tenth year following the policy or certificate issue date; or

(II) The end of the second year following the date the policy or certificate is no longer subject to the attained age rating.

(v) Nonforfeiture credits may be used for all care and services qualifying for benefits under the terms of the policy or certificate, up to the limits specified in the policy or certificate.

(f) All benefits paid by the insurer while the policy or certificate is in premium paying status and in the paid-up status, will not exceed the maximum benefits which would be payable if the policy or certificate had remained in premium paying status.

(g) There shall be no difference in the minimum nonforfeiture benefits as required under this section for group and individual policies.

(h) The requirements set forth in this section shall become effective twelve (12) months after adoption of this provision and shall apply as follows:

(i) Except as provided in paragraph (ii) below, the provisions of this section apply to any long-term care policy issued in this state on or after the effective date of this amended regulation.

(ii) For certificates issued on or after the effective date of this section, under a group long-term care insurance policy as defined in W.S. 26-38-103(a)(v), which policy was in force at the time this amended regulation became effective, the provisions of this section shall not apply.

(i) Premium charged for a policy or certificate containing nonforfeiture benefits or a contingent benefit upon lapse shall be subject to the loss ratio requirements of Section 13, treating the policy as a whole.

(j) To determine whether contingent nonforfeiture upon lapse provisions are triggered under subsection (d)(iii), a replacing insurer that purchased or otherwise assumed a block or blocks of long-term care insurance policies from another insurer shall calculate the percentage increase based upon the initial annual premium paid by the insured when the policy was first purchased from the original insurer.

(k) A nonforfeiture benefit for qualified long-term care insurance contracts, that are level premium contracts, shall be offered that meet the following requirements:

(i) The nonforfeiture provisions shall be appropriately captioned;

(ii) The nonforfeiture provision shall provide a benefit available in the event of default in the payment of any premiums and shall state that the amount of the benefit may be adjusted to being initially granted only as necessary to reflect changes in claims, persistency and interest as reflected in changes in rates for premium paying contracts approved by the Commissioner for the same contract form; and

(iii) The nonforfeiture provision shall provide at least one of the following:

(A) Reduced paid-up insurance;

(B) Extended term insurance;

(C) Shortened benefit period; or

(D) Other similar offerings approved by the Commissioner.

Section 17. Standards for Benefit Triggers

(a) A long-term care insurance policy shall condition the payment of benefits on a determination of the insured's ability to perform activities of daily living and on cognitive impairment. Eligibility for the payment of benefits shall not be more restrictive than requiring either a deficiency in the ability to perform not more than three (3) of the activities of daily living or the presence of cognitive impairment.

(b) (i) Activities of daily living shall include at least the following as defined in Section 5 and in the policy:

(A) Bathing;

(B) Continence;

(C) Dressing;

(D) Eating;

(E) Toileting; and

(F) Transferring.

(ii) Insurers may use activities of daily living to trigger covered benefits in addition to those contained in paragraph (i) as long as they are defined in the policy.

(c) An insurer may use additional provisions for the determination of when benefits are payable under a policy or certificate; however, the provisions shall not restrict, and are not in lieu of, the requirements contained in subsections (a) and (b).

(d) For purposes of this section, the determination of a deficiency shall not be more restrictive than:

(i) Requiring the hands-on assistance of another person to perform the prescribed activities of daily living; or

(ii) If the deficiency is due to the presence of a cognitive impairment, supervision or verbal cueing by another person is needed in order to protect the insured or others.

(e) Assessments of activities of daily living and cognitive impairment shall be performed by licensed or certified professionals, such as physicians, nurses or social workers.

(f) Long-term care insurance policies shall include a clear description of the process for appealing and resolving benefit determinations.

(g) The requirements set forth in this section shall be effective twelve (12) months after adoption of this provision and shall apply as follows:

(i) Except as provided in paragraph (ii) below, the provisions of this section apply to long-term care policy issued in this state on or after the effective date of the amended regulation.

(ii) For certificates issued on or after the effective date of this section, under a group long-term care insurance policy as defined in W.S. 26-38-103(a)(v), that was in force at the time this amended regulation became effective, the provisions of this section shall not apply.

Section 18. Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts

(a) For purposes of this section the following definitions apply:

(i) "Qualified long-term care services" are as defined under W.S. 26-38-103(a)(ix).

(ii) (A) "Chronically ill individual" has the meaning prescribed for this term by Section 7702B(c)(2) of the Internal Revenue Code of 1986, as amended. Under this provision, a chronically ill individual means any individual who has been certified by a licensed health care practitioner as:

(I) Being unable to perform (without substantial assistance from another individual) at least two (2) activities of daily living for a period of at least ninety (90) days due to loss of functional capacity; or

(II) Requiring substantial supervision to protect the individual from threats to health and safety due to severe cognitive impairment.

(B) The term "chronically ill individual" shall not include an individual otherwise meeting these requirements unless within the preceding twelve-month period a licensed health care practitioner has certified that the individual meets these requirements.

(iii) "Licensed health care practitioner" means a physician, as defined in Section 1861(r)(1) of the Social Security Act, a registered professional nurse, licensed social worker or other individual who meets the requirements prescribed by the Secretary of the Treasury.

(iv) "Maintenance or personal care services" means any care the primary purpose of which is the provision of needed assistance with any of the disabilities as a result of which the individual is chronically ill individual (including the protection from threats to health and safety due to severe cognitive impairment).

(b) A qualified long-term care insurance contract shall pay only for qualified long-term care services received by a chronically ill individual provided pursuant to a plan of care prescribed by a licensed health care practitioner.

(c) A qualified long-term care insurance contract shall condition the payment of benefits on a determination of the insured's inability to perform activities of daily living for an expected period of at least ninety (90) days due to a loss of functional capacity or to a severe cognitive impairment.

(d) Certifications regarding activities of daily living and cognitive impairment required pursuant to subsection (c) shall be performed by the following licensed or certified professionals: physicians, registered professional nurses, licensed social workers, or other individuals who meet requirements prescribed by the Secretary of the Treasury.

(e) Certifications required pursuant to subsection (c) may be performed by a licensed health care professional at the direction of the insurer as is reasonably necessary with respect to a specific claim, except that when a licensed health care practitioner has certified that an insured is unable to perform activities of daily living for an expected period of at least ninety (90) days due to a loss of functional capacity and the insured is in claim status, the certification may not be rescinded and additional certifications may not be performed until after the expiration of the ninety-day period.

(f) Qualified long-term care insurance contracts shall include a clear description of the process for appealing and resolving disputes with respect to benefit determinations.

Section 19. Standard Format Outline of Coverage

This section of the regulation implements, interprets and makes specific, the provisions of W.S.26-38-105(k) in prescribing a standard format and the content of an outline of coverage.

(a) The outline of coverage shall be a free-standing document, using no smaller than ten point type.

(b) The outline of coverage shall contain no material of an advertising nature.

(c) Text which is capitalized or underscored in the standard format outline of coverage may be emphasized by other means which provide prominence equivalent to such capitalization or underscoring.

(d) Use of the text and sequence of text of the standard format outline of coverage is mandatory, unless otherwise specifically indicated.

(e) Format for outline of coverage:

[COMPANY NAME]

[ADDRESS - CITY & STATE]

[TELEPHONE NUMBER]

LONG-TERM CARE INSURANCE OUTLINE OF COVERAGE

[Policy Number of Group Master Policy and Certificate Number]

[Except for policies or certificates which are guaranteed issue, the following caution statement, or language substantially similar, must appear as follows in the outline of coverage.]

Caution: The issuance of this long-term care insurance [policy] [certificate] is based upon your responses to the questions on your application. A copy of your [application] [enrollment form] [is enclosed] [was retained by you when you applied]. If your answers are incorrect or untrue, the company has the right to deny benefits or rescind your policy. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of your answers are incorrect, contact the company at this address: [insert address]

1.  This policy is [an individual policy of insurance] ([a group policy] which was issued in the [indicate jurisdiction in which group policy was issued]).

2.  PURPOSE OF OUTLINE OF COVERAGE. This outline of coverage provides a very brief description of the important features of the policy. You should compare this outline of coverage to outlines of coverage for other policies available to you. This is not an insurance contract, but only a summary of coverage. Only the individual or group policy contains governing contractual provisions. This means that the policy or group policy sets forth in detail the rights and obligations of both you and the insurance company. Therefore, if you purchase this coverage, or any other coverage, it is important that you READ YOUR POLICY (OR CERTIFICATE) CAREFULLY!

3.  TERMS UNDER WHICH THE POLICY OR CERTIFICATE MAY BE RETURNED AND PREMIUM REFUNDED.

(a) [Provide a brief description of the right to return -- "free look" provision of the policy.]

(b) [Include a statement that the policy either does or does not contain provisions providing for a refund or partial refund of premium upon the death of an insured or surrender of the policy or certificate. If the policy contains such provisions, include a description of them.]

4.  THIS IS NOT MEDICARE SUPPLEMENT COVERAGE. If you are eligible for Medicare, review the Medicare Supplement Buyer's Guide available from the insurance company.

(a) [For agents] Neither [insert company name] nor its agents represent Medicare, the federal government or any state government.

(b) [For direct response] [insert company name] is not representing Medicare, the federal government or any state government.

5.  LONG-TERM CARE COVERAGE. Policies of this category are designed to provide coverage for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services, provided in a setting other than an acute care unit of hospital, such as in a nursing home, in the community or in the home. This policy provides coverage in the form of a fixed dollar indemnity benefit for covered long-term care expenses, subject to policy [limitations] [waiting periods] and [coinsurance] requirements. [Modify this paragraph if the policy is not an indemnity policy.]

6.  BENEFITS PROVIDED BY THIS POLICY.

(a) [Covered services, related deductible(s), waiting periods, elimination periods and benefit maximums.]

(b) [Institutional benefits, by skill level.]

(c) [Non-institutional benefits, by skill level.]

[Any benefit screens must be explained in this section. If these screens differ for different benefits, explanation of the screen should accompany each benefit description. If an attending physician or other specified person must certify a certain level of functional dependency in order to be eligible for benefits, this too must be specified. If activities of daily living (ADLs) are used to measure an insured's need for long-term care, then these qualifying criteria or screens must be explained.]

7.  LIMITATIONS AND EXCLUSIONS.

[Describe:

(a) Preexisting conditions;

(b) Non-eligible facilities/provider;

(c) Non-eligible levels of care (e.g., unlicensed providers, care or treatment provided by a family member, etc.);

(d) Exclusions/exceptions;

(e) Limitations.]

[This section should provide a brief specific description of any policy provisions which limit, exclude, restrict, reduce, delay, or in any other manner operate to qualify payment of the benefits described in (6) above.]

THIS POLICY MAY NOT COVER ALL THE EXPENSES ASSOCIATED WITH YOUR LONG-TERM CARE NEEDS.

8.  RELATIONSHIP OF COST OF CARE AND BENEFITS. Because the costs of long-term care services will likely increase over time, you should consider whether and how the benefits of this plan may be adjusted. [As applicable, indicate the following:

(a) That the benefit level will not increase over time;

(b) Any automatic benefit adjustment provisions;

(c) Whether the insured will be guaranteed the option to buy additional benefits and the basis upon which benefits will be increased over time if not by a specified amount or percentage;

(d) If there is such a guarantee, include whether additional underwriting or health screening will be required, the frequency and amounts of the upgrade options, and any significant restrictions or limitations;

(e) And finally, describe whether there will be any additional premium charge imposed, and how that is to be calculated.]

9.  TERMS UNDER WHICH THE POLICY (OR CERTIFICATE) MAY BE CONTINUED IN FORCE OR DISCONTINUED.

[(a) Describe the policy renewability provisions;

(b) For group coverage, specifically describe continuation/conversion provisions applicable to the certificate and group policy;

(c) Describe waiver of premium provisions or state that there are not such provisions;

(d) State whether or not the company has a right to change premium, and if such a right exists, describe clearly and concisely each circumstance under which premium may change.]

10.  ALZHEIMER'S DISEASE AND OTHER ORGANIC BRAIN DISORDERS.

[State that the policy provides coverage for insureds clinically diagnosed as having Alzheimer's disease or related degenerative and dementing illnesses. Specifically describe each benefit screen or other policy provision which   provides preconditions to the availability of policy benefits for such an insured.]

11.  PREMIUM.

[(a) State the total annual premium for the policy; (b) If the premium varies with an applicant's choice among benefit options, indicate the portion of annual premium which corresponds to each benefit option.]

12.  ADDITIONAL FEATURES.

[(a) Indicate if medical underwriting is used;

(b) Describe other important features.]

Section 20. Requirement to Deliver Shopper's Guide

(a) A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the Commissioner, shall be provided to all prospective applicants of a long-term care insurance policy or certificate.

(i) In the case of agent solicitations, an agent must deliver the shopper's guide prior to the presentation of an application or enrollment form.

(ii) In the case of direct response solicitations, the shopper's guide must be presented in conjunction with any application or enrollment form.

Section 21. Suitability

(a) This section shall not apply to life insurance policies that accelerate benefits for long-term care.

(b) Every insurer, health care service plan or other entity marketing long-term care insurance shall:

(i) Develop and use suitability standards to determine whether the purchase or replacement of long-term care insurance is appropriate for the need of the applicant;

(ii) Train its agents in the use of its suitability standards; and

(iii) Maintain a copy of its suitability standards and make them available for inspection upon request by the Commissioner.

(c) (i) To determine whether the applicant meets the standards developed by the issuer, the agent and issuer shall develop procedures that take the following into consideration:

(A) The ability to pay for the proposed coverage and other pertinent financial information related to the purchase of the coverage;

(B) The applicant's goals or needs with respect to long-term care and the advantages and disadvantages of insurance to meet these goals or needs; and

(C) The values, benefits and costs of the applicant's existing insurance, if any, when compared to the values, benefits and costs of the recommended purchase or replacement.

(ii) The issuer, and where an agent is involved, the agent shall make reasonable efforts to obtain the information set out in paragraph (i) above. The efforts shall include presentation to the applicant, at or prior to application, the "Long-Term Care Insurance Personal Worksheet." The personal worksheet used by the issuer shall contain, at a minimum, the information contained in Appendix B, in not less than twelve (12) point type. The issuer may request the applicant to provide additional information to comply with its suitability standards. A copy of the issuer's personal worksheet shall be filed with the Commissioner.

(iii) A completed personal worksheet shall be returned to the issuer prior to the issuer's consideration of the applicant for coverage, except the personal worksheet need not be returned for sales of employer group long-term care insurance to employees and their spouses.

(iv) The sale or dissemination outside the company or agency by the issuer or agent of information obtained through the personal worksheet in Appendix B is prohibited.

(d) The issuer shall use the suitability standards it has developed pursuant to this section in determining whether issuing long-term care insurance coverage to an applicant is appropriate.

(e) Agents shall use the suitability standards developed by the issuer in marketing long-term care insurance.

(f) At the same time as the personal worksheet is provided to the applicant, the disclosure form entitled "Things You Should Know Before You Buy Long-Term Care Insurance" shall be provided.

The form shall be in the format contained in Appendix C, in not less than twelve (12) point type.

(g) If the issuer determines that the applicant does not meet its financial suitability standards, or if the applicant has declined to provide the information, the issuer may reject the application. In the alternative, the issuer shall send the applicant a letter similar to Appendix D. However, if the applicant has declined to provide financial information, the issuer may use some other method to verify the applicant's intent. Either the applicant's returned letter or a record of the alternative method of verification shall be made part of the applicant's file.

(h) The issuer shall report annually to the Commissioner the total number of applications received from residents of this state, the number of those who declined to provide information on the personal worksheet, the number of applicants who did not meet the suitability standards and the number of those who chose to confirm after receiving a suitability letter.

Section 22. Separability

If any provision of this regulation or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the regulation and the application of such provision to other persons or circumstances shall not be affected thereby.

Section 23. Effective Date

This regulation shall be effective upon filing with the Secretary of State.

APPENDIX A

RECISSION REPORTING FORM FOR

LONG-TERM CARE POLICIES

FOR THE STATE OF WYOMING FOR THE REPORTING YEAR 20[ ]

Company Name:___________________________________________________________

Address:__________________________________________________________________

---

Phone Number: ____________________________________________________________

Due: March 1 annually

Instructions:

The purpose of this form is to report all recissions of long-term care insurance policies or certificates. Those rescissions voluntarily effectuated by an insured are not required to be included in this report. Please furnish one form per recission. Date of Policy Date/s Policy Policy and Name of Issuance Claim/s Date of Form # Certificate # Insured Submitted Rescission

| Policy Form # | Policy and Certificate # | Name of Insured | Date of Policy Issuance | Date's Claim/s Submitted | Date of Rescission | | --- | --- | --- | --- | --- | --- | | | | | | | |

Detailed reason for rescission: ____________________________________________________________________________

---

---

---

---

Signature

---

Name and Title (please type)

---

Date

APPENDIX B

Long Term Care Insurance

Personal Worksheet

People buy long-term care insurance for many reasons. Some do not want to use their own assets to pay for long-term care. Some buy insurance to make sure they can choose the type of care they get. Others do not want their family to have to pay for care or do not want to go on Medicaid. But long-term care insurance may be expensive, and may not be right for everyone.

By state law, the insurance company must fill out part of the information on this worksheet and ask you to fill out the rest to help you and the company decide if you should buy this policy.

Premium Information

Policy Form Numbers ______________________

The premium for the coverage you are considering will be [$ per month, or $ per year,] _____________________

[a one-time single premium of $ .] _____________________

Type of Policy (noncancellable/guaranteed renewable): ________________________

The Company's Right to Increase Premiums: __________________________

[The company cannot raise your rates on this policy.] [The company has a right to increase premiums on this policy form in the future, provided it raises rates for all policies in the same class in this state.] [Insurers shall use appropriate bracketed statement. Rate guarantees shall not be shown on this form.]

Rate Increase History

The company has sold long-term care insurance since [year] and has sold this policy since [year]. [The company has never raised its rates for any long-term care policy it has sold in this state or any other state.] [The company has not raised its rates for this policy form or similar policy forms in this state or any other state in the last 10 years.] [The company has raised its premium rates on this policy form or similar policy forms in the last 10 years. Following is a summary of the rate increases.]

Drafting Note: A company may use the first bracketed sentence above only if it has never increased rates under any prior policy forms in this state or any other state. The issuer shall list each premium increase it has instituted on this or similar policy forms in this state or any other state during the last 10 years. The list shall provide the policy form, the calendar years the form was available for sale, and the calendar year and the amount (percentage) of each increase. The insurer shall provide minimum and maximum percentages if the rate increase is variable by rating characteristics. The insurer may provide, in a fair manner, additional explanatory information as appropriate.

Questions Related to Your Income

How will you pay each year's premium?

G From my Income   G From my Savings/Investments   G My Family will Pay

[G Have you considered whether you could afford to keep this policy if the premiums went up, for

37-28 example, by 20%?] Drafting Note: The issuer is not required to use the bracketed sentence if the policy is fully paid up or is noncancellable policy.

What is your annual income? (check one) G Under $10,000 G $[10-20,000] G $[20-30,000] G $[30-50,000] G Over $50,000

Drafting Note: The issuer may choose the numbers to put in the brackets to fit its suitability standards.

How do you expect your income to change over the next 10 years? (check one)

G No change     G Increase             G Decrease

If you will be paying premiums with money received only from your own income, a rule of thumb is that you may not be able to afford this policy if the premiums will be more than 7% of your income.

Will you buy inflation protection? (check one) G Yes G No

If not, have you considered how you will pay for the difference between future costs and your daily benefit amount?

G From my Income G From my Savings/Investments G My Family will Pay

The national average annual cost of care in [insert year] was [insert $ amount], but this figure varies across the country. In ten years the national average annual cost would be about [insert $ amount] if costs increase 5% annually.

Drafting Note: The projected cost can be based on federal estimates in a current year. In the above statement, the second figure equals 163% of the first figure.

What elimination period are you considering? Number of days_____ Approximate cost $_____

for that period of care.

How are you planning to pay for your care during the elimination period? (check one)

G From my Income   G From my Savings/Investments  G My Family will Pay

Questions Related to Your Savings and Investments

Not counting your home, about how much are all of your assets (your savings and investments) worth? (check one)

G Under $20,000    G $20,000-$30,000        G $30,000-$50,000      G Over $50,000

How do you expect your assets to change over the next ten years? (check one)

G Stay about the same G Increase G Decrease

If you are buying this policy to protect your assets and your assets are less than $30,000, you may wish to consider other options for financing your long-term care.

Disclosure Statement

| G The answers to the questions above describe my financial situation. Or G I choose not to complete this information. (Check one.) | | --- | | G I acknowledge that the carrier and/or its agent (below) has reviewed this form with me including the premium, premium rate increase history and potential for premium increases in the future. [For direct mail situations, use the following: I acknowledge that I have reviewed this form including the premium, premium rate increase history and potential for premium increases in the future.] I understand the above disclosures. I understand that the rates for this policy may increase in the future. (This box must be checked). |

Signed:________________________________ (Date)_______________________________________

(Applicant)

[G I explained to the applicant the importance of completing this information.

Signed:____________________________________ _______________________________________

(Agent) (Date)

Agent's Printed Name:____________________________________________________________________________ ]

[In order for us to process your application, please return this signed statement to [name of company], along with your application.]

[My agent has advised me that this policy does not seem to be suitable for me. However, I still want the company to consider my application.

Signed:___________________________________ _________________________________________ ]

(Applicant)  (Date)

Drafting Note: Choose the appropriate sentences depending on whether this is a direct mail or agent sale.

The company may contact you to verify your answers.

Drafting Note: When the Long-Term Care Insurance Personal Worksheet is furnished to employees and their spouses under employer group policies, the text from the heading "Disclosure Statement" to the end of the page may be removed.

APPENDIX C

Things You Should Know Before You Buy

Long-Term Care Insurance

Long-Term •   A long-term care insurance policy may pay most of the costs for your care Care in a nursing home. Many policies also pay for care at home or other Insurance community settings. Since policies can vary in coverage, you should read this policy and make sure you understand what it covers before you buy it.

•   [You should not buy this insurance policy unless you can afford to pay the premiums every year.] [Remember that the company can increase premiums in the future.]

Drafting Note: For single premium policies, delete this bullet; for noncancellable policies, delete the second sentence only.

•   The personal worksheet includes questions designed to help you and the company determine whether this policy is suitable for your needs.

Medicare  •  Medicare does not pay for most long-term care.

Medicaid  • Medicaid will generally pay for long-term care if you have very little income and few assets. You probably should not buy this policy if you are now eligible for Medicaid.

• Many people become eligible for Medicaid after they have used up their own financial resources by paying for long-term care services.

• When Medicaid pays your spouse's nursing home bills, you are allowed to keep your house and furniture, a living allowance, and some of your joint assets, • Your choice of long-term care services may be limited if you are receiving Medicaid. To learn more about Medicaid, contact your local or state Medicaid agency.

Shopper's • Make sure the insurance company or agent gives you a copy of a book called Guide the National Association of Insurance Commissioners' "Shopper's Guide to Long-Term Care Insurance." Read it carefully. If you have decided to apply for long-term care insurance, you have the right to return the policy within 30 days and get back any premium you have paid if you are dissatisfied for any reason or choose not to purchase the policy.

Counseling • Free counseling and additional information about long-term care insurance are available through your state's insurance counseling program. Contact your state insurance department or department of health, aging division for more information about the senior health insurance counseling program in your state.

APPENDIX D

Long-Term Care Insurance Suitability Letter

Dear [Applicant]:

Your recent application for long-term care insurance included a "personal worksheet," which asked questions about your finances and your reasons for buying long-term care insurance. For your protection, state law requires us to consider this information when we review your application, to avoid selling a policy to those who may not need coverage.

[Your answers indicate that long-term care insurance may not meet your financial needs. We suggest that you review the information provided along with you application, including the booklet "Shoppers Guide to Long-Term Care Insurance" and the page titled "Things You Should Know Before Buying Long-Term Care Insurance." Your state insurance department also has information about long-term care insurance and may be able to refer you to a counselor free of charge who can help you decide whether to buy this policy.]

[You chose not to provide any financial information for us to review.]

Drafting Note: Choose the paragraph that applies.

We have suspended our final review of your application. If, after careful consideration, you still believe this policy is what you want, check the appropriate box below and return this letter to us within the next 60 days. We will then continue reviewing your application and issue a policy if you meet our medical standards.

If we do not hear from you within the next 60 days, we will close your file and not issue you a policy. You should understand that you will not have any coverage until we hear back from you, approve your application and issue a policy.

Please check one box and return in the enclosed envelope.

G   Yes, [although my worksheet indicates that long-term care insurance may not be a suitable purchase,] I wish to purchase this coverage. Please resume review of my application.

Drafting Note: Delete the phrase in brackets if the applicant did not answer the questions about income.

G   No. I have decided not to buy a policy at this time.

---

APPLICANT'S SIGNATURE DATE

Please return to [issuer] at [address] by [date].

History

• Effective 2003-03-11

Chapter 38 Regulation Governing Allocation of Premium for the Purpose of Taxation

Wyo. Code R. 044.0002.38.07132017 Regulation Governing Allocation of Premium for the Purpose of Taxation

CHAPTER 38

REGULATIONS GOVERNING ALLOCATION OF PREMIUM

FOR THE PURPOSE OF TAXATION

Section 1. Authority

These regulations are promulgated pursuant to W.S. §§ 16-3-101 et seq., 26‑2‑110(a), 26‑3‑102(b) and 26-4-103.

Section 2. Scope

These regulations apply to each insurer that has direct premium income from or as a result of persons, property, subjects or risks located, resident, or to be performed in Wyoming.

Section 3. Proper Proportionate Allocation of Premium Taxes

(a) For the purpose of reporting and paying premium taxes, the amount of premium or consideration for insurance as to persons, property, subjects or risks in Wyoming insured, or covered under policies or contracts covering persons, property, subjects, or risks located or resident in more than one (1) state, shall be determined as follows:

(i) The result obtained when the percentage derived by dividing the number of Wyoming risks by the total number of risks under such policy or contract is multiplied by the total direct premium income derived from the policy or contract; or

(ii) The exact amount of premium or consideration collected from or on behalf of each person, property, subject or risk which is, in fact, located, resident or to be performed in Wyoming.

Section 4. Exclusiveness

No method of allocation which fails to recognize the actual locations, residences, or situs of performance as used herein shall be permissible.

Section 5. Foreign Contracts

These regulations are applicable notwithstanding the fact that the policy or contract of insurance is entered into, or the premiums are paid and received, in a state or states other than Wyoming.

Section 6. Amended Annual Premium Tax Returns

Amended annual premium tax returns will only be accepted within twelve (12) months after the original filing deadline.

Section 7. Premium Tax Refunds

Any claim for a refund due to an amended annual tax return shall be filed with the subsequent annual tax return that is due on March 1 in accordance with W.S. 26-4-103(k)(ii).

Section 8. Effective Date

These regulations shall become effective upon filing with the Secretary of State.

History

• Effective 2017-07-13

Chapter 40 Universal Life Insurance

Wyo. Code R. 044.0002.40.07132017 § 1 Authority

This regulation is promulgated pursuant to W.S. §§ 26‑2‑110 and 16‑3‑101, et seq.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.40.07132017 § 2 Definitions

(a) "Universal life insurance policy" means any individual life insurance policy under the provisions of which separately identified interest credits (other than in connection with dividend accumulations, premium deposit funds, or other supplemental accounts) and mortality and expense charges are made to the policy. A universal life insurance policy may provide for other credits and charges, such as charges for the cost of benefits provided by rider.

(b) "Flexible premium universal life insurance policy" means a universal life insurance policy which permits the policy owner to vary, independently of each other, the amount or timing of one or more premium payments or the amount of insurance.

(c) "Fixed premium universal life insurance policy" means a universal life insurance policy other than a flexible premium universal life insurance policy.

(d) "Interest‑indexed universal life insurance policy" means any universal life insurance policy where the interest credits are linked to an external referent.

(e) "Net Cash Surrender Value" means the maximum amount payable to the policy owner upon surrender.

(f) "Cash Surrender Value" means the Net Cash Surrender Value plus any amounts outstanding as policy loans.

(g) "Policy Value" means the amount to which separately identified interest credits and mortality, expense, or other charges are made under a universal life insurance policy.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.40.07132017 § 3 Mandatory Policy Provisions

The policy shall provide the following:

(a) Periodic Disclosure to Policy owner. The policy shall provide that the policy owner will be sent, without charge, at least annually, a report which will serve to keep such policy owner advised as to the status of the policy. The end of the current report period must be not more than three months previous to the date of the mailing of the report.

(b) Illustrative Reports. The policy shall provide for an illustrative report which will be sent to the policy owner upon request without charge, at least annually. If the policy owner requests reports of greater frequency, a reasonable fee may be charged only for such additional reports.

(c) Policy Guarantees. The policy shall provide guarantees of minimum interest credits and maximum mortality and expense charges. All values and data shown in the policy shall be based on guarantees. No figures based on non-guarantees shall be included in the policy.

(d) Calculation of Cash Surrender Values. The policy shall contain at least a general description of the calculation of cash surrender values including the following information:

(i) The guaranteed maximum expense charges and loads.

(ii) Any limitation on the crediting of additional interest. Interest credits shall not remain conditional for a period longer than twelve months.

(iii) The guaranteed minimum rate or rates of interest.

(iv) The guaranteed maximum mortality charges.

(v) Any other guaranteed charges.

(vi) Any surrender or partial withdrawal charges.

(e) Changes in Basic Coverage. If the policy owner has the right to change the basic coverage, any limitation on the amount or timing of such change shall be stated in the policy. If the contract confers upon the policy owner the right to increase the basic coverage without the consent of the insurer, no new period of contestability or exclusion for suicide shall be permitted on such increased coverage.

(f) Grace Period and Lapse. The policy shall provide for written notice to be sent to the policy owner's last known address at least thirty days prior to termination of coverage.

(i) A flexible premium policy shall provide for a grace period of at least thirty days after lapse. Unless otherwise defined in the policy, lapse shall occur on the date on which the net cash surrender value first equals zero.

(g) Maturity Date. If a policy provides for a "maturity date," "end date," or similar date, then the policy shall also contain a statement, in close proximity to that date, that it is possible that coverage may not continue to the maturity date even if scheduled premiums are paid in a timely manner, if such is the case.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.40.07132017 § 4 Disclosure Requirements

In connection with any advertising, solicitation, negotiation, or procurement of a universal life insurance policy:

(a) Any statement of policy cost factors or benefits shall contain:

(i) The corresponding guaranteed policy cost factors or benefits, clearly identified.

(ii) A statement explaining the non-guaranteed nature of any current interest rates, charges, or other fees applied to the policy, including the insurer's right to alter any of these factors.

(iii) Any limitations on the crediting of interest, including identification of those portions of the policy, premium or payments therefor, to which a specified interest rate shall be credited.

(b) Any illustration of the policy value shall be accompanied by the corresponding net cash surrender value.

(c) Any statement regarding the crediting of a specific current interest rate shall also contain the frequency and timing by which such rate is determined.

(d) If any statement refers to the policy being interest‑indexed, the index shall be described. In addition, a description shall be given of the frequency and timing of determining the interest rate and of any adjustments made to the index in arriving at the interest rate credited under the policy.

(e) Any illustrated benefits based upon non-guaranteed interest, mortality, or expense factors shall be accompanied by a statement indicating that these benefits are not guaranteed.

(f) If the guaranteed cost factors or initial policy cost assumptions will result in policy values becoming exhausted prior to the policy's maturity date, such facts shall be disclosed in the policy or in an illustration of policy values delivered to the insured not later than the date of delivery of the policy.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.40.07132017 § 5 Periodic Disclosure to Policy Owner

(a) Requirements. The policy shall provide that the policy owner will be sent, without charge, at least annually, a report that will serve to keep such policy owner advised of the status of the policy. The end of the current report period shall not be more than three months previous to the date of the mailing of the report.

(i) Such report shall include the following:

(A) The beginning and end of the current report period.

(B) The policy value at the end of the previous report period and at the end of the current report period.

(C) The total amounts which have been credited or debited to the policy value during the current report period, identifying each by type (e.g., interest, mortality, expense and riders).

(D) The current death benefit at the end of the current report period on each life covered by the policy.

(E) The net cash surrender value of the policy as of the end of the current report period.

(F) The amount of outstanding loans, if any, as of the end of the current report period.

(ii) For fixed premium policies: If, assuming guaranteed interest, mortality and expense loads and continued scheduled premium payments, the policy's net cash surrender value is such that it would not maintain insurance in force until the end of the next reporting period, a notice to this effect shall be included in the report.

(iii) For flexible premium policies: If, assuming guaranteed interest, mortality and expense loads, the policy's net cash surrender value will not maintain insurance in force until the end of the next reporting period unless further premium payments are made, a notice to this effect shall be included in the report.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.40.07132017 § 6 Interest‑indexed Universal Life Insurance Policies

(a) Initial Filing Requirements. The following information shall be submitted in connection with any filing of interest‑indexed universal life insurance policies ("interest‑indexed policies"). All such information received shall be treated confidentially to the extent permitted by law.

(i) A description of how the interest credits are determined, including:

(A) a description of the index;

(B) the relationship between the value of the index and the actual interest rate to be credited;

(C) the frequency and timing of determining the interest rate; and

(D) the allocation of interest credits, if more than one rate of interest applies to different portions of the policy value.

(ii) The insurer's investment policy, which includes a description of the following:

(A) how the insurer addressed the reinvestment risks;

(B) how the insurer plans to address the risk of capital loss on cash outflows;

(C) how the insurer plans to address the risk that appropriate investments may not be available or not available in sufficient quantities;

(D) how the insurer plans to address the risk that the indexed interest rate may fall below the minimum contractual interest rate guaranteed in the policy;

(E) the amount and type of assets currently held for interest indexed policies; and

(F) the amount and type of assets expected to be acquired in the future.

(iii) If policies are linked to an index for a specified period less than to the maturity date of the policy, a description of the method used (or currently contemplated) to determine interest credits upon the expiration of such period.

(iv) A description of any interest guarantee in addition to or in lieu of the index.

(v) A description of any maximum premium limitations and the conditions under which they apply.

(b) Additional Filing Requirements.

(i) Annually, every insurer shall submit a Statement of Actuarial Opinion by the insurer's actuary similar to the example contained in subsection (c) of this section.

(ii) Annually, every insurer shall submit a description of the amount and type of assets currently held by the insurer with respect to its interest‑indexed policies.

(iii) Prior to implementation, every domestic insurer shall submit a description of any material change in the insurer's investment strategy or method of determining the interest credits. A change is considered to be material if it would affect the form or definition of the index (i.e. any change in the information supplied in subsection (a) above) or if it would significantly change the amount or type of assets held for interest‑indexed policies.

(c) Statement of Actuarial Opinion for Interest‑Indexed Universal Life Insurance Policies.

I, , am (name) (position or relationship to Insurer)

for the XYZ Life Insurance Company (The Insurer) in the state of .

(1.) (State of Domicile of Insurer)

I am a member of the American Academy of Actuaries (or if not, state other qualifications to sign annual statement actuarial opinions).

I have examined the interest‑indexed universal life insurance policies of the Insurer in force as of December 31, 20XX, encompassing ____________ number of policies and $____________ of insurance in force.

I have considered the provisions of the policies. I have considered any reinsurance agreements pertaining to such policies, the characteristics of the identified assets and the investment policy adopted by the Insurer as they affect future insurance and investment cash flows under such policies and related assets. My examination included such tests and calculations as I considered necessary to form an opinion concerning the insurance and investment cash flows arising from the policies and related assets.

I relied on the investment policy of the Insurer and on projected investment cash flows as provided by ____________, Chief Investment Officer of the Insurer.

The tests were conducted under various assumptions as to future interest rates, and particular attention was given to those provisions and characteristics that might cause future insurance and investment cash flows to vary with changes in the level and prevailing interest rates.

In my opinion, the anticipated insurance and investment cash flows referred to above make good and sufficient provision for the contractual obligations of the Insurer under these insurance policies.

Signature of Actuary

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.40.07132017 § 7 Effective Date

This regulation becomes effective upon filing with the Secretary of State.

History

• Effective 2017-07-13

Chapter 41 Scope of Pool Coverage & Schedule of Benefits by WY Health Insurance Pool

Wyo. Code R. 044.0002.41.12092016 Scope of Pool Coverage & Schedule of Benefits by WY Health Insurance Pool

Chapter 41

SCOPE OF POOL COVERAGE AND SCHEDULE OF BENEFITS

OFFERED BY WYOMING HEALTH INSURANCE POOL

Section 1. Authority

This regulation is issued pursuant to the authority vested in the Wyoming Insurance Commissioner under W.S. §§ 26‑2‑110, 26‑43‑106 and 16‑3‑101, et seq.

Section 2. Eligibility

(a) A "resident" of the state for purposes of eligibility for pool coverage shall mean:

(i) Any individual person who occupies a dwelling in this state and has a present intent to make this state his home.

(ii) The pool administrator shall consider the following factors as indicating intent to remain in this state:

(A) Whether the applicant (or his custodial parent in the case of a minor) is registered to vote in this state;

(B) Whether the applicant (or his custodial parent in the case of a minor) has applied for or received a Wyoming driver's license;

(C) Whether the minor children of the applicant are enrolled to attend school in this state;

(D) If the applicant is of school age, then whether the applicant is enrolled to attend school in this state; and

(E) Whether the applicant (or his custodial parent in the case of a minor) has applied for or currently receives service in his name from any public utility at a dwelling within this state.

(iii) Any applicant currently occupying a dwelling in this state and meeting any two or more of the above‑listed criteria shall be considered a resident eligible for pool coverage.

(iv) Any applicant denied pool coverage due to the administrator's determination of resident status shall have a right to appeal the administrator's determination in the manner set forth in the Plan of Operation for the pool.

Section 3. Pool Coverage and Schedule of Benefits

The general benefit features for an insured of the pool are set forth in the Wyoming Health Insurance Pool Summary of Benefit Features, located at http://doi.wyo.gov.

Section 4. Effective Date

This regulation shall become effective upon filing with the Secretary of State.

History

• Effective 2016-12-09

Chapter 43 Wyoming Life and Health Insurance Guaranty Association Notice

Wyo. Code R. 044.0002.43.12092016 § 1 Authority

This regulation is issued pursuant to W.S. §§ 16-3-101, et seq., 26-2-110 and 26-42-101, et seq.

History

• Effective 2016-12-09

Wyo. Code R. 044.0002.43.12092016 § 2 Notices

This regulation establishes the form and content of the disclaimer as required by W.S. § 26-42-116. The summary document describes the general purposes and current limitations of the Association, and the notice required to be used when a policy is not covered by the Guaranty Association. The required form, Wyoming Life and Health Insurance Guaranty Disclaimer (the Disclaimer) is located at http://doi.wyo.gov.

The Disclaimer, in its entirety, is to be used by each insurer and shall be given to each insured either prior to or at the time of delivery of the policy or contract.

History

• Effective 2016-12-09

Wyo. Code R. 044.0002.43.12092016 § 3 Effective Date

This regulation shall be effective upon filing with the Secretary of State.

History

• Effective 2016-12-09

Chapter 45 Holding Company System

Wyo. Code R. 044.0002.45.12032025 Holding Company System

CHAPTER 45

HOLDING COMPANY SYSTEM

Section 1. Authority. These regulations are promulgated pursuant to the authority granted by W.S. §§ 26‑2‑109, 26‑2‑110 and 26‑44‑111 of the Wyoming Insurance Code.

Section 2. Purpose. The purposes of these regulations are to set forth rules and procedural requirements which the Commissioner deems necessary to carry out the provisions of the Insurance Holding Company System Regulatory Act W.S. §§ 26‑44‑101, et seq. of the Insurance Code hereinafter referred to as "the Act." The information called for by these regulations is hereby declared to be necessary and appropriate in the public interest and for the protection of the policyholders in this state.

Section 3. Forms ‑‑ General Requirements.

(a) Forms A, B, C, D, and F are intended to be guides in the preparation of the statements required by W.S. §§ 26‑44‑103, 26‑44‑104 and 26‑44‑105 of the Act. The required forms A, B, C, D and F are located at http://doi.wyo.gov. They are not intended to be blank forms which are to be filled in. The statements filed shall contain the numbers and captions of all items, but the text of the items may be omitted provided the answers thereto are prepared in such a manner as to indicate clearly the scope and coverage of the items. All instructions, whether appearing under the items of the form or elsewhere therein, are to be omitted. Unless expressly provided otherwise, if any item is inapplicable or the answer thereto is in the negative, an appropriate statement to that effect shall be made.

(b) Two complete copies of each statement including exhibits and all other papers and documents filed as a part thereof shall be filed with the Commissioner by personal delivery or mail addressed to: Insurance Commissioner of the State of Wyoming, to the address listed on the Department of Insurance's website (doi.wyo.gov), Attention: Examination Division. At least one of the copies shall be signed in the manner prescribed on the form. Unsigned copies shall be conformed. If the signature of any person is affixed pursuant to a power of attorney or other similar authority, a copy of such power of attorney or other authority shall also be filed with the statement.

(c) If an applicant requests a hearing on a consolidated basis under W.S. § 26-44-103(h) of the Act, in addition to filing the Form A with the commissioner, the applicant shall file a copy of Form A with the National Association of Insurance Commissioners (NAIC) in electronic form.

(d) Statements should be prepared electronically. Statements shall be easily readable and suitable for review and reproduction. Debits in credit categories and credits in debit categories shall be designated so as to be clearly distinguishable as such on photocopies. Statements shall be in the English language and monetary values shall be stated in United States currency. If any exhibit or other paper or document filed with the statement is in a foreign language, it shall be accompanied by a translation into the English language and any monetary value shown in a foreign currency shall be converted into United States currency.

Section 4. Forms ‑‑ Incorporation by Reference, Summaries and Omissions.

(a) Information required by any item of Form A, Form B, Form D, or Form F may be incorporated by reference in answer or partial answer to any other item. Information contained in any financial statement, annual report, proxy statement, statement filed with a governmental authority, or any other document may be incorporated by reference in answer or partial answer to any item of Form A, Form B, Form D, or Form F provided such document is filed as an exhibit to the statement. Excerpts of documents may be filed as exhibits if the documents are extensive. Documents currently on file with the Commissioner which were filed within three years need not be attached as exhibits. References to information contained in exhibits or in documents already on file shall clearly identify the material and shall specifically indicate that such material is to be incorporated by reference in answer to the item. Matter shall not be incorporated by reference in any case where such incorporation would render the statement incomplete, unclear or confusing in the opinion of the Insurance Commissioner.

(b) Where an item requires a summary or outline of the provisions of any document, only a brief statement shall be made as to the pertinent provisions of the document. In addition to such statement, the summary or outline may incorporate by reference particular parts of any exhibit or document currently on file with the Commissioner which was filed within three years and may be qualified in its entirety by such reference. In any case where two (2) or more documents required to be filed as exhibits are substantially identical in all material respects except as to the parties thereto, the dates of execution, or other details, a copy of only one of such documents need be filed with a schedule identifying the omitted documents and setting forth the material details in which such documents differ from the documents, a copy of which is filed.

Section 5. Forms ‑‑ Information Unknown or Unavailable and Extension of Time to Furnish.

(a) If it is impractical to furnish any required information, document or report at the time it is required to be filed, there shall be filed with the Commissioner as a separate document a request:

(i) identifying the information, document or report in question;

(ii) stating why the filing thereof at the time required is impractical; and

(iii) requesting an extension of time for filing the information, document or report to a specified date. The request for extension shall be deemed granted unless the Commissioner within forty‑five (45) days after receipt thereof enters an order denying the request.

Section 6. Forms ‑‑ Additional Information and Exhibits. In addition to the information expressly required to be included in Form A, Form B, Form C, Form D, and Form F, there shall be added such further material information, if any, as may be necessary to make the information contained therein not misleading. The person filing may also file such exhibits as it may desire in addition to those expressly required by the statement. Such exhibits shall be so marked as to indicate clearly the subject matters to which they refer. Changes to Forms A, B, C, D, or F shall include on the top of the cover page the phrase: "Change No. (insert number) to" and shall indicate the date of the change and not the date of the original filing.

Section 7. Definitions.

(a) "Executive officer" means chief executive officer, chief operating officer, chief financial officer, treasurer, secretary, controller, and any other individual performing functions corresponding to those performed by the foregoing officers under whatever title.

(b) "Foreign insurer" shall include an alien insurer except where clearly noted otherwise.

(c) "Ultimate controlling person" means that person which is not controlled by any other person.

(d) Unless the context otherwise requires, other terms found in these regulations and in W.S. § 26‑44‑101 of the Act are used as defined in the said W.S. § 26‑44‑101. Other nomenclature or terminology is according to the Insurance Code, or industry usage if not defined in the Code.

Section 8. Acquisition of Control ‑‑ Statement Filing. A person required to file a statement pursuant to W.S. § 26‑44‑103 of the Act shall furnish the required information on Form A, hereby made a part of this regulation.

Section 9. Amendments to Form A. The applicant shall promptly advise the Commissioner of any changes in the information so furnished on Form A arising subsequent to the date upon which such information was furnished but prior to the Commissioner's disposition of the application.

Section 10. Acquisition of Domestic Insurers.

(a) If the person being acquired is deemed to be a "domestic insurer" solely because of the provisions of W.S. § 26‑44‑103(a)(ii) of the Act, the name of the domestic insurer on the cover page should be indicated as follows:

"ABC Insurance Company, a subsidiary of XYZ Holding Company."

(b) Where an insurer as set forth in W.S. § 26‑44‑103(a)(ii) is being acquired, references to "the insurer" contained in Form A shall refer to both the domestic subsidiary insurer and the person being acquired.

Section 11. Annual Registration of Insurers ‑‑ Statement Filing. An insurer required to file an annual registration statement pursuant to W.S. § 26‑44‑104 of the Act shall furnish the required information on Form B, hereby made a part of these regulations.

Section 12. Summary of Registration ‑‑ Statement Filing. An insurer required to file an annual registration statement pursuant to W.S. § 26‑44‑104 of the Act is also required to furnish information required on Form C, hereby made a part of these regulations.

Section 13. Amendments to Form B.

(a) An amendment to Form B shall be filed within 15 days after the end of any month in which there is a material change to the information provided in the annual registration statement.

(b) Amendments shall be filed in the Form B format with only those items which are being amended reported. Each such amendment shall include at the top of the cover page "Amendment No. (insert number) to Form B for (insert year)" and shall indicate the date of the change and not the date of the original filings.

Section 14. Alternative and Consolidated Registrations.

(a) Any authorized insurer may file a registration statement on behalf of any affiliated insurer or insurers which are required to register under W.S. § 26‑44‑104 of the Act. A registration statement may include information not required by the Act regarding any insurer in the insurance holding company system even if such insurer is not authorized to do business in this State. In lieu of filing a registration statement on Form B, the authorized insurer may file a copy of the registration statement or similar report which it is required to file in its State of domicile, provided:

(i) the statement or report contains substantially similar information required to be furnished on Form B; and

(ii) the filing insurer is the principal insurance company in the insurance holding company system.

(b) The question of whether the filing insurer is the principal insurance company in the insurance holding company system is a question of fact and an insurer filing a registration statement or report in lieu of Form B on behalf of an affiliated insurer, shall set forth a brief statement of facts which will substantiate the filing insurer's claim that it, in fact, is the principal insurer in the insurance holding company system.

(c) With the prior approval of the Commissioner, an unauthorized insurer may follow any of the procedures which could be done by an authorized insurer under paragraph (a) above.

(d) Any insurer may take advantage of the provisions of W.S. § 26‑44‑104(j) or (k) of the Act without obtaining the prior approval of the Commissioner. The Commissioner, however, reserves the right to require individual filings if he deems such filings necessary in the interest of clarity, ease of administration or the public good.

Section 15. Disclaimers and Termination of Registration.

(a) A disclaimer of affiliation or a request for termination of registration claiming that a person does not, or will not upon the taking of some proposed action, control another person (hereinafter referred to as the "subject") shall contain the following information:

(i) the number of authorized, issued and outstanding voting securities of the subject;

(ii) with respect to the person whose control is denied and all affiliates of such person, the number and percentage of shares of the subject's voting securities which are held of record or known to be beneficially owned, and the number of such shares concerning which there is a right to acquire, directly or indirectly;

(iii) all material relationships and bases for affiliation between the subject and the person whose control is denied and all affiliates of such person;

(iv) a statement explaining why such person should not be considered to control the subject.

(b) A request for termination of registration shall be deemed to have been granted unless the Commissioner, within forty-five (45) days after he receives the request, notifies the registrant otherwise.

Section 16. Transactions Subject to Prior Notice ‑‑ Notice Filing.

(a) An insurer required to give notice of a proposed transaction pursuant to W.S. § 26‑44‑105 of the Act shall furnish the required information on Form D, hereby made a part of these regulations.

(b) Agreements for cost sharing services and management services shall at a minimum and as applicable:

(i) Identify the person providing services and the nature of such services;

(ii) Set forth the methods to allocate costs;

(iii) Require timely settlement, not less frequently than on a quarterly basis, and compliance with the requirements in the Accounting Practices and Procedures Manual;

(iv) Prohibit advancement of funds by the insurer to the affiliate except to pay for services defined in the agreement;

(v) State that the insurer will maintain oversight for functions provided to the insurer by the affiliate and that the insurer will monitor services annually for quality assurance;

(vi) Define records and data of the insurer to include all records and data developed or maintained under or related to the agreement that are otherwise the property of the insurer, in whatever form maintained, including, but not limited to, claims and claim files, policyholder lists, application files, litigation files, premium records, rate books, underwriting manuals, personnel records, financial records or similar records within the possession, custody or control of the affiliate;

(vii) Specify that all records and data of the insurer are and remain the property of the insurer and are subject to control of the insurer, and;

(A) Are subject to control of the insurer;

(B) Are identifiable; and

(C) Are segregated from all other persons' records and data or are readily capable of segregation at no additional cost to the insurer;

(viii) State that all funds and invested assets of the insurer are the exclusive property of the insurer, held for the benefit of the insurer and are subject to the control of the insurer;

(ix) Include standards for termination of the agreement with and without cause;

(x) Include provisions for indemnification of the insurer in the event of gross negligence or willful misconduct on the part of the affiliate providing the services and for any actions by the affiliate that violate provisions of the agreement required in paragraphs (xi) through (xv) of Section 16(b) of this regulation;

(xi) Specify that, if the insurer is placed in supervision, seizure, conservatorship or receivership pursuant to Chapter 28 of the Wyoming Insurance Code [title 26]:

(A) All of the rights of the insurer under the agreement extend to the receiver or commissioner to the extent permitted by the Wyoming insurance code [title 26];

(B) All records and data of the insurer shall be identifiable and segregated from all other persons' records and data or readily capable of segregation at no additional cost to the receiver or the commissioner; and

(C) A complete set of records and data of the insurer will immediately be made available to the receiver or the commissioner, shall be made available in a usable format, and shall be turned over to the receiver or commissioner immediately upon the receiver or the commissioner's request, and the cost to transfer data to the receiver or the commissioner shall be fair and reasonable; and

(D) The affiliated persons(s) will make available all employees essential to the operations of the insurer and the services associated therewith for the immediate continued performance of the essential services ordered or directed by the receiver or commissioner;

(xii) Specify that the affiliate has no automatic right to terminate the agreement if the insurer is placed into supervision, seizure, conservatorship or receivership pursuant to Chapter 28 of the Wyoming Insurance Code; and

(xiii) Specify that the affiliate will continue to maintain any systems, programs, or other infrastructure notwithstanding supervision, seizure, conservatorship or receivership pursuant to Chapter 28 of the insurance code, and will make them available to the receiver or commissioner as ordered or directed by the receiver or commissioner, for so long as the affiliate continues to receive timely payment for post-receivership services rendered, and unless released by the receiver, commissioner or supervising court.

Section 17. Enterprise Risk Report. The ultimate controlling person of an insurer required to file an enterprise risk report pursuant to W.S. § 26-44-104 of the Act shall furnish the required information on Form F, hereby made a part of these regulations.

Section 18. Extraordinary Dividends and Other Distributions.

(a) Requests for approval of extraordinary dividends or any other extraordinary distribution to shareholders shall include the following:

(i) The amount of the proposed dividend;

(ii) The date established for payment of the dividend;

(iii) A statement as to whether the dividend is to be in cash or other property and, if in property, a description thereof, its cost, and its fair market value together with an explanation of the basis for valuation;

(iv) A copy of the calculations determining that the proposed dividend is extraordinary. The work paper shall include the following information:

(A) The amounts, dates and form of payment of all dividends or distributions (including regular dividends but excluding distributions of the insurers own securities) paid within the period of twelve (12) consecutive months ending on the date fixed for payment of the proposed dividend for which approval is sought and commencing on the day after the same day of the same month in the last preceding year;

(B) Surplus as regards policyholders (total capital and surplus) as of December 31 of the year immediately preceding;

(C) If the insurer is a life insurer, the net gain from operations for the 12‑month period ending December 31 of the year immediately preceding;

(D) If the insurer is not a life insurer, the net income less realized capital gains for the 12‑month period ending December 31 of the year immediately preceding and the two preceding 12‑months periods; and

(E) If the insurer is not a life insurer, the dividends paid to stockholders excluding distributions of the insurer's own securities in the preceding two (2) calendar years.

(v) A balance sheet and statement of income for the period intervening from the last annual statement filed with the Commissioner and the end of the month preceding the month in which the request for dividend approval is submitted; and

(vi) A brief statement as to the effect of the proposed dividend upon the insurer's surplus and the reasonableness of surplus in relation to the insurer's outstanding liabilities and the adequacy of surplus relative to the insurer's financial needs.

(b) Subject to W.S. § 26‑44‑106 of the Act, each registered insurer shall report to the Commissioner all dividends and other distributions to shareholders within fifteen (15) business days following the declaration thereof, including the same information required by subsections (a)(iv)(A) ‑ (E) of this section.

Section 19. Adequacy of Surplus. The factors set forth in W.S. § 26‑44‑108 of the Act are not intended to be an exhaustive list. In determining the adequacy and reasonableness of an insurer's surplus no single factor is necessarily controlling. The Commissioner, instead, will consider the net effect of all of these factors plus other factors bearing on the financial condition of the insurer. In comparing the surplus maintained by other insurers, the Commissioner will consider the extent to which each of these factors varies from company to company and in determining the quality and liquidity of investments in subsidiaries, the Commissioner will consider the individual subsidiary and may discount or disallow its valuation to the extent that the individual investments so warrant.

Section 20. Group Capital Calculation.

(a) Where an insurance holding company system has previously filed the annual group capital calculation at least once, the lead state commissioner has the discretion to exempt the ultimate controlling person from filing the annual group capital calculation if the lead state commissioner makes a determination based upon that filing that the insurance holding company system meets all of the following criteria:

(i) Has annual direct written and unaffiliated assumed premium (including international direct and assumed premium), but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, of less than $1,000,000,000;

(ii) Has no insurers within its holding company structure that are domiciled outside of the United States or one of its territories;

(iii) Has no banking, depository or other financial entity that is subject to an identified regulatory capital framework within its holding company structure;

(iv) The holding company system attests that there are no material changes in the transactions between insurers and non-insurers in the group that have occurred since the last filing of the annual group capital; and

(v) The non-insurers within the holding company system do not pose a material financial risk to the insurer's ability to honor policyholder obligations.

(b) Where an insurance holding company system has previously filed the annual group capital calculation at least once, the lead state commissioner has the discretion to accept in lieu of the group capital calculation a limited group capital filing if:

(i) The insurance holding company system has annual direct written and unaffiliated assumed premium (including international and assumed premium), but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, of less than $1,000,000,000, and all of the following additional criteria are met:

(A) Has no insurers within its holding company structure that are domiciled outside of the United States or one of its territories;

(B) Does not include a banking, depository or other financial entity that is subject to an identified regulatory capital framework; and

(C) The holding company system attests that there are no material changes in transactions between insurers and non-insurers in the group that have occurred since the last filing of the report to the lead state commissioner and the non-insurers within the holding company system do not pose a material financial risk to the insurers ability to honor policyholder obligations.

(c) For an insurance holding company that has previously met an exemption with respect to the group capital calculation pursuant Section 20(a) or 20(b) of this regulation, the lead state commissioner may require at any time the ultimate controlling person to file an annual group capital calculation, completed in accordance with the NAIC Group Capital Calculation Instructions, if any of the following criteria are met:

(i) Any insurer within the insurance holding company system is in a Risk-Based Capital action level event as set forth in W.S. §§ 26-48-103 through 26-48-106 or a similar standard for a non-U.S. insurer; or

(ii) Any insurer within the insurance holding company system meets one or more of the standards of an insurer deemed to be in hazardous financial condition as defined in W.S. §§ 26-3-115, 26-3-116, and 26-44-108; or

(iii) Any insurer within the insurance holding company system otherwise exhibits qualities of troubled insurer as determined by the lead state commissioner based on unique circumstances including, but not limited to , the type and volume of business written, ownership and organization structure, federal agency requests, and international supervisor requests.

(d) A non-U.S. jurisdiction is considered to "recognize and accept" the group capital calculation if it satisfies the following criteria:

(i) With respect to the W.S. § 26-44-104(p)(i)(D):

(A) The non-U.S. jurisdiction recognized the U.S. State regulatory approach to group supervision and group capital, by providing confirmation by a competent regulatory authority, in such jurisdiction, that insurers and insurance groups whose lead state is accredited by the NAIC under the NAIC Accreditation Program shall be subject only to worldwide prudential insurance group supervision including worldwide group governance, solvency and capital, and reporting, at the level of the worldwide parent undertaking of the insurance or reinsurance group by the non-U.S jurisdiction; or

(B) Were no U.S. Insurance groups operate in the non-U.S. jurisdiction, that non-U.S. jurisdiction indicates formally in writing to the lead state with a copy to the International Association of Insurance Supervisors that the group capital calculation is an acceptable international capital standard. This will serve as the documentation otherwise required in Section 20(d)(i)(A).

(ii) The non-U.S. jurisdiction provides confirmation by a competent regulatory authority in such jurisdiction that information regarding insurers and their parent, subsidiary, or affiliated entities, if applicable, shall be provided to the lead state commissioner in accordance with a memorandum of understanding or similar document between the commissioner and such jurisdiction, including but not limited to the International Association of Insurance Supervisors Multilateral Memorandum of Understanding or other multilateral memoranda of understanding coordinated by the NAIC. The commissioner shall determine, in consultation with the NAIC Committee Process, if the requirements of the information sharing agreements are in force.

(e) A list of non-U.S. jurisdictions that "recognize and accept" the group capital calculation will be published through the NAIC Committee Process:

(i) A list of jurisdictions that "recognize and accept" the group capital calculation pursuant to W.S. § 26-44-104(p)(i)(D), is published through the NAIC Committee Process to assist the lead state commissioner in determining which insurers shall file an annual group capital calculation, The list will clarify those situations in which a jurisdiction is exempted from filing under W.S. § 26-44-104(p)(i)(D). To assist with determination under W.S. § 26-44-104(p)(i)(D), the list will also identify whether a jurisdiction that is exempted under either W.S. §§ 26-44-104(p)(i)(C) and 26-44-104(p)(i)(D) a group capital filing for any U.S. based insurance group's operations in that non-U.S. jurisdiction.

(ii) For a non-U.S. jurisdiction where no U.S. insurance groups operate, the confirmation provided to meet the requirement of Section 20(d)(i)(B) will serve as support of recommendation to be published as a jurisdiction that "recognizes and accepts" the group capital calculation through the NAIC Committee Process.

(iii) If the lead state commissioner makes a determination pursuant to W.S. § 26-44-104(p)(i)(D) that differs from the NAIC List, the lead state commissioner shall provide thoroughly documented justification to the NAIC and other states.

(iv) Upon determination by the lead state commissioner that a non-U.S. jurisdiction no longer meets one or more of the requirement to "recognize and accept" the group capital calculation, the lead state commissioner may provide a recommendation to the NAIC that the non-U.S. jurisdiction be removed from the list of jurisdictions that "recognize and accepts" the group capital calculation.

History

• Effective 2025-12-03

Chapter 46 Regulation Governing Premium Trust Accounts

Wyo. Code R. 044.0002.46.07132017 § 1 Authority

This regulation is promulgated pursuant to W.S. §§ 16-3-101 et seq., 26‑2‑109, 26‑2‑110, and 26-9-229.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.46.07132017 § 2 Definitions

For the purpose of this regulation, the following definitions apply:

(a) "Licensee" means a producer, agent, or any other person holding a license issued by the Wyoming Insurance Department.

(b) "Qualified Financial Institution" has the same meaning as in W.S. § 26-5-114.

(c) "Trust Account" or "Premium Trust Account" means an account held in a Qualified Financial Institution for the purpose of holding premium payments, but excludes accounts into which premiums are deposited that are owned by the insurer entitled to the premiums.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.46.07132017 § 3 Establishment of Trust Account

(a) The trust account shall be:

(i) Established and maintained in a qualified financial institution located within Wyoming;

(ii) Separate and distinct from the licensee's operating and personal accounts; and

(iii) Shall have a separate account number, a separate check register, and different checks. The checks, check register and bank records for the account shall be clearly identified with the wording "Premium Trust Account."

(b) The licensee may establish the trust account with an initial deposit of the licensee's own funds only if such deposit is required to open the account, or to avoid bank charges or fees for maintaining the account. The deposit of the licensee's own funds shall not exceed the amount required to open the account or to avoid bank charges or fees.

(c) Upon the first deposit of any premiums or return premiums to the account, the licensee shall:

(i) Immediately withdraw all of the funds described in subsection (b); or

(ii) Maintain all funds described in subsection (b) within the account and separately account for those funds in the licensee's books and records.

(d) No bank charges or fees shall be paid from funds deposited in the trust account. Such charges or fees shall be paid from the licensee's own funds. If the qualified financial institution deducts any bank charges or fees from the trust account balance, the licensee shall reimburse the trust account those amounts within ten (10) business days following receipt of written notice of the deduction.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.46.07132017 § 4 Deposit of Funds

(a) Upon receipt of premium or return premium, licensee shall either:

(i) Remit such funds to the appropriate payee;

(ii) Credit such funds to the account of the appropriate payee; or

(iii) Deposit such funds in the licensee's trust account by the close of the fifth (5th) business day following their receipt.

(b) Subsequent transmittals of premiums and return premiums shall be made in accordance with the following:

(i) All premiums received, less commissions if authorized, shall be remitted to the insurer or its entitled agent on or before the contractual due date or within forty‑five (45) days after receipt, if there is no contractual due date.

(ii) All return premiums shall be paid to the insured or credited to the insured's account by the close of the fifth (5th) business day following receipt of the funds.

(iii) If the return premium is reflected as a credit on the licensee's billing statement, the licensee shall pay the return premium or credit the insured's account by the close of the fifth (5th) business day subsequent to payment of the statement or the due date of the statement, whichever is sooner.

(iv) If the return premium is to be credited to the insured's account, the credit must be shown and applied to the next billing statement sent to the insured.

(A) If the credit results in a credit balance on the insured's account, the credit shall be returned by the close of the fifth (5th) business day following the billing statement unless the licensee receives written authorization from the insured to retain the credit balance and other developed credit balances for a period of no more than twelve (12) months from the date of authorization. Such authorization must contain a notification to the insured that he has the right to withdraw the authorization in writing and that the return premium will be refunded within fifteen (15) days of the authorization withdrawal. A copy of the authorization shall be maintained in the licensee's file and a copy shall be given to the insured at the time that the authorization is obtained. If authorization is obtained, the licensee shall send monthly written notification to the insured which clearly reflects a credit owed to the insured.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.46.07132017 § 5 Commissions

Any fees or commissions earned by the licensee and deposited in the trust account with any premium shall be withdrawn and paid into an operating or business account on or before the contractual due date of the premiums to the insurer, or within forty‑five (45) days after receipt, if there is no contractual due date.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.46.07132017 § 6 Interest

No licensee shall establish an interest bearing trust account.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.46.07132017 § 7 Record Keeping

All licensees who maintain and use a trust account shall maintain, at the principal place of business, accurate accounting records kept on a consistent basis which will facilitate an audit trail. The records shall show, at a minimum, the following:

(a) Any written authorization from the insured to retain credit balances, income, or funds placed in the premium trust account, or from an insurer to retain income on funds placed in the premium trust account;

(b) The existence and the source of any fees and commissions in the trust account;

(c) That a generally accepted form of reconciliation has been completed on a monthly basis showing transfers into and out of the account.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.46.07132017 § 8 Effective Date

This regulation shall be effective upon filing with the Secretary of State.

History

• Effective 2017-07-13

Chapter 47 Annual Statement Regulations

Wyo. Code R. 044.0002.47.12311996 Annual Statement Regulations

CHAPTER 47

ANNUAL STATEMENT REGULATION

Section 1. Authority

This regulation is issued pursuant to the authority vested in the Wyoming Insurance Commis- sioner under W.S. 26-3-123 of the Wyoming Insurance Code and W.S. 16-3-101, et seq., the Wyoming Administrative Procedure Act.

Section 2. Purpose

The purpose of this regulation is to define the annual statement blank which shall be filed with the Department on or before March 1 of each year or within any extended time the commissioner grants, not to exceed thirty (30) days.

Section 3. Applicability and Scope

This regulation applies to all insurers reporting to the Wyoming Insurance Department as re- quired by W.S. 26-3-123.

Section 4. Requirements

All companies reporting to the Wyoming Insurance Department in accordance with the require- ments of W.S. 26-3-123 shall file with the Department the appropriate National Association of Insurance Commissioners’ annual statement blank which shall be prepared in accordance with the National Asso- ciation of Insurance Commissioners’ Annual Statement Instructions and follow those accounting proce- dures and practices prescribed by the National Association of Insurance Commissioners’ Accounting Practice and Procedures Manual.

Section 5. Severability

Any section or provision of this regulation held by a Court to be invalid or unconstitutional shall not affect the validity of any other section or provision of this regulation.

Section 6. Effective Date

This regulation shall be effective upon filing with the Secretary of State.

History

• Effective 1996-12-31

Chapter 48 Valuation of Securities and Other Investments

Wyo. Code R. 044.0002.48.12311996 Valuation of Securities and Other Investments

CHAPTER 48

VALUATION OF SECURITIES AND OTHER INVESTMENTS

Section 1. Authority

This regulation governing valuation of securities and other investments is promulgated by the authority of and pursuant to the Wyoming Administrative Procedure Act, W.S. 16-3-101 et seq., W.S.26-2-110, and W.S. 26-6-301 and 302.

Section 2. Purpose

The purpose of this regulation is to protect the consumers of insurance in the state of Wyoming by creating fair and equitable standards for valuing securities and other investments owned by insurance companies, thereby ensuring that insurance companies meet minimum solvency standards.

Section 3. Valuation of Securities

All securities owned by insurers shall be valued in accordance with the most recent standards promulgated by the National Association of Insurance Commissioners’ Securities Valuation Office.

Section 4. Valuation of Other Investments

Other invested assets of insurance companies shall be valued in accordance with the most recent procedures promulgated by the National Association of Insurance Commissioners.

Section 5. Effective Date

This regulation becomes effective immediately upon filing with the Secretary of State.

History

• Effective 1996-12-31

Chapter 49 Regulation to implement the Small Employer Health Insurance Availability Act

Wyo. Code R. 044.0002.49.10132015 Regulation to implement the Small Employer Health Insurance Availability Act

CHAPTER 49

SMALL EMPLOYER HEALTH INSURANCE

Section 1. Authority

This Regulation is issued pursuant to the authority vested in the Commissioner under W.S. §§ 26-2-110, 26-19-304(a)(xii) and 26-19-310.

Section 2. Definitions

(a) For the purposes of this Regulation: "Associate member of an employee organization" means any individual who participates in an employee benefit plan (as defined in 29 U.S.C. § 1002(1)) that is a multi-employer plan (as defined in 29 U.S.C. § 1002(37A)), other than the following:

(i) An individual, or the beneficiary of such individual, who is employed by a participating employer within a bargaining unit covered by at least one of the collective bargaining agreements under or pursuant to which the employee benefit plan is established or maintained; or

(ii) An individual who is a present or former employee, or a beneficiary of such employee, of the sponsoring employee organization, of an employer who is or was a party to at least one of the collective bargaining agreements under or pursuant to which the employee benefit plan is established or maintained, or of the employee benefit plan or of a related plan.

(b) "New entrant" means an eligible employee, or the dependent of an eligible employee, if coverage is offered to the dependent, who becomes part of an employer group after the initial period for enrollment in a health benefit plan, and who enrolls on a timely basis within the prescribed enrollment period. If an eligible employee has continued coverage under the provisions of W.S. § 26-19-113, or under the provisions of applicable Federal law, and the continued coverage is voluntarily continued to, or is voluntarily terminated on, a date that is after the end of that person's prescribed initial enrollment period of a health benefit plan, that eligible employee and his or her dependents shall not be considered late enrollees, as defined in W.S. § 26-19-302(xv).

(c) "Qualifying previous coverage" and "qualifying existing coverage" means public or private benefits or coverage provided under:

(i) Medicare, Medicaid, the Wyoming Health Insurance Pool, or other health benefit programs or coverages operated or maintained by any governmental entity;

(ii) An employer-based health insurance or health benefit arrangement that provides benefits similar to or exceeding benefits provided under the basic health plan; or

(iii) An individual health benefit plan (including coverage issued by a health maintenance organization, prepaid hospital or medical care plan, or a fraternal benefit society) that provides benefits similar to or exceeding the benefits provided under the basic health benefit plan.

(d) "Risk characteristic" means the claims experience, duration of coverage, or any similar characteristic related to the experience of a small employer group or of any member of a small employer group.

(e) "Risk load" means the percentage above the applicable base premium rate that is charged by a small employer carrier to a small employer to reflect the risk characteristics of the small employer group.

Section 3. Applicability and Scope

(a) This Regulation shall apply to any health benefit plan, whether provided on a group or individual basis, which:

(i) Meets one or more of the conditions set forth in W.S. § 26-19-303;

(ii) Provides coverage to two or more eligible employees of a small employer, without regard to whether the policy or certificate was issued in this state; and

(iii) Is in effect on or after the effective date of W.S. § 26-19-301 et seq.

(b) A carrier that provides an individual health benefit plan to two or more of the employees of a small employer shall be considered a small employer carrier and shall be subject to the provisions of W.S. § 26-19-301 et seq. and this Regulation with respect to such policies if the small employer contributes directly or indirectly to the premiums for the policies and the carrier is aware or should have been aware of such contribution as is explained in W.S. § 26-19-303.

(c) In the case of a carrier that provides individual health benefit plans to two or more employees of a small employer, the small employer shall be considered to be an eligible small employer as defined in W.S. § 26-19-302(a)(xxii) and the small employer carrier shall be subject to W.S. § 26-19- 306(a) (relating to guaranteed issue of coverage) if:

(i) The small employer has at least two (2) employees;

(ii) The small employer contributes directly or indirectly to the premiums charged by the carrier; and

(iii) The carrier is aware or should have been aware of the contribution by the employer.

(d) The provisions of W.S. § 26-19-301 et seq. and this Regulation shall apply to a health benefit plan provided to a small employer or to the employees of a small employer without regard to whether the health benefit plan is offered under or provided through a group policy or trust arrangement of any size sponsored by an association or discretionary group.

(e) An individual health insurance policy shall not be subject to the provisions of W.S. § 26-19-301 et seq. and this Regulation solely because the policyholder elects a deduction under Section 162(l) of the Internal Revenue Code.

(f) Change in Employer Status:

(i) If a small employer, as defined by applicable federal or state law, is issued a health benefit plan under the terms of W.S. § 26-19-301 et seq., the provisions of W.S. § 26- 19-301 et seq. and this Regulation shall continue to apply to the health benefit plan in the case that the small employer subsequently employs more than the required number of eligible employees to be considered a small employer. A carrier providing coverage to such an employer shall, within sixty (60) days of becoming aware that the employer has more than the required number of eligible employees to be considered a small employer but no later than the anniversary date of the employer's health benefit plan, notify the employer that the protection provided under W.S. § 26-19-301 et seq. and this Regulation shall cease to apply to the employer if such employer fails to renew its current health benefit plan or elects to enroll in a different health benefit plan.

(ii) If a health benefit plan is issued to an employer that is not a small employer as defined in W.S. § 26-19-302(a)(xxii) or as defined by applicable federal or state law, but subsequently the employer becomes a small employer (due to the loss or change of work status of one or more eligible employees), the terms of W.S. § 26-19-301 et seq. shall not apply to the health benefit plan. The carrier providing a health benefit plan to such an employer shall not become a small employer carrier under the terms of W.S. § 26-19-301 et seq. solely because the carrier continues to provide coverage under the health benefit plan to the employer

(iii) A carrier providing coverage to an employer described in subparagraph (f)(ii) , who becomes aware that the employer meets the requirements to be a small employer, as defined by applicable federal or state law, shall notify the employer within sixty (60) days of the options and protections available to the employer under W.S. § 26-19-301 et seq., including the employer's option to purchase a small employer health benefit plan from any small employer carrier.

(iv) If a small employer has employees in more than one state, the provisions of W.S. § 26-19-301 et seq. and this Regulation shall apply to a health benefit plan issued to the small employer if:

(A) The majority of eligible employees of such small employer are employed in this state, or are residents of Wyoming; or

(B) If no state contains a majority of the eligible employees of the small employer, the primary business location for plan determination of the small employer shall be Wyoming.

(v) In determining whether the laws of Wyoming or another state apply to a health benefit plan issued to a small employer, the provisions of subparagraph (iv) shall be applied as of the plan issuance date.

(vi) If a health benefit plan is subject to W.S. § 26-19-301 et seq. and this Regulation, these provisions shall apply to all individuals covered under the health benefit plan, whether they reside in Wyoming or in another state.

(g) A carrier that is not operating as a small employer carrier in Wyoming shall not become subject to these provisions solely because a small employer that was issued a health benefit plan in another state by that carrier moves to Wyoming.

Section 4. Establishment of Classes of Business

(a) A small employer carrier that establishes more than one class of business as defined in W.S. § 26-19-302(a)(vii) shall maintain on file for inspection by the Commissioner the following information:

(i) A description of each criterion employed by the carrier (or any of its agents) for determining membership in the class of business;

(ii) A statement describing the justification for establishing a separate class of business, and documentation substantiating differences in expected claims experience or administrative costs; and

(iii) A statement disclosing which, if any, health benefit plans are available in the class and any significant limitations related to the purchase of such plans.

(b) A carrier may not use group size as a criterion for establishing eligibility for a health benefit plan or for a class of business.

Section 5. Transition for Assumptions of Business from Another Carrier

(a) A small employer carrier shall not transfer or assume the entire insurance obligation and/or risk of a health benefit plan covering a small employer in Wyoming unless:

(i) The transaction has been approved by the Commissioner of the state of domicile of the assuming carrier;

(ii) The transaction has been approved by the Commissioner of the state of domicile of the ceding carrier; and

(iii) The transaction otherwise meets the requirements of this section.

(b) A carrier domiciled in Wyoming that proposes to assume or cede the entire insurance obligation and/or risk of one or more small employer health benefit plans from another carrier shall make a filing for approval with the Commissioner at least sixty (60) days prior to the date of the proposed transaction. The Commissioner may approve the transaction if the Commissioner finds that the transaction is in the best interests of the individuals insured under the health benefit plans to be transferred and is consistent with the purposes of W.S. § 26-19-301 et seq. and this Regulation. The Commissioner shall not approve the transaction until at least thirty (30) days after the date of the filing; except that, if the ceding carrier is in hazardous financial condition, the Commissioner may approve the transaction as soon as the Commissioner deems reasonable after the filing.

(c) The filing required under paragraph (b) above shall:

(i) Describe the class of business (including any eligibility requirements) of the ceding carrier from which the health benefit plans will be ceded;

(ii) Describe whether the assuming carrier will maintain the assumed health benefit plans as a separate class of business, pursuant to subsection (k), or will incorporate them into an existing class of business, pursuant to subsection (l). If the assumed health benefit plans will be incorporated into an existing class of business, the filing shall describe the class of business into which the health benefit plans will be incorporated;

(iii) Describe whether the health benefit plans being assumed are currently available for purchase by small employers;

(iv) Describe the potential effect of the assumption, if any, on the benefits provided by the health benefit plans to be assumed;

(v) Describe the potential effect of the assumption, if any, on the premiums for the health benefit plans to be assumed;

(vi) Describe any other potential material effects of the assumption on the coverage provided to the small employers covered by the health benefit plans to be assumed; and

(vii) Include any other information required by the Commissioner.

(d) A small employer carrier required to make a filing under subparagraph (b) above shall also make an informational filing with the Commissioner of each state in which there are small employer health benefit plans that would be included in the transaction. The informational filing to each state shall be made concurrently with the filing made under subparagraph (b) and shall include at least the information specified in subparagraph (c) for the small employer health benefit plans in that state.

(e) A small employer carrier shall not transfer or assume the entire insurance obligation and/or risk of a health benefit plan covering a small employer in Wyoming unless:

(i) The carrier has provided notice to the Commissioner at least sixty (60) days prior to the date of the proposed assumption. The notice shall contain the information specified in subparagraph (c).

(f) If the assumption of a class of business would result in the assuming small employer carrier being out of compliance with the limitations related to premium rates contained in W.S. § 26-19-304(a)(i), the assuming carrier shall make a filing with the Commissioner pursuant to W.S. § 26-19- 304(c) seeking suspension of the application of W.S.§ 26-19-304(a)(i).

(g) An assuming carrier seeking suspension of the application of W.S. § 26-19- 304(a)(i) shall not complete the assumption of health benefit plans covering small employers in Wyoming unless the Commissioner grants the suspension requested pursuant to subparagraph (f).

(h) Unless a different period is approved by the Commissioner, a suspension of the application of W.S. § 26-19-304(a)(i) shall, with respect to an assumed class of business, be for no more than fifteen (15) months and, with respect to each individual small employer, shall last only until the anniversary date of such employer's coverage (except that the period with respect to an individual small employer may be extended beyond its first anniversary date for a period of up to twelve (12) months if the anniversary date occurs within three (3) months of the date of assumption of the class of business).

(i) Except as provided in subparagraph (b), a small employer carrier shall not cede or assume the entire insurance obligation and/or risk for a small employer health benefit plan unless the transaction includes the ceding to the assuming carrier of the entire class of business which includes such health benefit plan.

(j) A small employer carrier may cede less than an entire class of business to an assuming carrier if:

(i) One or more small employers in the class have exercised their right under contract or Wyoming law to reject (either directly or by implication) the ceding of their health benefit plans to another carrier. In that instance, the transaction shall include each health benefit plan in the class of business except those health benefit plans for which a small employer has rejected the proposed cession; or

(ii) After a written request from the transferring carrier, the Commissioner determines that the transfer of less than the entire class of business is in the best interests of the small employers insured in that class of business.

(k) Except as provided in subsection (l), a small employer carrier that assumes one or more health benefit plans from another carrier shall maintain such health benefit plans as a separate class of business.

(l) A small employer carrier that assumes one or more health benefit plans from another carrier may exceed the limitation contained in W.S. § 26-19-302(a)(vii) (relating to the maximum number of classes of business a carrier may establish) due solely to such assumption for a period of up to fifteen (15) months after the date of the assumption, provided that the carrier complies with the following provisions:

(i) Upon assumption of the health benefit plans, such health benefit plans shall be maintained as a separate class of business. During the fifteen-month (15) period following the assumption, each of the assumed small employer health benefit plans shall be transferred by the assuming small employer carrier into a single class of business operated by the assuming small employer carrier. The assuming small employer carrier shall select the class of business into which the assumed health benefit plans will be transferred in a manner such that the transfer results in the least possible change to the benefits and rating method of the assumed health benefit plans.

(ii) The transfers authorized in subparagraph (a) shall occur with respect to each small employer on the anniversary date of the small employer's coverage, except that the period with respect to an individual small employer may be extended beyond its first anniversary date for a period of up to twelve (12) months if the anniversary date occurs within three (3) months of the date of assumption of the class of business.

(iii) A small employer carrier making a transfer pursuant to subparagraph (i) may alter the benefits of the assumed health benefit plans to conform to the benefits currently offered by the carrier in the class of business into which the health benefit plans have been transferred.

(iv) The premium rate for an assumed small employer health benefit plan shall not be modified by the assuming small employer carrier until the health benefit plan is transferred pursuant to subparagraph (i). Upon transfer, the assuming small employer carrier shall calculate a new premium rate for the health benefit plan from the rate manual established for the class of business into which the health benefit plan is transferred. In making such calculation, the risk load applied to the health benefit plan shall be no higher than the risk load applicable to such health benefit plan prior to the assumption.

(v) During the fifteen-month period provided in this subsection, the transfer of small employer health benefit plans from the assumed class of business in accordance with this subsection shall not be considered a violation of the first sentence of W.S. § 26-19- 304(b).

(m) An assuming carrier may not apply eligibility requirements (including minimum participation and contribution requirements) with respect to an assumed health benefit plan (or with respect to any health benefit plan subsequently offered to a small employer covered by such an assumed health benefit plan) that are more stringent than the requirements applicable to such health benefit plan prior to the assumption.

(n) The Commissioner may approve a longer period of transition upon application of a small employer carrier. The application shall be made within sixty (60) days after the date of assumption of the class of business and shall clearly state the justification for a longer transition period.

(o) Nothing in this section or in W.S. § 26-19-301 et seq. is intended to:

(i) Reduce or diminish any legal or contractual obligation or requirement, including any obligation of the ceding or assuming carrier related to the transaction;

(ii) Authorize a carrier that is not admitted to transact the business of insurance in this state to offer or insure health benefit plans in this state; or

(iii) Reduce or diminish the protection related to an assumption reinsurance transaction otherwise provided by law.

Section 6. Restrictions Relating to Premium Rates

(a) A small employer carrier shall develop a separate rate manual for each class of business. Base premium rates and new business premium rates charged to small employers by the small employer carrier shall be computed solely from the applicable rate manual developed pursuant to this subsection. To the extent that a portion of the premium rates charged by a small employer carrier is based on the carrier's discretion, the manual shall specify the criteria and factors considered by the carrier in exercising such discretion. The carrier shall also provide the Commissioner, upon request, the rate manual and any additional information or documentation specified in this Section.

(i) A small employer carrier that modifies the rating method used in the rate manual for a class of business shall maintain with the rate manual for a period of six (6) years information and documentation containing the following:

(A) The reasons the change in rating method is being modified;

(B) A complete description of each of the proposed modifications to the rating method;

(C) A description of how the change in rating method would affect the premium rates currently charged to small employers in the class of business, including an estimate from a qualified actuary of the number of groups or individuals (and a description of the types of groups or individuals) whose premium rates may change by more than ten percent (10%) due to the proposed change in rating method (not generally including increases in premium rates applicable to all small employers in a health benefit plan);

(D) A certification from a qualified actuary that the new rating method would be based on objective and credible data and would be actuarially sound and appropriate; and

(E) A certification from a qualified actuary that the proposed change in rating method would not produce premium rates for small employers that would be in violation of W.S. § 26-19-304.

(ii) For the purpose of this section a change in rating method shall mean:

(A) A change in the number of case characteristics used by a small employer carrier to determine premium rates for health benefit plans in a class of business;

(B) A change in the manner or procedures by which insureds are assigned into categories for the purpose of applying a case characteristic to determine premium rates for health benefit plans in a class of business;

(C) A change in the method of allocating expenses among health benefit plans in a class of business; or

(D) A change in a rating factor with respect to any case characteristic if the change would produce a change in premium for any small employer that exceeds ten percent (10%). A change in a rating factor shall mean the cumulative change with respect to such factor considered over a twelve (12) month period. If a small employer carrier changes rating factors with respect to more than one case characteristic in a twelve (12) month period, the carrier shall consider the cumulative effect of all such changes in applying the ten percent (10%) test.

(b) The rate manual developed pursuant to subsection (a) shall specify the case characteristics and rate factors to be applied by the small employer carrier in establishing premium rates for the class of business.

(c) A small employer carrier shall use the same case characteristics in establishing premium rates for each health benefit plan in a class of business and shall apply them in the same manner in establishing premium rates for each health benefit plan. Case characteristics shall be applied without regard to the risk characteristics of a small employer.

(d) The rate manual developed pursuant to subsection (a) shall clearly illustrate the relationship among the base premium rates charged for each health benefit plan in the class of business. If the new business premium rate is different than the base premium rate for a health benefit plan, the rate manual shall illustrate the difference.

(e) Differences among base premium rates for health benefit plans shall be based solely on the reasonable and objective differences in the design and benefits of the health benefit plans and shall not be based in any way on the actual or expected health status or claims experience of the small employer groups that choose or are expected to choose a particular health benefit plan. A small employer carrier shall apply case characteristics and rate factors within a class of business in a manner that assures that premium differences among health benefit plans for identical small employer groups vary only due to reasonable and objective differences in the design and benefits of the health benefit plans and are not due to the actual or expected health status or claims experience of the small employer groups that choose or are expected to choose a particular health benefit plan.

(f) Except as provided in subparagraph (g), a premium charged to a small employer for a health benefit plan shall not include a separate application fee, underwriting fee, or any other separate fee or charge.

(g) A carrier may charge a separate fee with respect to a health benefit plan (but only one fee with respect to such plan) provided the fee is no more than five dollars ($5.00) per month per employee and is applied in a uniform manner to each health benefit plan in a class of business, with such fee being included in determining the carrier's compliance with W.S. § 26-19-304.

(h) A small employer carrier shall allocate administrative expenses to the basic and standard health benefit plans on no less favorable of a basis than expenses are allocated to other health benefit plans in the class of business. The rate manual developed pursuant to subsection (a) shall describe the method of allocating administrative expenses to the health benefit plans in the class of business for which the manual was developed.

(i) Each rate manual, updates, and changes developed pursuant to subsection (a) shall be maintained by the carrier for a period of six (6) years.

(j) The rate manual and rating practices of a small employer carrier shall comply with any guidelines issued by the Commissioner.

(k) If group size is used as a case characteristic, the highest rate factor associated with a group size shall not exceed the lowest rate factor by more than 20 percent (20%).

(l) A small employer carrier shall revise its rate manual each rating period to reflect changes in base premium rates and changes in new business premium rates.

(m) A small employer carrier shall keep on file for a period of at least six (6) years the calculations used to determine the change in base premium rates and new business premium rates for each health benefit plan for each rating period.

(n) Changes in premium rates for a small employer shall be subject to the provisions in W.S. § 26-19-304.

Section 7. Requirement to Insure Entire Groups

(a) A small employer carrier:

(i) That offers coverage to a small employer shall offer to provide coverage to each eligible employee and may offer coverage to each dependent of an eligible employee.

Except as provided in paragraph (ii), the small employer carrier shall provide the same health benefit plan to each employee and eligible dependent(s);

(ii) May offer the employees the option of choosing among one or more health benefit plans, provided that each employee may choose any of the offered plans. The choice among benefit plans may not be limited, restricted or conditioned based upon the risk characteristics of the employees or their dependents, unless allowed by applicable federal or state law;

(iii) Shall require each small employer that applies for coverage, as part of the application process, to provide a complete list of eligible employees and dependents, if offered, as defined in applicable federal or state law. Employees who are listed as being in their waiting period, probationary period or other period with similar limitations of coverage must be identified, including the ending date for each employee's period of limitation. Any subsequent lists submitted to the carrier shall also contain the information required in this section. The carrier shall require the employer to provide appropriate supporting documentation to verify the information required under this paragraph;

(iv) Shall secure a waiver with respect to each eligible employee and eligible dependents if dependent coverage is offered who declines an offer of coverage. The waiver shall be signed by the eligible employee or by the employee on behalf of the eligible dependent(s). The waiver shall certify that the individual who declined coverage was informed of the availability of coverage under the health benefit plan. The waiver form shall include the reason for declining coverage ,a written warning of the penalties imposed on late enrollees and a statement informing of any special enrollment rights, as allowed by applicable federal or state law. Waivers shall be maintained by the carrier for a period of six (6) years;

(v) Shall not issue coverage to a small employer that refuses to provide the list required under subparagraph (iii) or a waiver required under subparagraph (iv);

(vi) Shall not issue coverage to a small employer if the carrier, or the carrier's producer, has reason to believe that the small employer has induced or pressured an eligible employee or eligible dependent, if dependent coverage is offered, to decline coverage due the individual's risk characteristics.

(vii) Shall offer new entrants to a small employer group an opportunity to enroll in the health benefit plan. A new entrant who does not exercise the opportunity to enroll in the health benefit plan within the period provided by the small employer carrier may be treated as a late enrollee by the carrier, provided that the period provided to enroll in the health benefit plan extends at least thirty (30) days after the date the new entrant is notified of his or her opportunity to enroll. If a small employer carrier has offered more than one health benefit plan to a small employer group pursuant to subsection (a)(ii), the new entrant shall be offered the same choice of health benefit plans as the other members of the group.

(viii) Shall not apply a waiting period, elimination period or other similar limitation of coverage unless allowed by applicable federal and state law.

(ix) Shall accept new entrants for coverage by the small employer carrier without any restrictions or limitations on coverage related to the risk characteristics of the employees or their dependents if dependent coverage is offered, except that a carrier may exclude coverage for preexisting medical conditions, if allowed by applicable federal or state law.

(x) May assess a risk load to the premium rate associated with a new entrant, consistent with the requirements of W.S. § 26-19-304. The risk load shall be the same risk load charged to the small employer group immediately prior to acceptance of the new entrant.

(b) A producer shall:

(i) Notify a small employer carrier, prior to submitting an application for coverage with the carrier on behalf of a small employer, of any circumstances that would indicate that the small employer has induced or pressured an eligible employee or eligible dependent, if dependent coverage is offered, to decline coverage due to the individual's risk characteristics.

Section 8. Consideration of Industry

(a) Except as provided in subsections (b) and (c), a small employer carrier may not consider the trade or occupation of the employees of a small employer or the industry or type of business in which the small employer is engaged in determining whether to issue or continue to provide coverage to the small employer.

(b) A small employer carrier may use industry as a case characteristic in establishing premium rates, subject to applicable federal and state law.

(c) A small employer carrier may consider trade, occupation or industry as part of the eligibility criteria for a class of business, subject to applicable federal and state law.

Section 9. Application to Re-enter State

(a) A carrier that has been prohibited from writing coverage for small employers in Wyoming pursuant to W.S. § 26-19-305(c) may not resume offering health benefit plans to small employers in Wyoming until the carrier has made a petition and has been approved by the Commissioner.

(b) In the case of a small employer carrier doing business in only one established geographic service area of Wyoming, if the small employer carrier elects to nonrenew a health benefit plan under W.S. § 26-19-305(a)(vi), the small employer carrier shall be prohibited from offering health benefit plans to small employers in any part of the service area for a period of five (5) years. In addition, the small employer carrier shall not offer health benefit plans to small employers in any other geographic area of the state without the prior approval of the Commissioner.

Section 10. Qualifying Previous and Qualifying Existing Coverage

(a) For the purposes of W.S. § 26-19-302(a)(xv) and 26-19-306(c)(ii), an individual will be considered to have previous or existing coverage if the previous or existing policy, certificate or other benefit arrangement met the relevant definition of Section 2(c) of this Regulation. The small employer carrier shall interpret W.S. § 26-19-301 et seq. and this Regulation no less favorably to an insured individual than the following:

(i) A health insurance policy, certificate or other health benefit arrangement shall be considered employer-based if an employer sponsors the plan or arrangement or makes a contribution to the plan or arrangement.

(ii) A health insurance policy, certificate or other benefit arrangement shall be considered to provide benefits similar to or exceeding the benefits provided under the basic health benefit plan if it provides benefits that:

(A) Have an actuarial value as considered for a normal distribution of groups that is not substantially less than the actuarial value of the basic health benefit plan; or

(B) Provides coverage for hospitalization and physician services that is substantially similar to or exceeds the coverage for such services in the basic health benefit plan.

(b) In making a determination under subsection (a), a small employer carrier shall evaluate the previous or existing policy, certificate or other benefit arrangement taken as a whole and shall not base its decision solely on the fact that one portion of the previous or existing policy, certificate or benefit arrangement provides less coverage than the comparable portion of the basic health benefit plan.

(c) For the purposes of W.S. § 26-19-306(c)(ii), an individual will be considered to have qualifying previous coverage with respect to a particular service if the previous policy, certificate or other benefit arrangement met the definition in Section 2(c) of this Regulation and provided any benefit with respect to that service.

(d) A small employer carrier shall ascertain the source of previous or existing coverage of each eligible employee and each eligible dependent(s) if dependent coverage is offered at the time such employee or dependent initially enrolls into the health benefit plan. The small employer carrier shall contact the source of such previous or existing coverage to determine the benefits or limitations of the previous or existing coverage.

Section 11. Restrictive Riders and Rates

(a) Except as permitted in applicable federal and state law, a small employer carrier shall not modify or restrict a basic or standard health benefit plan in any manner for the purposes of restricting or excluding coverage or benefits for specific diseases, medical conditions or services otherwise covered by the plan.

(b) Except as permitted in applicable federal and state law, a small employer carrier shall not modify or restrict any health benefit plan with respect to any eligible employee or dependent of an eligible employee if dependent coverage is offered, through riders, endorsements or otherwise, for the purpose of restricting or excluding the coverage or benefits provided to such employee or dependent if dependent coverage is offered for specific diseases, medical conditions or services otherwise covered by the plan.

Section 12. Rules Related to Fair Marketing

(a) A small employer carrier shall actively market each of its health benefit plans in Wyoming. A small employer carrier may not suspend the marketing or issuance of the basic and standard health benefit plans unless the carrier has good cause and has received the prior approval of the Commissioner.

(b) In marketing the basic and standard health benefit plans, a small employer carrier shall use at least the same sources and methods of distribution that it uses to market other health benefit plans. Any producer authorized by a small employer carrier to market health benefit plans in Wyoming shall also be authorized to market the basic and standard health benefit plans.

(c) A small employer carrier shall actively offer all health benefit plans actively marketed in Wyoming to any small employer that applies for or makes an inquiry regarding health insurance coverage. The offer shall be in writing and the offer may be provided directly to the small employer or delivered through a producer and shall include at least the following information:

(i) A general description of the benefits contained in the basic and standard health benefit plans and any other health benefit plan being offered to the small employer; and

(ii) Information describing how the small employer may enroll in the plans.

(d) A small employer carrier shall provide a price quote to a small employer directly or through an authorized producer within fifteen (15) working days of receiving a request for a quote and such information as is necessary to provide the quote. A small employer carrier shall notify a small employer directly or through an authorized producer within ten (10) working days of receiving a request for a price quote of any additional information needed to provide the quote.

(e) A small employer carrier may not apply more stringent or detailed requirements related to the application process for the basic and standard health benefit plans than are applied for other health benefit plans.

(f) The small group carrier shall not require a small employer to join or contribute to any association or group as a condition of being accepted for coverage, unless, membership in an association or other group is a requirement for accepting a small employer into a particular health benefit plan.

(g) A small employer carrier shall not require, as a condition to the offer or sale of a health benefit plan to a small employer, that the small employer purchase or qualify for any other insurance product or service.

(h) Carriers offering individual and group health benefit plans in Wyoming shall be responsible for determining whether the plans are subject to the requirements of W.S. § 26- 19-301 et seq. and this Regulation. Carriers shall elicit the following information from applicants for such plans at the time of application:

(i) Whether or not any portion of the premium will be paid by or on behalf of a small employer, either directly or through wage adjustments or other means of reimbursement; and

(ii) Whether or not the prospective policyholder, certificate holder or any prospective insured individual intends to treat the health benefit plan as part of a plan or program under Section 162 (other than Section 162(l)), Section 125 or Section 106 of the United States Internal Revenue Code.

(i) If a small employer carrier fails to comply with subparagraph (h), the small employer carrier shall be deemed to be on notice of any information that could reasonably have been attained if the small employer carrier had complied with subparagraph (h).

(j) A small employer carrier shall file annually on or before March 15, in a format prescribed by the Commissioner, the following information related to health benefit plans issued by the small employer carrier to small employers in Wyoming:

(i) The number of small employers that were issued health benefit plans in the previous calendar year, separated as to newly issued plans and renewals;

(ii) The number of small employers that were issued the basic health benefit plan and the standard health benefit plan in the previous calendar year, separated as to newly issued plans and renewals;

(iii) The number of small employer health benefit plans in force in each county, or by zip code, of the state as of December 31 of the previous calendar year;

(iv) The number of small employer health benefit plans that were voluntarily not renewed by small employers in the previous calendar year;

(v) The number of small employer health benefit plans that were terminated or non-renewed for reasons other than nonpayment of premium by the carrier in the previous calendar year; and

(vi) The number of small employer health benefit plans that were issued to small employers that were uninsured for at least the three (3) months prior to issue.

Section 13. Effective Date

(a) This regulation shall become effective upon filing with the Secretary of State.

History

• Effective 2015-10-13

Chapter 50 Credit for Reinsurance

Wyo. Code R. 044.0002.50.12082021 Credit for Reinsurance

CHAPTER 50

CREDIT FOR REINSURANCE REGULATION

Section 1. Authority. This regulation is promulgated pursuant to W.S. 26-5-116(a), 26-2-110(a) and 16-3-101 et seq.

Section 2. Purpose. The purpose of this regulation is to set forth rules and procedural requirements which the Wyoming Insurance Commissioner deems necessary to carry out the provisions of W.S. 26-5-111 through 26-5-117 of the Insurance Code. The actions and information required by this regulation are declared to be necessary and appropriate in the public interest and for the protection of the ceding insurers in this state.

Section 3. Severability. If any provision of this regulation, or the application of the provision to any person or circumstance, is held invalid, the remainder of the regulation, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected.

Section 4. Credit for Reinsurance ‑ Reinsurer Licensed in this State. Pursuant to W.S. 26-5-112(a)(i), the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that was licensed in this state as of any date on which statutory financial statement credit for reinsurance is claimed.

Section 5. Credit for Reinsurance ‑ Accredited Reinsurers.

(a) Pursuant to W.S. 26-5-112(a)(ii), the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer which is accredited as a reinsurer in this state as of the date on which statutory financial statement credit for reinsurance is claimed. An accredited reinsurer shall:

(i) File a properly executed Form AR‑1 (located at the Department of Insurance website, doi.wyo.gov) as evidence of its submission to this state's jurisdiction and to this state's authority to examine its books and records;

(ii) File with the commissioner a certified copy of a certificate of authority or other acceptable evidence that it is licensed to transact insurance or reinsurance in at least one state, or, in the case of a United States branch of an alien assuming insurer, is entered through and licensed to transact insurance or reinsurance in at least one state;

(iii) File annually with the commissioner a copy of its annual statement filed with the Insurance Department of its state of domicile or, in the case of an alien assuming insurer, with the state through which it is entered and in which it is licensed to transact insurance or reinsurance, and a copy of its most recent audited financial statement; and

(iv) Maintain a surplus in an amount not less than $20,000,000 or obtain the affirmative approval of the commissioner upon a finding that it has adequate financial capacity to meet its reinsurance obligations and is otherwise qualified to assume reinsurance from domestic insurers.

(b) If the commissioner determines that the assuming insurer has failed to meet or maintain any of these qualifications, he may upon written notice and opportunity for a hearing, suspend or revoke the accreditation. Credit shall not be allowed a domestic ceding insurer under this section if the assuming insurer's accreditation has been revoked by the commissioner, or if the reinsurance was ceded while the assuming insurer's accreditation was under suspension by the commissioner.

Section 6. Credit for Reinsurance ‑ Reinsurer Domiciled and Licensed in Another State.

(a) Pursuant to W.S. 26-5-112(a)(iii) the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer which as of the date on which statutory financial statement credit for reinsurance is claimed:

(i) Is domiciled in (or, in the case of a United States branch of an alien assuming insurer, is entered through) a state which employs standards regarding credit for reinsurance substantially similar to those applicable under W.S. 26-5-111 through 26-5-117 and this regulation;

(ii) Maintains a surplus as regards policyholders in an amount not less than $20,000,000; and

(iii) Files a properly executed Form AR‑1 with the commissioner as evidence of its submission to Wyoming's authority to examine its books and records.

(b) The provisions of this section relating to surplus as regards policyholders shall not apply to reinsurance ceded and assumed pursuant to pooling arrangements among insurers in the same holding company system. As used in this section, "substantially similar" standards means credit for reinsurance standards which the commissioner determines equal or exceed the standards of W.S. 26-5-111 through 26-5-117 and this regulation.

Section 7. Credit for Reinsurance ‑ Reinsurers Maintaining Trust Funds.

(a) Pursuant to W.S. 26-5-112(a)(v) the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer which, as of any date on which statutory financial statement credit for reinsurance is claimed, and thereafter for so long as credit for reinsurance is claimed, maintains a trust fund in an amount prescribed below in a qualified U.S. financial institution as defined in W.S. 26-5-114(b), for the payment of the valid claims of its U.S. domiciled ceding insurers, their assigns and successors in interest. The assuming insurer shall report annually to the commissioner substantially the same information as that required to be reported on the National Association of Insurance Commissioners ("NAIC") annual statement form by licensed insurers to enable the commissioner to determine the sufficiency of the trust fund.

(b) The following requirements apply to the following categories of assuming insurer:

(i) The trust fund for a single assuming insurer shall consist of funds in trust in an amount not less than the assuming insurer's liabilities attributable to reinsurance ceded by U.S. domiciled insurers, and in addition, the assuming insurer shall maintain a trusteed surplus of not less than $20,000,000, except as provided in paragraph (ii) of this subsection.

(ii) At any time after the assuming insurer has permanently discontinued underwriting new business secured by the trust for at least three full years, the commissioner with principal regulatory oversight of the trust may authorize a reduction in the required trusteed surplus, but only after a finding, based on an assessment of the risk, that the new required surplus level is adequate for the protection of U.S. ceding insurers, policyholders and claimants in light of reasonably foreseeable adverse loss development. The risk assessment may involve an actuarial review, including an independent analysis of reserves and cash flows, and shall consider all material risk factors, including when applicable the lines of business involved, the stability of the incurred loss estimates and the effect of the surplus requirements on the assuming insurer's liquidity or solvency. The minimum required trusteed surplus may not be reduced to an amount less than thirty percent (30%) of the assuming insurer's liabilities attributable to reinsurance ceded by U.S. ceding insurers covered by the trust.

(iii) The trust fund for a group including incorporated and individual unincorporated underwriters shall consist of:

(A) For reinsurance ceded under reinsurance agreements with an inception, amendment or renewal date on or after January 1, 1993, funds in trust in an amount not less than the respective underwriters' several liabilities attributable to business ceded by U.S. domiciled ceding insurers to any underwriter of the group;

(B) For reinsurance ceded under reinsurance agreements with an inception date on or before December 31, 1992, and not amended or renewed after that date, notwithstanding the other provisions of this regulation, funds in trust in an amount not less than the respective underwriters' several insurance and reinsurance liabilities attributable to business written in the United States; and

(C) In addition to these trusts, the group shall maintain a trusteed surplus of which $100,000,000 shall be held jointly for the benefit of the United States domiciled ceding insurers of any member of the group for all the years of account.

(iv) The incorporated members of the group shall not be engaged in any business other than underwriting as a member of the group and shall be subject to the same level of regulation and solvency control by the group's domiciliary regulator as are the unincorporated members. The group shall, within ninety (90) days after its financial statements are due to be filed with the group's domiciliary regulator, provide to the commissioner:

(A) An annual certification by the group's domiciliary regulator of the solvency of each underwriter member of the group; or

(B) If a certification is unavailable, a financial statement prepared by independent public accountants of each underwriter member of the group.

(v) The trust fund for a group of incorporated insurers under common administration whose members possess aggregate policyholders surplus of $10,000,000,000 (calculated and reported in substantially the same manner as prescribed by the annual statement instructions and Accounting Practices and Procedures Manual of the NAIC) and which has continuously transacted an insurance business outside the United States for at least three (3) years immediately prior to making application for accreditation shall:

(A) Consist of funds in trust in an amount not less than the assuming insurers' several liabilities attributable to business ceded by U.S. domiciled ceding insurers to any members of the group pursuant to reinsurance contracts issued in the name of such group;

(B) Maintain a joint trusteed surplus of which $100,000,000 shall be held jointly for the benefit of U.S. domiciled ceding insurers of any member of the group; and

(C) File a properly executed Form AR-1 as evidence of the submission to this state's authority to examine the books and records of any of its members and shall certify that any member examined will bear the expense of any such examination.

(vi) Within ninety (90) days after the statements are due to be filed with the group's domiciliary regulator, the group shall file with the commissioner an annual certification of each underwriter member's solvency by the member's domiciliary regulators, and financial statements, prepared by independent public accountants, of each underwriter member of the group.

(c) Credit for reinsurance shall not be granted unless the form of the trust and any amendments to the trust have been approved by either the commissioner of the state where the trust is domiciled or the commissioner of another state who, pursuant to the terms of the trust instrument, has accepted responsibility for regulatory oversight of the trust. The form of the trust and any trust amendments also shall be filed with the commissioner of every state in which the ceding insurer beneficiaries of the trust are domiciled. The trust instrument shall provide that:

(i) Contested claims shall be valid and enforceable out of funds in trust to the extent remaining unsatisfied thirty (30) days after entry of the final order of any court of competent jurisdiction in the United States;

(ii) Legal title to the assets of the trust shall be vested in the trustee for the benefit of the grantor's United States ceding insurers, their assigns and successors in interest;

(iii) The trust shall be subject to examination as determined by the commissioner;

(iv) The trust shall remain in effect for as long as the assuming insurer, or any member or former member of a group of insurers, shall have outstanding obligations under reinsurance agreements subject to the trust; and

(v) No later than February 28 of each year the trustee of the trust shall report to the commissioner in writing setting forth the balance in the trust and listing the trust's investments at the preceding year end, and shall certify the date of termination of the trust, if so planned, or certify that the trust shall not expire prior to the next following December 31.

(vi) Notwithstanding any other provisions in the trust instrument, if the trust fund is inadequate because it contains an amount less than the amount required by this subsection or if the grantor of the trust has been declared insolvent or placed into receivership, rehabilitation, liquidation or similar proceedings under the laws of its state or country of domicile, the trustee shall comply with an order of the commissioner with regulatory oversight over the trust or with an order of a court of competent jurisdiction directing the trustee to transfer to the commissioner with regulatory oversight over the trust or other designated receiver all of the assets of the trust fund.

(vii) The assets shall be distributed by and claims shall be filed with and valued by the commissioner with regulatory oversight over the trust in accordance with the laws of the state in which the trust is domiciled applicable to the liquidation of domestic insurance companies.

(viii) If the commissioner with regulatory oversight over the trust determines that the assets of the trust fund or any part thereof are not necessary to satisfy the claims of the U.S. beneficiaries of the trust, the commissioner with regulatory oversight over the trust shall return the assets, or any part thereof, to the trustee for distribution in accordance with the trust agreement.

(ix) The grantor shall waive any right otherwise available to it under U.S. law that is inconsistent with this provision.

(d) For purposes of this section, the term "liabilities" shall mean the assuming insurer's gross liabilities attributable to reinsurance ceded by U.S. domiciled insurers excluding liabilities that are otherwise secured by acceptable means, and, shall include:

(i) For business ceded by domestic insurers authorized to write accident and health, and property and casualty insurance:

(A) Losses and allocated loss expenses paid by the ceding insurer, recoverable from the assuming insurer;

(B) Reserves for losses reported and outstanding;

(C) Reserves for losses incurred but not reported;

(D) Reserves for allocated loss expenses; and

(E) Unearned premiums.

(ii) For business ceded by domestic insurers authorized to write life, health and annuity insurance:

(A) Aggregate reserves for life policies and contracts net of policy loans and net due and deferred premiums;

(B) Aggregate reserves for accident and health policies;

(C) Deposit funds and other liabilities without life or disability contingencies; and

(D) Liabilities for policy and contract claims.

(e) Assets deposited in trusts established pursuant to W.S. 26-5-112 and this section shall be valued according to their current fair market value and shall consist only of cash in U.S. dollars, certificates of deposit issued by a U.S. financial institution as defined in W.S. 26-5-114, clean, irrevocable, unconditional and "evergreen" letters of credit issued or confirmed by a qualified U.S. financial institution, as defined in W.S. 26-5-114, and investments of the type specified in this subsection, but investments in or issued by an entity controlling, controlled by or under common control with either the grantor or beneficiary of the trust shall not exceed five percent (5%) of total investments. No more than twenty percent (20%) of the total of the investments in the trust may be foreign investments authorized under paragraphs (i)(E), (iii), (vi)(B) or (vii) of this subsection, and no more than ten percent (10%) of the total of the investments in the trust may be securities denominated in foreign currencies. For purposes of applying the preceding sentence, a depository receipt denominated in dollars and representing rights conferred by a foreign security shall be classified as a foreign investment denominated in a foreign currency. The assets of a trust established to satisfy the requirements of W.S. 26-5-112 shall be invested only as follows:

(i) Government obligations that are not in default as to principal or interest, that are valid and legally authorized and that are issued, assumed or guaranteed by:

(A) The United States or by any agency or instrumentality of the United States;

(B) A state of the United States;

(C) A territory, possession or other governmental unit of the United States;

(D) An agency or instrumentality of a governmental unit referred to in subparagraphs (B) and (C) of this paragraph if the obligations shall be by law (statutory or otherwise) payable, as to both principal and interest, from taxes levied or by law required to be levied or from adequate special revenues pledged or otherwise appropriated or by law required to be provided for making these payments, but shall not be obligations eligible for investment under this paragraph if payable solely out of special assessments on properties benefited by local improvements; or

(E) The government of any other country that is a member of the Organization for Economic Cooperation and Development and whose government obligations are rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC;

(ii) Obligations that are issued in the United States, or that are dollar denominated and issued in a non-U.S. market, by a solvent U.S. institution (other than an insurance company) or that are assumed or guaranteed by a solvent U.S. institution (other than an insurance company) and that are not in default as to principal or interest if the obligations:

(A) Are rated A or higher (or the equivalent) by a securities rating agency recognized by the Securities Valuation Office of the NAIC, or if not so rated, are similar in structure and other material respects to other obligations of the same institution that are so rated;

(B) Are insured by at least one authorized insurer (other than the investing insurer or a parent, subsidiary or affiliate of the investing insurer) licensed to insure obligations in this state and, after considering the insurance, are rated AAA (or the equivalent) by a securities rating agency recognized by the Securities Valuation Office of the NAIC; or

(C) Have been designated as Class One or Class Two by the Securities Valuation Office of the NAIC;

(iii) Obligations issued, assumed or guaranteed by a solvent non‑U.S. institution chartered in a country that is a member of the Organization for Economic Cooperation and Development or obligations of U.S. corporations issued in a non-U.S. currency, provided that in either case the obligations are rated A or higher (or the equivalent) by a rating agency recognized by the Securities Valuation Office of the NAIC;

(iv) An investment made pursuant to the provisions of paragraph (i), (ii) or (iii) of this subsection shall be subject to the following additional limitations:

(A) An investment in or loan upon the obligations of an institution other than an institution that issues mortgage-related securities shall not exceed five percent (5%) of the assets of the trust;

(B) An investment in any one mortgage-related security shall not exceed five percent (5%) of the assets of the trust;

(C) The aggregate total investment in mortgage-related securities shall not exceed twenty-five percent (25%) of the assets of the trust; and

(D) Preferred or guaranteed shares issued or guaranteed by a solvent U.S. institution are permissible investments if all of the institution's obligations are eligible as investments under paragraphs (ii)(A) and (ii)(C) of this subsection, but shall not exceed two percent (2%) of the assets of the trust.

(v) As used in this regulation:

(A) "Mortgage-related security" means an obligation that is rated AA or higher (or the equivalent) by a securities rating agency recognized by the Securities Valuation Office of the NAIC and that either:

(I) Represents ownership of one or more promissory notes or certificates of interest or participation in the notes (including any rights designed to assure servicing of, or the receipt or timeliness of receipt by the holders of the notes, certificates, or participation of amounts payable under, the notes, certificates or participation), that:

(1.) Are directly secured by a first lien on a single parcel of real estate, including stock allocated to a dwelling unit in a residential cooperative housing corporation, upon which is located a dwelling or mixed residential and commercial structure, or on a residential manufactured home as defined in 42 U.S.C. section 5402(6), whether the manufactured home is considered real or personal property under the laws of the state in which it is located; and

(2.) Were originated by a savings and loan association, savings bank, commercial bank, credit union, insurance company, or similar institution that is supervised and examined by a federal or state housing authority, or by a mortgagee approved by the Secretary of Housing and Urban Development pursuant to 12 U.S.C. sections 1709 and 1715-b, or, where the notes involve a lien on the manufactured home, by an institution or by a financial institution approved for insurance by the Secretary of Housing and Urban Development pursuant to 12 U.S.C. section 1703; or

(II) Is secured by one or more promissory notes or certificates of deposit or participations in the notes (with or without recourse to the insurer of the notes) and, by its terms, provides for payments of principal in relation to payments, or reasonable projections of payments, or notes meeting the requirements of paragraphs (I)(1.) and (I)(2.) of this subsection;

(B) "Promissory note," when used in connection with a manufactured home, shall also include a loan, advance or credit sale as evidenced by a retail installment sales contract or other instrument.

(vi) Equity interests

(A) Investments in common shares or partnership interests of a solvent U.S. institution are permissible if:

(I) Its obligations and preferred shares, if any, are eligible as investments under this subsection; and

(II) The equity interests of the institution (except an insurance company) are registered on a national securities exchange as provided in the Securities Exchange Act of 1934, 15 U.S.C. sections 78a to 78kk or otherwise registered pursuant to that Act, and if otherwise registered, price quotations for them are furnished through a nationwide automated quotations system approved by the Financial Industry Regulatory Authority, or successor organization. A trust shall not invest in equity interests under this paragraph an amount exceeding one percent (1%) of the assets of the trust even though the equity interests are not so registered and are not issued by an insurance company;

(B) Investments in common shares of a solvent institution organized under the laws of a country that is a member of the Organization for Economic Cooperation and Development, if:

(I) All its obligations are rated A or higher, (or the equivalent), by a rating agency recognized by the Securities Valuation Office of the NAIC; and

(II) The equity interests of the institution are registered on a securities exchange regulated by the government of a country that is a member of the Organization for Economic Cooperation and Development;

(C) An investment in or loan upon any one institution's outstanding equity interests shall not exceed one percent (1%) of the assets of the trust. The cost of an investment in equity interests made pursuant to this paragraph, when added to the aggregate cost of other investments in equity interests then held pursuant to this paragraph, shall not exceed ten percent (10%) of the assets in the trust;

(vii) Obligations issued, assumed or guaranteed by a multinational development bank, provided the obligations are rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC.

(viii) Investment companies.

(A) Securities of an investment company registered pursuant to the Investment Company Act of 1940, 15 U.S.C. § 80a, are permissible investments if the investment company:

(I) Invests at least ninety percent (90%) of its assets in the types of securities that qualify as an investment under paragraph (i), (ii) or (iii) of this subsection or invests in securities that are determined by the commissioner to be substantively similar to the types of securities set forth in paragraph (i), (ii) or (iii) of this subsection; or

(II) Invests at least ninety percent (90%) of its assets in the types of equity interests that qualify as an investment under paragraph (vi)(A) of this subsection;

(B) Investments made by a trust in investment companies under this paragraph shall not exceed the following limitations:

(I) An investment in an investment company qualifying under subparagraph (A)(I) of this paragraph shall not exceed ten percent (10%) of the assets in the trust and the aggregate amount of investment in qualifying investment companies shall not exceed twenty-five percent (25%) of the assets in the trust; and

(II) Investments in an investment company qualifying under subparagraph (A)(II) of this paragraph shall not exceed five percent (5%) of the assets in the trust and the aggregate amount of investment in qualifying investment companies shall be included when calculating the permissible aggregate value of equity interests pursuant to paragraph (vi)(A) of this subsection.

(ix) Letters of Credit.

(A) In order for a letter of credit to qualify as an asset of the trust, the trustee shall have the right and the obligation pursuant to the deed of trust or some other binding agreement (as duly approved by the commissioner), to immediately draw down the full amount of the letter of credit and hold the proceeds in trust for the beneficiaries of the trust if the letter of credit will otherwise expire without being renewed or replaced.

(B) The trust agreement shall provide that the trustee shall be liable for its negligence, willful misconduct or lack of good faith. The failure of the trustee to draw against the letter of credit in circumstances where such draw would be required shall be deemed to be negligence and/or willful misconduct.

(f) A specific security provided to a ceding insurer by an assuming insurer pursuant to Section 11 of this regulation shall be applied, until exhausted, to the payment of liabilities of the assuming insurer to the ceding insurer holding the specific security prior to, and as a condition precedent for, presentation of a claim by the ceding insurer for payment by a trustee of a trust established by the assuming insurer pursuant to this section.

Section 8. Credit for Reinsurance--Certified Reinsurers.

(a) Pursuant to W.S. 26-5-112(a)(vi), the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that has been certified as a reinsurer in this state at all times for which statutory financial statement credit for reinsurance is claimed under this section. The credit allowed shall be based upon the security held by or on behalf of the ceding insurer in accordance with a rating assigned to the certified reinsurer by the commissioner. The security shall be in a form consistent with the provisions of W.S. 26-5-112(a)(vi) and 26-5-113, and sections 12, 13, or 14 of this chapter. The amount of security required in order for full credit to be allowed shall correspond with the following requirements:

(i) Ratings Security Required

Secure - 1 0%

Secure - 2 10%

Secure - 3 20%

Secure - 4 50%

Secure - 5 75%

Vulnerable - 6 100%

(ii) Affiliated reinsurance transactions shall receive the same opportunity for reduced security requirements as all other reinsurance transactions.

(iii) The commissioner shall require the certified reinsurer to post one hundred percent (100%), for the benefit of the ceding insurer or its estate, security upon the entry of an order of rehabilitation, liquidation or conservation against the ceding insurer.

(iv) In order to facilitate the prompt payment of claims, a certified reinsurer shall not be required to post security for catastrophe recoverables for a period of one year from the date of the first instance of a liability reserve entry by the ceding company as a result of a loss from a catastrophic occurrence as recognized by the commissioner. The one year deferral period is contingent upon the certified reinsurer continuing to pay claims in a timely manner. Reinsurance recoverables for only the following lines of business as reported on the NAIC annual financial statement related specifically to the catastrophic occurrence will be included in the deferral:

(A) Line 1: Fire

(B) Line 2: Allied Lines

(C) Line 3: Farmowners multiple peril

(D) Line 4: Homeowners multiple peril

(E) Line 5: Commercial multiple peril

(F) Line 9: Inland Marine

(G) Line 12: Earthquake

(H) Line 21: Auto physical damage

(v) Credit for reinsurance under this section shall apply only to reinsurance contracts entered into or renewed on or after the effective date of the certification of the assuming insurer. Any reinsurance contract entered into prior to the effective date of the certification of the assuming insurer that is subsequently amended after the effective date of the certification of the assuming insurer, or a new reinsurance contract, covering any risk for which collateral was provided previously, shall only be subject to this section with respect to losses incurred and reserves reported from and after the effective date of the amendment or new contract.

(vi) Nothing in this section shall prohibit the parties to a reinsurance agreement from agreeing to provisions establishing security requirements that exceed the minimum security requirements established for certified reinsurers under this section.

(b) Certification Procedure.

(i) The commissioner shall post notice on the Insurance Department's website promptly upon receipt of any application for certification, including instructions on how members of the public may respond to the application. The commissioner may not take final action on the application until at least thirty (30) days after posting the notice required by this paragraph.

(ii) The commissioner shall issue written notice to an assuming insurer that has made application and been approved as a certified reinsurer. Included in the notice shall be the rating assigned the certified reinsurer in accordance with subsection (a) of this section. The commissioner shall publish a list of all certified reinsurers and their ratings.

(iii) In order to be eligible for certification, the assuming insurer shall meet the following requirements:

(A) The assuming insurer must be domiciled and licensed to transact insurance or reinsurance in a qualified jurisdiction, as determined by the commissioner pursuant to subsection (c) of this section.

(B) The assuming insurer shall maintain capital and surplus, or its equivalent, of no less than $250,000,000 calculated in accordance with subparagraph (iv)(HH) of this subsection. This requirement may also be satisfied by an association including incorporated and individual unincorporated underwriters having minimum capital and surplus equivalents (net of liabilities) of at least $250,000,000 and a central fund containing a balance of at least $250,000,000.

(C) The assuming insurer shall maintain financial strength ratings from two or more rating agencies deemed acceptable by the commissioner. These ratings shall be based on interactive communication between the rating agency and the assuming insurer and shall not be based solely on publicly available information. These financial strength ratings will be one factor used by the commissioner in determining the rating that is assigned to the assuming insurer. Acceptable rating agencies include the following:

(I) Standard & Poor's;

(II) Moody's Investors Service;

(III) Fitch Ratings;

(IV) A.M. Best Company; or

(V) Any other Nationally Recognized Statistical Rating Organization.

(D) The certified reinsurer must comply with any other requirements reasonably imposed by the commissioner.

(iv) Each certified reinsurer shall be rated on a legal entity basis, with due consideration being given to the group rating where appropriate, except that an association including incorporated and individual unincorporated underwriters that has been approved to do business as a single certified reinsurer may be evaluated on the basis of its group rating. Factors that may be considered as part of the evaluation process include, but are not limited to, the following:

(A) The certified reinsurer's financial strength rating from an acceptable rating agency. The maximum rating that a certified reinsurer may be assigned will correspond to its financial strength rating as outlined in the table below. The commissioner shall use the lowest financial strength rating received from an approved rating agency in establishing the maximum rating of a certified reinsurer. A failure to obtain or maintain at least two financial strength ratings from acceptable rating agencies will result in loss of eligibility for certification:

| Ratings | Best | S&P | Moody's | Fitch | | --- | --- | --- | --- | --- | | Secure - 1 | A++ | AAA | Aaa | AAA | | Secure - 2 | A+ | AA+, AA, AA- | Aa1, Aa2, Aa3 | AA+, AA, AA- | | Secure - 3 | A | A+, A | A1, A2 | A+, A | | Secure - 4 | A- | A- | A3 | A- | | Secure - 5 | B++, B+ | BBB+, BBB, BBB- | Baa1, Baa2, Baa3 | BBB+, BBB, BBB- | | Vulnerable - 6 | B, B-C++, C+, C, C-, D, E, F | BB+, BB, BB-, B+, B, B-, CCC, CC, C, D, R | Ba1, Ba2, Ba3, B1, B2, B3, Caa, Ca, C | BB+, BB, BB-, B+, B, B-, CCC+, CC, CCC-, DD |

(B) The business practices of the certified reinsurer in dealing with its ceding insurers, including its record of compliance with reinsurance contractual terms and obligations;

(C) For certified reinsurers domiciled in the U.S., a review of the most recent applicable NAIC Annual Statement Blank, either Schedule F (for property/casualty reinsurers) or Schedule S (for life and health reinsurers);

(D) For certified reinsurers not domiciled in the U.S., a review annually of Form CR-F (for property/casualty reinsurers) or Form CR-S (for life and health reinsurers) (located at the Department of Insurance website, doi.wyo.gov);

(E) The reputation of the certified reinsurer for prompt payment of claims under reinsurance agreements, based on an analysis of ceding insurers' Schedule F reporting of overdue reinsurance recoverables, including the proportion of obligations that are more than ninety (90) days past due or are in dispute, with specific attention given to obligations payable to companies that are in administrative supervision or receivership;

(F) Regulatory actions against the certified reinsurer;

(G) The report of the independent auditor on the financial statements of the insurance enterprise, on the basis described in paragraph (H) below;

(H) For certified reinsurers not domiciled in the U.S., audited financial statements, regulatory filings, and actuarial opinion (as filed with the non-U.S. jurisdiction supervisor, with a translation into English). Upon the initial application for certification, the commissioner will consider audited financial statements for the last two (2) years filed with its non-U.S. jurisdiction supervisor;

(I) The liquidation priority of obligations to a ceding insurer in the certified reinsurer's domiciliary jurisdiction in the context of an insolvency proceeding;

(J) A certified reinsurer's participation in any solvent scheme of arrangement, or similar procedure, which involves U.S. ceding insurers. The commissioner shall receive prior notice from a certified reinsurer that proposes participation by the certified reinsurer in a solvent scheme of arrangement; and

(K) Any other information deemed relevant by the commissioner.

(v) Based on the analysis conducted under subparagraph (iv)(E) of a certified reinsurer's reputation for prompt payment of claims, the commissioner may make appropriate adjustments in the security the certified reinsurer is required to post to protect its liabilities to U.S. ceding insurers, provided that the commissioner shall, at a minimum, increase the security the certified reinsurer is required to post by one rating level under subparagraph (iv)(A) if the commissioner finds that:

(A) More than fifteen percent (15%) of the certified reinsurer's ceding insurance clients have overdue reinsurance recoverables on paid losses of ninety (90) days or more which are not in dispute and which exceed $100,000 for each cedent; or

(B) The aggregate amount of reinsurance recoverables on paid losses which are not in dispute that are overdue by ninety (90) days or more exceeds $50,000,000.

(vi) The assuming insurer shall submit a properly executed Form CR-1 (located at the Department of Insurance website, doi.wyo.gov) as evidence of its submission to the jurisdiction of this state, appointment of the commissioner as an agent for service of process in this state, and agreement to provide security for one hundred percent (100%) of the assuming insurer's liabilities attributable to reinsurance ceded by U.S. ceding insurers if it resists enforcement of a final U.S. judgment. The commissioner shall not certify any assuming insurer that is domiciled in a jurisdiction that the commissioner has determined does not adequately and promptly enforce final U.S. judgments or arbitration awards.

(vii) The certified reinsurer must agree to meet applicable information filing requirements as determined by the commissioner, both with respect to an initial application for certification and on an ongoing basis. All information submitted by certified reinsurers which are not otherwise public information subject to disclosure shall be exempted from disclosure under W.S. 16-4-201 through 16-4-205 and shall be withheld from public disclosure. The applicable information filing requirements are, as follows:

(A) Notification within ten (10) days of any regulatory actions taken against the certified reinsurer, any change in the provisions of its domiciliary license or any change in rating by an approved rating agency, including a statement describing the changes and the reasons for them;

(B) Annually, Form CR-F or CR-S, as applicable;

(C) Annually, the report of the independent auditor on the financial statements of the insurance enterprise, on the basis described in subsection (D) below;

(D) Annually, the most recent audited financial statements, regulatory filings, and actuarial opinion (as filed with the certified reinsurer's supervisor, with a translation into English). Upon the initial certification, audited financial statements for the last two (2) years filed with the certified reinsurer's supervisor;

(E) At least annually, an updated list of all disputed and overdue reinsurance claims regarding reinsurance assumed from U.S. domestic ceding insurers;

(F) A certification from the certified reinsurer's domestic regulator that the certified reinsurer is in good standing and maintains capital in excess of the jurisdiction's highest regulatory action level; and

(G) Any other information that the commissioner may reasonably require.

(viii) Change in Rating or Revocation of Certification.

(A) In the case of a downgrade by a rating agency or other disqualifying circumstance, the commissioner shall upon written notice assign a new rating to the certified reinsurer in accordance with the requirements of paragraph (iv)(A).

(B) The commissioner shall have the authority to suspend, revoke, or otherwise modify a certified reinsurer's certification at any time if the certified reinsurer fails to meet its obligations or security requirements under this section, or if other financial or operating results of the certified reinsurer, or documented significant delays in payment by the certified reinsurer, lead the commissioner to reconsider the certified reinsurer's ability or willingness to meet its contractual obligations.

(C) If the rating of a certified reinsurer is upgraded by the commissioner, the certified reinsurer may meet the security requirements applicable to its new rating on a prospective basis, but the commissioner shall require the certified reinsurer to post security under the previously applicable security requirements as to all contracts in force on or before the effective date of the upgraded rating. If the rating of a certified reinsurer is downgraded by the commissioner, the commissioner shall require the certified reinsurer to meet the security requirements applicable to its new rating for all business it has assumed as a certified reinsurer.

(D) Upon revocation of the certification of a certified reinsurer by the commissioner, the assuming insurer shall be required to post security in accordance with section 11 in order for the ceding insurer to continue to take credit for reinsurance ceded to the assuming insurer. If funds continue to be held in trust in accordance with section 7, the commissioner may allow additional credit equal to the ceding insurer's pro rata share of the funds, discounted to reflect the risk of uncollectibility and anticipated expenses of trust administration. Notwithstanding the change of a certified reinsurer's rating or revocation of its certification, a domestic insurer that has ceded reinsurance to that certified reinsurer may not be denied credit for reinsurance for a period of three (3) months for all reinsurance ceded to that certified reinsurer, unless the reinsurance is found by the commissioner to be at high risk of uncollectibility.

(c) Qualified Jurisdictions.

(i) If upon conducting an evaluation under this section with respect to the reinsurance supervisory system of any non-U.S. assuming insurer, the commissioner determines that the jurisdiction qualifies to be recognized as a qualified jurisdiction, the commissioner shall publish notice and evidence of the recognition in an appropriate manner. The commissioner may establish a procedure to withdraw recognition of those jurisdictions that are no longer qualified.

(ii) In order to determine whether the domiciliary jurisdiction of a non-U.S. assuming insurer is eligible to be recognized as a qualified jurisdiction, the commissioner shall evaluate the reinsurance supervisory system of the non-U.S. jurisdiction, both initially and on an ongoing basis, and consider the rights, benefits, and the extent of reciprocal recognition afforded by the non-U.S. jurisdiction to reinsurers licensed and domiciled in the U.S. The commissioner shall determine the appropriate approach for evaluating the qualifications of those jurisdictions, and create and publish a list of jurisdictions whose reinsurers may be approved by the commissioner as eligible for certification. A qualified jurisdiction must agree to share information and cooperate with the commissioner with respect to all certified reinsurers domiciled within that jurisdiction. Additional factors to be considered in determining whether to recognize a qualified jurisdiction, in the discretion of the commissioner, include but are not limited to the following:

(A) The framework under which the assuming insurer is regulated.

(B) The structure and authority of the domiciliary regulator with regard to solvency regulation requirements and financial surveillance.

(C) The substance of financial and operating standards for assuming insurers in the domiciliary jurisdiction.

(D) The form and substance of financial reports required to be filed or made publicly available by reinsurers in the domiciliary jurisdiction and the accounting principles used.

(E) The domiciliary regulator's willingness to cooperate with U.S. regulators in general and the commissioner in particular.

(F) The history of performance by assuming insurers in the domiciliary jurisdiction.

(G) Any documented evidence of substantial problems with the enforcement of final U.S. judgments in the domiciliary jurisdiction. A jurisdiction will not be considered to be a qualified jurisdiction if the commissioner has determined that it does not adequately and promptly enforce final U.S. judgments or arbitration awards.

(H) Any relevant international standards or guidance with respect to mutual recognition of reinsurance supervision adopted by the International Association of Insurance Supervisors or successor organization.

(I) Any other matters deemed relevant by the commissioner.

(iii) A list of qualified jurisdictions shall be published through the NAIC committee process. The commissioner shall consider this list in determining qualified jurisdictions. If the commissioner approves a jurisdiction as qualified that does not appear on the list of qualified jurisdictions, the commissioner shall provide thoroughly documented justification with respect to the criteria provided under subsections 8(c)(ii)(A) to (I).

(iv) U.S. jurisdictions that meet the requirements for accreditation under the NAIC financial standards and accreditation program shall be recognized as qualified jurisdictions.

(d) Recognition of Certification Issued by an NAIC Accredited Jurisdiction.

(i) If an applicant for certification has been certified as a reinsurer in an NAIC accredited jurisdiction, the commissioner has the discretion to defer to that jurisdiction's certification and to defer to the rating assigned by that jurisdiction if the assuming insurer submits a properly executed Form CR-1 and any additional information that the commissioner requires. The assuming insurer shall be considered a certified reinsurer in this state.

(ii) Any change in the certified reinsurer's status or rating in the other jurisdiction shall apply automatically in this state as of the date it takes effect in the other jurisdiction. The certified reinsurer shall notify the commissioner of any change in its status or rating within 10 days after receiving notice of the change.

(iii) The commissioner may withdraw recognition of the other jurisdiction's rating at any time and assign a new rating in accordance with subsection (b)(viii) of this section.

(iv) The commissioner may withdraw recognition of the other jurisdiction's certification at any time, with written notice to the certified reinsurer. Unless the commissioner suspends or revokes the certified reinsurer's certification in accordance with subparagraph (b)(viii) of this section, the certified reinsurer's certification shall remain in good standing in this state for a period of three (3) months, which shall be extended if additional time is necessary to consider the assuming insurer's application for certification in this state.

(e) Mandatory Funding Clause. In addition to the clauses required under section 14, reinsurance contracts entered into or renewed under this section shall include a proper funding clause, which requires the certified reinsurer to provide and maintain security in an amount sufficient to avoid the imposition of any financial statement penalty on the ceding insurer under this section for reinsurance ceded to the certified reinsurer.

(f) The commissioner shall comply with all reporting and notification requirements that may be established by the NAIC with respect to certified reinsurers and qualified jurisdictions.

Section 9. Credit for Reinsurance--Reciprocal Jurisdictions.

(a) Pursuant to W.S. § 26-5-112(a)(vii), the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that is licensed to write reinsurance by, and has its head office or is domiciled in, a Reciprocal Jurisdiction, and which meets the other requirements of this regulation.

(b) A "Reciprocal Jurisdiction" is a jurisdiction, as designated by the commissioner pursuant to Subsection (d) of this Section, that meets one of the following:

(i) A non-U.S. jurisdiction that is subject to an in-force covered agreement with the United States, each within its legal authority, or, in the case of a covered agreement between the United States and the European Union, is a member state of the European Union. For purposes of this subsection, a "covered agreement" is an agreement entered into pursuant to the Dodd-Frank Wall Street Reform and Consumer Protection Act, 31 U.S.C. §§ 313 and 314, that is currently in effect or in a period of provisional application and addresses the elimination, under specified conditions, of collateral requirements as a condition for entering into any reinsurance agreement with a ceding insurer domiciled in this state or for allowing the ceding insurer to recognize credit for reinsurance;

(ii) A U.S. jurisdiction that meets the requirements for accreditation under the NAIC financial standards and accreditation program; or

(iii) A qualified jurisdiction, as determined by the commissioner pursuant to W.S. § 26-5-112(a)(vi)(C) and Section 8(c) of this regulation, which is not otherwise described in Paragraph (i) or (ii) above and which the commissioner determines meets all of the following additional requirements:

(A) Provides that an insurer which has its head office or is domiciled in such qualified jurisdiction shall receive credit for reinsurance ceded to a U.S.-domiciled assuming insurer in the same manner as credit for reinsurance is received for reinsurance assumed by insurers domiciled in such qualified jurisdiction;

(B) Does not require a U.S.-domiciled assuming insurer to establish or maintain a local presence as a condition for entering into a reinsurance agreement with any ceding insurer subject to regulation by the non-U.S. jurisdiction or as a condition to allow the ceding insurer to recognize credit for such reinsurance;

(C) Recognizes the U.S. state regulatory approach to group supervision and group capital, by providing written confirmation by a competent regulatory authority, in such qualified jurisdiction, that insurers and insurance groups that are domiciled or maintain their headquarters in this state or another jurisdiction accredited by the NAIC shall be subject only to worldwide prudential insurance group supervision including worldwide group governance, solvency and capital, and reporting, as applicable, by the commissioner or the commissioner of the domiciliary state and will not be subject to group supervision at the level of the worldwide parent undertaking of the insurance or reinsurance group by the qualified jurisdiction; and

(D) Provides written confirmation by a competent regulatory authority in such qualified jurisdiction that information regarding insurers and their parent, subsidiary, or affiliated entities, if applicable, shall be provided to the commissioner in accordance with a memorandum of understanding or similar document between the commissioner and such qualified jurisdiction, including but not limited to the International Association of Insurance Supervisors Multilateral Memorandum of Understanding or other multilateral memoranda of understanding coordinated by the NAIC.

(c) Credit shall be allowed when the reinsurance is ceded from an insurer domiciled in this state to an assuming insurer meeting each of the conditions set forth below.

(i) The assuming insurer must be licensed to transact reinsurance by, and have its head office or be domiciled in, a Reciprocal Jurisdiction.

(ii) The assuming insurer must have and maintain on an ongoing basis, minimum capital and surplus, or its equivalent, calculated on at least an annual basis as of the preceding December 31 or at the annual date otherwise statutorily reported to the Reciprocal Jurisdiction, and confirmed as set forth in Subsection (c)(vii) of this Section according to the methodology of its domiciliary jurisdiction, in the following amounts:

(A) No less than $250,000,000; or

(B) If the assuming insurer is an association, including incorporated and individual unincorporated underwriters:

(I) Minimum capital and surplus equivalents (net of liabilities) or own funds of the equivalent of at least $250,000,000; and

(II) A central fund containing a balance of the equivalent of at least $250,000,000.

(iii) The assuming insurer must have and maintain on an ongoing basis a minimum solvency or capital ratio, as applicable, as follows:

(A) If the assuming insurer has its head office or is domiciled in a Reciprocal Jurisdiction as defined in Section 9(b)(i), the ratio specified in the applicable covered agreement;

(B) If the assuming insurer is domiciled in a Reciprocal Jurisdiction as defined in Section 9(b)(ii), a risk-based capital (RBC) ratio of three hundred percent (300%) of the authorized control level, calculated in accordance with the formula developed by the NAIC; or

(C) If the assuming insurer is domiciled in a Reciprocal Jurisdiction as defined in Section 9(b)(iii), after consultation with the Reciprocal Jurisdiction and considering any recommendations published through the NAIC Committee Process, such solvency or capital ratio as the commissioner determines to be an effective measure of solvency.

(iv) The assuming insurer must agree to and provide adequate assurance, in the form of a properly executed Form RJ-1 (located at the Department of Insurance website, doi.wyo.gov), of its agreement to the following:

(A) The assuming insurer must agree to provide prompt written notice and explanation to the commissioner if it falls below the minimum requirements set forth in Paragraphs (ii) or (iii) of this subsection, or if any regulatory action is taken against it for serious noncompliance with applicable law.

(B) The assuming insurer must consent in writing to the jurisdiction of the courts of this state and to the appointment of the commissioner as agent for service of process.

(I) The commissioner may also require that such consent be provided and included in each reinsurance agreement under the commissioner's jurisdiction.

(II) Nothing in this provision shall limit or in any way alter the capacity of parties to a reinsurance agreement to agree to alternative dispute resolution mechanisms, except to the extent such agreements are unenforceable under applicable insolvency or delinquency laws.

(C) The assuming insurer must consent in writing to pay all final judgments, wherever enforcement is sought, obtained by a ceding insurer, that have been declared enforceable in the territory where the judgment was obtained.

(D) Each reinsurance agreement must include a provision requiring the assuming insurer to provide security in an amount equal to one hundred percent (100%) of the assuming insurer's liabilities attributable to reinsurance ceded pursuant to that agreement if the assuming insurer resists enforcement of a final judgment that is enforceable under the law of the jurisdiction in which it was obtained or a properly enforceable arbitration award, whether obtained by the ceding insurer or by its legal successor on behalf of its estate, if applicable.

(E) The assuming insurer must confirm that it is not presently participating in any solvent scheme of arrangement, which involves this state's ceding insurers, and agrees to notify the ceding insurer and the commissioner and to provide one hundred percent (100%) security to the ceding insurer consistent with the terms of the scheme, should the assuming insurer enter into such a solvent scheme of arrangement. Such security shall be in a form consistent with the provisions of W.S. §§ 26-5-112(a)(vi) and 26-5-113, and Section 12, 13 or 14 of this regulation. For purposes of this regulation, the term "solvent scheme of arrangement" means a foreign or alien statutory or regulatory compromise procedure subject to requisite majority creditor approval and judicial sanction in the assuming insurer's home jurisdiction either to finally commute liabilities of duly noticed classed members or creditors of a solvent debtor, or to reorganize or restructure the debts and obligations of a solvent debtor on a final basis, and which may be subject to judicial recognition and enforcement of the arrangement by a governing authority outside the ceding insurer's home jurisdiction.

(F) The assuming insurer must agree in writing to meet the applicable information filing requirements as set forth in Paragraph (v) of this subsection.

(v) The assuming insurer or its legal successor must provide, if requested by the commissioner, on behalf of itself and any legal predecessors, the following documentation to the commissioner:

(A) For the two years preceding entry into the reinsurance agreement and on an annual basis thereafter, the assuming insurer's annual audited financial statements, in accordance with the applicable law of the jurisdiction of its head office or domiciliary jurisdiction, as applicable, including the external audit report;

(B) For the two years preceding entry into the reinsurance agreement, the solvency and financial condition report or actuarial opinion, if filed with the assuming insurer's supervisor;

(C) Prior to entry into the reinsurance agreement and not more than semi-annually thereafter, an updated list of all disputed and overdue reinsurance claims outstanding for 90 days or more, regarding reinsurance assumed from ceding insurers domiciled in the United States; and

(D) Prior to entry into the reinsurance agreement and not more than semi-annually thereafter, information regarding the assuming insurer's assumed reinsurance by ceding insurer, ceded reinsurance by the assuming insurer, and reinsurance recoverable on paid and unpaid losses by the assuming insurer to allow for the evaluation of the criteria set forth in Paragraph (vi) of this subsection.

(vi) The assuming insurer must maintain a practice of prompt payment of claims under reinsurance agreements. The lack of prompt payment will be evidenced if any of the following criteria is met:

(A) More than fifteen percent (15%) of the reinsurance recoverables from the assuming insurer are overdue and in dispute as reported to the commissioner;

(B) More than fifteen percent (15%) of the assuming insurer's ceding insurers or reinsurers have overdue reinsurance recoverable on paid losses of 90 days or more which are not in dispute and which exceed for each ceding insurer $100,000, or as otherwise specified in a covered agreement; or

(C) The aggregate amount of reinsurance recoverable on paid losses which are not in dispute, but are overdue by 90 days or more, exceeds $50,000,000, or as otherwise specified in a covered agreement.

(vii) The assuming insurer's supervisory authority must confirm to the commissioner on an annual basis that the assuming insurer complies with the requirements set forth in Paragraphs (ii) and (iii) of this subsection.

(viii) Nothing in this provision precludes an assuming insurer from providing the commissioner with information on a voluntary basis.

(d) The commissioner shall timely create and publish a list of Reciprocal Jurisdictions.

(i) A list of Reciprocal Jurisdictions is published through the NAIC Committee Process. The commissioner's list shall include any Reciprocal Jurisdiction as defined under Section 9(b)(i) and (ii), and shall consider any other Reciprocal Jurisdiction included on the NAIC list. The commissioner may approve a jurisdiction that does not appear on the NAIC list of Reciprocal Jurisdictions as provided by applicable law, regulation, or in accordance with criteria published through the NAIC Committee Process.

(ii) The commissioner may remove a jurisdiction from the list of Reciprocal Jurisdictions upon a determination that the jurisdiction no longer meets one or more of the requirements of a Reciprocal Jurisdiction, as provided by applicable law, regulation, or in accordance with a process published through the NAIC Committee Process, except that the commissioner shall not remove from the list a Reciprocal Jurisdiction as defined under Section 9(b)(i) and (ii). Upon removal of a Reciprocal Jurisdiction from this list, credit for reinsurance ceded to an assuming insurer domiciled in that jurisdiction shall be allowed, if otherwise allowed pursuant to W.S. § 26-5-112 et seq. or this regulation.

(e) The commissioner shall timely create and publish a list of assuming insurers that have satisfied the conditions set forth in this section and to which cessions shall be granted credit in accordance with this section.

(i) If an NAIC accredited jurisdiction has determined that the conditions set forth in Subsection (c) have been met, the commissioner has the discretion to defer to that jurisdiction's determination, and add such assuming insurer to the list of assuming insurers to which cessions shall be granted credit in accordance with this subsection. The commissioner may accept financial documentation filed with another NAIC accredited jurisdiction or with the NAIC in satisfaction of the requirements of Subsection (c).

(ii) When requesting that the commissioner defer to another NAIC accredited jurisdiction's determination, an assuming insurer must submit a properly executed Form RJ-1 and additional information as the commissioner may require. A state that has received such a request will notify other states through the NAIC Committee Process and provide relevant information with respect to the determination of eligibility.

(f) If the commissioner determines that an assuming insurer no longer meets one or more of the requirements under this section, the commissioner may revoke or suspend the eligibility of the assuming insurer for recognition under this section.

(i) While an assuming insurer's eligibility is suspended, no reinsurance agreement issued, amended or renewed after the effective date of the suspension qualifies for credit except to the extent that the assuming insurer's obligations under the contract are secured in accordance with Section 11 of this regulation.

(ii) If an assuming insurer's eligibility is revoked, no credit for reinsurance may be granted after the effective date of the revocation with respect to any reinsurance agreements entered into by the assuming insurer, including reinsurance agreements entered into prior to the date of revocation, except to the extent that the assuming insurer's obligations under the contract are secured in a form acceptable to the commissioner and consistent with the provisions of Section 11 of this regulation.

(g) Before denying statement credit or imposing a requirement to post security with respect to Section 9(f) of this regulation or adopting any similar requirement that will have substantially the same regulatory impact as security, the commissioner shall:

(i) Communicate with the ceding insurer, the assuming insurer, and the assuming insurer's supervisory authority that the assuming insurer no longer satisfies one of the conditions listed in Subsection (c) of this section;

(ii) Provide the assuming insurer with 30 days from the initial communication to submit a plan to remedy the defect, and 90 days from the initial communication to remedy the defect, except in exceptional circumstances in which a shorter period is necessary for policyholder and other consumer protection;

(iii) After the expiration of 90 days or less, as set out in Paragraph (ii), if the commissioner determines that no or insufficient action was taken by the assuming insurer, the commissioner may impose any of the requirements as set out in this Subsection; and

(iv) Provide a written explanation to the assuming insurer of any of the requirements set out in this Subsection.

(h) If subject to a legal process of rehabilitation, liquidation or conservation, as applicable, the ceding insurer, or its representative, may seek and, if determined appropriate by the court in which the proceedings are pending, may obtain an order requiring that the assuming insurer post security for all outstanding liabilities.

Section 10. Credit for Reinsurance Required by Law. Pursuant to W.S. 26-5-112(a)(iv) the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer not meeting the requirements of W.S. 26-5-112(a)(i), (ii), (iii), (v), (vi), or (vii) but only with respect to the insurance of risks located in jurisdictions where such reinsurance is required by the applicable law or regulation of that jurisdiction. As used in this section, "jurisdiction" means any state, district or territory of the United States and any lawful national government.

Section 11. Reduction from Liability for Reinsurance Ceded to an Unauthorized Assuming Insurer not Meeting the Requirements of Sections 4 Through 10.

(a) Pursuant to W.S. 26-5-113 the commissioner shall allow a reduction from liability for reinsurance ceded by a domestic insurer to an assuming insurer not meeting the requirements of W.S. 26-5-112 in an amount not exceeding the liabilities carried by the ceding insurer. The reduction shall be in the amount of funds held by or on behalf of the ceding insurer, including funds held in trust for the exclusive benefit of the ceding insurer, under a reinsurance contract with such assuming insurer as security for the payment of obligations under the reinsurance contract. The security shall be held in the United States subject to withdrawal solely by, and under the exclusive control of, the ceding insurer or, in the case of a trust, held in a qualified United States financial institution as defined in W.S. 26-5-114(b). This security may be in the form of any of the following:

(i) Cash.

(ii) Securities listed by the Securities Valuation Office of the NAIC, including those deemed exempt from filing as defined by the Purposes and Procedures Manual of the Securities Valuation Office, and qualifying as admitted assets.

(iii) Clean, irrevocable, unconditional, and "evergreen" letters of credit issued or confirmed by a qualified United States institution, as defined in W.S. 26-5-114(a) effective no later than December 31 of the year for which filing is being made, and in the possession of or in trust for the ceding insurer on or before the filing date of its annual statement. Letters of credit meeting applicable standards of issuer acceptability as of the dates of their issuance or confirmation shall, notwithstanding the issuing or confirming institution's subsequent failure to meet applicable standards of issuer acceptability, continue to be acceptable as security until their expiration, extension, renewal, modification or amendment, whichever first occurs; or any other form of security acceptable to the commissioner.

(b) An admitted asset or a reduction from liability for reinsurance ceded to an unauthorized assuming insurer pursuant to this section shall be allowed only when the requirements of section 15 and the applicable portions of sections 12, 13, or 14 of this regulation have been satisfied.

Section 12. Trust Agreements Qualified Under Section 11.

(a) As used in this section:

(i) "Beneficiary" means the entity for whose sole benefit the trust has been established and any successor of the beneficiary by operation of law. If a court of law appoints a successor in interest to the named beneficiary, then the named beneficiary includes and is limited to the court-appointed domiciliary receiver including conservator, rehabilitator or liquidator.

(ii) "Grantor" means the entity that has established a trust for the sole benefit of the beneficiary. When established in conjunction with a reinsurance agreement, the grantor is the unlicensed, unaccredited assuming insurer.

(iii) "Obligations", as used in Subsection (b)(xi) of this section, means:

(A) Reinsured losses and allocated loss expenses paid by the ceding company, but not recovered from the assuming insurer;

(B) Reserves for reinsured losses reported and outstanding;

(C) Reserves for reinsured losses incurred but not reported; and

(D) Reserves for allocated reinsured loss expenses and unearned premiums.

(b) Required conditions.

(i) The trust agreement shall be entered into between the beneficiary, the grantor and a trustee which shall be a qualified United States financial institution as defined in W.S. 26-5-114(b).

(ii) The trust agreement shall create a trust account into which assets shall be deposited.

(iii) All assets in the trust account shall be held by the trustee at the trustee's office in the United States.

(iv) The trust agreement shall provide that:

(A) The beneficiary shall have the right to withdraw assets from the trust account at any time, without notice to the grantor, subject only to written notice from the beneficiary to the trustee;

(B) No other statement or document is required to be presented to withdraw assets, except that the beneficiary may be required to acknowledge receipt of withdrawn assets;

(C) It is not subject to any conditions or qualifications outside of the trust agreement; and

(D) It shall not contain references to any other agreements or documents except as provided for under paragraphs (xi) and (xii) of this subsection.

(v) The trust agreement shall be established for the sole benefit of the beneficiary.

(vi) The trust agreement shall require the trustee to:

(A) Receive assets and hold all assets in a safe place;

(B) Determine that all assets are in a form that the beneficiary, or the trustee upon direction by the beneficiary, may whenever necessary negotiate any assets without consent or signature from the grantor or any other person or entity;

(C) Furnish to the grantor and the beneficiary a statement of all assets in the trust account upon its inception and at intervals no less frequent than the end of each calendar quarter;

(D) Notify the grantor and the beneficiary within ten (10) days, of any deposits to or withdrawals from the trust account;

(E) Upon written demand of the beneficiary, immediately take any and all steps necessary to transfer absolutely and unequivocally all right, title and interest in the assets held in the trust account to the beneficiary and deliver physical custody of the assets to the beneficiary; and

(F) Allow no substitutions or withdrawals of assets from the trust account, except on written instructions from the beneficiary, except that the trustee may, without the consent of but with notice to the beneficiary, upon call or maturity of any trust asset, withdraw the asset upon condition that the proceeds are paid into the trust account.

(vii) The trust agreement shall provide that at least thirty (30) days, but not more than forty‑five (45) days, prior to termination of the trust account, written notification of termination shall be delivered by the trustee to the beneficiary.

(viii) The trust agreement shall be made subject to and governed by the laws of the state in which the trust is domiciled.

(ix) The trust agreement shall prohibit invasion of the trust corpus for the purpose of paying commission to, or reimbursing the expenses of, the trustee. In order for a letter of credit to qualify as an asset of the trust, the trustee shall have the right and the obligation pursuant to the deed of trust or some other binding agreement (as duly approved by the commissioner), to immediately draw down the full amount of the letter of credit and hold the proceeds in trust for the beneficiaries of the trust if the letter of credit will otherwise expire without being renewed or replaced.

(x) The trust agreement shall provide that the trustee shall be liable for its own negligence, willful misconduct, or lack of good faith. The failure of the trustee to draw against the letter of credit in circumstances where the draw would be required shall be deemed to be negligence, willful misconduct, or both.

(xi) Notwithstanding other provisions of this regulation, when a trust agreement is established in conjunction with a reinsurance agreement covering risks other than life, annuities and accident and health, where it is customary practice to provide a trust agreement for a specific purpose, the trust agreement may , provide that the ceding insurer shall use and apply amounts drawn upon the trust account, without diminution because of the insolvency of the ceding insurer or the assuming insurer, only for the following purposes:

(A) To pay or reimburse the ceding insurer for the assuming insurer's share under the specific reinsurance agreement regarding any losses and allocated loss expenses paid by the ceding insurer, but not recovered from the assuming insurer, or for unearned premiums due to the ceding insurer if not otherwise paid by the assuming insurer;

(B) To pay the assuming insurer any amounts held in the trust account that exceed "one hundred two percent (102%) percent of the actual amount required to fund the assuming insurer's obligations under the specific reinsurance agreement; or

(C) Where the ceding insurer has received notification of termination of the trust account and where the assuming insurer's entire obligations under the specific reinsurance agreement remain unliquidated and undischarged ten (10) days prior to the termination date, to withdraw amounts equal to those obligations and deposit those amounts in a separate account in the name of the ceding insurer in any qualified United States financial institution as defined in W.S. 26-5-114(b) apart from its general assets and in trust for the uses and purposes specified in subparagraphs (A) and (B) above as may remain executory after the withdrawal and for any period after the termination date.

(xii) Notwithstanding other provisions of this regulation, when a trust agreement is established to meet the requirements of section 11 in conjunction with a reinsurance agreement covering life, annuities or accident and health risks, and where it is customary to provide a trust agreement for a specific purpose, the trust agreement may require the ceding insurer to use and apply amounts drawn upon the trust account, without diminution because of the insolvency of the ceding insurer or the assuming insurer only for the following purposes:

(A) To pay or reimburse the ceding insurer for:

(I) The assuming insurer's share under the specific reinsurance agreement of premiums returned, but not yet recovered from the assuming insurer, to the owners of policies reinsured under the reinsurance agreement on account of cancellations of the policies; and

(II) The assuming insurer's share under the specific reinsurance agreement of surrenders and benefits or losses paid by the ceding insurer, but not yet recovered from the assuming insurer, under the terms and provisions of the policies reinsured under the reinsurance agreement;

(B) To pay to the assuming insurer amounts held in the trust account in excess of the amount necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer; or

(C) Where the ceding insurer has received notification of termination of the trust and where the assuming insurer's entire obligations under the specific reinsurance agreement remain unliquidated and undischarged ten (10) days prior to the termination date, to withdraw amounts equal to the assuming insurer's share of liabilities, to the extent that the liabilities have not yet been funded by the assuming insurer, and deposit those amounts in a separate account, in the name of the ceding insurer in any qualified U.S. financial institution apart from its general assets, in trust for the uses and purposes specified in Subparagraphs (A) and (B) of this paragraph as may remain executory after withdrawal and for any period after the termination date.

(xiii) Either the reinsurance agreement or the trust agreement shall stipulate that assets deposited in the trust account shall be valued according to their current fair market value and shall consist only of cash in United States dollars, certificates of deposit issued by a United States bank and payable in United States dollars, and investments permitted by the Insurance Code or any combination of the above, provided investments in or issued by an entity controlling, controlled by, or under common control with either the grantor or the beneficiary of the trust shall not exceed five percent (5%) of total investments. The agreement may further specify the types of investments to be deposited. If the reinsurance agreement covers life, annuities, or accident and health risks, then the provisions required by this paragraph shall be included in the reinsurance agreement.

(c) Permitted conditions.

(i) The trust agreement may provide that the trustee may resign upon delivery of a written notice of resignation effective not less than ninety (90) days after the beneficiary and grantor receive the notice and that the trustee may be removed by the grantor by delivery to the trustee and the beneficiary of a written notice of removal, effective not less than ninety (90) days after the trustee and the beneficiary receive the notice provided that no resignation or removal shall be effective until a successor trustee has been duly appointed and approved by the beneficiary and the grantor and all assets in the trust have been transferred to the new trustee.

(ii) The grantor may have the full and unqualified right to vote any shares of stock in the trust account and to receive from time to time payments of any dividends or interest upon any shares of stock or obligations included in the trust account. Any interest or dividends shall be either forwarded promptly upon receipt to the grantor or deposited in a separate account established in the grantor's name.

(iii) The trustee may be given authority to invest and accept substitutions of any funds in the account, provided that no investment or substitution shall be made without prior approval of the beneficiary, unless the trust agreement specifies categories of investments acceptable to the beneficiary and authorizes the trustee to invest funds and to accept substitutions which the trustee determines are at least equal in current fair market value to the assets withdrawn and are consistent with the restrictions in subsection (d)(i)(B) of this section.

(iv) The trust agreement may provide that the beneficiary may at any time designate a party to which all or part of the trust assets are to be transferred. This transfer may be conditioned upon the trustee receiving, prior to or simultaneously, other specified assets.

(v) The trust agreement may provide that, upon termination of the trust account, all assets not previously withdrawn by the beneficiary shall, with written approval by the beneficiary, be delivered to the grantor.

(d) Additional conditions applicable to reinsurance agreements:

(i) A reinsurance agreement may contain provisions that:

(A) Require the assuming insurer to enter into a trust agreement and to establish a trust account for the benefit of the ceding insurer, and specifying what the agreement is to cover;

(B) Require the assuming insurer, prior to depositing assets with the trustee, to execute assignments or endorsements in blank, or to transfer legal title to the trustee of all shares, obligations or any other assets requiring assignments, in order that the ceding insurer, or the trustee upon the direction of the ceding insurer, may whenever necessary negotiate these assets without consent or signature from the assuming insurer or any other entity;

(C) Require that all settlements of account between the ceding insurer and the assuming insurer be made in cash or its equivalent; and

(D) Stipulate that the assuming insurer and the ceding insurer agree that the assets in the trust account, established pursuant to the provisions of the reinsurance agreement, may be withdrawn by the ceding insurer at any time, notwithstanding any other provisions in the reinsurance agreement, and shall be utilized and applied by the ceding insurer or its successors in interest by operation of law, including without limitation any liquidator, rehabilitator, receiver, or conservator of such company, without diminution because of insolvency on the part of the ceding insurer or the assuming insurer, only for the following purposes:

(I) To pay or reimburse the ceding insurer for:

(1.) The assuming insurer's share under the specific reinsurance agreement of premiums returned, but not yet recovered from the assuming insurer, to the owners of policies reinsured under the reinsurance agreement because of cancellations of the policies;

(2.) The assuming insurer's share of surrenders and benefits or losses paid by the ceding insurer pursuant to the provisions of the policies reinsured under the reinsurance agreement; and

(3.) Any other amounts necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer;

(II) To make payment to the assuming insurer of amounts held in the trust account in excess of the amount necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer.

(ii) The reinsurance agreement also may contain provisions that:

(A) Give the assuming insurer the right to seek approval from the ceding insurer, which shall not be unreasonably or arbitrarily withheld, to withdraw from the trust account all or any part of the trust assets and transfer those assets to the assuming insurer, provided:

(I) The assuming insurer shall, at the time of withdrawal, replace the withdrawn assets with other qualified assets having a current fair market value equal to the market value of the assets withdrawn so as to maintain at all times the deposit in the required amount; or

(II) After withdrawal and transfer, the current fair market value of the trust account is no less than one hundred two (102%) percent of the required amount.

(B) Provide for the return of any amount withdrawn in excess of the actual amounts required for Paragraph (i)(D) of this subsection and for interest payments at a rate not in excess of the prime rate of interest on the amounts;

(C) Permit the award by any arbitration panel or court of competent jurisdiction of:

(I) Interest at a rate different from that provided in subparagraph (B);

(II) Court or arbitration costs;

(III) Attorney's fees; and

(IV) Any other reasonable expenses.

(e) Financial reporting. A trust agreement may be used to reduce any liability for reinsurance ceded to an unauthorized assuming insurer in financial statements required to be filed with this Department in compliance with the provisions of this regulation when established on or before the date of filing of the financial statement of the ceding insurer. The reduction for the existence of an acceptable trust account may be up to the current fair market value of acceptable assets available to be withdrawn from the trust account at that time, but the reduction shall be no greater than the specific obligations under the reinsurance agreement that the trust account was established to secure.

(f) Existing agreements. Notwithstanding the effective date of this regulation, any trust agreement or underlying reinsurance agreement that existed as of, July 1, 1992, the effective date of W.S. 26-5-117 will continue to be acceptable until the expiration or renewal date of the agreement, at which time the agreements shall fully comply with this regulation for the trust agreement to be acceptable.

(g) The failure of any trust agreement to specifically identify the beneficiary as defined in subsection (a) of this section shall not be construed to affect any actions or rights which the commissioner may take or possess pursuant to Wyoming law.

Section 13. Letters of Credit Qualified Under Section 11.

(a) The letter of credit must be clean, irrevocable, and unconditional and issued or confirmed by a qualified United States financial institution as defined in W.S. 26-5-114(a). The letter of credit shall contain an issue date and date of expiration and shall stipulate that the beneficiary need only draw a sight draft under the letter of credit and present it to obtain funds and that no other document need be presented. The letter of credit shall also indicate that it is not subject to any condition or qualifications outside of the letter of credit. The letter of credit itself shall not contain reference to any other agreements, documents, or entities, except as provided in subsection (h)(i) of this section. As used in this section, "beneficiary" means the domestic insurer for whose benefit the letter of credit has been established and any successor of the beneficiary by operation of law. If a court of law appoints a successor in interest to the named beneficiary, then the named beneficiary includes and is limited to the court appointed domiciliary receiver including conservator, rehabilitator, or liquidator.

(b) The heading of the letter of credit may include a boxed section containing the name of the applicant and other appropriate notations to provide a reference for the letter of credit. The boxed section shall be clearly marked to indicate that the information is for internal identification purposes only.

(c) The letter of credit shall contain a statement to the effect that the obligation of the qualified United States financial institution under the letter of credit is in no way contingent upon reimbursement with respect thereto.

(d) The term of the letter of credit shall be for at least one year and shall contain an "evergreen clause" which prevents the expiration of the letter of credit without due notice from the issuer. The "evergreen clause" shall provide for a period of no less than thirty (30) days' notice prior to the expiration date or nonrenewal.

(e) The letter of credit shall state whether it is subject to and governed by the laws of Wyoming or the Uniform Customs and Practice for Documentary Credits of the International Chamber of Commerce (Publication 600) (UCP 600) or International Standby Practices of the International Chamber of Commerce Publication 590 (ISP98), or any successor publication, and all drafts drawn thereunder shall be presentable at an office in the United States of a qualified United States financial institution.

(f) If the letter of credit is made subject to the Uniform Customs and Practice for Documentary Credits of the International Chamber of Commerce (Publication 500), or any successor publication, then the letter of credit shall specifically address and provide for an extension of time to draw against the letter of credit in the event that one or more of the occurrences specified in Article 17 of Publication 500 or any other successor publication, occur.

(g) If the letter of credit is issued by a financial institution authorized to issue letters of credit, other than a qualified United States financial institution as described in subsection (a) of this section, then the following additional requirements shall be met:

(i) The issuing financial institution shall formally designate the confirming qualified United States financial institution as its agent for the receipt and payment of the drafts; and

(ii) The "evergreen clause" shall provide for thirty (30) days notice prior to expiration date for nonrenewal.

(h) Reinsurance agreement provisions.

(i) The reinsurance agreement in conjunction with which the letter of credit is obtained may contain provisions which:

(A) Require the assuming insurer to provide letters of credit to the ceding insurer and specify what they are to cover;

(B) Stipulate that the assuming insurer and ceding insurer agree that the letter of credit provided by the assuming insurer pursuant to the provisions of the reinsurance agreement may be drawn upon at any time, notwithstanding any other provisions in the agreement, and shall be utilized by the ceding insurer or its successors in interest only for one or more of the following reasons:

(I) To pay or reimburse the ceding insurer for:

(1.) The assuming insurer's share under the specific reinsurance agreement of premiums returned, but not yet recovered from the assuming insurers, to the owners of policies reinsured under the reinsurance agreement on account of cancellations of such policies;

(2.) The assuming insurer's share, under the specific reinsurance agreement, of surrenders and benefits or losses paid by the ceding insurer, but not yet recovered from the assuming insurers, under the terms and provisions of the policies reinsured under the reinsurance agreement; and

(3.) Any other amounts necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer;

(II) Where the letter of credit will expire without renewal or be reduced or replaced by a letter of credit for a reduced amount and where the assuming insurer's entire obligations under the reinsurance agreement remain unliquidated and undischarged ten (10) days prior to the termination date, to withdraw amounts equal to the assuming insurer's share of the liabilities, to the extent that the liabilities have not yet been funded by the assuming insurer and exceed the amount of any reduced or replacement letter of credit, and deposit those amounts in a separate account in the name of the ceding insurer in a qualified U.S. financial institution apart from its general assets, in trust for such uses and purposes specified in subsection (h)(i)(B)(I) of this section as may remain after withdrawal and for any period after the termination date.

(C) All of the provisions of paragraph (i) of this subsection shall be applied without diminution because of insolvency on the part of the ceding insurer or assuming insurer.

(ii) Nothing contained in paragraph (i) of this subsection shall preclude the ceding insurer and assuming insurer from providing for:

(A) An interest payment, at a rate not in excess of the prime rate of interest, on the amounts held pursuant to subparagraph (i)(B) of this subsection; or

(B) The return of any amounts drawn down on the letters of credit in excess of the actual amounts required for the above or any amounts that are subsequently determined not to be due.

Section 14. Other Security. A ceding insurer may take credit for unencumbered funds withheld by the ceding insurer in the United States subject to withdrawal solely by the ceding insurer and under its exclusive control.

Section 15. Reinsurance Contract.

(a) Credit will not be granted, nor an asset or reduction from liability allowed, to a ceding insurer for reinsurance effected with assuming insurers meeting the requirements of sections 4, 5, 6, 7, 8, 9 or 11 of this regulation or otherwise in compliance with W.S. 26-5-112 after the adoption of this regulation unless the reinsurance agreement:

(i) Includes a proper insolvency clause, which stipulates that reinsurance is payable directly to the liquidator or successor without diminution regardless of the status of the ceding company, pursuant to W.S. 26-5-115;

(ii) Includes a provision pursuant to W.S. 26-5-112(c) whereby the assuming insurer, if an unauthorized assuming insurer, has submitted to the jurisdiction of an alternative dispute resolution panel or court of competent jurisdiction within the United States, has agreed to comply with all requirements necessary to give the court or panel jurisdiction, has designated an agent upon whom service of process may be effected, and has agreed to abide by the final decision of the court or panel; and

(iii) Includes a proper reinsurance intermediary clause, if applicable, which stipulates that the credit risk for the intermediary is carried by the assuming insurer.

Section 16. Contracts Affected. All new and renewal reinsurance transactions entered into after the effective date of this rule shall conform to the requirements of W.S. 26-5-111 through 26-5-117 and this regulation if credit is to be given to the ceding insurer for such reinsurance.

Section 17. Effective Date. This regulation shall become effective immediately upon filing with the Secretary of State.

History

• Effective 2021-12-08

Chapter 51 Uniform Health Claim Forms Regulation

Wyo. Code R. 044.0002.51.07132017 § 1 Authority

This regulation is promulgated pursuant to W.S. §§ 26-2-110, 26-15-127, 16-3-101 et seq.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.51.07132017 § 2 Definitions

As used in this regulation:

(a) "ASC X12N" and any future iterations, standard format means the standards for electronic data interchange within the health care industry developed by the Accredited Standards Committee X12N Insurance Subcommittee of the American National Standards Institute.

(b) "CDT Procedure Codes" means the current dental terminology prescribed by the American Dental Association.

(c) "CPT Codes" means the physicians' current procedural terminology published by the American Medical Association.

(d) "HCFA" means the Health Care Financing Administration of the U.S. Department of Health and Human Services.

(e) "HCFA Form 1450" means the health insurance claim form maintained by HCFA for use by institutional care practitioners.

(f) "HCFA Form 1500" means the health insurance claim form maintained by HCFA for use by health care practitioners.

(g) "HCPCS" means HCFA's Common Procedure Coding System, a coding system which describes products, supplies, procedures and health professional services and includes, the American Medical Associations (AMA's) Physician Current Procedural Terminology codes, alphanumeric codes, and related modifiers. This includes:

(i) "HCPCS Level 1 Codes" which are the AMA's CPT codes and modifiers for professional services and procedures.

(ii) "HCPCS Level 2 Codes" which are national alpha-numeric codes and modifiers for health care products and supplies, as well as some codes for professional services not included in the AMA's CPT.

(iii) "HCPCS Level 3 Codes" which are local alpha-numeric codes and modifiers for items and services not included in HCPCS Level 1 or HCPCS Level 2.

(h) "Health Care Practitioner" means:

(i) A chiropractor licensed under W.S. § 33-10-101 et seq.

(ii) A corporation or partnership of health care practitioners defined in this section.

(iii) A dentist licensed under W.S. § 33-15-101 et seq.

(iv) A nurse licensed under W.S. § 33-21-119 et seq.

(v) An optometrist licensed under W.S. § 33-23-101 et seq.

(vi) A physician licensed under W.S. § 33-26-101 et seq.

(vii) A podiatrist licensed under W.S. § 33-9-101 et seq.

(viii) A psychologist licensed under W.S. § 33-27-113 et seq.

(ix) A physical, speech and audiology, occupational, or respiratory therapist licensed under W.S. §§ 33-25-101 et seq.; 33-33-101 et seq.; 33-40-101 et seq.; or 33-43-101 et seq.

(x) A home health agency licensed under W.S. § 35-2-901(a).

(i) "ICD-CM Codes" means the diagnosis and procedure codes in the International Classification of Diseases, clinical modifications published by the U.S. Department of Health and Human Services.

(j) "Institutional Care Practitioner" means:

(i) A hospice;

(ii) A hospital;

(iii) A skilled nursing facility, extended care facility, intermediate care facility, convalescent nursing home, or personal care facility; and

(iv) A home health agency.

(k) "Issuer" means an insurance company, fraternal benefit society, health care service plan, health maintenance organization, and third party administrator, and any other public and or private entity reimbursing the costs of health care expenses.

(l) "J5xx Form" means the uniform dental claim form approved by the American Dental Association for use by dentists.

(m) "NDC," National Drug Code, means the identifying drug number maintained by the Food and Drug Administration (FDA).

(n) "NSF," National Standard Format, means a flat file format standard for submission of health care claims electronically.

(o) "Revenue Codes" means the codes established for use by institutional care practitioners by the National Uniform Billing Committee.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.51.07132017 § 3 Applicability and Scope

(a) Except as otherwise specifically provided, the requirements of this regulation apply to issuers, health care practitioners, and institutional care practitioners.

(b) Nothing in this regulation shall prevent an issuer from requesting additional information that is not contained on the forms required under this regulation to determine eligibility of the claim for payment if required by applicable statutes, rules or regulations or required under the terms of the policy or certificate issued to the claimant.

(c) Nothing in this regulation shall prohibit an issuer, health care practitioner, or institutional care practitioner from using alternative procedures for filing claims as are specified in an existing written contract between the health care practitioner or institutional care practitioner and issuer.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.51.07132017 § 4 Requirements for Use of HCFA Form 1500

(a) Health care practitioners shall use the HCFA Form 1500 and instructions provided by HCFA for use of the HCFA Form 1500 when filing claims with issuers for professional services. Health care practitioners that bill patients directly shall provide a properly completed HCFA Form 1500 in addition to any other explanatory information used to bill the patient when requested by the patient.

(b) Issuers may only require health care practitioners to use the following coding system and/or descriptors for the initial filing of claims for health care services:

(i) HCPCS Codes;

(ii) ICD-CM Codes;

(iii) In the case of Workers' Compensation, specific body part and other information used for the coding of charges; and

(iv) NDC codes for pharmaceuticals supplied by physicians and home health agency.

(c) Issuers may only require health care practitioners to use other explanations with a code or to furnish additional information with the initial submission of a HCFA Form 1500 under the following circumstances:

(i) When the procedure code used describes a treatment or service that is not otherwise classified; or

(ii) When the procedure code is followed by a CPT modifier. Health care practitioners may use item 19 of the HCFA Form 1500 to explain multiple modifiers, unless item 19 is used for other purposes in accordance with the instructions for this form.

(d) Health care practitioners may use item 19 of the HCFA Form 1500 to indicate the form is an amended version of a form previously submitted to the issuer by inserting the word "amended" in the space provided.

(e) Health care practitioners billing for services based on the amount of time involved shall define on line 19 the time interval in Item 24 G of the HCFA Form 1500, if the time interval is not already defined by the HCPCS code. If not defined by either HCPCS or in line 19, units will be assumed to be days of treatment.

(f) Health care practitioners shall provide the unique physician identification number, as assigned by HCFA, in box 17a and the federal tax identification number or social security number to complete Item 25 of the HCFA Form 1500, as required by the HCFA instructions.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.51.07132017 § 5 Requirements for Use of HCFA Form 1450

(a) Institutional care practitioners shall use the HCFA Form 1450 and instructions provided by HCFA for use of the HCFA Form 1450 when filing claims with issuers for health care services. Institutional care providers that bill patients directly shall provide a properly completed HCFA Form 1450 in addition to any other explanatory information used to bill the patient when requested by the patient.

(b) Issuers may only require institutional care practitioners to use the following coding system for the initial filing of claims for health care services:

(i) ICD--CM Codes;

(ii) Revenue Codes;

(iii) HCPCS Codes; and

(iv) The information outlined in Section 5 of this regulation if the charges include direct services furnished by a health care practitioner and the direct services are not covered by the instructions for the HCFA form 1450.

(c) Hospitals may use the HCFA Form 1500 to supplement a HCFA Form 1450 if necessary in billing patients or their representatives or filing claims with issuers for outpatient services.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.51.07132017 § 6 Requirements for Use of J5xx ADA Form; CDT Procedure Codes

(a) Dentists shall use the J5xx Form and instructions provided by the American Dental Association for filing claims with issuers for professional services. Dentists that bill patients directly shall provide a properly completed J5xx Form in addition to any other form used to bill the patient when requested by the patient.

(b) Issuers may not require a dentist to use any code other than the CDT Procedure Codes for the initial filing of claims for dental care services, unless the use of supplemental codes are defined and permitted in a written contract between the issuer and dentist. Clearly defined supplemental codes may be used only for procedures not elsewhere defined by CDT Procedure Codes.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.51.07132017 § 7 General Provisions

(a) Health care practitioners and institutional care practitioners shall file claims in a manner consistent with the requirements of this regulation. Claims filed in paper form shall be printed on 8.5 x 11 inch paper.

(b) Issuers shall accept forms submitted in compliance with this regulation for the processing of claims.

(c) Health care practitioners, institutional care practitioners, and issuers shall:

(i) Use and accept the most current editions of the HCFA Form 1500, HCFA Form 1450, or J5xx Form and the most current instructions for these forms in the billing of patients or their representatives and filing claims with issuers.

(ii) Modify their billing and claim reimbursement practices to encompass the coding changes for all billing and claim filing by the effective date of the changes set forth by the developers of the forms, codes, and procedures required under this regulation.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.51.07132017 § 8 Mandatory Electronic Format

Unless otherwise provided by federal or state law, issuers that elect to receive claims or elect to send payments by electronic means shall support the NSF for electronic media claims and electronic remittance notice (ERN) as an interim standard format until the American National Standards Institute (ANSI) ASC X12N standard format for the health care claims submission transaction set (837) and the ASC X12N health care claim payment transaction set (835) or their successors become the required standard formats.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.51.07132017 § 9 Effective Date

These regulations shall be effective upon filing with the Secretary of State.

History

• Effective 2017-07-13

Chapter 52 Credit Life and Disability Insurance

Wyo. Code R. 044.0002.52.12311996 Credit Life and Disability Insurance

CHAPTER 52

CREDIT LIFE AND DISABILITY INSURANCE

Section 1. Authority

These regulations pertaining to Credit Life and Disability Insurance supplement the provisions of Chapter 21, Wyoming Insurance Code. They are promulgated by authority of and pursuant to the Wyo- ming Administrative Procedure Acts 16-3-101 et seq. and to the Wyoming Insurance Code W.S. 26-2- 110, 26-2-125, 26-13-101 et seq., 26-21-101 et seq.

Section 2. Purpose

The purpose of these rules is: to aid in the effectuation of Chapter 21, Wyoming Insurance Code pertaining to Credit Life and Disability Insurance, to limit commissions, to provide for filing of pre- mium (rates), to furnish certain statistical information and to define certain unfair methods of competi- tion and unfair trade practices.

Section 3. Definitions

As used herein, the following terms are thus defined:

(a) “Experience dividend or refund” is a form of commission whereby an agent of the insurer receives, directly or indirectly, money or any other thing of value in lieu of or in addition to a lawful agent’s commission by reason of the mortality or morbidity experience of the insurer, or the profit of the insurer, by whatever means arrived at, on the insurer’s policies sold by said agent.

(b) “Creditor agent” means a creditor, as defined herein, who is also an appointed agent of an insurer.

(c) “General agent” means a duly appointed agent of the insurer who is an independent contractor on behalf of an insurer and who services and supervises other duly appointed agents of the insurer pursuant to an agreement with the insurer, and who is not affiliated in any way with a creditor or creditor agent, other than as a supervisor thereof. No “general agent” shall be a partner, firm member, associate, joint venturer, stockholder, corporation officer, director or employee of a “creditor agent” nor shall the converse be allowed.

(i) “Person” shall have the meaning set forth in W.S. 26-1-102(a)(xx).

Section 4. Collection and Remittance of Premiums

A creditor may remit and an insurer may collect premiums on a monthly balance basis if the insurance charges or premiums are not added to the amount of the loan and do not constitutepart of the outstanding indebtedness, or if no direct or indirect, interest, finance, carrying, credit or service charges are made to the debtor in connection with the insurance charges or premiums. In those instances in which identifiable insurance charges or premiums are added to the total amount of indebtedness and direct or indirect interest, finance, carrying, credit or service charges are made thereon, the creditor shall at the time of imposition of such additional interest or other charge be deemed to have loaned the insur- ance charges or premiums to the debtor and the premiums shall be deemed collected for the insurer at the time they are added to the indebtedness, in which event the creditor shall remit and the insurer shall collect on a single premium basis only.

Section 5. Premium or Rate Filings

In addition to those matters referred to in W.S. 26-21-107(b), in passing upon premium or rate filings, the Insurance Commissioner will give consideration to available mortality and morbidity data pertaining to the debtors of a creditor of a class or classes of debtors of a creditor, previous experience, if any, for an actuarially credible period on such creditor’s debtors, including the experience of any subsid- iary or affiliate of the creditor, available age data and a reasonable rate of expense. Age data and prior experience of the creditor’s program should always be submitted. Commissions or other payments, credits, dividends or allowances to creditors, agents or general agents shall not be considered a justification, or any part of a justification, of a higher premium as being reasonable in relation to benefits.

Section 6. Rates

Notwithstanding Section 5 of these rules, the following rates for credit life and credit disability insurance will be deemed to be acceptable without the submission of substantiating data:

(a) For decreasing term credit life insurance where the debt is repayable in substantially equal monthly installments, a single premium of $.50 per year, per $100.00 of initial indebtedness.

(b) For decreasing term credit life insurance, on two lives, on a single indebtedness, repay- able in substantially equal monthly installments, a single premium of $.80 per year, per $100.00 of initial indebtedness.

(c) For credit life insurance based upon the outstanding balance, a monthly premium of $.77 per $1,000.00 of the outstanding balance of indebtedness.

(d) For level term single premium credit life insurance, a premium of $.90, per $100.00 of the amount of insured indebtedness.

(e) Any insurer which owns, or controls, or is owned or controlled by a creditor shall be exempt from the provisions of Section 5 of these rules only if its rates are not greater than $.45 for decreasing term life; $.73 for joint life; $.69 for monthly outstanding balance and $.81 for level term.

(f) For accidental death and dismemberment insurance, a single premium of $.05 per year per $100.00 of initial insured indebtedness.

(g) For credit disability insurance, if premiums are paid for the entire duration of the indebt- edness:

| Non-Retroactive Benefits | | | | | Retroactive Benefits | | --- | --- | --- | --- | --- | --- | | | 14-Day | 30-Day | 7-Day | 14-Day | 30-Day | | 12 | $1.40 | $ .80 | $3.00 | $2.20 | $1.70 | | 24 | 2.20 | 1.60 | 4.00 | 3.00 | 2.50 | | 36 | 3.00 | 2.40 | 5.00 | 3.80 | 3.30 | | 48 | 3.50 | 2.90 | 5.70 | 4.30 | 3.80 | | 60 | 3.90 | 3.30 | 6.30 | 4.70 | 4.20 | | 72 | 4.30 | 3.70 | 6.90 | 5.10 | 4.60 | | 84 | 4.70 | 4.10 | 7.50 | 5.50 | 5.00 | | 96 | 5.10 | 4.50 | 8.10 | 5.90 | 5.40 | | 108 | 5.50 | 4.90 | 8.70 | 6.30 | 5.80 | | 120 | 5.90 | 5.30 | 9.30 | 6.70 | 6.20 |

Premiums payable on other than a single premium basis, or for indebtedness of monthly durations not shown above, or for benefits on a basis different from those illustrated above, shall be actuarially consistent with the above rates. The above rates are premised upon a pre-existing condition exclusion in the policy not to exceed twelve (12) months.

(h) An insurer which owns or controls, or is owned or controlled by, a creditor, shall be exempt from the provisions of Section 5 of these rules only if its rates for credit disability coverages are at least ten (10) percent lower than those otherwise permitted by subsection f.

(i) For the purposes of this section, “control” means the possession, direct or indirect, of the power to direct or cause the direction of the management or the policies of an insurer or creditor whether through ownership or voting securities, by contract or otherwise. Control shall be rebuttably presumed for purposes of stock ownership if ten (10) percent or more of the voting securities of an insurer are constructively owned by a creditor or vice versa. All rate filings shall certify the status of the insurer in respect to its creditor affiliations.

Section 7. Refunds

W.S. 26-21-109(b) Wyoming Insurance Code requires that refund formulae be filed with and approved by the Commissioner. No refund formula may be utilized unless it is at least as favorable to the insured debtor as a formula providing a pro rata refund of premium. In no event need a refund or credit be made if the amount thereof is less than one dollar.

Section 8. Prohibited Transactions

The following practices, when engaged in by insurers or agents in connection with the sale or placement of credit life, disability insurance, or as an inducement thereto, shall be considered to consti- tute “unfair methods of competition” and “unfair trade practices” within the meaning of W.S. 26-13-101 et seq. and are prohibited:

(a) The offer or grant by an insurer to a creditor of any special favor or advantage not set out in the insurance contract other than the payment of agents’ commissions.

(b) Agreement by an insurer to deposit with a bank or financial institution money or securi- ties of the insurer with the design or intent that the same offset or take the place of a deposit of money or securities which otherwise would be required of the creditor by such bank or financial institution as a compensating balance or offsetting deposit for a loan or other advancement.

(c) Deposit by an insurer of money or securities without interest or a lesser rate of interest than is currently being paid other depositors with a creditor bank or financial institution. This prohibition shall not be construed to prohibit the maintenance by an insurer of such demand deposits as are reason- ably necessary for use in the ordinary course of business of the insurer.

(d) Premiums received by a creditor or agent must be paid to the insurer within forty-five (45) days of the end of the month in which they are received.

Section 9. Statistical Reporting

Each insurer writing credit life or credit disability insurance within this state shall keep and maintain statistical data of its experience on these kinds of insurance. The insurer shall, on or before the first day of June of each year, file with the Insurance Commissioner its statistical experience data for the year ending December 31st immediately preceding. Such experience shall be reported on forms con- forming to those now or hereafter from time to time adopted by the National Association of Insurance Commissioners.

Section 10. Experience Dividends, Experience Refunds and Commissions

No experience dividend or refund shall be paid to any agent of the insurer, directly or indirectly, in lieu of or in addition to a lawful agent’s commission. Nothing herein shall prohibit the payment of an experience dividend or refund to persons from whom premium is ultimately derived in accordance with W.S. 26-13-111, W.S. 26-17-124 and W.S. 26-19-105.

No insurer shall pay compensation, either directly or indirectly, in excess of thirty percent (30%) of the net written prima facie premium to any creditor agent, nor in excess of seven and one-half percent (7 ½%) of the net written prima facie premium to any general agent. Prima facie premium means pre- mium using the premium rates set forth in Section 6 of this regulation or actuarially consistent premium rates for plans not described in Section 6. Compensation, as used in this regulation, means any valuable consideration, in whatever form, direct or indirect, paid by or on behalf of any insurer or any person to any other person directly or indi- rectly benefitting a creditor, creditor agent or general agent as a result of or having any connection to any credit transaction excluding dividends or the share of profits earned by any person other than the creditor or general agent of an insurer on account of that person’s ownership interest in an insurer which has assumed any credit life or disability risks from another insurer pursuant to a reinsurance agreement. In order to assist in the enforcement of this rule, any licensed agent and an officer of any insurer writing credit life or credit disability insurance in this state shall on January 1, 1990, and on the same date of each year thereafter, file with the Commissioner a notarized affidavit stating whether or not the insurer or agent has paid or received compensation in excess of the limits set forth herein. In the event the rates charged by an insurer are higher than the rates specified in Section 6 of these rules, the aggregate monetary amount of all compensation to any person shall not exceed that which would have been payable had the rates set forth in said Section 6 been charged. In all cases where an insurer has assumed credit life and disability risks from another insurer pursuant to a reinsurance agreement:

(a) The offer or grant by an insurer to a creditor of any special favor or advantage not set out in the insurance contract other than the payment of agents’ commissions is prohibited.

(b) No insurer shall reinsure any Wyoming risks with any insurer who is not authorized to transact insurance in one or more states and having surplus to policyholders in an amount not less than the paid in capital stock and surplus required under W.S. 26-3-108.

(c) In addition to the statistical experience data required in the annual report, each insurer shall submit complete copies of all reinsurance treaties or contracts covering Wyoming risks as well as information showing how much reinsurance is in force on each Wyoming risk and in what company.

Section 11. Effective Date

This regulation shall become effective July 1, 1980. No form or rate approved prior to the effec- tive date of this regulation shall be used in this state after 1 September 1980, except that insurers whose premium rates do not exceed those rates set forth as being prima facie acceptable in Section 6 of this regulation may continue to use such conforming rates. All extensions, renewals, reissues, replacements, addenda, endorsements or other modifications of existing group credit insurance contracts or forms shall be made to conform to the requirements of these regulations. The amendments to Sections 3(i), 6(f), 6(g), 10, 10(b), 10(c) are effective when filed.

Section 12. Severability

If any section or portion of a section of these rules or the applicability thereto to any person or circumstance is held invalid, the invalidity shall not affect other provisions or application of these rules and regulations which can be given effect without the valid provision or application,and to these ends the rules are severable.

History

• Effective 1996-12-31

Chapter 53 Actuarial Opinion and Memorandum Regulation

Wyo. Code R. 044.0002.53.12272010 Actuarial Opinion and Memorandum Regulation

CHAPTER 53

ACTUARIAL OPINION AND MEMORANDUM REGULATION

Section 1. Purpose The purpose of this regulation is to prescribe:

(a) Requirements for statements of actuarial opinion that are to be submitted in accordance with Wyo. Stat. § 26-6-208, and for memoranda in support thereof;

(b) Rules applicable to the appointment of an appointed actuary; and

(c) Guidance as to the meaning of "adequacy of reserves."

Section 2. Authority

This regulation is issued pursuant to the authority vested in the Commissioner of Insurance of the State of Wyoming under Wyo. Stat. §§ 26-6-208(b), 26-2-110 and pursuant to the Wyoming Administrative Procedure Act, Wyo. Stat. § 16-3-101, et seq. This regulation will take effect for annual statements for the year 2005.

Section 3. Scope

(a) This regulation shall apply to all life insurance companies and fraternal benefit societies doing business in this State and to all life insurance companies and fraternal benefit societies that are authorized to reinsure life insurance, annuities or accident and health insurance business in this State. This regulation shall be applied in a manner that allows the appointed actuary to utilize his or her professional judgment in performing the asset analysis and developing the actuarial opinion and supporting memoranda, consistent with relevant actuarial standards of practice. However, the commissioner shall have the authority to specify specific methods of actuarial analysis and actuarial assumptions when, in the commissioner's judgment, these specifications are necessary for an acceptable opinion to be rendered relative to the adequacy of reserves and related items.

(b) This regulation shall be applicable to all annual statements filed with the office of the commissioner after the effective date of this regulation. A statement of opinion on the adequacy of the reserves and related actuarial items based on an asset adequacy analysis in accordance with Section 6 of this regulation, and a memorandum in support thereof in accordance with Section 7 of this regulation, shall be required each year.

Section 4. Definitions

(a) "Actuarial Opinion" means the opinion of an appointed actuary regarding the adequacy of the reserves and related actuarial items based on an asset adequacy analysis in accordance with Section 6 of this regulation and with applicable Actuarial Standards of Practice.

(b) "Actuarial Standards Board" means the board established by the American Academy of Actuaries to develop and promulgate standards of actuarial practice.

(c) "Annual statement" means that statement required by Wyo. Stat.§ 26-3-123(a) of the Insurance Law to be filed by the company with the office of the commissioner annually.

(d) "Appointed actuary" means an individual who is appointed or retained in accordance with the requirements set forth in Section 5(c) of this regulation to provide the actuarial opinion and supporting memorandum as required by Wyo. Stat. § 26-6-208.

(e) "Asset adequacy analysis" means an analysis that meets the standards and other requirements referred to in Section 5(d) of this regulation.

(f) "Commissioner" means the Insurance Commissioner of this State.

(g) "Company" means a life insurance company, fraternal benefit society or reinsurer subject to the provisions of this regulation.

(h) "Qualified actuary" means an individual who meets the requirements set forth in Section 5(b) of this regulation.

Section 5. General Requirements

(a) Submission of Statement of Actuarial Opinion

(i) There is to be included on or attached to Page 1 of the annual statement for each year beginning with the year in which this regulation becomes effective the statement of an appointed actuary, entitled "Statement of Actuarial Opinion," setting forth an opinion relating to reserves and related actuarial items held in support of policies and contracts, in accordance with Section 6 of this regulation.

(ii) Upon written request by the company, the commissioner may grant an extension of the date for submission of the statement of actuarial opinion.

(b) Qualified Actuary. A "qualified actuary" is an individual who:

(i) Is a member in good standing of the American Academy of Actuaries;

(ii) Is qualified to sign statements of actuarial opinion for life and health insurance company annual statements in accordance with the American Academy of Actuaries qualification standards for actuaries signing such statements;

(iii) Is familiar with the valuation requirements applicable to life and health insurance companies;

(iv) Has not been found by the commissioner (or if so found has subsequently been reinstated as a qualified actuary), following appropriate notice and hearing to have:

(A) Violated any provision of, or any obligation imposed by, the Insurance Law or other law in the course of his or her dealings as a qualified actuary;

(B) Been found guilty of fraudulent or dishonest practices;

(C) Demonstrated his or her incompetency, lack of cooperation, or untrustworthiness to act as a qualified actuary;

(D) Submitted to the commissioner during the past five (5) years, pursuant to this regulation, an actuarial opinion or memorandum that the commissioner rejected because it did not meet the provisions of this regulation including standards set by the Actuarial Standards Board; or

(E) Resigned or been removed as an actuary within the past five (5) years as a result of acts or omissions indicated in any adverse report on examination or as a result of failure to adhere to generally acceptable actuarial standards; and

(v) Has not failed to notify the commissioner of any action taken by any commissioner of any other state similar to that under Paragraph (iv) above.

(c) Appointed Actuary. An "appointed actuary" is a qualified actuary who is appointed or retained to prepare the Statement of Actuarial Opinion required by this regulation, either directly by or by the authority of the board of directors through an executive officer of the company other than the qualified actuary. The company shall give the commissioner timely written notice of the name, title (and, in the case of a consulting actuary, the name of the firm) and manner of appointment or retention of each person appointed or retained by the company as an appointed actuary and shall state in the notice that the person meets the requirements set forth in Subsection (b) of this section. Once notice is furnished, no further notice is required with respect to this person, provided that the company shall give the commissioner timely written notice in the event the actuary ceases to be appointed or retained as an appointed actuary or to meet the requirements set forth in Subsection (b) of this section. If any person appointed or retained as an appointed actuary replaces a previously appointed actuary, the notice shall so state and give the reasons for replacement.

(d) Standards for Asset Adequacy Analysis. The asset adequacy analysis required by this regulation:

(i) Shall conform to the Standards of Practice as promulgated from time to time by the Actuarial Standards Board and on any additional standards under this regulation, which standards are to form the basis of the statement of actuarial opinion in accordance with this regulation; and

(ii) Shall be based on methods of analysis as are deemed appropriate for such purposes by the Actuarial Standards Board.

(e) Liabilities to be Covered.

(i) Under authority of Wyo. Stat. § 26-6-208, the statement of actuarial opinion shall apply to all in force business on the statement date, whether directly issued or assumed, regardless of when or where issued, e. g., reserves of Exhibits 8, 9 and 10, and claim liabilities in Exhibit 11, Part 1 and equivalent items in the separate account statement or statements.

(ii) If the appointed actuary determines as the result of asset adequacy analysis that a reserve should be held in addition to the aggregate reserve held by the company and calculated in accordance with methods set forth in the Standard Valuation Law, the company shall establish the additional reserve.

(iii) Additional reserves established under Paragraph (ii) above and deemed not necessary in subsequent years may be released. Any amounts released shall be disclosed in the actuarial opinion for the applicable year. The release of such reserves would not be deemed an adoption of a lower standard of valuation.

Section 6. Statement of Actuarial Opinion Based On an Asset Adequacy Analysis

(a) General Description. The statement of actuarial opinion submitted in accordance with this section shall consist of:

(i) A paragraph identifying the appointed actuary and his or her qualifications (see Subsection (b)(i));

(ii) A scope paragraph identifying the subjects on which an opinion is to be expressed and describing the scope of the appointed actuary's work, including a tabulation delineating the reserves and related actuarial items that have been analyzed for asset adequacy and the method of analysis, (see Subsection (b)(ii)) and identifying the reserves and related actuarial items covered by the opinion that have not been so analyzed;

(iii) A reliance paragraph describing those areas, if any, where the appointed actuary has deferred to other experts in developing data, procedures or assumptions, (e.g., anticipated cash flows from currently owned assets, including variation in cash flows according to economic scenarios (see Subsection (b)(iii)), supported by a statement of each such expert in the form prescribed by Subsection (e); and

(iv) An opinion paragraph expressing the appointed actuary's opinion with respect to the adequacy of the supporting assets to mature the liabilities (see Subsection (b)(vi)).

(v) One or more additional paragraphs will be needed in individual company cases as follows:

(A) If the appointed actuary considers it necessary to state a qualification of his or her opinion;

(B) If the appointed actuary must disclose an inconsistency in the method of analysis or basis of asset allocation used at the prior opinion date with that used for this opinion;

(C) If the appointed actuary must disclose whether additional reserves as of the prior opinion date are released as of this opinion date, and the extent of the release;

(D) If the appointed actuary chooses to add a paragraph briefly describing the assumptions that form the basis for the actuarial opinion.

(b) Recommended Language. The following paragraphs are to be included in the statement of actuarial opinion in accordance with this section. Language is that which in typical circumstances should be included in a statement of actuarial opinion. The language may be modified as needed to meet the circumstances of a particular case, but the appointed actuary should use language that clearly expresses his or her professional judgment. However, in any event the opinion shall retain all pertinent aspects of the language provided in this section.

(i) The opening paragraph should generally indicate the appointed actuary's relationship to the company and his or her qualifications to sign the opinion. For a company actuary, the opening paragraph of the actuarial opinion should include a statement such as: "I, [name], am [title] of [insurance company name] and a member of the American Academy of Actuaries. I was appointed by, or by the authority of, the Board of Directors of said insurer to render this opinion as stated in the letter to the commissioner dated [insert date]. I meet the Academy qualification standards for rendering the opinion and am familiar with the valuation requirements applicable to life and health insurance companies." For a consulting actuary, the opening paragraph should include a statement such as: "I, [name], a member of the American Academy of Actuaries, am associated with the firm of [name of consulting firm]. I have been appointed by, or by the authority of, the Board of Directors of [name of company] to render this opinion as stated in the letter to the commissioner dated [insert date]. I meet the Academy qualification standards for rendering the opinion and am familiar with the valuation requirements applicable to life and health insurance companies."

(ii) The scope paragraph should include a statement such as: "I have examined the actuarial assumptions and actuarial methods used in determining reserves and related actuarial items listed below, as shown in the annual statement of the company, as prepared for filing with state regulatory officials, as of December 31, 20[ ]. Tabulated below are those reserves and related actuarial items which have been subjected to asset adequacy analysis.Asset Adequacy Tested Amounts—Reserves and Liabilities Total Formula Additional Analysis Other Amount Statement Item Reserves Actuarial Method Amount (1)+(2)+(3)(1)Reserves (a) (2) (b) (3) (4) Exhibit 8 A Life Insurance

Asset Adequacy Tested Amounts—Reserves and Liabilities

| Statement Item | Formula Reserves (1) | Additional Actuarial Reserves (a) (2) | Analysis Method (b) | Other Amount (3) | Total Amount (1)+(2)+(3) (4) | | --- | --- | --- | --- | --- | --- | | Exhibit 8 A Life Insurance | | | | | | | B Annuities | | | | | | | C Supplementary Contracts Involving Life Contingencies | | | | | | | D Accidental Death Benefit | | | | | | | E Disability—Active | | | | | | | F Disability—Disabled | | | | | | | G Miscellaneous | | | | | | | Total (Exhibit 8 Item 1, Page 3) | | | | | | | Exhibit 9 A Active Life Reserve | | | | | | | B Claim Reserve | | | | | | | Total (Exhibit 9 Item 2, Page 3) | | | | | | | Exhibit 10 Premium and Other Deposit Funds (Column 5, Line 14) | | | | | | | Guaranteed Interest Contracts (Column 2, Line 14) | | | | | | | Other (Column 6, Line 14) | | | | | | | Supplemental Contracts and Annuities Certain (Column 3, Line 14) | | | | | | | Dividend Accumulations or Refunds (Column 4, Line 14) | | | | | | | Total Exhibit 10 (Column 1, Line 14) | | | | | | | Exhibit 11 Part 1 1 Life (Page 3, Line 4.1) | | | | | | | 2 Health (Page 3, Line 4.2) | | | | | | | Total Exhibit 11, Part 1 | | | | | | | Separate Accounts (Page 3 of the Annual Statement of the Separate Accounts, Lines 1, 2, 3.1, 3.2, 3.3) | | | | | | | TOTAL RESERVES | | | | | |

| IMR (General Account, Page ___ Line ___) | | | --- | --- | | (Separate Accounts, Page ___ Line ___) | | | AVR (Page ___ Line ___) | (c) | | Net Deferred and Uncollected Premium | |

| Notes: (a) The additional actuarial reserves are the reserves established under Paragraph (ii) of Section 5(e). (b) The appointed actuary should indicate the method of analysis, determined in accordance with the standards for asset adequacy analysis referred to in Section 5(d) of this regulation, by means of symbols that should be defined in footnotes to the table. (c) Allocated amount of Asset Valuation Reserve (AVR). | | --- |

(iii) If the appointed actuary has relied on other experts to develop certain portions of the analysis, the reliance paragraph should include a statement such as: "I have relied on [name], [title] for [e.g., "anticipated cash flows from currently owned assets, including variations in cash flows according to economic scenarios" or "certain critical aspects of the analysis performed in conjunction with forming my opinion"], as certified in the attached statement. I have reviewed the information relied upon for reasonableness."

A statement of reliance on other experts should be accompanied by a statement by each of the experts in the form prescribed by Section 6(e).

(iv) If the appointed actuary has examined the underlying asset and liability records, the reliance paragraph should include a statement such as: "My examination included such review of the actuarial assumptions and actuarial methods and of the underlying basic asset and liability records and such tests of the actuarial calculations as I considered necessary. I also reconciled the underlying basic asset and liability records to [exhibits and schedules listed as applicable] of the company's current annual statement."

(v) If the appointed actuary has not examined the underlying records, but has relied upon data (e.g., listings and summaries of policies in force or asset records) prepared by the company, the reliance paragraph should include a statement such as:

"In forming my opinion on [specify types of reserves] I relied upon data prepared by [name and title of company officer certifying in force records or other data] as certified in the attached statements. I evaluated that data for reasonableness and consistency. I also reconciled that data to [exhibits and schedules to be listed as applicable] of the company's current annual statement. In other respects, my examination included review of the actuarial assumptions and actuarial methods used and tests of the calculations I considered necessary."

The section shall be accompanied by a statement by each person relied upon in the form prescribed by Subsection E.

(vi) The opinion paragraph should include a statement such as: "In my opinion the reserves and related actuarial values concerning the statement items identified above:

A.  Are computed in accordance with presently accepted actuarial standards consistently applied and are fairly stated, in accordance with sound actuarial principles;

B.  Are based on actuarial assumptions that produce reserves at least as great as those called for in any contract provision as to reserve basis and method, and are in accordance with all other contract provisions;

C.  Meet the requirements of the Insurance Law and regulation of the state of [state of domicile]; and are at least as great as the minimum aggregate amounts required by the state in which this statement is filed;

D.  Are computed on the basis of assumptions consistent with those used in computing the corresponding items in the annual statement of the preceding year-end (with any exceptions noted below); and

E.  Include provision for all actuarial reserves and related statement items which ought to be established.

The reserves and related items, when considered in light of the assets held by the company with respect to such reserves and related actuarial items including, but not limited to, the investment earnings on the assets, and the considerations anticipated to be received and retained under the policies and contracts, make adequate provision, according to presently accepted actuarial standards of practice, for the anticipated cash flows required by the contractual obligations and related expenses of the company. (At the discretion of the commissioner, this language may be omitted for an opinion filed on behalf of a company doing business only in this state and in no other state.)

The actuarial methods, considerations and analyses used in forming my opinion conform to the appropriate Standards of Practice as promulgated by the Actuarial Standards Board, which standards form the basis of this statement of opinion.

This opinion is updated annually as required by statute. To the best of my knowledge, there have been no material changes from the applicable date of the annual statement to the date of the rendering of this opinion which should be considered in reviewing this opinion.

or

The following material changes which occurred between the date of the statement for which this opinion is applicable and the date of this opinion should be considered in reviewing this opinion: (Describe the change or changes.)

Note: Choose one of the above two paragraphs, whichever is applicable.

The impact of unanticipated events subsequent to the date of this opinion is beyond the scope of this opinion. The analysis of asset adequacy portion of this opinion should be viewed recognizing that the company's future experience may not follow all the assumptions used in the analysis.

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Signature of Appointed Actuary

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Address of Appointed Actuary

---

Telephone Number of Appointed Actuary

---

Date"

(c) Assumptions for New Issues. The adoption for new issues or new claims or other new liabilities of an actuarial assumption that differs from a corresponding assumption used for prior new issues or new claims or other new liabilities is not a change in actuarial assumptions within the meaning of this Section 6.

(d) Adverse Opinions. If the appointed actuary is unable to form an opinion, then he or she shall refuse to issue a statement of actuarial opinion. If the appointed actuary's opinion is adverse or qualified, then he or she shall issue an adverse or qualified actuarial opinion explicitly stating the reasons for the opinion. This statement should follow the scope paragraph and precede the opinion paragraph.

(e) Reliance on Information Furnished by Other Persons. If the appointed actuary relies on the certification of others on matters concerning the accuracy or completeness of any data underlying the actuarial opinion, or the appropriateness of any other information used by the appointed actuary in forming the actuarial opinion, the actuarial opinion should so indicate the persons the actuary is relying upon and a precise identification of the items subject to reliance. In addition, the persons on whom the appointed actuary relies shall provide a certification that precisely identifies the items on which the person is providing information and a statement as to the accuracy, completeness or reasonableness, as applicable, of the items. This certification shall include the signature, title, company, address and telephone number of the person rendering the certification, as well as the date on which it is signed.

(f) Alternate Option.

(i) The Standard Valuation Law gives the commissioner broad authority to accept the valuation of a foreign insurer when that valuation meets the requirements applicable to a company domiciled in this state in the aggregate. As an alternative to the requirements of Subsection (b)(vi)(C), the commissioner may make one or more of the following additional approaches available to the opining actuary:

(A) A statement that the reserves "meet the requirements of the insurance laws and regulations of the State of [state of domicile] and the formal written standards and conditions of this state for filing an opinion based on the law of the state of domicile." If the commissioner chooses to allow this alternative, a formal written list of standards and conditions shall be made available. If a company chooses to use this alternative, the standards and conditions in effect on July 1 of a calendar year shall apply to statements for that calendar year, and they shall remain in effect until they are revised or revoked. If no list is available, this alternative is not available.

(B) A statement that the reserves "meet the requirements of the insurance laws and regulations of the State of [state of domicile] and I have verified that the company's request to file an opinion based on the law of the state of domicile has been approved and that any conditions required by the commissioner for approval of that request have been met." If the commissioner chooses to allow this alternative, a formal written statement of such allowance shall be issued no later than March 31 of the year it is first effective. It shall remain valid until rescinded or modified by the commissioner.

The rescission or modifications shall be issued no later than March 31 of the year they are first effective. Subsequent to that statement being issued, if a company chooses to use this alternative, the company shall file a request to do so, along with justification for its use, no later than April 30 of the year of the opinion to be filed. The request shall be deemed approved on October 1 of that year if the commissioner has not denied the request by that date.

(C) A statement that the reserves "meet the requirements of the insurance laws and regulations of the State of [state of domicile] and I have submitted the required comparison as specified by this state."

(I) If the commissioner chooses to allow this alternative, a formal written list of products (to be added to the table in Item (II) below) for which the required comparison shall be provided will be published. If a company chooses to use this alternative, the list in effect on July 1 of a calendar year shall apply to statements for that calendar year, and it shall remain in effect until it is revised or revoked. If no list is available, this alternative is not available.

(II) If a company desires to use this alternative, the appointed actuary shall provide a comparison of the gross nationwide reserves held to the gross nationwide reserves that would be held under NAIC codification standards. Gross nationwide reserves are the total reserves calculated for the total company in force business directly sold and assumed, indifferent to the state in which the risk resides, without reduction for reinsurance ceded. The information provided shall be at least:

| (1) Product Type | (2) Death Benefit or Account Value | (3) Reserves Held | (4) Codification Reserves | (5) Codification Standard | | --- | --- | --- | --- | --- | | | | | | | | | | | | |

(III) The information listed shall include all products identified by either the state of filing or any other states subscribing to this alternative.

(IV) If there is no codification standard for the type of product or risk in force or if the codification standard does not directly address the type of product or risk in force, the appointed actuary shall provide detailed disclosure of the specific method and assumptions used in determining the reserves held.

(V) The comparison provided by the company is to be kept confidential to the same extent and under the same conditions as the actuarial memorandum.

(ii) Notwithstanding the above, the commissioner may reject an opinion based on the laws and regulations of the state of domicile and require an opinion based on the laws of this state. If a company is unable to provide the opinion within sixty (60) days of the request or such other period of time determined by the commissioner after consultation with the company, the commissioner may contract an independent actuary at the company's expense to prepare and file the opinion.

Section 7. Description of Actuarial Memorandum Including an Asset Adequacy Analysis and Regulatory Asset Adequacy Issues Summary

(a) General

(i) In accordance with Wyo. Stat. § 26-6-208, the appointed actuary shall prepare a memorandum to the company describing the analysis done in support of his or her opinion regarding the reserves. The memorandum shall be made available for examination by the commissioner upon his or her request but shall be returned to the company after such examination and shall not be considered a record of the insurance department or subject to automatic filing with the commissioner.

(ii) In preparing the memorandum, the appointed actuary may rely on, and include as a part of his or her own memorandum, memoranda prepared and signed by other actuaries who are qualified within the meaning of Section 5(b) of this regulation, with respect to the areas covered in such memoranda, and so state in their memoranda.

(iii) If the commissioner requests a memorandum and no such memorandum exists or if the commissioner finds that the analysis described in the memorandum fails to meet the standards of the Actuarial Standards Board or the standards and requirements of this regulation, the commissioner may designate a qualified actuary to review the opinion and prepare such supporting memorandum as is required for review. The reasonable and necessary expense of the independent review shall be paid by the company but shall be directed and controlled by the commissioner.

(iv) The reviewing actuary shall have the same status as an examiner for purposes of obtaining data from the company and the work papers and documentation of the reviewing actuary shall be retained by the commissioner; provided, however, that any information provided by the company to the reviewing actuary and included in the work papers shall be considered as material provided by the company to the commissioner and shall be kept confidential to the same extent as is prescribed by law with respect to other material provided by the company to the commissioner pursuant to the statute governing this regulation. The reviewing actuary shall not be an employee of a consulting firm involved with the preparation of any prior memorandum or opinion for the insurer pursuant to this regulation for any one of the current year or the preceding three (3) years.

(v) In accordance with Wyo. Stat. § 26-6-208, the appointed actuary shall prepare a regulatory asset adequacy issues summary, the contents of which are specified in Subsection (c). The regulatory asset adequacy issues summary will be submitted no later than March 15 of the year following the year for which a statement of actuarial opinion based on asset adequacy is required. The regulatory asset adequacy issues summary is to be kept confidential to the same extent and under the same conditions as the actuarial memorandum.

(b) Details of the Memorandum Section Documenting Asset Adequacy Analysis: When an actuarial opinion is provided, the memorandum shall demonstrate that the analysis has been done in accordance with the standards for asset adequacy referred to in Section 5(d) of this regulation and any additional standards under this regulation. It shall specify:

(i) For reserves:

(A) Product descriptions including market description, underwriting and other aspects of a risk profile and the specific risks the appointed actuary deems significant;

(B) Source of liability in force;

(C) Reserve method and basis;

(D) Investment reserves;

(E) Reinsurance arrangements;

(F) Identification of any explicit or implied guarantees made by the general account in support of benefits provided through a separate account or under a separate account policy or contract and the methods used by the appointed actuary to provide for the guarantees in the asset adequacy analysis;

(G) Documentation of assumptions to test reserves for the following:

(I) Lapse rates (both base and excess);

(II) Interest crediting rate strategy;

(III) Mortality;

(IV) Policyholder dividend strategy;

(V) Competitor or market interest rate;

(VI) Annuitization rates;

(VII) Commissions and expenses; and

(VIII) Morbidity.

The documentation of the assumptions shall be such that an actuary reviewing the actuarial memorandum could form a conclusion as to the reasonableness of the assumptions.

(ii) For assets:

(A) Portfolio descriptions, including a risk profile disclosing the quality, distribution and types of assets;

(B) Investment and disinvestment assumptions;

(C) Source of asset data;

(D) Asset valuation bases; and

(E) Documentation of assumptions made for:

(I) Default costs;

(II) Bond call function;

(III) Mortgage prepayment function;

(IV) Determining market value for assets sold due to disinvestment strategy; and

(V) Determining yield on assets acquired through the investment strategy.

The documentation of the assumptions shall be such that an actuary reviewing the actuarial memorandum could form a conclusion as to the reasonableness of the assumptions.

(iii) For the analysis basis:

(A) Methodology;

(B) Rationale for inclusion or exclusion of different blocks of business and how pertinent risks were analyzed;

(C) Rationale for degree of rigor in analyzing different blocks of business (include in the rationale the level of "materiality" that was used in determining how rigorously to analyze different blocks of business);

(D) Criteria for determining asset adequacy (include in the criteria the precise basis for determining if assets are adequate to cover reserves under "moderately adverse conditions" or other conditions as specified in relevant actuarial standards of practice); and

(E) Whether the impact of federal income taxes was considered and the method of treating reinsurance in the asset adequacy analysis;

(iv) Summary of material changes in methods, procedures, or assumptions from prior year's asset adequacy analysis;

(v) Summary of results; and

(vi) Conclusions.

(c) Details of the Regulatory Asset Adequacy Issues Summary

(i) The regulatory asset adequacy issues summary shall include:

(A) Descriptions of the scenarios tested (including whether those scenarios are stochastic or deterministic) and the sensitivity testing done relative to those scenarios. If negative ending surplus results under certain tests in the aggregate, the actuary should describe those tests and the amount of additional reserve as of the valuation date which, if held, would eliminate the negative aggregate surplus values.

Ending surplus values shall be determined by either extending the projection period until the in force and associated assets and liabilities at the end of the projection period are immaterial or by adjusting the surplus amount at the end of the projection period by an amount that appropriately estimates the value that can reasonably be expected to arise from the assets and liabilities remaining in force.

(B) The extent to which the appointed actuary uses assumptions in the asset adequacy analysis that are materially different than the assumptions used in the previous asset adequacy analysis;

(C) The amount of reserves and the identity of the product lines that had been subjected to asset adequacy analysis in the prior opinion but were not subject to analysis for the current opinion;

(D) Comments on any interim results that may be of significant concern to the appointed actuary;. For example, the impact of the insufficiency of assets to support the payment of benefits and expenses and the establishment of statutory reserves during one or more interim periods;

(E) The methods used by the actuary to recognize the impact of reinsurance on the company's cash flows, including both assets and liabilities, under each of the scenarios tested; and

(F) Whether the actuary has been satisfied that all options whether explicit or embedded, in any asset or liability (including but not limited to those affecting cash flows embedded in fixed income securities) and equity-like features in any investments have been appropriately considered in the asset adequacy analysis.

(ii) The regulatory asset adequacy issues summary shall contain the name of the company for which the regulatory asset adequacy issues summary is being supplied and shall be signed and dated by the appointed actuary rendering the actuarial opinion.

(d) Conformity to Standards of Practice. The memorandum shall include the following statement: "Actuarial methods, considerations and analyses used in the preparation of this memorandum conform to the appropriate Standards of Practice as promulgated by the Actuarial Standards Board, which standards form the basis for this memorandum."

(e) Use of Assets Supporting the Interest Maintenance Reserve and the Asset Valuation Reserve An appropriate allocation of assets in the amount of the interest maintenance reserve (IMR), whether positive or negative, shall be used in any asset adequacy analysis. Analysis of risks regarding asset default may include an appropriate allocation of assets supporting the asset valuation reserve (AVR); these AVR assets may not be applied for any other risks with respect to reserve adequacy. Analysis of these and other risks may include assets supporting other mandatory or voluntary reserves available to the extent not used for risk analysis and reserve support.

The amount of the assets used for the AVR shall be disclosed in the table of reserves and liabilities of the opinion and in the memorandum. The method used for selecting particular assets or allocated portions of assets shall be disclosed in the memorandum.

(f) Documentation. The appointed actuary shall retain on file, for at least seven (7) years, sufficient documentation so that it will be possible to determine the procedures followed, the analyses performed, the bases for assumptions and the results obtained.

Section 8. Severability.

If any section or portion of a section of this regulation or its applicability to any person or circumstance is held invalid by a court, the remainder of the regulation or the applicability of the provision to other persons or circumstances shall not be affected.

Section 9. Effective Date.

This regulation becomes effective immediately upon filing with the Secretary of State.

History

• Effective 2010-12-27

Chapter 54 Privacy of Consumer Financial and Health Information

Wyo. Code R. 044.0002.54.04252023 Privacy of Consumer Financial and Health Information

123

Chapter 54

Privacy of Consumer Financial and Health Information

and Standards for Safeguarding Customer Information

ARTICLE I. GENERAL PROVISIONS

Section 1. Authority. This regulation is promulgated pursuant to Wyoming Statutes §§ 26-2-110, 26-2-133, and 26-13-101 et seq.

Section 2. Applicability.

(a) This regulation applies to:

(i) Nonpublic personal financial information about individuals who obtain or are claimants or beneficiaries of products or services primarily for personal, family, or household purposes. This regulation does not apply to information about companies or about individuals who obtain products or services for business, commercial, or agricultural purposes; and

(ii) All nonpublic personal health information.

(b) A licensee domiciled in Wyoming who is in compliance with this regulation in a state that has not enacted laws or regulations meeting the requirements of Title V of the Gramm-Leach-Bliley Act (PL 102-106) may nonetheless be deemed as in compliance with Title V of the Gramm-Leach-Bliley Act in the other state.

Section 3. Definitions.

(a) "Affiliate" means a company that controls, is controlled by, or is under common control with another company.

(b) "Clear and conspicuous" means a notice is reasonably understandable and designed to call attention to the nature and significance of the information contained therein.

(i) A licensee makes its notice reasonably understandable if it:

(A) Presents the information in the notice in clear, concise sentences, paragraphs, and sections;

(B) Uses short explanatory sentences or bullet lists;

(C) Uses definite, concrete, everyday words, and active voice;

(D) Avoids multiple negatives;

(E) Avoids legal and highly technical business terminology; and

(F) Avoids explanations that are imprecise and readily subject to different interpretations.

(ii) A licensee shall design its notice to call attention to the nature and significance of the information by using:

(A) Plain language headings to call attention to the notice;

(B) Typeface, type size, style, and graphic devices that are distinctive and easy to read;

(C) Wide margins and ample line spacing; and

(D) Boldface or italics for key words.

(iii) Notices on web sites shall call attention to the nature and significance of the information by using text or visual cues to encourage scrolling down the page to view the entire notice and to ensure other elements on the web site (such as text, graphics, hyperlinks, or sound) do not distract from the notice. The licensee shall either:

(A) Place the notice on a screen consumers frequently access, such as a page on which transactions are conducted; or

(B) Place a link on a screen consumers frequently access that connects directly to the notice and is labeled appropriately.

(c) "Collect" means to obtain information that the licensee can organize or retrieve by name of an individual, identifying number, symbol, or other identifying particular assigned to an individual, regardless of the underlying source of the information.

(d) "Company" means a corporation, limited liability company, business trust, general or limited partnership, association, sole proprietorship, or similar organization.

(e) "Consumer" means an individual or that individual's legal representative who is seeking or who has obtained an insurance product or service from a licensee to be used primarily for personal, family, or household purposes, and about whom the licensee has nonpublic personal information and includes:

(i) An individual who provides nonpublic personal information to a licensee in connection with seeking or obtaining financial, investment, or economic advisory services relating to an insurance product or service regardless of whether the licensee establishes an ongoing advisory relationship.

(ii) An applicant for insurance prior to the inception of insurance coverage.

(iii) A consumer of another financial institution is not a licensee's consumer solely because the licensee is acting as agent for, or provides processing or other services to, that financial institution.

(iv) An individual is a licensee's consumer if the individual is:

(A) A beneficiary of a life insurance policy underwritten by the licensee;

(B) A claimant under an insurance policy issued by the licensee;

(C) An insured or an annuitant under an insurance policy or an annuity issued by the licensee; or

(D) A mortgagor of a mortgage covered under a mortgage insurance policy.

(v) Provided the licensee provides the initial, annual, and revised notices to the plan sponsor, group, or blanket insurance policyholder, group annuity contract holder, or workers' compensation policyholder, and the licensee does not disclose to a nonaffiliated third party nonpublic personal financial information about an individual other than as permitted under this regulation, an individual is not the consumer of the licensee solely because he or she is:

(A) A participant or a beneficiary of an employee benefit plan the licensee administers or sponsors or for which the licensee acts as a trustee, insurer, or fiduciary;

(B) Covered under a group or blanket insurance policy or group annuity contract issued by the licensee; or

(C) A claimant covered by a workers' compensation plan.

(vi) The individuals described in the above subparagraphs (v)(A) through (C) are consumers of a licensee if the licensee does not meet all the conditions of paragraph (v).

(vii) In no event shall the individuals, solely by virtue of the status described in subparagraphs (v)(A) through (C) be deemed customers for purposes of this regulation.

(viii) An individual is not a licensee's consumer solely because he or she is a beneficiary or named trustee for a trust.

(f) "Consumer reporting agency" has the same meaning as in Section 603(f) of the federal Fair Credit Reporting Act (15 U.S.C. 1681a(f)).

(g) "Control" means:

(i) Ownership, control, or power to vote twenty-five percent (25%) or more of the outstanding shares of any class of voting security of the company, directly or indirectly, or acting through one or more other persons;

(ii) Control in any manner over the election of a majority of the directors, trustees, or general partners (or individuals exercising similar functions) of the company; or

(iii) The power to exercise, directly or indirectly, a controlling influence over the management or policies of the company, as determined by the Commissioner.

(h) "Customer" means a consumer who has a customer relationship with a licensee.

(i) "Customer information" means nonpublic personal information, whether in paper, electronic, or other form, maintained by or on behalf of the licensee.

(j) "Customer information systems" means the electronic or physical methods used to access, collect, store, use, transmit, protect, or dispose of customer information.

(k) "Customer relationship" means a continuing relationship between a consumer and a licensee under which the licensee provides one or more insurance products or services to the consumer to be used primarily for personal, family, or household purposes.

(i) A consumer has a continuing relationship with a licensee if the consumer:

(A) Is a current policyholder of an insurance product issued by or through the licensee; or

(B) Obtains financial, investment, or economic advisory services relating to an insurance product or service from the licensee for a fee.

(ii) A consumer does not have a continuing relationship with a licensee if the consumer:

(A) Applies for insurance but does not purchase the insurance;

(B) Purchases airline travel insurance from the licensee in an isolated transaction;

(C) Is no longer a current policyholder of an insurance product or no longer obtains insurance services with or through the licensee;

(D) Is a beneficiary or claimant under a policy and has submitted a claim under a policy choosing a settlement option involving an ongoing relationship with the licensee;

(E) Is a beneficiary or a claimant under a policy and has submitted a claim under that policy choosing a lump sum settlement option;

(F) Had a policy that lapsed, expired, or otherwise inactive or dormant under the licensee's business practices, and the licensee has not communicated with the customer about the relationship for a period of twelve (12) consecutive months, other than providing annual privacy notices, material required by law or regulation, communication at the direction of a state or federal authority, or promotional materials;

(G) Is an insured or an annuitant under an insurance policy or annuity, respectively, but is not the policyholder or owner of the insurance policy or annuity; or

(H) Has a last known address according to the licensee's records that is invalid.

(l) "Financial institution" means any institution whose business is engaging in activities that are financial in nature or incidental to such financial activities as described in Section 4(k) of the Bank Holding Company Act of 1956 (12 U.S.C. 1843(k)). Financial institution does not include:

(i) Any person or entity with respect to any financial activity that is subject to the jurisdiction of the Commodity Futures Trading Commission under the Commodity Exchange Act (7 U.S.C. 1 et seq.);

(ii) The Federal Agricultural Mortgage Corporation or any entity charged and operating under the Farm Credit Act of 1971 (12 U.S.C. 2001 et seq.); or

(iii) Institutions chartered by Congress specifically to engage in securitizations, secondary market sales (including sales of servicing rights), or similar transactions related to a consumer transaction as long as the institutions do not sell or transfer nonpublic personal information to a nonaffiliated third party.

(m) "Financial product or service" means a product or service a financial holding company could offer by engaging in an activity that is financial in nature or incidental to such a financial activity under Section 4(k) of the Bank Holding Company Act of 1956 (12 U.S.C. 1843(k)).

(i) Financial service includes a financial institution's evaluation or brokerage of information that the financial institution collects in connection with a request or an application from a consumer for a financial product or service.

(n) "Health care" means preventive, diagnostic, therapeutic, rehabilitative, maintenance, or palliative care, services, procedures, tests, or counseling that:

(i) Relates to the physical, mental, or behavioral condition of an individual;

(ii) Affects the structure or function of the human body or any part of the human body, including the banking of blood, sperm, organs, or any other tissue; or

(iii) Prescribing, dispensing, or furnishing to an individual drugs or biologicals, or medical devices, or health care equipment, and supplies.

(o) "Health care provider" means a physician or other health care practitioner licensed, accredited, or certified to perform specified health services consistent with state law, or a health care facility.

(p) "Health information" means any information or data except age or gender, whether oral or recorded in any form or medium, created by or derived from a health care provider or the consumer relating to:

(i) The past, present, or future physical, mental, or behavioral health or condition of an individual;

(ii) The provision of health care to an individual; or

(iii) Payment for the provision of health care to an individual.

(q) "Insurance product or service" means any product or service offered by a licensee pursuant to the Wyoming Insurance Code.

(i) Insurance service includes a licensee's evaluation, brokerage, or distribution of information the licensee collects in connection with a request or an application from a consumer for an insurance product or service.

(r) "Licensee" means all licensed insurers, producers, and other persons licensed or required to be licensed pursuant to the Wyoming Insurance Code, except that "licensee" shall not include: a purchasing group; or an unauthorized insurer regarding surplus line business conducted pursuant to W.S. § 26-11-101 et seq.

(i) A licensee is not subject to the notice and opt-out requirements for nonpublic personal financial information set forth in Articles I, II, III, IV, and VII if the licensee is an employee, agent, or other representative of another licensee (the principal) and:

(A) The principal otherwise complies with and provides the notices required by this regulation; and

(B) The licensee does not disclose any nonpublic personal information to any person other than the principal or its affiliates in a manner permitted by this regulation.

(ii) Subject to subsection (iii) of this subsection, "licensee" shall also include an unauthorized insurer that accepts business placed through a licensed surplus lines broker in Wyoming, but only regarding the surplus lines placements placed pursuant to the Wyoming Insurance Code.

(iii) A surplus lines broker or insurer shall be deemed in compliance with the notice and opt-out requirements for nonpublic personal financial information set forth in Articles I, II, III, IV, and VII provided:

(A) The broker or insurer does not disclose nonpublic personal information of a consumer or a customer to nonaffiliated third parties for any purpose, including joint servicing or marketing under section 14 of this regulation, except as permitted by section 15 or 16 of this regulation; and

(B) The broker or insurer delivers a notice to the consumer at the time a customer relationship is established on which the following is printed in 16-point type:

PRIVACY NOTICE

"Neither the U.S. brokers that handled this insurance nor the insurers underwriting this insurance will disclose nonpublic personal information concerning the buyer to non-affiliates of the brokers or insurers except as permitted by law."

(s) "Nonaffiliated third party" means any person except a licensee's affiliate or a person employed jointly by a licensee and any company that is not the licensee's affiliate (but nonaffiliated third party includes the other company that jointly employs the person).

(i) Nonaffiliated third party includes any company affiliated solely by virtue of the direct or indirect ownership or control of the company by the licensee or its affiliate in conducting merchant banking or investment banking activities of the type described in Section 4(k)(4)(H) or insurance company investment activities of the type described in Section 4(k)(4)(I) of the federal Bank Holding Company Act (12 U.S.C. 1843(k)(4)(H) and (I)) or as otherwise defined by Wyoming Statute.

(t) "Nonpublic personal information" includes nonpublic personal financial information and nonpublic personal health information.

(u) "Nonpublic personal financial information" means personally identifiable financial information and any list, description, or other grouping of consumers (and publicly available information pertaining to them) derived using any personally identifiable financial information that is not publicly available.

(i) Nonpublic personal financial information includes any list of individuals' names and street addresses derived in whole or in part using personally identifiable financial information that is not publicly available, such as account numbers.

(ii) Nonpublic personal financial information does not include:

(A) Health information;

(B) Publicly available information, except as included on a list described in subsection (3)(t) above; or

(C) Any list, description or other grouping of consumers (and publicly available information pertaining to them) derived without using any personally identifiable financial information that is not publicly available.

(D) Any list of individuals' names and addresses that contains only publicly available information, is not derived in whole or in part using personally identifiable financial information that is not publicly available, and is not disclosed in a manner indicating that any of the individuals on the list is a consumer of a financial institution.

(v) "Nonpublic personal health information" means health information:

(i) That identifies an individual who is the subject of the information; or

(ii) With respect to which there is a reasonable basis to believe the information could be used to identify an individual.

(w) "Personally identifiable financial information" means any information:

(i) A consumer provides to a licensee to obtain an insurance product or service from the licensee;

(ii) About a consumer resulting from a transaction involving an insurance product or service between a licensee and a consumer; or

(iii) The licensee otherwise obtains about a consumer in connection with providing an insurance product or service to that consumer.

(iv) Personally identifiable financial information includes:

(A) Information a consumer provides to a licensee on an application to obtain an insurance product or service;

(B) Account balance information and payment history;

(C) The fact an individual is or has been one of the licensee's customers or has obtained an insurance product or service from the licensee;

(D) Any information about the licensee's consumer if disclosed in a manner indicating that the individual is or has been the licensee's consumer;

(E) Any information a consumer provides to a licensee or that the licensee or its agent otherwise obtains in connection with collecting on a loan or servicing a loan;

(F) Any information the licensee collects through an Internet cookie (an information-collecting device from a web server); and

(G) Information from a consumer report.

(v) Personally identifiable financial information does not include:

(A) Health information;

(B) A list of names and addresses of customers of an entity that is not a financial institution; and

(C) Information that does not identify a consumer, such as aggregate information or blind data not containing personal identifiers such as account numbers, names or addresses.

(x) "Publicly available information" means any information a licensee has a reasonable basis to believe is lawfully made available to the general public from:

(i) Federal, state, or local government records;

(ii) Widely distributed media; or

(iii) Disclosures to the general public required by federal, state, or local law.

(iv) A licensee has a reasonable basis to believe information is lawfully made available to the general public if the licensee has taken steps to determine:

(A) That the information is of the type available to the general public; and

(B) Whether an individual can direct that the information not be made available to the general public and, if so, that the licensee's consumer has not done so.

(v) "Publicly available information" includes:

(A) Information in government records including real estate records and security interest filings.

(B) Information from widely distributed media such as a telephone book, a television or radio program, a newspaper, or a web-site that is available to the general public on an unrestricted basis. A web site is not restricted merely because an Internet service provider or a site operator requires a fee or a password, if available to the general public.

(C) Information a licensee has a reasonable basis to believe is lawfully made available.

(I) Mortgage information is lawfully made available to the general public if the licensee has determined the information is of the type included on the public record in the jurisdiction where the mortgage would be recorded.

(II) An individual's telephone number is lawfully made available to the general public if the licensee has located the telephone number in the telephone book or the consumer has informed licensee that the telephone number is not unlisted.

ARTICLE II. PRIVACY AND OPT-OUT NOTICES FOR FINANCIAL INFORMATION

Section 4. Initial Privacy Notice to Consumers Required.

(a) A licensee shall provide a clear and conspicuous notice that accurately reflects its privacy policies and practices to:

(i) An individual who becomes the licensee's customer, not later than when the licensee establishes a customer relationship. except as provided in subsection 4(e) of this section; and

(ii) A consumer, before the licensee discloses any nonpublic personal financial information to any nonaffiliated third party, if the licensee makes a disclosure other than as authorized by sections 15 and 16.

(b) A licensee is not required to provide an initial notice to a consumer under subsection 4(a)(ii) of this section if:

(i) The licensee does not disclose any nonpublic personal financial information about the consumer to any nonaffiliated third party, other than as authorized by sections 15 and 16, and the licensee does not have a customer relationship with the consumer; or

(ii) A notice has been provided by an affiliated licensee, as long as the notice clearly identifies all licensees to whom the notice applies and is accurate with respect to the licensee and the other institutions.

(c) A licensee establishes a customer relationship at the time the licensee and the consumer enter into a continuing relationship or when:

(i) The insurer delivers an insurance policy or contract to the consumer that was obtained through the licensee; or

(ii) The consumer agrees to obtain financial, economic, or investment advisory services relating to insurance products or services for a fee from the licensee.

(d) When an existing customer obtains a new insurance product or service to be used primarily for personal, family, or household purposes, the licensee satisfies the initial notice requirements of subsection 4(a) if the licensee:

(i) Provides a revised policy notice, under section 8 covering the customer's new insurance product or service; or

(ii) Recently provided initial, revised, or annual notice to the customer that was accurate with respect to the new insurance product or service.

(e) Exceptions to allow subsequent delivery of notice.

(i) A licensee may provide the initial notice required by subsection 4(a) within a reasonable time after the licensee establishes a customer relationship if:

(A) Establishing the customer relationship is not at the customer's election; or

(B) Providing notice not later than when the licensee establishes a customer relationship would substantially delay the customer's transaction and the customer agrees to receive the notice at a later time.

(ii) Exceptions include:

(A) If a licensee acquires or is assigned a customer's policy from another financial institution or residual market mechanism and the customer does not have a choice about the licensee's acquisition or assignment.

(B) Providing notice would substantially delay the customer's transaction when the licensee and the individual agree over the telephone to enter into a customer relationship involving prompt delivery of the insurance product or service.

(C) Providing notice would not substantially delay the customer's transaction when the relationship is initiated in person at the licensee's office or through other means by which the customer may view the notice, such as on a web site.

(f) When a licensee is required to deliver an initial privacy notice, the licensee shall deliver it according to section 10. If the licensee uses a short-form initial notice for non-customers according to section 6(c), the licensee may deliver its privacy notice according to section 6(c)(iii).

Section 5. Annual Privacy Notice to Customers Required.

(a) Except as indicated below, a licensee shall provide a clear and conspicuous notice to customers that accurately reflects its privacy policies and practices not less than annually during the continuation of the customer relationship. A licensee may define the twelve-consecutive-month period, but the licensee shall apply it to the customer on a consistent basis. A licensee provides an annual notice if it provides notice in each calendar year following the year in which the licensee provided the initial notice.

(b) A licensee is not required to provide an annual notice if:

(i) The licensee only provides nonpublic personal information about its customers to nonaffiliated third parties pursuant to sections 14, 15, and 16; and

(ii) The licensee has not changed its privacy policies and practices relating to the disclosure of nonpublic personal information from those policies and practices that were set forth in the most recent notice sent to customers pursuant to this section or section 4.

(c) A licensee is not required to provide annual notice to a former customer.

(d) A licensee no longer has a continuing relationship with an individual if:

(i) The individual no longer holds a current policy or no longer uses insurance services with or through the licensee.

(ii) The individual's policy is lapsed, expired, or otherwise inactive and the licensee has not communicated with the customer about the relationship for a period of twelve (12) consecutive months, other than to provide material required by law.

(iii) The individual's last known address is deemed invalid or undeliverable and subsequent attempts by the licensee to obtain a current valid address for the individual have been unsuccessful.

(iv) In the case of providing real estate settlement services, at the time the customer completes execution of all documents related to the real estate closing, payment for those services has been received, or the licensee has completed all of its responsibilities with respect to the settlement, including filing documents on the public record, whichever is later.

(e) When a licensee is required by this section to deliver an annual privacy notice, the licensee shall deliver it according to section 10.

Section 6. Information to be Included in Privacy Notices.

(a) The initial, annual, and revised privacy notices that a licensee provides under sections 4, 5, and 8 shall include each of the following items of information, in addition to any other information the licensee wishes to provide, that applies to the licensee and to the consumers to whom the licensee sends its privacy notice:

(i) The categories of nonpublic personal financial information the licensee collects;

(ii) The categories of nonpublic personal financial information the licensee discloses;

(iii) The categories of affiliates and nonaffiliated third parties to whom the licensee discloses nonpublic personal financial information, other than those parties to whom the licensee discloses information under sections 15 and 16;

(iv) The categories of nonpublic personal financial information about the licensee's former customers the licensee discloses and the categories of affiliates and nonaffiliated third parties to whom the licensee discloses nonpublic personal financial information about the licensee's former customers, other than those parties to whom the licensee discloses information under sections 15 and 16;

(v) If a licensee discloses nonpublic personal financial information to a nonaffiliated third party under section 15 (and no other exception in sections 15 and 16 applies to that disclosure), a separate description of the categories of information the licensee discloses and the categories of third parties with whom the licensee has contracted;

(vi) An explanation of the consumer's right under section 11(a) to opt-out of the disclosure of nonpublic personal financial information to nonaffiliated third parties, including the methods by which the consumer may exercise that right at that time;

(vii) Any disclosures the licensee makes under Section 603(d)(2)(A)(iii) of the federal Fair Credit Reporting Act (15 U.S.C. 1681a(d)(2)(A)(iii)) (that is, notices regarding the ability to opt-out of disclosures of information among affiliates);

(viii) The licensee's policies and practices with respect to protecting the confidentiality and security of nonpublic personal information; and

(ix) Any disclosure the licensee makes under subsection (b) of this section.

(b) If a licensee discloses nonpublic personal financial information as authorized under sections 15 and 16, the licensee is not required to list those exceptions in the initial or annual privacy notices required by sections 4 and 5. When describing the categories of parties to whom disclosure is made, the licensee is required to state only that it makes disclosures to other affiliated or nonaffiliated third parties, as applicable, as permitted by law.

(c) A licensee may satisfy the initial notice requirements in sections 4(a)(ii) and 7 for a consumer who is not a customer by providing a short-form initial notice at the same time the licensee delivers an opt-out notice as required in section 7.

(i) A short-form initial notice shall:

(A) Be clear and conspicuous;

(B) State that the licensee's privacy notice is available upon request; and

(C) Explain a reasonable means by which the consumer may obtain that notice.

(ii) The licensee shall deliver its short-form initial notice according to section 9. The licensee is not required to deliver its privacy notice with its short-form initial notice, but may provide to the consumer a reasonable means to obtain its privacy notice. If a consumer who receives the licensee's short-form notice requests the licensee's privacy notice, the licensee shall deliver its privacy notice according to section 10.

(iii) The licensee provides a reasonable means for a consumer to obtain a copy of its privacy notice if the licensee:

(A) Provides a toll-free telephone number the consumer may call to request the notice; or

(B) Maintains copies of the notice on hand that the licensee provides to consumers immediately upon request.

(d) The licensee's notice for future disclosures may include:

(i) Categories of nonpublic personal financial information the licensee reserves the right to disclose in the future, but does not currently disclose; and

(ii) Categories of affiliated or nonaffiliated third parties to whom the licensee reserves the future right to disclose, but to whom the licensee does not currently disclose, nonpublic personal financial information.

(e) Sample clauses illustrating some of the notice content required by this section are included in the Sample Clauses Illustration, located on the Department of Insurance website at: DOI.wyo.gov.

Section 7. Form of Opt-Out Notice to Consumers and Opt-Out Methods.

(a) If a licensee is required to provide an opt-out notice under section 11(a), it shall provide a clear and conspicuous notice to each of its consumers accurately explaining the right to opt-out under that section and stating:

(i) That the licensee discloses or reserves the right to disclose nonpublic personal financial information about its consumer to a nonaffiliated third party;

(ii) That the consumer has the right to opt-out of that disclosure; and

(iii) A reasonable means by which the consumer may exercise the opt-out right.

(b) A licensee provides adequate opt-out notice to a nonaffiliated third party if the licensee:

(i) Identifies all categories of nonpublic personal financial information it discloses or reserves the right to disclose, and all categories of nonaffiliated third parties to which the licensee discloses the information, as described in paragraphs 6(a)(ii) and (iii), and states that the consumer can opt-out of the disclosure of that information; and

(ii) Identifies the insurance products or services the consumer obtains from the licensee, either singly or jointly, to which the opt-out direction would apply.

(iii) A licensee provides a reasonable means to exercise an opt-out right if it:

(A) Designates check-off boxes in a prominent position on the relevant forms with the opt-out notice;

(B) Includes a reply form together with the opt-out notice;

(C) Provides an electronic means to opt-out, such as a form that can be sent via electronic mail, or a process at the licensee's website, if the consumer agrees to the electronic delivery of information; or

(D) Provides a toll-free telephone number consumers may call to opt-out.

(c) A licensee does not provide a reasonable means of opting-out if:

(i) The only means of opting-out is for the consumer to write his or her own letter exercising the opt-out right; or

(ii) The only means of opting-out as described in any notice subsequent to the initial notice is to use a check-off box the licensee provided with the initial notice but did not include with the subsequent notice.

(d) A licensee may require each consumer to opt-out through a specific means, as long as that means is reasonable for that consumer.

(e) A licensee may provide the opt-out notice together with or on the same written or electronic form as the initial notice the licensee provides in accordance with section 4.

(f) If a licensee provides the opt-out notice later than required for the initial notice in accordance with section 4, the licensee shall also include a copy of the initial notice with the opt-out notice in writing or, if the consumer agrees, electronically.

(g) If two (2) or more consumers jointly obtain an insurance product or service from a licensee, the licensee may provide a single opt-out notice that explains how the licensee will treat an opt-out direction by a joint consumer.

(i) Any of the joint consumers may exercise the right to opt-out. The licensee may either:

(A) Treat an opt-out direction by a joint consumer as applying to all of the associated joint consumers; or

(B) Permit each joint consumer to opt-out separately.

(ii) If a licensee permits each joint consumer to opt-out separately, the licensee shall permit one of the joint consumers to opt-out on behalf of all of the joint consumers.

(iii) A licensee may not require all joint consumers to opt-out before it implements any opt-out direction.

(h) A licensee shall comply with a consumer's opt-out direction as soon as reasonably practicable after the licensee receives it.

(i) A consumer may exercise the right to opt-out at any time.

(i) A consumer's direction to opt-out under this section is effective until the consumer revokes it in writing or, if the consumer agrees, electronically.

(ii) When a customer relationship terminates, the customer's opt-out direction continues to apply to the nonpublic personal financial information the licensee collected during or related to that relationship. If the individual subsequently establishes a new customer relationship with the licensee, the opt-out direction that applied to the former relationship does not apply to the new relationship.

(j) When a licensee is required to deliver an opt-out notice, the licensee shall deliver it according to section 10.

Section 8. Revised Privacy Notices.

(a) Except as otherwise authorized in this regulation, a licensee shall not, directly or through an affiliate, disclose any nonpublic personal financial information about a consumer to a nonaffiliated third party other than as described in the initial notice that the licensee provided to that consumer under section 4, unless:

(i) The licensee has provided to the consumer a clear and conspicuous revised notice accurately describing its policies and practices;

(ii) The licensee has provided to the consumer a new opt-out notice;

(iii) The licensee has given the consumer a reasonable opportunity, before the licensee discloses the information to the nonaffiliated third party, to opt-out of the disclosure; and

(iv) The consumer does not opt-out.

(b) Except as otherwise permitted by sections 14, 15, and 16, a licensee shall provide a revised notice before it:

(i) Discloses a new category of nonpublic personal financial information to any nonaffiliated third party;

(ii) Discloses nonpublic personal financial information to a new category of nonaffiliated third party; or

(iii) Discloses nonpublic personal financial information about a former customer to a nonaffiliated third party, if that former customer has not had the opportunity to exercise an opt-out right regarding that disclosure.

(c) A revised notice is not required if the licensee discloses nonpublic personal financial information to a new nonaffiliated third party the licensee adequately described in its prior notice.

(d) When a licensee is required to deliver a revised privacy notice by this section, the licensee shall deliver it according to section 10.

Section 9. Privacy Notices to Group Policyholders. Unless a licensee is providing privacy notices directly to covered individuals described in section 3(e)(v)(A), (B), or (C), a licensee shall provide initial, annual, and revised notices to the plan sponsor, group or blanket insurance policyholder or group annuity contract holder, or workers' compensation policyholder, in the manner described in sections 4, 5, and 8 of this regulation, describing the licensee's privacy practices with respect to nonpublic personal information about individuals covered under the policies, contracts, or plans.

Section 10. Delivery.

(a) A licensee shall provide any notices this regulation requires so that each consumer can reasonably be expected to receive actual notice in writing or, if the consumer agrees, electronically.

(b) A licensee may reasonably expect a consumer will receive actual notice if the licensee:

(i) Hand-delivers a printed copy of the notice to the consumer;

(ii) Mails a printed copy of the notice to the last known address of the consumer separately, or in a policy, billing, or other written communication;

(iii) Posts the notice on the electronic site and requires the consumer to acknowledge receipt of the notice as a necessary step to obtaining a particular insurance product or service; or

(iv) For an isolated transaction with a consumer, such as the licensee providing an insurance quote or selling the consumer travel insurance, posts the notice and requires the consumer to acknowledge receipt of the notice as a necessary step to obtaining the particular insurance product or service.

(c) A licensee may not, however, reasonably expect that a consumer will receive actual notice of its privacy policies and practices if it:

(i) Only posts a sign in its office or generally publishes advertisements of its privacy policies and practices; or

(ii) Sends the notice via electronic mail to a consumer who does not obtain an insurance product or service from the licensee electronically.

(d) A licensee may reasonably expect that a customer will receive actual notice of the licensee's annual privacy notice if:

(i) The customer uses the licensee's website to access insurance products and services electronically and agrees to receive notices at the website and the licensee posts its current privacy notice continuously in a clear and conspicuous manner; or

(ii) The customer has requested that the licensee refrain from sending any information regarding the customer relationship, and the licensee's current privacy notice remains available to the customer upon request.

(e) A licensee may not provide any notice required by this regulation solely by orally explaining the notice, either in person or over the telephone.

(f) For customers only, a licensee shall provide the initial notice required by section 4(a), the annual notice required by section 5(a), and the revised notice required by section 8 so that the customer can retain them or obtain them later in writing or, if the customer agrees, electronically.

(g) A licensee may provide a privacy notice to the customer so the customer can retain it or obtain it later if the licensee:

(i) Hand-delivers a printed copy of the notice to the customer;

(ii) Mails a printed copy of the notice to the last known address of the customer; or

(iii) Makes its current privacy notice available on a website (or a link to another website) for the customer who obtains an insurance product or service electronically and agrees to receive the notice at the website.

(h) A licensee may provide a joint notice from the licensee and one or more of its affiliates or other financial institutions, as identified in the notice. A licensee also may provide accurate notice on behalf of another financial institution.

(i) If two (2) or more consumers jointly obtain an insurance product or service from a licensee, the licensee may satisfy the initial, annual, and revised notice requirements of sections 4(a), 5(a) and 8(a), respectively, by providing one notice to those consumers jointly.

ARTICLE III. LIMITS ON DISCLOSURES OF FINANCIAL INFORMATION

Section 11. Limits on Disclosure of Nonpublic Personal Financial Information to Nonaffiliated Third Parties.

(a) A licensee may not, directly or through any affiliate, disclose any nonpublic personal financial information about a consumer to a nonaffiliated third party unless:

(i) The licensee has provided to the consumer an initial notice as required under section 4;

(ii) The licensee has provided to the consumer an opt-out notice as required in section 7;

(iii) The licensee has given the consumer a reasonable opportunity, before it discloses the information to the nonaffiliated third party, to opt-out of the disclosure; and

(iv) The consumer does not opt-out.

(b) Opt-out means a direction by the consumer that the licensee not disclose nonpublic personal financial information about that consumer to a nonaffiliated third party, other than as permitted by sections 14, 15, and 16.

(c) A licensee provides a consumer with a reasonable opportunity to opt-out if:

(i) The licensee mails the required notices to the consumer and allows the consumer to opt-out by mailing a form, calling a toll-free telephone number, or any other reasonable means within thirty (30) days from the date the licensee mailed the notices.

(ii) A customer opens an on-line account with a licensee and agrees to receive the required notices electronically, and the licensee allows the customer to opt-out by any reasonable means within thirty (30) days after the date the customer acknowledges receipt of the notices in conjunction with opening the account.

(iii) For an isolated transaction such as providing the consumer with an insurance quote, a licensee provides the consumer with a reasonable opportunity to opt-out if the licensee provides the required notices at the time of the transaction and requests that the consumer decide, as a necessary part of the transaction, whether to opt-out before completing the transaction.

(iv) A licensee shall comply with this section, regardless of whether the licensee and the consumer have established a customer relationship.

(v) Unless a licensee complies with this section, the licensee may not, directly or through any affiliate, disclose any nonpublic personal financial information about a consumer the licensee has collected, regardless of whether the licensee collected it before or after receiving the direction to opt-out from the consumer.

(d) A licensee may allow a consumer to select certain nonpublic personal financial information or certain nonaffiliated third parties to which the consumer wishes to opt-out.

Section 12. Limits on Re-disclosure and Reuse of Nonpublic Personal Financial Information.

(a) If a licensee receives nonpublic personal financial information from a nonaffiliated financial institution under an exception in this regulation, the licensee's disclosure and use of that information is limited as follows. The licensee may disclose:

(i) Information to affiliates of the financial institution from which the licensee received the information;

(ii) Information to its affiliates, but the licensee's affiliates may, in turn, disclose and use the information only to the extent that the licensee may disclose and use the information; and

(iii) Information pursuant to an exception in this regulation, in the ordinary course of business to carry out the activity covered by the exception under which the licensee received the information.

(b) If a licensee receives information from a nonaffiliated financial institution for claims settlement purposes, the licensee may disclose the information for fraud prevention, or in response to a properly authorized subpoena. The licensee may not disclose that information to a third party for marketing purposes or use that information for its own marketing purposes.

(c) If a licensee receives nonpublic personal financial information from a nonaffiliated financial institution other than under an exception in this regulation, the licensee may disclose the information only:

(i) To affiliates of the financial institution from which the licensee received the information;

(ii) To its affiliates, but its affiliates may, in turn, disclose the information only to the extent that the licensee may disclose the information; and

(iii) To any other person, if the disclosure would be lawful if made directly to that person by the financial institution from which the licensee received the information.

(d) If a licensee obtains a customer list from a nonaffiliated financial institution outside of the exceptions in this regulation:

(i) The licensee may use that list for its own purposes; and

(ii) The licensee may disclose that list to another nonaffiliated third party only if the financial institution from which the licensee purchased the list could have lawfully disclosed the list to that third party. That is, the licensee may disclose the list in accordance with the privacy policy of the financial institution from which the licensee received the list, as limited by the opt-out direction of each consumer whose nonpublic personal financial information the licensee intends to disclose, and the licensee may disclose the list in accordance with an exception in this regulation, such as to the licensee's attorneys or accountants.

(iii) If a licensee discloses nonpublic personal financial information to a nonaffiliated third party under an exception, the third party may disclose and use that information only as follows. The third party may disclose the information:

(A) To the licensee's affiliates;

(B) To its affiliates, but its affiliates may, in turn, disclose and use the information only to the extent that the third party may disclose and use the information; and

(C) In the ordinary course of business to carry out the activity covered by the exception under which it received the information.

(iv) If a licensee discloses nonpublic personal financial information to a nonaffiliated third party other than under an exception in this regulation, the third party may disclose the information only:

(A) To the licensee's affiliates;

(B) To the third party's affiliates, but the third party's affiliates may disclose the information only to the extent the third party can disclose the information; and

(C) To any other person, if the disclosure would be lawful if the licensee made it directly to that person.

Section 13. Limits on Sharing Account Number Information for Marketing Purposes.

(a) A licensee shall not, directly or through an affiliate, disclose, other than to a consumer reporting agency, a policy number or similar form of access number or access code for a consumer's policy or transaction account to any nonaffiliated third party for use in telemarketing, direct mail marketing, or other marketing through electronic mail to the consumer.

(b) Section 13(a) does not apply if a licensee discloses a policy number or similar form of access number or access code:

(i) To the licensee's service provider solely to perform marketing for the licensee's own products or services, as long as the service provider is not authorized to directly initiate charges to the account;

(ii) To a licensee who is a producer solely to perform marketing for the licensee's own products or services; or

(iii) To a participant in an affinity or similar program where the participants in the program are identified to the customer when the customer enters into the program.

(c) Policy number or transaction account.

(i) A policy number, or similar form of access number or access code, does not include a number or code in an encrypted form, as long as the licensee does not provide the recipient with a means to decode the number or code.

(ii) For purposes of this section, a policy or transaction account is an account other than a deposit account or a credit card account. A policy or transaction account does not include an account to which third parties cannot initiate charges.

ARTICLE IV. EXCEPTIONS TO LIMITS ON DISCLOSURES OF FINANCIAL INFORMATION

Section 14. Exception to Opt-Out Requirements for Disclosure of Nonpublic Personal Financial Information for Service Providers and Joint Marketing.

(a) The opt-out requirements in sections 7 and 11 do not apply when a licensee provides nonpublic personal financial information to a nonaffiliated third party to perform services for the licensee or functions on the licensee's behalf, if the licensee:

(i) Provides the initial notice in accordance with section 4; and

(ii) Enters into a contractual agreement with the third party prohibiting the third party from disclosing or using the information other than to carry out the purposes for which the licensee disclosed the information, including use under an exception in the ordinary course of business to carry out those purposes.

(b) If a licensee discloses nonpublic personal financial information under this section to a financial institution with which the licensee performs joint marketing, the licensee's contractual agreement with that institution meets the requirements of section 14(a)(ii) if it prohibits the institution from disclosing or using the nonpublic personal financial information except as necessary to carry out the joint marketing or under an exception in the ordinary course of business to carry out that joint marketing.

(c) The services a nonaffiliated third party performs for a licensee under section 14(a) may include marketing the licensee's own products or services or marketing financial products or services offered pursuant to joint agreements between the licensee and one or more financial institutions.

(d) "Joint agreement" means a written contract pursuant to which a licensee and one or more financial institutions jointly offer, endorse, or sponsor a financial product or service.

Section 15. Exceptions to Notice and Opt-Out Requirements for Disclosure of Nonpublic Personal Financial Information for Processing and Servicing Transactions.

(a) The requirements for initial notice in section 4(a), the opt-out in sections 7 and 11, and service providers and joint marketing in section 14 do not apply if the licensee discloses nonpublic personal financial information as necessary to effect, administer, or enforce a transaction a consumer requests or authorizes, or in connection with:

(i) Servicing or processing an insurance product or service a consumer requests or authorizes;

(ii) Maintaining or servicing the consumer's account with a licensee, or with another entity as part of a private label credit card program or other extension of credit on behalf of such entity;

(iii) A proposed or actual securitization, secondary market sale (including sales of servicing rights), or similar transaction related to a transaction of the consumer; or

(iv) Reinsurance, stop loss, or excess loss insurance.

(b) "Necessary to effect, administer, or enforce a transaction" means the disclosure is:

(i) Required, or is one of the lawful or appropriate methods, to enforce the licensee's rights or the rights of other persons engaged in carrying out the financial transaction or providing the product or service; or

(ii) Required, or is a usual, appropriate, or acceptable method:

(A) To carry out the transaction or the product or service business of which the transaction is a part, and record, service, or maintain the consumer's account in the ordinary course of providing the insurance product or service;

(B) To administer or service benefits or claims relating to the transaction or the product or service business of which it is a part;

(C) To provide a confirmation, statement, or other record of the transaction, or information on the status or value of the insurance product or service to the consumer or the consumer's agent or broker;

(D) To accrue or recognize incentives or bonuses provided by a licensee or any other party associated with the transaction;

(E) To underwrite insurance at the consumer's request or for any of the following purposes as they relate to a consumer's insurance: account administration, reporting, investigating or preventing fraud or material misrepresentation, processing premium payments, processing insurance claims, administering insurance benefits (including utilization review activities), participating in research projects, or as otherwise required or specifically permitted by federal or state law; or

(iii) In connection with:

(A) The authorization, settlement, billing, processing, clearing, transferring, reconciling, or collection of amounts charged, debited, or otherwise paid using a debit, credit, or other payment card, check or account number, or by other payment means;

(B) The transfer of receivables, accounts, or interests therein; or

(C) The audit of debit, credit, or other payment information.

Section 16. Other Exceptions to Notice and Opt-Out Requirements for Disclosure of Nonpublic Personal Financial Information.

(a) The requirements for initial notice to consumers in section 4(a), the opt-out in sections 7 and 11, and service providers and joint marketing in section 14 do not apply when a licensee discloses nonpublic personal financial information:

(i) With the consent or at the direction of the consumer, provided the consumer has not revoked the consent or direction:

(A) To protect the confidentiality or security of a licensee's records pertaining to the consumer, service, product, or transaction;

(B) To protect against or prevent actual or potential fraud or unauthorized transactions;

(C) For required institutional risk control or for resolving consumer disputes or inquiries;

(D) To persons holding a legal or beneficial interest relating to the consumer; or

(E) To persons acting in a fiduciary or representative capacity on behalf of the consumer.

(ii) To provide information to insurance rate advisory organizations, guaranty funds or agencies, agencies rating a licensee, persons assessing the licensee's compliance with industry standards, and the licensee's attorneys, accountants, and auditors;

(iii) To the extent specifically permitted or required under other provisions of law and in accordance with the federal Right to Financial Privacy Act of 1978 (12 U.S.C. 3401 et seq.), to law enforcement agencies (including the Federal Reserve Board, Office of the Comptroller of the Currency, Federal Deposit Insurance Corporation, National Credit Union Administration, the Securities and Exchange Commission, the Secretary of the Treasury, with respect to 31 U.S.C. Chapter 53, Subchapter II (Records and Reports on Monetary Instruments and Transactions) and 12 U.S.C. Chapter 21 (Financial Recordkeeping), a state insurance authority, and the Federal Trade Commission), self-regulatory organizations, or for an investigation on a matter related to public safety;

(iv) To a consumer reporting agency in accordance with the federal Fair Credit Reporting Act (15 U.S.C. 1681 et seq.);

(v) From a consumer report reported by a consumer reporting agency;

(vi) In connection with a proposed or actual sale, merger, transfer, or exchange of all or a portion of a business or operating unit if the disclosure of nonpublic personal financial information concerns solely consumers of the business or unit;

(A) To comply with federal, state, or local laws, rules, and other applicable legal requirements;

(B) To comply with a properly authorized civil, criminal, or regulatory investigation, subpoena, or summons by federal, state, or local authorities; or

(C) To respond to judicial process or government regulatory authorities with jurisdiction over a licensee for examination, compliance, or other purposes as authorized by law; or

(vii) For purposes related to replacing a group benefit plan, group health plan, group welfare plan, or workers' compensation plan.

(b) A consumer may revoke consent by subsequently exercising the right to opt-out of future disclosures of nonpublic personal information as permitted under section 7.

ARTICLE V. RULES FOR HEALTH INFORMATION

Section 17. When Authorization Required for Disclosure of Nonpublic Personal Health Information.

(a) A licensee shall not disclose nonpublic personal health information about a consumer or customer unless an authorization is obtained from the consumer or customer whose nonpublic personal health information is sought to be disclosed.

(b) Nothing in this section shall prohibit, restrict, or require an authorization for the disclosure of nonpublic personal health information by a licensee for performance of insurance functions by or on behalf of the licensee: claims administration; claims adjustment and management; detection, investigation or reporting of actual and potential fraud, misrepresentation or criminal activity; underwriting; policy placement or issuance; loss control; ratemaking and guaranty fund functions; reinsurance and excess loss insurance; risk management; case management; disease management; quality assurance; quality improvement; performance evaluation; provider credentialing verification; utilization review; peer review activities; actuarial, scientific, medical or public policy research; grievance procedures; internal administration of compliance, managerial, and information systems; policyholder service functions; auditing; reporting; database security; administration of consumer disputes and inquiries; external accreditation standards; the replacement of a group benefit plan or workers compensation policy or program; activities in connection with a sale, merger, transfer or exchange of all or part of a business or operating unit; any activity that permits disclosure without authorization pursuant to the federal Health Insurance Portability and Accountability Act privacy rules promulgated by the U.S. Department of Health and Human Services; disclosure that is required, or is one of the lawful or appropriate methods, to enforce the licensee's rights or the rights of other persons engaged in carrying out a transaction or providing a product or service that a consumer requests or authorizes; and any activity otherwise permitted by law, required pursuant to governmental reporting authority or to comply with legal process. Health information may be shared by affiliates for the specific purpose of processing claims. Additional insurance functions may be added with approval of the Commissioner to the extent they are necessary for appropriate performance of insurance functions and are fair and reasonable to the interest of consumers.

Section 18. Authorizations.

(a) A valid authorization to disclose nonpublic personal health information pursuant to this Article V shall be in written or electronic form and shall contain all of the following:

(i) The identity of the consumer or customer who is the subject of the nonpublic personal health information; and

(ii) A general description of the types of nonpublic personal health information to be disclosed.

(b) Requirements.

(i) The signature of the consumer or customer who is the subject of the nonpublic personal health information, or the individual legally empowered to grant authority, and the date signed and

(ii) Notice of the length of time the authorization is valid, that the consumer or customer may revoke the authorization at any time, and the procedure for making a revocation.

(c) An authorization for purposes of Article V shall specify a length of time the authorization shall remain valid, which in no event shall be for more than twenty-four (24) months.

(d) A consumer or customer who is the subject of nonpublic personal health information may revoke an authorization provided pursuant to Article V at any time, subject to the rights of an individual who acted in reliance on the authorization prior to notice of the revocation.

(e) A licensee shall retain the authorization or a copy thereof in the record of the individual who is the subject of nonpublic personal health information.

Section 20. Authorization Request Delivery. A request for authorization and an authorization form may be delivered to a consumer or a customer as part of an opt-out notice pursuant to section 10, provided the request and authorization form are clear and conspicuous. An authorization form is not required to be delivered to the consumer or customer or included in any other notices unless the licensee intends to disclose protected health information pursuant to section 17.

ARTICLE VI. SAFEGUARDING CUSTOMER INFORMATION

Section 20. Information Security Program. Each licensee shall implement a comprehensive written information security program that includes administrative, technical, and physical safeguards for protecting customer information. The information security program shall be appropriate to the size and complexity of the licensee and the nature and scope of its activities.

Section 21. Objectives of Information Security Program.

(a) A licensee's information security program shall be designed to:

(i) Ensure the security and confidentiality of customer information;

(ii) Protect against any anticipated threats or hazards to the security or integrity of the information; and

(iii) Protect against unauthorized access to or use of the information that could result in substantial harm or inconvenience to any customer.

Section 22. Methods of Development and Implementation.

(a) In assessing the risk, the licensee:

(i) Identifies reasonably foreseeable internal or external threats that could result in unauthorized disclosure, misuse, alteration, or destruction of customer information or customer information systems;

(ii) Assesses the likelihood and potential damage of these threats, taking into consideration the sensitivity of customer information; and

(iii) Assesses the sufficiency of policies, procedures, customer information systems, and other safeguards in place to control risks.

(b) In managing and controlling the risk, the licensee:

(i) Designs its information security program to control the identified risks, commensurate with the sensitivity of the information, as well as the complexity and scope of the licensee's activities;

(ii) Trains staff, as appropriate, to implement the licensee's information security program; and

(iii) Regularly tests or otherwise regularly monitors the key controls, systems, and procedures of the information security program. The frequency and nature of these tests or other monitoring practices are determined by the licensee's risk assessment.

(c) In overseeing the service provider arrangements, the licensee:

(i) Exercises appropriate due diligence in selecting its service providers; and

(ii) Requires its service providers to implement appropriate measures designed to meet the objectives of this regulation, and, where indicated by the licensee's risk assessment, takes appropriate steps to confirm its service providers have satisfied these obligations.

(d) In adjusting the program, the licensee:

(i) Monitors, evaluates, and adjusts, as appropriate, the information security program in light of any relevant changes in technology, the sensitivity of its customer information, internal or external threats to information, and the licensee's own changing business arrangements, such as mergers and acquisitions, alliances and joint ventures, outsourcing arrangements, and changes to customer information systems.

ARTICLE VII. ADDITIONAL PROVISIONS

Section 24. Protection of Fair Credit Reporting Act. Nothing in this regulation shall be construed to modify, limit, or supersede the operation of the federal Fair Credit Reporting Act (15 U.S.C. 1681 et seq.).

Section 25. Nondiscrimination.

(a) A licensee shall not unfairly discriminate against any consumer or customer who has opted-out from the disclosure of his nonpublic personal financial information pursuant to this regulation.

(b) A licensee shall not unfairly discriminate against a consumer or customer who has not granted authorization for the disclosure of his nonpublic personal health information pursuant to this regulation.

Section 26. Effective Date. This regulation shall be effective upon filing with the Secretary of State.

History

• Effective 2023-04-25

Chapter 57 Regulation on Custodial Agreements and the Use of Clearing Corporations

Wyo. Code R. 044.0002.57.07132017 § 1 Authority

This regulation is issued pursuant to W.S. §§ 26-2-110, 26-8-202(b), and 16-3-101, et seq.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.57.07132017 § 2 Applicability and Scope

This regulation applies to Wyoming domestic insurers and any other licensed insurers holding securities in the custody of a custodian pursuant to W.S. §§ 26-3-111 and 26-8-101.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.57.07132017 § 3 Definition

When used in this regulation, the term:

(a) "Agent" means a national bank, state bank, or trust company that maintains an account in its name in a clearing corporation or that is a member of the Federal Reserve System and through which a custodian participates in a clearing corporation, including the Treasury/Reserve Automated Debt Entry Securities System (TRADES) or Treasury Direct systems, except that with respect to securities issued by institutions organized or existing under the laws of a foreign country or securities used to meet the deposit requirements pursuant to the laws of a foreign country as a condition of doing business therein, "agent" may include a corporation that is organized or existing under the laws of a foreign country and that is legally qualified under those laws to accept custody of securities.

(b) "Clearing corporation" means a corporation as defined in W.S.

§ 34.1-8-102(a)(v) that is organized for the purpose of effecting transactions in securities by computerized book-entry, except that with respect to securities issued by institutions organized or existing under the laws of a foreign country or securities used to meet the deposit requirements pursuant to the laws of a foreign country as a condition of doing business therein, "clearing corporation" may include a corporation that is organized or existing under the laws of a foreign country and which is legally qualified under those laws to effect transactions in securities by computerized book-entry. Clearing corporation also includes TRADES and "Treasury Direct" book-entry securities systems established pursuant to 31 U.S.C. § 3100 et seq., 12 U.S.C. pt. 391, and 5 U.S.C. pt. 301.

(c) "Custodian" means a national bank, state bank or trust company that shall at all times during which it acts as a custodian pursuant to this regulation be no less than adequately capitalized as determined by the standards adopted by United States banking regulators and that is regulated by either state banking laws or is a member of the Federal Reserve System and that is legally qualified to accept custody of securities in accordance with the standards set forth below, except that with respect to securities issued by

institutions organized or existing under the laws of a foreign country, or securities used to meet the deposit requirements pursuant to the laws of a foreign country as a condition of doing business therein, "custodian" may include a bank or trust company incorporated or organized under the laws of a country other than the United States that is regulated as such by that country's government or an agency thereof that shall at all times during which it acts as a custodian pursuant to this regulation be no less than adequately capitalized as determined by the standards adopted by international banking authorities and that is legally qualified to accept custody of securities;

(d) "Custodied securities" means securities held by the custodian or its agent or in a clearing corporation, including the TRADES or Treasury Direct systems.

(e) "Treasury/Reserve Automated Debt Entry Securities System" (TRADES) and "Treasury Direct" mean the book entry securities systems established pursuant to 31

U.S.C. § 3100 et seq., 12 U.S.C. pt. 391 and 5 U.S.C. pt. 301. The operation of TRADES and Treasury Direct are subject to 31 C.F.R. pt. 357, et seq.

(f) "Security" has the same meaning as that defined in W.S.

§ 34.1-8-102(a)(xv).

(g) "Securities certificate" has the same meaning as that defined W.S.

§ 34.1-8-102(a)(xvi).

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.57.07132017 § 4 Custody Agreement; Requirements

(a) An insurance company may, by written agreement with a custodian, provide for the custody of its securities with that custodian. The securities that are the subject of the agreement may be held by the custodian or its agent or in a clearing corporation.

(b) The agreement shall be in writing and shall be authorized by a resolution of the board of directors of the insurance company or of an authorized committee of the board. The terms of the agreement shall comply with the following:

(i) Securities certificates held by the custodian shall be held separate from the securities certificates of the custodian and of all of its other customers.

(ii) Securities held indirectly by the custodian and securities in a clearing corporation shall be separately identified on the custodian's official records as being owned by the insurance company. The records shall identify which securities are held by the custodian or by its agent and which securities are in a clearing corporation. If the securities are in a clearing corporation, the records shall also identify where the securities are and if in a clearing corporation, the name of the clearing corporation and if through an agent, the name of the agent.

(iii) All custodied securities that are registered shall be registered in the name of the company or in the name of a nominee of the company or in the name of the custodian or its nominee or, if in a clearing corporation, in the name of the clearing corporation or its nominee.

(iv) Custodied securities shall be held subject to the instructions of the insurance company and shall be withdrawable upon the demand of the insurance company, except that custodied securities used to meet the deposit requirements set forth in W.S. § 26-3-111 shall, to the extent required by that section, be under the control of the Commissioner and shall not be withdrawn by the insurance company without the approval of the Commissioner.

(v) The custodian shall be required to send or cause to be sent to the insurance company a confirmation of all transfers of custodied securities to or from the account of the insurance company. In addition, the custodian shall be required to furnish no less than monthly the insurance company with reports of holdings of custodied securities at times and containing information reasonably requested by the insurance company. The custodian's trust committee's annual reports of its review of the insurer's trust accounts shall also be provided to the insurer. Reports and verifications may be transmitted in electronic or paper form.

(vi) During the course of the custodian's regular business hours, an officer or employee of the insurance company, an independent accountant selected by the insurance company and a representative of an appropriate regulatory body shall be entitled to examine, on the premises of the custodian, the custodian's records relating to custodied securities, but only upon furnishing the custodian with written instructions to that effect from an appropriate officer of the insurance company.

(vii) The custodian and its agents shall be required to send to the insurance company:

(A) All reports which they receive from a clearing corporation on their respective systems of internal accounting control; and

(B) Reports prepared by outside auditors on the custodian's or its agent's internal accounting control of custodied securities that the insurance company may reasonably request.

(viii) The custodian shall maintain records sufficient to determine and verify information relating to custodied securities that may be reported in the insurance company's annual statement and supporting schedules and information required in an audit of the financial statements of the insurance company.

(ix) The custodian shall provide, upon written request from an appropriate officer of the insurance company, the appropriate affidavits, substantially in the form found on the Department's website located at http://doi.wyo.gov.

(x) A national bank, state bank, or trust company shall secure and maintain insurance protection in an adequate amount covering the bank's or trust company's duties and activities as custodian for the insurer's assets, and shall state in the custody agreement that protection is in compliance with the requirements of the custodian's banking regulator. The Commissioner may determine whether the type of insurance is appropriate and the amount of coverage is adequate.

(xi) The custodian shall be obligated to indemnify the insurance company for any loss of custodied securities, except that the custodian shall not be so obligated to the extent that the loss was caused by other than the negligence or dishonesty of the custodian.

(xii) In the event that there is a loss of custodied securities for which the custodian shall be obligated to indemnify the insurance company as provided in Paragraph (xi) above, the custodian shall promptly replace the securities or the value thereof and the value of any loss of rights or privileges resulting from the loss of securities.

(xiii) The agreement may provide that the custodian will not be liable for a failure to take an action required under the agreement in the event and to the extent that the taking of the action is prevented or delayed by war (whether declared or not and including existing wars), revolution, insurrection, riot, civil commotion, act of God, accident, fire, explosion, stoppage of labor, strikes or other differences with employees, laws, regulations, orders or other acts of any governmental authority, or any other cause whatever beyond its reasonable control.

(xiv) In the event that the custodian gains entry in a clearing corporation through an agent, there shall be an agreement between the custodian and the agent under which the agent shall be subject to the same liability for loss of custodied securities as the custodian. However, if the agent shall be subject to regulation under the laws of a jurisdiction that is different from the jurisdiction the laws of which regulate the custodian, the Commissioner of the state of domicile of the insurance company may accept a standard of liability applicable to the agent that is different from the standard of liability applicable to the custodian.

(xv) The custodian shall provide written notification to the insurer's domiciliary commissioner if the custodial agreement with the insurer has been terminated or if 100 percent (100%) of the account assets in any one custody account have been withdrawn. This notification shall be remitted to the Commissioner within three (3) business days of the receipt by the custodian of the insurer's written notice of termination or within three (3) business days of the withdrawal of 100 percent (100%) of the account assets.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.57.07132017 § 5 Deposit with Affiliates; Requirements

(a) Nothing in this regulation shall prevent an insurance company from depositing securities with another insurance company with which the depositing insurance company is affiliated, provided that the securities are deposited pursuant to a written agreement authorized by the board of directors of the depositing insurance company or an authorized committee thereof and that the receiving insurance company is organized under the laws of one of the states of the United States of America or of the District of Columbia. If the respective states of domicile of the depositing and receiving insurance companies are not the same, the depositing insurance company shall have given notice of the deposit to the Commissioner in the state of its domicile and the Commissioner shall not have objected to it within thirty (30) days of the receipt of the notice.

(b) The terms of the agreement shall comply with the following:

(i) The insurance company receiving the deposit shall maintain records adequate to identify and verify the securities belonging to the depositing insurance company.

(ii) The receiving insurance company shall allow representatives of an appropriate regulatory body to examine records relating to securities held subject to the agreement.

(iii) The depositing insurance company may authorize the receiving insurance company:

(A) To hold the securities of the depositing insurance company in bulk, in certificates issued in the name of the receiving insurance company or its nominee, and to commingle them with securities owned by other affiliates of the receiving insurance company; and

(B) To provide for the securities to be held by a custodian, including the custodian of securities of the receiving insurance company or in a clearing corporation.

History

• Effective 2017-07-13

Wyo. Code R. 044.0002.57.07132017 § 6 Effective Date

This regulation becomes effective upon filing with the Secretary of State.

History

• Effective 2017-07-13

Chapter 58 Recognition of the 2001 Mortality Table

Wyo. Code R. 044.0002.58.01092006 Recognition of the 2001 Mortality Table

Chapter 58

RECOGNITION OF THE 2001 CSO MORTALITY TABLE

FOR USE IN DETERMINING MINIMUM RESERVE LIABILITIES

AND NONFORFEITURE BENEFITS REGULATION

Section 1. Authority

This regulation is promulgated by the Commissioner of Insurance pursuant to Wyo. Stat.§§ 26-2-110(a), 26-6-205(b)(i)(C)(III), 26-16-209(j)(vi) and Chapter 6 of the Wyoming Insurance Regulations.

Section 2. Purpose

The purpose of this regulation is to recognize, permit and prescribe the use of the 2001 Commissioners Standard Ordinary (CSO) Mortality Table in accordance with Wyo. Stat.§§ 26-6-205(b)(i)(C)(III) and 26-16-209(j)(vi).

Section 3. Definitions

(a) "2001 CSO Mortality Table" means that mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. The 2001 CSO Mortality Table is included in the Proceedings of the NAIC (2nd Quarter 2002). Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables.

(b) "2001 CSO Mortality Table (F)" means that mortality table consisting of the rates of mortality for female lives from the 2001 CSO Mortality Table.

(c) "2001 CSO Mortality Table (M)" means that mortality table consisting of the rates of mortality for male lives from the 2001 CSO Mortality Table.

(d) "Composite mortality tables" means mortality tables with rates of mortality that do not distinguish between smokers and nonsmokers.

(e) "Smoker and nonsmoker mortality tables" means mortality tables with separate rates of mortality for smokers and nonsmokers.

Section 4. 2001 CSO Mortality Table

(a) At the election of the company for any one or more specified plans of insurance and subject to the conditions stated in this regulation, the 2001 CSO Mortality Table may be used as the minimum standard for policies issued on or after January 1, 2005, and before the date specified in Subsection (b) to which Wyo. Stat. §§ 26-6-205(b)(i)(C)(III) and 26-16-209(j)(vi) are applicable. If the company elects to use the 2001 CSO Mortality Table, it shall do so for both valuation and nonforfeiture purposes

(b) Subject to the conditions stated in this regulation, the 2001 CSO Mortality Table shall be used in determining minimum standards for policies issued on and after January 1, 2009, to which Wyo. Stat. § 26-6-205(b)(i)(C)(III) and 26-16-290(j)(vi) are applicable.

Section 5. Conditions

(a) For each plan of insurance with separate rates for smokers and nonsmokers an insurer may use:

(i) Composite mortality tables to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits;

(ii) Smoker and nonsmoker mortality tables to determine the valuation net premiums and additional minimum reserves, if any, required by Wyo. Stat. § 26-6-205 and use composite mortality tables to determine the basic minimum reserves, minimum cash surrender values and amounts of paid-up nonforfeiture benefits; or

(iii) Smoker and nonsmoker mortality to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits.

(b) For plans of insurance without separate rates for smokers and nonsmokers the composite mortality tables shall be used.

(c) For the purpose of determining minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits, the 2001 CSO Mortality Table may, at the option of the company for each plan of insurance, be used in its ultimate or select and ultimate form.

(d) When the 2001 CSO Mortality Table is the minimum reserve standard for any plan for a company, the actuarial opinion in the annual statement filed with the commissioner shall be based on an asset adequacy analysis as specified in Wyo. Stat. § 26-6-208 and Chapter 53 of the Wyoming Insurance Regulations. A commissioner may exempt a company from this requirement if it only does business in this state and in no other state.

Section 6. Gender-Blended Tables

(a) For any ordinary life insurance policy delivered or issued for delivery in this state on and after January 1, 2005, that utilizes the same premium rates and charges for male and female lives or is issued in circumstances where applicable law does not permit distinctions on the basis of gender, a mortality table that is a blend of the 2001 CSO Mortality Table (M) and the 2001 CSO Mortality Table (F) may, at the option of the company for each plan of insurance, be substituted for the 2001 CSO Mortality Table for use in determining minimum cash surrender values and amounts of paid-up nonforfeiture benefits. No change in minimum valuation standards is implied by this subsection of the regulation.

(b) The company may choose from among the blended tables developed by the American Academy of Actuaries CSO Task Force and adopted by the NAIC in December 2002.

(c) It shall not, in and of itself, be a violation of Wyo. Stat. § 26-13-109 for an insurer to issue the same kind of policy of life insurance on both a sex-distinct and sex-neutral basis.

Section 7. Severability

If any provision of this regulation or its application to any person or circumstance is for any reason held to be invalid, the remainder of the regulation and the application of the provision to other persons or circumstances shall not be affected.

Section 8. Effective Date

​​​​​​​The effective date of this regulation is upon filing with the Secretary of State.

History

• Effective 2006-01-09

Chapter 59 Regulation Permitting the Recognition of Preferred Mortality Tables For Use In Determining Minimum Reserve Liabilities

Wyo. Code R. 044.0002.59.12272010 Regulation Permitting the Recognition of Preferred Mortality Tables For Use In Determining Minimum Reserve Liabilities

Chapter 59

REGULATION PERMITTING THE RECOGNITION OF

PREFERRED MORTALITY TABLES FOR USE IN

DETERMINING MINIMUM RESERVE LIABILITIES

Section 1. Authority

This regulation is promulgated by the Commissioner of Insurance pursuant to Wyo. Stat. §§ 26-2-110(a) and 26-6-205(b)(i)(C)(III).

Section 2. Purpose

The purpose of this regulation is to recognize, permit and prescribe the use of mortality tables that reflect differences in mortality between preferred and standard lives in determining minimum reserve liabilities in accordance with Wyo. Stat. § 26-6-205(b)(i)(C)(III).

Section 3. Definitions

(a) "2001 CSO Mortality Table" means that mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. The 2001 CSO Mortality Table is included in the Proceedings of the NAIC (2nd Quarter 2002) and supplemented by the 2001 CSO Preferred Class Structure Mortality Table defined below in Subsection (b). Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables. Mortality tables in the 2001 CSO Mortality Table include the following:

(i) "2001 CSO Mortality Table (F)" means that mortality table consisting of the rates of mortality for female lives from the 2001 CSO Mortality Table.

(ii) "2001 CSO Mortality Table (M)" means that mortality table consisting of the rates of mortality for male lives from the 2001 CSO Mortality Table.

(iii) "Composite mortality tables" means mortality tables with rates of mortality that do not distinguish between smokers and nonsmokers.

(iv) "Smoker and nonsmoker mortality tables" means mortality tables with separate rates of mortality for smokers and nonsmokers.

(b) "2001 CSO Preferred Class Structure Mortality Table" means mortality tables with separate rates of mortality for Super Preferred Nonsmokers, Preferred Nonsmokers, Residual Standard Nonsmokers, Preferred Smokers, and Residual Standard Smoker splits of the 2001 CSO Nonsmoker and Smoker tables as adopted by the NAIC at the September, 2006, national meeting and published in the Proceedings of the NAIC (3rd Quarter 2006). Unless the context indicates otherwise, the "2001 CSO Preferred Class Structure Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table. It includes both the smoker and nonsmoker mortality tables. It includes both the male and female mortality tables and the gender composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality table.

(c) "Statistical agent" means an entity with proven systems for protecting the confidentiality of individual insured and insurer information; demonstrated resources for and history of ongoing electronic communications and data transfer ensuring data integrity with insurers, which are its members or subscribers; and a history of and means for aggregation of data and accurate promulgation of the experience modifications in a timely manner.

Section 4. 2001 CSO Mortality Table

At the election of the company, for each calendar year of issue, for any one or more specified plans of insurance and subject to satisfying the conditions stated in this regulation, the 2001 CSO Preferred Class Structure Mortality Table may be substituted in place of the 2001 CSO Smoker or Nonsmoker Mortality Table as the minimum valuation standard for policies issued on or after January 1, 2007. For policies issued on or after January 1, 2005, and prior to January 1, 2007, these tables may be substituted with the consent of the commissioner and subject to the conditions of Section 5. In determining such consent, the commissioner may rely on the consent of the commissioner of the company's state of domicile. No such election shall be made until the company demonstrates at least 20 percent of the business to be valued on this table is in one or more of the preferred classes. A table from the 2001 CSO Preferred Class Structure Mortality Table used in place of a 2001 CSO Mortality Table, pursuant to the requirements of this rule, will be treated as part of the 2001 CSO Mortality Table only for purposes of reserve valuation pursuant to the requirements of the NAIC model regulation, "Recognition of the 2001 CSO Mortality Table for Use in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits Model Regulation."

Section 5. Conditions

(a) For each plan of insurance with separate rates for preferred and standard nonsmoker lives, an insurer may use the Super Preferred Nonsmoker, Preferred Nonsmoker, and Residual Standard Nonsmoker tables to substitute for the nonsmoker mortality table found in the 2001 CSO Mortality Table to determine minimum reserves. At the time of election and annually thereafter, except for business valued under the Residual Standard Nonsmoker Table, the appointed actuary shall annually certify that:

(i) The present value of death benefits over the next ten years after the valuation date, using the anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the valuation basic table corresponding to the valuation table being used for that class.

(ii) The present value of death benefits over the future life of the contracts, using the anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the valuation basic table corresponding to the valuation table being used for that class.

(b) For each plan of insurance with separate rates for preferred and standard smoker lives, an insurer may use the Preferred Smoker and Residual Standard Smoker tables to substitute for the smoker mortality tables found in the 2001 CSO Mortality Table to determine minimum reserves. At the time of election and annually thereafter, for business valued under the Preferred Smoker Table, the appointed actuary shall certify that:

(i) The present value of death benefits over the next ten years after the valuation date, using the anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the preferred smoker valuation basic table corresponding to the valuation table being used for that class.

(ii) The present value of death benefits over the future life of the contracts, using anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the preferred smoker valuation basic table.

(c) Unless exempted by the commissioner, every authorized insurer using the 2001 CSO Preferred Class Structure Table shall annually file with the commissioner, with the NAIC, or with a statistical agent designated by the NAIC and acceptable to the commissioner, statistical reports showing mortality and such other information as the commissioner may deem necessary or expedient for the administration of the provisions of this regulation. The form of the reports shall be established by the commissioner or the commissioner may require the use of a form established by the NAIC or by a statistical agent designed by the NAIC and acceptable to the commissioner.

(d) The use of the 2001 CSO Preferred Class Structure Table for the valuation of policies issued prior to January 1, 2007 shall not be permitted in any statutory financial statement in which a company reports, with respect to any policy or portion of a policy coinsured, either of the following:

(i) In cases where the mode of payment of the reinsurance premium is less frequent than the mode of payment of the policy premium, a reserve credit that exceeds, by more than the amount specified in this paragraph as Y, the gross reserve calculated before reinsurance. Y is the amount of the gross reinsurance premium that (a) provides coverage for the period from the next policy premium due date to the earlier of the end of the policy year and the next reinsurance premium due date, and (b) would be refunded to the ceding entity upon the termination of the policy.

(ii) In cases where the mode of payment of the reinsurance premium is more frequent than the mode of payment of the policy premium, a reserve credit that is less than the gross reserve, calculated before reinsurance, by an amount that is less than the amount specified in this paragraph as Z. Z is the amount of the gross reinsurance premium that the ceding entity would need to pay the assuming company to provide reinsurance coverage from the period of the next reinsurance premium due date to the next policy premium due date minus any liability established for the proportionate amount not remitted to the reinsurer. For purposes of this condition, both the reserve credit and the gross reserve before reinsurance (i) for the mean reserve method shall be defined as the mean reserve minus the deferred premium asset, and (ii) for the mid-terminal reserve method shall include the unearned premium reserve. A company may estimate and adjust its accounting on an aggregate basis in order to meet the conditions to use the 2001 CSO Preferred Class Structure Table.

Section 6. Severability

If any provision of this regulation or its application to any person or circumstance is for any reason held to be invalid, the remainder of the regulation and the application of the provision to other persons or circumstances shall not be affected.

Section 7. Effective Date

The effective date of this regulation is upon filing with the Secretary of State.

History

• Effective 2010-12-27

Chapter 60 Regulation of Military Sales Practices

Wyo. Code R. 044.0002.60.07132017 Regulation of Military Sales Practices

Model Regulation Service—July 2007

CHAPTER 60

REGULATION OF MILITARY SALES PRACTICES

Section 1. Authority

This regulation is issued under the authority of W.S. §§ 26‑2‑110, 26-13-101 et seq., and 16‑3‑101, et seq.

Section 2. Exemptions

(a) This regulation shall not apply to solicitations or sales involving the following, unless otherwise stated in this regulation:

(i) Credit insurance;

(ii) Group life insurance or group annuities where there is no in-person solicitation of individuals by an insurance producer or where the contract or certificate does not include a side fund;

(iii) An application to the existing insurer that issued the existing policy or contract when a contractual change or a conversion privilege is being exercised, or when the existing policy or contract is being replaced by the same insurer pursuant to a program filed with and approved by the commissioner, or when a term conversion privilege is exercised among corporate affiliates;

(iv) Individual stand-alone health policies, including disability income policies;

(v) Contracts offered by Servicemembers' Group Life Insurance (SGLI) or Veterans' Group Life Insurance (VGLI), as authorized by 38 U.S.C. Section 1965 et seq, and contracts offered by State Sponsored Life Insurance (SSLI) as authorized by 37 U.S.C. Section 707 et seq.;

(vi) Life insurance contracts offered through or by a non-profit military association, qualifying under Section 501(c)(23) of the Internal Revenue Code (IRC), and which are not underwritten by an insurer; or

(vii) Contracts used to fund:

(A) An employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act (ERISA);

(B) A plan described by Sections 401(a), 401(k), 403(b), 408(k), or 408(p) of the IRC, as amended, if established or maintained by an employer;

(C) A government or church plan defined in Section 414 of the IRC, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under Section 457 of the IRC;

(D) A nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor;

(E) Settlements of, or assumptions of liabilities associated with, personal injury litigation or any dispute or claim resolution process; or

(F) Prearranged funeral contracts.

(b) Nothing herein shall be construed to abrogate the ability of organizations to educate members of the United States Armed Forces in accordance with Department of Defense DoD Instruction 1344.07 - Personal Commercial Solicitation on DoD Installations or successor directive.

(c) For purposes of this regulation, general advertisements, direct mail, and internet marketing shall not constitute "solicitation." Telephone marketing shall not constitute "solicitation" provided the caller explicitly and conspicuously discloses that the product concerned is life insurance and makes no statements that avoid a clear and unequivocal statement that life insurance is the subject matter of the solicitation. Provided however, nothing in this subsection shall be construed to exempt an insurer or insurance producer from this regulation in any in-person meeting established as a result of the "solicitation" exemptions identified in this subsection.

Section 3. Definitions

(a) "Active Duty" means full-time duty in the active military service of the United States and includes members of the reserve component (National Guard and Reserve) while serving under published orders for active duty or full-time training. The term does not include members of the reserve component who are performing active duty or active duty for training under military calls or orders specifying periods of less than 31 calendar days.

(b) "Department of Defense (DoD) Personnel" means all active duty service members and all civilian employees, including nonappropriated fund employees and special government employees, of the Department of Defense.

(c) "Door to Door" means a solicitation or sales method whereby an insurance producer proceeds randomly or selectively from household to household without a prior specific appointment.

(d) "General Advertisement" means an advertisement having as its sole purpose the promotion of the reader's or viewer's interest in the concept of insurance, or the promotion of the insurer or the insurance producer.

(e) "Insurer" means an insurance company required to be licensed under the laws of this state to provide life insurance products, including annuities.

(f) "Insurance producer" means a person required to be licensed under the laws of this state to sell, solicit, or negotiate life insurance, including annuities.

(g) "Known" or "Knowingly" means, depending on its use herein, the insurance producer or insurer had actual awareness, or in the exercise of ordinary care should have known, at the time of the act or practice complained of, that the person solicited:

(i) is a service member; or

(ii) is a service member with a pay grade of E-4 or below.

(h) "Life Insurance" means insurance coverage on human lives including benefits of endowment and annuities, and may include benefits in the event of death or dismemberment by accident and benefits for disability income and, unless otherwise specifically excluded, includes individually issued annuities.

(i) "Military Installation" means any federally owned, leased, or operated base, reservation, post, camp, building, or other facility to which service members are assigned for duty, including barracks, transient housing, and family quarters.

(j) "MyPay" is a Defense Finance and Accounting Service (DFAS) web-based system that enables service members to process certain discretionary pay transactions or provide updates to personal information data elements without using paper forms.

(k) "Service Member" means any active duty officer (commissioned and warrant) or enlisted member of the United States Armed Forces.

(l) "Side Fund" means a fund or reserve that is part of or otherwise attached to a life insurance policy (excluding individually issued annuities) by rider, endorsement, or other mechanism that accumulates premium or deposits with interest or by other means. The term does not include:

(i) accumulated value or cash value or secondary guarantees provided by a universal life policy;

(ii) cash values provided by a whole life policy that are subject to standard nonforfeiture law for life insurance; or

(iii) a premium deposit fund that:

(A) contains only premiums paid in advance that accumulate interest;

(B) imposes no penalty for withdrawal;

(C) does not permit funding beyond future required premiums;

(D) is not marketed or intended as an investment; and

(E) does not carry a commission, either paid or calculated.

(m) "Specific Appointment" means a prearranged appointment agreed upon by both parties and definite as to place and time.

(n) "United States Armed Forces" means all components of the Army, Navy, Air Force, Marine Corps, and Coast Guard.

Section 4. Practices Declared False, Misleading, Dishonest or Untrustworthy on a Military Installation

(a) The following acts or practices when committed on a military installation by an insurer or insurance producer with respect to the in-person solicitation of life insurance are declared to be false, misleading, dishonest or untrustworthy:

(i) Knowingly soliciting the purchase of any life insurance product "door to door" or without first establishing a specific appointment for each meeting with the prospective purchaser.

(ii) Soliciting service members in a group or "mass" audience or in a "captive" audience where attendance is not voluntary.

(iii) Knowingly making appointments with or soliciting service members during their normally scheduled duty hours.

(iv) Making appointments with or soliciting service members in barracks, day rooms, unit areas, transient personnel housing, or other areas where the installation commander has prohibited solicitation.

(v) Soliciting the sale of life insurance without first obtaining permission from the installation commander or the commander's designee.

(vi) Posting unauthorized bulletins, notices, or advertisements.

(vii) Failing to present DD Form 2885, Personal Commercial Solicitation Evaluation, to service members solicited, or encouraging service members solicited not to complete or submit a DD Form 2885.

(viii) Knowingly accepting an application for life insurance or issuing a policy of life insurance on the life of an enlisted member of the United States Armed Forces without first obtaining for the insurer's files a completed copy of any required form which confirms that the applicant has received counseling or fulfilled any other similar requirement for the sale of life insurance established by regulations, directives, or rules of the DoD or any branch of the Armed Forces.

(b) The following acts or practices when committed on a military installation by an insurer or insurance producer constitute corrupt practices, improper influences, or inducements and are declared to be false, misleading, deceptive, or unfair:

(i) Using DoD personnel, directly or indirectly, as a representative or agent in any official or business capacity with or without compensation with respect to the solicitation or sale of life insurance to service members.

(ii) Using an insurance producer to participate in any United States Armed Forces sponsored education or orientation program.

Section 5. Practices Declared False, Misleading, or Misrepresentative Regardless of Location

(a) The following acts or practices by an insurer or insurance producer constitute corrupt practices, improper influences or inducements and are declared to be false, misleading, or misrepresentative:

(i) Submitting, processing or assisting in the submission or processing of any allotment form or similar device used by the United States Armed Forces to direct a service member's pay to a third party for the purchase of life insurance. The foregoing includes, but is not limited to, using or assisting in using a service member's "MyPay" account or other similar internet or electronic medium for such purposes. This subsection does not prohibit assisting a service member by providing insurer or premium information necessary to complete any allotment form.

(ii) Knowingly receiving funds from a service member for the payment of premium from a depository institution with which the service member has no formal banking relationship. For purposes of this section, a formal banking relationship is established when the depository institution:

(A) provides the service member a deposit agreement and periodic statements and makes the disclosures required by the Truth in Savings Act, 12 U.S.C. § 4301 et seq. and the regulations promulgated thereunder; and

(B) permits the service member to make deposits and withdrawals unrelated to the payment or processing of insurance premiums.

(iii) Employing any device or method or entering into any agreement whereby funds received from a service member by allotment for the payment of insurance premiums are identified on the service member's Leave and Earnings Statement or equivalent or successor form as "Savings" or "Checking" and where the service member has no formal banking relationship as defined in subsection 5(a)(ii).

(iv) Entering into any agreement with a depository institution for the purpose of receiving funds from a service member whereby the depository institution, with or without compensation, agrees to accept direct deposits from a service member with whom it has no formal banking relationship.

(v) Using DoD personnel, directly or indirectly, as a representative or agent in any official or unofficial capacity with or without compensation with respect to the solicitation or sale of life insurance to service members who are junior in rank or grade, or to the family members of such personnel.

(vi) Offering or giving anything of value, directly or indirectly, to DoD personnel to procure their assistance in encouraging, assisting, or facilitating the solicitation or sale of life insurance to another service member.

(vii) Knowingly offering or giving anything of value to a service member with a pay grade of E-4 or below for his or her attendance to any event where an application for life insurance is solicited.

(viii) Advising a service member with a pay grade of E-4 or below to change his or her income tax withholding or state of legal residence for the sole purpose of increasing disposable income to purchase life insurance.

(b) The following acts or practices by an insurer or insurance producer lead to confusion regarding source, sponsorship, approval or affiliation and are declared to be false, misleading, deceptive, or unfair:

(i) Making any representation, or using any device, title, descriptive name or identifier that has the tendency or capacity to confuse or mislead a service member into believing that the insurer, insurance producer, or product offered is affiliated, connected, or associated with, endorsed, sponsored, sanctioned or recommended by the U.S. Government, the United States Armed Forces, or any state or federal agency or government entity. Examples of prohibited insurance producer titles include, but are not limited to, "Battalion Insurance Counselor," "Unit Insurance Advisor," "Servicemen's Group Life Insurance Conversion Consultant," or "Veteran's Benefits Counselor."

(A) Nothing herein shall be construed to prohibit a person from using a professional designation awarded after the successful completion of a course of instruction in the business of insurance by an accredited institution of higher learning. Such designations include, but are not limited to, Chartered Life Underwriter (CLU), Chartered Financial Consultant (ChFC), Certified Financial Planner (CFP), Master of Science In Financial Services (MSFS), or Masters of Science Financial Planning (MS).

(ii) Soliciting the purchase of any life insurance product through the use of or in conjunction with any third-party organization that promotes the welfare of or assists members of the United States Armed Forces in a manner that has the tendency or capacity to confuse or mislead a service member into believing that either the insurer, insurance producer, or insurance product is affiliated, connected, or associated with, endorsed, sponsored, sanctioned, or recommended by the U.S. Government, or the United States Armed Forces.

(c) The following acts or practices by an insurer or insurance producer lead to confusion regarding premiums, costs, or investment returns and are declared to be false, misleading, deceptive, or unfair:

(i) Using or describing the credited interest rate on a life insurance policy in a manner that implies that the credited interest rate is a net return on premium paid.

(ii) Excluding individually issued annuities, misrepresenting the mortality costs of a life insurance product, including stating or implying that the product "costs nothing" or is "free."

(d) The following acts or practices by an insurer or insurance producer regarding SGLI or VGLI are declared to be false, misleading, deceptive, or unfair:

(i) Making any representation regarding the availability, suitability, amount, cost, exclusions or limitations to coverage provided to a service member or dependents by SGLI or VGLI, which is false, misleading, or deceptive.

(ii) Making any representation regarding conversion requirements, including the costs of coverage, or exclusions or limitations to coverage of SGLI or VGLI to private insurers which is false, misleading or deceptive.

(iii) Suggesting, recommending, or encouraging a service member to cancel or terminate his or her SGLI policy or issuing a life insurance policy that replaces an existing SGLI policy unless the replacement shall take effect upon or after the service member's separation from the United States Armed Forces.

(e) The following acts or practices by an insurer and or insurance producer regarding disclosure are declared to be false, misleading, deceptive, or unfair:

(i) Deploying, using or contracting for any lead generating materials designed exclusively for use with service members that do not clearly and conspicuously disclose that the recipient will be contacted by an insurance producer, if that is the case, for the purpose of soliciting the purchase of life insurance.

(ii) Failing to disclose that a solicitation for the sale of life insurance will be made when establishing a specific appointment for an in-person, meeting with a prospective purchaser.

(iii) Excluding individually issued annuities, failing to clearly and conspicuously disclose the fact that the product being sold is life insurance.

(iv) Failing to make, at the time of sale or offer to an individual known to be a service member, the written disclosures required by Section 10 of the "Military Personnel Financial Services Protection Act," Pub. L. No. 109-290, p.16.

(v) Excluding individually issued annuities, when the sale is conducted in-person with an individual known to be a service member, failing to provide the applicant at the time the application is taken:

(A) an explanation of any free look period with instructions on how to cancel if a policy is issued; and

(B) either a copy of the application or a written disclosure. The copy of the application or the written disclosure shall clearly and concisely set out the type of life insurance, the death benefit applied for, and its expected first year cost.

(f) The following acts or practices by an insurer or insurance producer with respect to the sale of certain life insurance products are declared to be false, misleading, deceptive, or unfair:

(i) Excluding individually issued annuities, recommending the purchase of any life insurance product which includes a side fund to a service member in pay grades E-4 and below unless the insurer has reasonable grounds for believing that the life insurance death benefit, standing alone, is suitable.

(ii) Offering for sale or selling a life insurance product which includes a side fund to a service member in pay grades E-4 and below who is currently enrolled in SGLI, is presumed unsuitable unless, after the completion of a needs assessment, the insurer demonstrates that the applicant's SGLI death benefit, together with any other military survivor benefits, savings and investments, survivor income, and other life insurance are insufficient to meet the applicant's insurable needs for life insurance.

(A) "Insurable needs" are the risks associated with premature death taking into consideration the financial obligations and immediate and future cash needs of the applicant's estate and/or survivors or dependents.

(B) "Other military survivor benefits" include, but are not limited to: the Death Gratuity, Funeral Reimbursement, Transition Assistance, Survivor and Dependents' Educational Assistance, Dependency and Indemnity Compensation, TRICARE Healthcare benefits, Survivor Housing Benefits and Allowances, Federal Income Tax Forgiveness, and Social Security Survivor Benefits.

(iii) Excluding individually issued annuities, offering for sale or selling any life insurance contract which includes a side fund:

(A) unless interest credited accrues from the date of deposit to the date of withdrawal and permits withdrawals without limit or penalty;

(B) unless the applicant has been provided with a schedule of effective rates of return based upon cash flows of the combined product. For this disclosure, the effective rate of return will consider all premiums and cash contributions made by the policyholder and all cash accumulations and cash surrender values available to the policyholder in addition to life insurance coverage. This schedule will be provided for at least each policy year from one (1) to ten (10) and for every fifth policy year thereafter ending at age 100, policy maturity, or final expiration; and

(C) that by default diverts or transfers funds accumulated in the side fund to pay, reduce or offset any premiums due.

(iv) Excluding individually issued annuities, offering for sale or selling any life insurance contract that after considering all policy benefits, including but not limited to endowment, return of premium, or persistency, does not comply with standard nonforfeiture law for life insurance.

(v) Selling any life insurance product to an individual known to be a service member that excludes coverage if the insured's death is related to war, declared or undeclared, or any act related to military service except for an accidental death coverage, e.g., double indemnity, which may be excluded.

Section 6. Effective Date

This regulation shall become effective upon filing with the Secretary of State.

History

• Effective 2017-07-13

Chapter 61 Preneed Life Insurance Minimum Standards for Determining Reserve Liabilities and Nonforfeiture Values

Wyo. Code R. 044.0002.61.11102008 Preneed Life Insurance Minimum Standards for Determining Reserve Liabilities and Nonforfeiture Values

CHAPTER 61

PRENEED LIFE INSURANCE MINIMUM STANDARDS FOR DETERMINING RESERVE LIABILITIES AND NONFORFEITURE VALUES

Section 1. Authority

This regulation is promulgated by the commissioner of insurance pursuant to Wyo. Stat. §§ 26-2-110(a), 26-6-205(b)(i)(C)(III) and 26-32-201 and Wyo. Stat.§ 16-3-101, et seq. of the Wyoming Administrative Procedure Act.

Section 2. Purpose

The purpose of this regulation is to establish for preneed insurance products minimum mortality standards for reserves and nonforfeiture values, and to require the use of the 1980 Commissioners Standard Ordinary (CSO) Life Valuation Mortality Table for use in determining the minimum standard of valuation of reserves and the minimum standard nonforfeiture values for preneed insurance products.

Section 3. Definitions

(a) The term "2001 CSO Mortality Table" means that mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. The 2001 CSO Mortality Table is included in the Proceedings of the NAIC (2nd Quarter 2002). Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables.

(b) The term "Ultimate 1980 CSO" means the Commissioners' 1980 Standard Ordinary Life Valuation Mortality Tables (1980 CSO) without ten-year (10-year) selection factors, incorporated into the 1980 amendments to the NAIC Standard Valuation Law approved in December 1983.

(c) For the purposes of this regulation, preneed insurance is any life insurance policy or certificate that is issued in combination with, in support of, with an assignment to, or as a guarantee for a prearrangement agreement for goods and services to be provided at the time of and immediately following the death of the insured. Goods and services may include, but are not limited to embalming, cremation, body preparation, viewing or visitation, coffin or urn, memorial stone, and transportation of the deceased. The status of the policy or contract as preneed insurance is determined at the time of issue in accordance with the policy form filing.

Section 4. Minimum Valuation Mortality Standards

For preneed insurance contracts, as defined in section 3(c), and similar policies and contracts, the minimum mortality standard for determining reserve liabilities and nonforfeiture values for both male and female insureds shall be the Ultimate 1980 CSO.

Section 5. Minimum Valuation Interest Rate Standards

(a) The interest rates used in determining the minimum standard for valuation of preneed insurance shall be the calendar year statutory valuation interest rates as defined in Wyo. Stat. § 26-6-201, et seq.

(b) The interest rates used in determining the minimum standard for nonforfeiture values for preneed insurance shall be the calendar year statutory nonforfeiture interest rates as defined in Wyo. Stat. § 26-16-201, et seq.

Section 6. Minimum Valuation Method Standards

(a) The method used in determining the standard for the minimum valuation of reserves of preneed insurance shall be the method defined in Wyo. Stat. § 26-6-201, et seq.

(b) The method used in determining the standard for the minimum nonforfeiture values for preneed insurance shall be the method defined in Wyo. Stat.§ 26-16-201, et seq.

Section 7. Transition Rules

(a) For preneed insurance policies issued on or after the effective date of this regulation and before January 1, 2012, the 2001 CSO may be used as the minimum standard for reserves and minimum standard for nonforfeiture benefits for both male and female insureds.

(b) If an insurer elects to use the 2001 CSO as a minimum standard for any policy issued on or after the effective date of this regulation and before January 1, 2012, the insurer shall provide, as a part of the actuarial opinion memorandum submitted in support of the company's asset adequacy testing, an annual written notification to the domiciliary commissioner. The notification shall include:

(i) A complete list of all preneed policy forms that use the 2001 CSO as a minimum standard;

(ii) A certification signed by the appointed actuary stating that the reserve methodology employed by the company in determining reserves for the preneed policies issued after the effective date and using the 2001 CSO as a minimum standard, develops adequate reserves (for the purposes of this certification, the preneed insurance policies using the 2001 CSO as a minimum standard cannot be aggregated with any other policies); and

(iii) Supporting information regarding the adequacy of reserves for preneed insurance policies issued after the effective date of this regulation and using the 2001 CSO as a minimum standard for reserves.

(c) Preneed insurance policies issued on or after January 1, 2012, must use the Ultimate 1980 CSO in the calculation of minimum nonforfeiture values and minimum reserves.

Section 8. Effective Date

This rule shall become effective on January 1, 2009.

History

• Effective 2008-11-10

Chapter 63 Medical Necessity Review Rights

Wyo. Code R. 044.0002.63.10132015 Medical Necessity Review Rights

Chapter 63

Medical Necessity Review Rights

Section 1. Authority

(a) This regulation is promulgated pursuant to W.S. §§ 26-40-201 and 26-2-110 of the Wyoming Insurance Code and pursuant to the Wyoming Administrative Procedures Act, W.S. § 16-3-101, et seq.

Section 2. Purpose and Intent

(a) The purpose of this Rule is to provide uniform standards for giving notice to claimants of their right to an independent review of any denial of an insurance claim as not medically necessary or on a similar basis, and to establish internal and external review procedures to assure that claimants under any insurance policy have the opportunity for an independent review in accordance with W. S. § 26-40-201.

Section 3. Definitions

(a) For purposes of this Rule:

(b) "Ambulatory review" means utilization review of health care services performed or provided in an outpatient setting.

(c) "Authorized representative" means:

(i) A person to whom a claimant has given express written consent to represent the claimant in an external review;

(ii) A person authorized by law to provide substituted consent for a claimant; or

(iii) A family member of the claimant or the claimant's treating health care professional only when the claimant is unable to provide consent.

(d) "Case management" means a coordinated set of activities conducted for individual patient management of serious, complicated, protracted or other health conditions.

(e) "Certification" means a determination by an insurer or its designee utilization review organization, or the claimant's treating health care professional that medical service has been reviewed and, based on the information provided, satisfies the statutory requirements for medical necessity as defined by W.S. § 26-40-102.

(f) "Claimant" means a policyholder, subscriber, enrollee or other individual participating in an insurance policy.

(g) "Clinical review criteria" means the written screening procedures, decision abstracts, clinical protocols and practice guidelines used by an insurer to determine the necessity and appropriateness of health care services.

(h) "Commissioner" means the Commissioner of Insurance.

(i) "Concurrent review" means utilization review conducted during a patient's hospital stay or course of treatment.

(j) "Denial of claim" means a determination by an insurer or its designee utilization review organization that a medical service that is a covered benefit has been reviewed and, based upon the information provided, does not meet the requirements for medical necessity or other similar basis, and the requested service or payment for the service is therefore denied, reduced or terminated..

(k) "Insurance carrier" means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that transacts the business of insurance as defined by W.S. §26-1-102(a)(xv).

(l) "Discharge planning" means the formal process for determining, prior to discharge from a facility, the coordination and management of the care that a patient receives following discharge from a facility.

(m) "Disclose" means to release, transfer or otherwise divulge protected health information to any person other than the individual who is the subject of the protected health information.

(n) "Emergency medical condition" means the sudden and, at the time, unexpected onset of a health condition or illness that requires immediate medical attention, where failure to provide medical attention would result in a serious impairment to bodily functions, serious dysfunction of a bodily organ or part, or would place the person's health in serious jeopardy.

(o) "Emergency services" means health care items and services furnished or required to evaluate and treat an emergency medical condition.

(p) "Facility" means an institution providing medical services or a health care setting, including but not limited to, hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings.

(q) "Insurance policy" means any contract, certificate, agreement, clauses, riders, and endorsements, offered or issued by an insurance carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services.

(r) "Health care professional" means a physician or other health care practitioner licensed, accredited or certified to perform specified health care services consistent with state law.

(s) "Health care provider" or "provider" means a health care professional or a facility.

(t) "Health information" means information or data, whether oral or recorded in any form or medium, and personal facts or information about events or relationships that relates to:

(i) The past, present or future physical, mental, or behavioral health or condition of an individual or a member of the individual's family;

(ii) The provision of health care services to an individual; or

(iii) Payment for the provision of health care services to an individual.

(u) "Independent review organization" means an entity that conducts independent external reviews of claim denials.

(v) "Medical services" or "health care services" means services for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease or an admission, availability of care, continued stay or other care provided by a facility.

(w) "Medically necessary" includes but is not limited to "medical necessity" as defined by W.S. § 26-40-102(a)(iii).

(x) "NAIC" means the National Association of Insurance Commissioners.

(y) "Person" means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity or any combination of the foregoing.

(z) "Prospective review" means utilization review conducted prior to an admission or a course of treatment.

(aa) "Protected health information" means health information:

(i) That identifies an individual who is the subject of the information; or

(ii) With respect to which there is a reasonable basis to believe that the information could be used to identify an individual.

(bb) "Retrospective review" means a review of medical necessity conducted after services have been provided to a patient, but does not include the review of a claim that is limited to an evaluation of reimbursement levels, veracity of documentation, accuracy of coding or adjudication for payment.

(cc) "Second opinion" means an opportunity or requirement to obtain a clinical evaluation by a provider other than the one originally making a recommendation for a proposed health care service to assess the clinical necessity and appropriateness of the initial proposed health care service.

(dd) "Utilization review" means a set of formal techniques designed to monitor the use of, or evaluate the clinical necessity, appropriateness, efficacy, or efficiency of, health care services, procedures, or settings. Techniques may include ambulatory review, prospective review, second opinion, certification, concurrent review, case management, discharge planning, or retrospective review.

(ee) "Utilization review organization" means an entity that conducts utilization review, other than an insurance carrier performing a review for its own insurance policies.

Section 4. Applicability and Scope

(a) Except as provided in subsection (b), this Rule shall apply to all insurance carriers.

(b) The provisions of this Rule shall not apply to a policy or certificate that provides coverage for long-term care insurance, as defined by W. S. § 26-38-103, or to a Medicare supplement policy of insurance, as defined by the commissioner by regulation, coverage under a plan through Medicare, Medicaid, or the federal employees health benefits program, any coverage issued under Chapter 55 of Title 10, U.S. Code and any coverage issued as supplement to that coverage, any coverage issued as supplemental to liability insurance, Wyoming Workers' Compensation or automobile medical-payment insurance.

Section 5. Notice of Right to Review

(a) An insurance carrier shall notify the claimant in writing of the claimant's right to request a review of any claim denied on the basis of not being medically necessary or on a similar basis. The notice shall include the appropriate statement and information set forth in subsection (b). The notice shall be sent to the claimant each time and at the same time as an insurance carrier sends written notice of the denial of claim on the basis of medical necessity or other similar basis.

(b) The notice of right to review shall include:

(i) Notice of the right to an internal review by the insurer which shall include:

(A) That the request for an internal review must be filed within thirty (30) days of the date the claimant received the denial of claim;

(B) That the claimant may submit additional information that relates to the claim;

(C) That the claimant may request the signed opinion of at least one (1) health care professional who is not an employee of the insurer;

(D) The procedure for filing the request for internal review; and

(E) That the claimant may have the right to an expedited review under circumstances where a delayed review would adversely affect the claimant.

(ii) Notice of the right to an external review by an Independent Review Organization approved by the commissioner which shall include the following or substantially equivalent language:

(A) "We have denied your request for the provision of or payment for a health care service or course of treatment. After completion of an internal review, you may have the right to have our decision reviewed by health care professionals who have no association with us and are not the attending health care professional or the health care professional's partner by following the procedures outlined in this notice."

(B) That the request must be made within one hundred twenty (120) days of the receipt of the notice of claim denial following the completion of the internal review;

(C) That the request for review shall be filed on a form approved by the commissioner and include a health care professional's certification as to medical necessity;

(D) That the request shall be made in duplicate and include a fee of fifteen dollars ($15.00) payable by check or money order to the Office of the Wyoming State Treasurer.

(I) The fee may be waived for a claimant whose income is at or below the current federal poverty level guidelines and who files a financial hardship application available upon request from the Wyoming Insurance Department.

(E) That the insurer shall be responsible for the costs of an external review by an independent review organization; and

(F) That the claimant may have the right to an expedited review under circumstances where a delayed review would adversely affect the claimant.

(iii) Notice of the right to an internal and external expedited review which shall include:

(A) A statement that the expedited review shall be completed as expeditiously as the claimant's medical condition or circumstances require, and in any event within seventy-two (72) hours, where:

(I) The timeframe for the completion of a normal review would seriously jeopardize the life or health of the claimant or would jeopardize the claimant's ability to regain maximum function; or

(II) The claimant's claim concerns a request for an admission, availability of care, continued stay or health care service for which the claimant received emergency services, but has not been discharged from a facility.

(B) That the request for internal expedited review shall be filed pursuant to the requirements of the insurer. A request for external expedited review must be filed on a form approved by the commissioner and include a health care professional's certification as to medical necessity and of the need for an expedited review.

(c) As part of any notice required by this Rule, the insurer shall include an authorization form, or other document approved by the commissioner that complies with the requirements of 45 CFR Section 164.508, by which the claimant, for purposes of conducting an external review under this Rule, authorizes the insurer and the claimant's treating health care provider to disclose protected health information, including medical records, concerning the claimant that are pertinent to the external review.

Section 6. Request for External Review

(a) All requests for external review shall be made in writing to the insurer, on a form approved by the commissioner, together with a copy and fee of fifteen dollars ($15.00) payable by check or money order to the Wyoming State Treasurer. For any single claimant, there is an annual limit on fees of seventy-five dollars ($75.00) per calendar year.

(b) A claimant or the claimant's authorized representative may make a request for an external review of a denied claim or final denied claim.

(c) A claimant or the claimant's authorized representative may submit additional new information with the request for external review for consideration during the external review process.

(d) The request for external review shall be accompanied by a health care professional certification of medical necessity.

(e) The request for an expedited review shall be accompanied by a health care professional certification of need for expedited review.

Section 7. Exhaustion of Internal Review Process

(a) Except as provided in subsection (d), a request for an external review pursuant to Section 6 of this Rule shall not be made until the claimant has exhausted the insurer's internal review process required by W.S. § 26-40-201(b)(iii).

(b) A claimant shall be considered to have exhausted the insurer's internal review process for purposes of this section, if the claimant or the claimant's authorized representative:

(i) Has filed a request for internal review involving a denied claim; and

(ii) Except to the extent the claimant or the claimant's authorized representative requested or agreed to a delay, has not received a written decision on the request for internal review from the insurer within forty five (45) days following the date the claimant or the claimant's authorized representative filed the request for internal review with the insurer.

(c) Notwithstanding paragraph (b), a claimant or the claimant's authorized representative may not make a request for an external review of a denied claim involving a retrospective review determination until the claimant has exhausted the insurance carrier's internal review process.

(d) At the same time a claimant or the claimant's authorized representative files a request for an expedited internal review of a denied claim, the claimant or the claimant's authorized representative may file a request for an expedited external review of the denied claim under Section 9 of this Rule if:

(i) the claimant has a medical condition where the timeframe for completion of an internal review of the denied claim would seriously jeopardize the life or health of the claimant or would jeopardize the claimant's ability to regain maximum function; or

(ii) the claimant's claim concerns a request for admission, availability of care, continued stay or health care service for which the claimant received emergency services, but has not been discharged from a health care facility.

(e) Upon receipt of a request for an expedited external review under subparagraph (d) of this section, the independent review organization conducting the external review in accordance with the provisions of Section 9 of this Rule shall determine whether the claimant shall be required to complete the expedited internal review process before it conducts the expedited external review.

(i) Upon a determination that the claimant must first complete the expedited internal review process the independent review organization immediately shall notify the claimant and, if applicable, the claimant's authorized representative of this determination and that it will not proceed with the expedited external review set forth in Section 9 of this Rule until completion of the expedited internal review process and the expedited internal review process remains unresolved.

(f) A request for an external review of a denied claim may be made before the claimant has exhausted the health carrier's internal review procedures whenever the insurer agrees to waive the exhaustion requirement.

Section 8. Standard External Review

(a) Within one hundred twenty (120) days after the date of receipt of a notice of a denial of claim pursuant to Section 5 of this Rule, a claimant or the claimant's authorized representative may file a request for an external review with the insurer on a form approved by the commissioner.

(b) Within five (5) business days after the date of receipt of a request for external review pursuant to paragraph (a), the insurer shall send a copy of the request to the commissioner together with the fee.

(c) Within five (5) business days following the date of receipt of the external review request from the claimant, the insurer shall complete a preliminary review of the request to determine whether:

(i) The individual is or was a claimant in the insurance policy at the time the health care service was requested or, in the case of a retrospective review, was a claimant in the insurance policy at the time the health care service was provided;

(ii) The health care service that is the subject of the claim denial is a covered service under the claimant's insurance policy, but for a determination by the insurer that the health care service is not covered because it does not meet the requirements for medical necessity or other similar basis;

(iii) The claimant has exhausted the insurer's internal review process unless the claimant is not required to exhaust the insurer's internal review process pursuant to Section 7 of this Rule; and

(iv) The claimant has provided all the information, forms and fee required to process an external review, including the release form provided under Section 5(c) of this Rule.

(d) Within one (1) business day after completion of the preliminary review, the insurer shall notify the commissioner and claimant and, if applicable, the claimant's authorized representative in writing whether:

(i) The request is complete; and

(ii) The request is eligible for external review.

(e) If the request:

(i) Is not complete, the insurer shall inform the claimant and, if applicable, the claimant's authorized representative and the commissioner in writing and include in the notice what information or materials are needed to make the request complete; or

(ii) Is not eligible for external review, the insurer shall inform the claimant and, if applicable, the claimant's authorized representative and the commissioner in writing and include in the notice the reasons for its ineligibility.

(A) The commissioner may specify the form for the insurer's notice of determination that the request for standard external review is ineligible for review.

(B) The notice of determination shall include a statement informing the claimant and, if applicable, the claimant's authorized representative of the insurer's determination that the external review request is ineligible for review and may be appealed to the commissioner.

(f) The commissioner may determine that a request is eligible for external review under Section 8 of this Rule notwithstanding a insurer's determination that the request is ineligible and require that it be referred for external review.

(g) In making a determination under subparagraph (f) of this section, the commissioner's decision shall be made in accordance with the terms of the claimant's insurance policy and shall be subject to all applicable provisions of W. S.§§ 26-40-102(a) and 26-40-201.

(h) Whenever the insurance carrier determines that a request is eligible for external review following the preliminary review conducted pursuant to subsection (c), or that the claimant has provided the information requested to make their submission complete as required by paragraph (e)(i) of this section, the carrier shall, within one (1) business day of making such determination:

(i) Assign an independent review organization from the list of approved independent review organizations compiled and maintained by the commissioner pursuant to Section 11 of this Rule to conduct the external review and notify the commissioner of the name of the assigned independent review organization; and

(ii) Notify in writing the claimant and, if applicable, the claimant's authorized representative of the request's eligibility and acceptance for external review.

(i) In reaching a decision, the assigned independent review organization is not bound by any decisions or conclusions reached during the insurer's review process as set forth in the internal review process.

(j) The insurance carrier shall include in the notice that the claimant or the claimant's authorized representative may submit in writing to the assigned independent review organization additional information for consideration by the independent review organization. Such information shall be submitted within five (5) business days following the date of receipt of the notice. Once the assigned independent review organization receives additional information from the claimant, the independent review organization will forward the information to the issuer within one (1) business day of receipt.

(k) Within five (5) business days after the determination by the insurer that the external review request is eligible for external review as identified in paragraph (h) of this section, , the insurance carrier or its designated utilization review organization shall provide to the assigned independent review organization the health information considered in making the claim denial.

(l) Except as provided in paragraph (e), failure by the insurer or its utilization review organization to provide the health information within the time specified in paragraph

(k) shall not delay the conduct of the external review.

(m) The independent review organization shall within five (5) days of receipt of the external review request from the insurer determine whether the documentation is complete and immediately notify the claimant and the insurer in writing what information is missing, if any.

(n) The assigned independent review organization shall review all of the information and documents received pursuant to subsection (k) and any other health information submitted in writing to the independent review organization by the claimant or the claimant's authorized representative pursuant to subsection (j).

(o) The insurance carrier may reconsider its denial of the claim at any point prior to the completion of the external review.

(p) Reconsideration by the insurer of its denial of claim determination pursuant to paragraph (o) shall not delay or terminate the external review.

(q) The external review may only be terminated if the insurance carrier decides, upon completion of its reconsideration, to reverse its denial of claim and provide coverage or payment for the health care service that is the subject of the denied claim.

(i) Within one (1) business day after making the decision to reverse its claim denial, as provided in paragraph (q), the insurer shall notify the claimant and, if applicable, the claimant's authorized representative, the assigned independent review organization, and the commissioner in writing of its decision.

(ii) The assigned independent review organization shall terminate the external review upon receipt of the notice from the insurance carrier that the claim denial has been reversed.

(r) In addition to the health information provided pursuant to subsection (k), the assigned independent review organization, to the extent the health information is available and the independent review organization considers them appropriate, shall consider the following in reaching a decision:

(i) The claimant's medical records;

(ii) The attending health care professional's recommendation;

(iii) Consulting reports from appropriate health care professionals and other documents submitted by the insurer, claimant, the claimant's authorized representative, or the claimant's treating provider;

(iv) The terms of coverage under the claimant's insurance policy;

(v) The standards identified in W.S. § 26-40-102(a)(iii).

(vi) All evidence based research used in the insurer's denial of the claim.

(s) Within forty-five (45) days after the date of receipt of the request for an external review, the assigned independent review organization shall provide written notice of its decision to uphold or reverse the denial of claim as medically necessary, to:

(i) The claimant;

(ii) If applicable, the claimant's authorized representative;

(iii) The insurance carrier; and

(iv) The commissioner.

(t) The independent review organization shall include in the notice sent pursuant to paragraph (s):

(i) A general description of the reason for the request for external review;

(ii) The date the independent review organization received the assignment from the insurer to conduct the external review;

(iii) The date the external review was conducted;

(iv) The date of its decision;

(v) The principal reason or reasons for its decision;

(vi) The rationale for its decision; and

(vii) References to the evidence or health information that they considered in reaching their conclusion, including references to how W.S. § 26-40-102 applies to the information reviewed.

(u) Upon receipt of a notice of a decision pursuant to paragraph (s) reversing the denial of claim, the insurance carrier within five (5) business days shall approve the covered benefit that was the subject of the denied claim.

(v) Upon receipt of a notice of decision pursuant to paragraph (s) reversing the denial of a claim, the commissioner shall refund the fee to the claimant.

(w) The assignment by the insurer of an approved independent review organization shall be on a rotational basis established by the commissioner.

Section 9. Expedited External Review

(a) A claimant or the claimant's authorized representative may make a request for an expedited external review with the commissioner at the time the claimant receives:

(i) A denial of claim if:

(A) The denied claim involves a medical condition of the claimant for which the timeframe for completion of an expedited internal review of a claim denial, if a standard external review would seriously jeopardize the life or health of the claimant or would jeopardize the claimant's ability to regain maximum function; or

(B) The claimant's claim concerns a request for an admission, availability of care, continued stay or health care service for which the claimant received emergency services, but has not been discharged from a health care facility; and

(C) The claimant or the claimant's authorized representative has filed a request for an expedited review of a claim denial as not being medically necessary or on a similar basis.

(b) The request shall be made in duplicate and include a fee of fifteen dollars ($15.00) payable by check or money order to the Wyoming State Treasurer. For any single claimant, there is an annual limit on fees of seventy-five dollars ($75.00).

(i) Upon receipt of a request for an expedited external review, the insurer immediately shall send a copy of the request and the fee to the commissioner;

(ii) Immediately upon receipt of the request pursuant to paragraph (i), the insurance carrier shall determine whether the request meets the reviewability requirements set forth in Section 8(c)(i) through 8(c)(iv) of this Rule. The insurance carrier shall immediately notify the commissioner and the claimant and, if applicable, the claimant's authorized representative of its eligibility determination.

(c) The commissioner may specify the form for the insurer's notice of initial determination under this subsection and any supporting information to be included in the notice.

(i) The notice of initial determination shall include a statement informing the claimant and, if applicable, the claimant's authorized representative that a insurer's initial determination that an external review request is ineligible for review may be appealed to the commissioner.

(d) The commissioner may determine that a request is eligible for expedited external review notwithstanding an insurance carrier's initial determination that the request is ineligible and require that it be referred for expedited external review.

(e) In making a determination under paragraph (d) of this section, the commissioner's decision shall be made in accordance with the terms of the claimant's insurance policy and shall be subject to all applicable provisions of this Rule.

(f) Upon determination that the request meets the reviewability requirements, the insurer immediately shall assign an independent review organization to conduct the expedited external review from the list of approved independent review organizations compiled and maintained by the commissioner pursuant to Section 11 of this Rule. The insurer shall immediately notify the commissioner of the name of the assigned independent review organization.

(g) Upon receipt of the request for expedited external review, the insurance carrier or its designee utilization review organization shall provide or transmit all necessary documents and information considered in making the denial of claim to the assigned independent review organization electronically or by telephone or facsimile or any other available expeditious method.

(h) As expeditiously as the claimant's medical condition or circumstances require, but in no event more than seventy-two (72) hours after the date of receipt of the request for an expedited external review that meets the reviewability requirements set forth in Section 8c)(i) through 8(c)(iv) of this Rule, the assigned independent review organization shall:

(i) Make a decision to uphold or reverse the denial of claim; and

(ii) Notify the claimant and, if applicable, the claimant's authorized representative, the insurance carrier, and the commissioner of the decision.

(iii) The assigned independent review organization is not bound by any decisions or conclusions reached during the insurance carrier's internal review process.

(i) If the notice provided pursuant to paragraph (h) was not in writing, within forty-eight (48) hours after the date of providing that notice, the assigned independent review organization shall:

(i) Provide written confirmation of the decision to the claimant and, if applicable, the claimant's authorized representative, the insurer, and the commissioner; and

(ii) Include the information set forth in Section 8(t) of this Rule.

(j) Upon receipt of the notice of a decision pursuant to paragraph (i) reversing the denial of claim, the insurance carrier immediately shall approve the covered benefit that was the subject of the denied claim.

(k) An expedited external review may not be provided for retrospective claim denials.

(l) The assignment by the insurer of an approved independent review organization shall be on the same basis as provided in Section 8(w).

Section 10. Binding Nature of External Review Decision

(a) An external (or expedited) review decision is binding on the insurance carrier except to the extent the insurance carrier has other remedies available under applicable state law.

(b) An external review decision is binding on the claimant except to the extent the claimant has other remedies available under applicable federal or state law.

(c) A claimant or the claimant's authorized representative may not file a subsequent request for external review involving the same denied claim for which the claimant has already received an external review decision pursuant to W.S. § 26-40-201.

Section 11. Approval of Independent Review Organizations

(a) The commissioner shall approve independent review organizations eligible to be assigned to conduct external reviews under W.S. § 26-40-201.

(b) In order to be eligible for approval by the commissioner under this section to conduct external reviews an independent review organization:

(i) Shall be accredited by Utilization Review Accreditation Commission (URAC) or another nationally recognized private accrediting entity that the commissioner has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations established under Section 12 of this Rule; and

(ii) Shall submit an application for approval in accordance with subsection (c).

(c) The commissioner shall develop an application form for initially approving and for re-approving independent review organizations to conduct external reviews.

(d) Any independent review organization wishing to be approved to conduct external reviews under this Rule shall submit the application form and include with the form all documentation and information necessary for the commissioner to determine if the independent review organization satisfies the minimum qualifications established under Section 12 of this Rule.

(e) Subject to subparagraph (i) of this paragraph, an independent review organization is eligible for approval under this section only if it is accredited by URAC or another nationally recognized private accrediting entity that the commissioner has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations under Section 12 of this Rule.

(i) The commissioner may approve independent review organizations that are not accredited by URAC or another nationally recognized private accrediting entity if there are no acceptable nationally recognized private accrediting entities providing independent review organization accreditation.

(ii) The independent review organization shall submit an application fee in the sum of one hundred dollars ($100.00) to the commissioner with an application for approval and re-approval.

(iii) An approval is effective for two (2) years, unless the commissioner determines before its expiration that the independent review organization is not satisfying the minimum qualifications established under Section 12 of this Rule.

(iv) Whenever the commissioner determines that an independent review organization has lost its accreditation or no longer satisfies the minimum requirements established under Section 12 of this Rule, the commissioner shall terminate the approval of the independent review organization and remove the independent review organization from the list of independent review organizations approved to conduct external reviews under this Rule that is maintained by the commissioner pursuant to subsection (f).

(f) The commissioner shall maintain and update a list of approved independent review organizations within fifteen (15) days of approval or determination of eligibility.

Section 12. Minimum Qualifications for Independent Review Organizations

(a) To be approved under Section 11 of this Rule to conduct external reviews, an independent review organization shall have and maintain written policies and procedures that govern all aspects of both the standard external review process and the expedited external review process set forth in this Rule that include, at a minimum:

(i) A quality assurance mechanism in place that:

(A) Ensures that external reviews are conducted within the specified time frames and required notices are provided in a timely manner;

(B) Ensures the selection of qualified and impartial clinical reviewers to conduct external reviews on behalf of the independent review organization and suitable matching of reviewers to specific cases and that the independent review organization employs or contracts with an adequate number of clinical reviewers to meet this objective;

(C) Ensures the confidentiality of medical and treatment records and clinical review criteria; and

(D) Ensures that any person employed by or under contract with the independent review organization adheres to the requirements of this Rule;

(ii) A toll-free telephone service to receive information on a 24-hour- day, 7-day-a-week basis related to external reviews that is capable of accepting, recording or providing appropriate instruction to incoming telephone callers during other than normal business hours; and

(iii) Agree to maintain and provide to the commissioner the information set out in Section 14 of this Rule.

(b) All clinical reviewers assigned by an independent review organization to conduct external reviews shall be health care professionals or other appropriate health care providers who meet the following minimum qualifications:

(i) Be an expert in the treatment of the claimant's medical condition that is the subject of the external review;

(ii) Be knowledgeable about the recommended health care service or treatment through recent or current actual clinical experience treating patients with the same or similar medical condition of the claimant;

(iii) Hold a non-restricted license in a state of the United States and, for physicians, a current certification by a recognized American medical specialty board in the area or areas appropriate to the subject of the external review; and

(iv) Have no history of disciplinary actions or sanctions, including loss of staff privileges or participation restrictions, that have been taken or are pending by any hospital, governmental agency or unit, or regulatory body that raise a substantial question as to the clinical reviewer's physical, mental or professional competence or moral character.

(c) In addition to the requirements set forth in paragraph (a) of this section an independent review organization may not own or control, be a subsidiary of or in any way be owned or controlled by, or exercise control with a insurance policy, a national, state or local trade association of insurance policies, or a national, state or local trade association of health care providers.

(d) In addition to the requirements set forth in paragraph (a), (b) and (c) of this section, to be approved pursuant to Section 11 of this Rule to conduct an external review of a specified case, neither the independent review organization selected to conduct the external review nor any clinical reviewer assigned by the independent organization to conduct the external review may have a material professional, familial or financial conflict of interest with any of the following:

(i) The insurer that is the subject of the external review;

(ii) The claimant whose treatment is the subject of the external review or the claimant's authorized representative;

(iii) Any officer, director or management employee of the insurer that is the subject of the external review;

(iv) The health care provider, the health care provider's medical group or independent practice association recommending the health care service or treatment that is the subject of the external review;

(v) The facility at which the recommended health care service or treatment would be provided; or

(vi) The developer or manufacturer of the principal drug, device, procedure or other therapy being recommended for the claimant whose treatment is the subject of the external review.

(e) In determining whether an independent review organization or a clinical reviewer of the independent review organization has a material professional, familial or financial conflict of interest for purposes of paragraph (d) of this section, the commissioner shall take into consideration situations where the independent review organization to be assigned to conduct an external review of a specified case or a clinical reviewer to be assigned by the independent review organization to conduct an external review of a specified case may have an apparent professional, familial or financial relationship or connection with a person described in paragraph (d) of this section, but that the characteristics of that relationship or connection are such that they are not a material professional, familial or financial conflict of interest that results in the disapproval of the independent review organization or the clinical reviewer from conducting the external review.

(f) An independent review organization that is accredited by URAC or another nationally recognized private accrediting entity that has independent review accreditation standards that the commissioner has determined are equivalent to or exceed the minimum qualifications of this section shall be presumed in compliance with this section to be eligible for approval under Section 11 of this Rule.

(g) The commissioner shall initially review and periodically review the independent review organization accreditation standards of URAC and other nationally recognized private accrediting entities to determine whether the entity's standards are, and continue to be, equivalent to or exceed the minimum qualifications established under this section. The commissioner may accept a review conducted by the NAIC for the purpose of the determination under this paragraph.

(h) Upon request, a nationally recognized private accrediting entity shall make its current independent review organization accreditation standards available to the commissioner or the NAIC in order for the commissioner to determine if the entity's standards are equivalent to or exceed the minimum qualifications established under this section. The commissioner may exclude any private accrediting entity that is not reviewed by the NAIC.

(i) An independent review organization shall be unbiased. An independent review organization shall establish and maintain written procedures to ensure that it is unbiased in addition to any other procedures required under this section.

Section 13. Hold Harmless for Independent Review Organizations

(a) No independent review organization or clinical reviewer working on behalf of an independent review organization or an employee, agent or contractor of an independent review organization shall be liable in damages to any person for any opinions rendered or acts or omissions performed within the scope of the organization's or person's duties under the law during or upon completion of an external review conducted pursuant to this Rule, unless the opinion was rendered or act or omission performed in bad faith or involved gross negligence.

Section 14. External Review Reporting Requirements

(a) An independent review organization assigned pursuant to Section 8 or Section 9 of this Rule to conduct an external review shall maintain written records grouped by assigning insurer on all Wyoming requests for external review for which it conducted an external review during a calendar year and, upon request, submit a report to the commissioner, as required under paragraph (b) of this section.

(b) Each independent review organization required to maintain written records on all requests for external review pursuant to paragraph (a) of this section for which it was assigned to conduct an external review shall submit to the commissioner, upon request, a report in the format specified by the commissioner.

(c) The report shall include in the aggregate and for each insurance carrier:

(i) The total number of requests for external review;

(ii) The number of requests for external review resolved and, of those resolved, the number resolved upholding the denied claim or final denied claim and the number resolved reversing the denied claim or final denied claim;

(iii) The average length of time for resolution;

(iv) A summary of the types of coverages or cases for which an external review was sought, as provided in the format required by the commissioner;

(v) The number of external reviews pursuant to Section 8 of this Rule that were terminated as the result of a reconsideration by the insurer of its denied claim or final denied claim after the receipt of additional information from the claimant or the claimant's authorized representative; and

(vi) Any other information the commissioner may request or require.

(d) The independent review organization shall retain the written records required pursuant to this subsection for at least three (3) years.

(e) Each insurer shall maintain written records in the aggregate, and for each type of insurance policy offered by the insurer on all requests for external review that the insurer receives notice of from the insurers pursuant to W.S. § 26-40-201.

(f) Each insurer required to maintain written records on all requests for external review pursuant to paragraph (a) of this section shall submit to the commissioner, upon request, a report in the format specified by the commissioner.

(i) The report shall include in the aggregate and by type of insurance policy:

(A) The total number of requests for external review;

(B) From the total number of requests for external review reported under subparagraph (A) of this paragraph, the number of requests determined eligible for a full external review; and

(C) Any other information the commissioner may request or require.

(g) The insurer shall retain the written records required pursuant to this subsection for at least five (5) years.

Section 15. Funding of External Review

(a) The insurance carrier against which a request for a standard external review or an expedited external review is filed shall pay the cost of the independent review organization for conducting the external review.

Section 16. Disclosure Requirements

(a) Each insurance carrier shall include a description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage or other evidence of coverage it provides to claimants.

(b) The description required under subsection (a) shall include a statement that informs the claimant of the right of the claimant to file a request for an internal or external review in compliance with W.S. § 26-40-201.

(c) In addition to subsection (b), the statement shall inform the claimant that, when filing a request for an external review, the claimant will be required to authorize the release of any medical records of the claimant that may be required to be reviewed for the purpose of reaching a decision on the external review.

Section 17. Severability

(a) If any provision of this Rule, or the application of the provision to any person or circumstance shall be held invalid, the remainder of the Rule, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected.

Section 18. Enforceability

Section 19. Any violation of these regulations shall be enforceable pursuant to the provisions of W.S. §26-1-107, W.S. §26-3-116, W.S. §26-9-211, and any other applicable rule or statute.

Section 20. Effective Date

(a) This Rule shall become effective upon filing with the Secretary of State.

History

• Effective 2015-10-13

Chapter 64 Regulation Governing Suitability and Annuity Transactions

Wyo. Code R. 044.0002.64.04052023 Regulation Governing Suitability and Annuity Transactions

CHAPTER 64

REGULATION GOVERNING SUITABILITY IN ANNUITY TRANSACTIONS

Section 1. Authority. These regulations are promulgated pursuant to W.S. §§ 16-3-101 et seq., 26‑2‑110, 26-2-125 and 26-13-101 et seq.

Section 2. Scope and Purpose.

(a) This regulation applies to any sale or recommendation of an annuity.

(b) The purpose of this regulation is to require producers, as defined in this regulation, to act in the best interest of the consumer when making a recommendation of an annuity and to require insurers to establish and maintain a system to supervise recommendations so that the insurance needs and financial objectives of consumers at the time of the transaction are effectively addressed.

(c) Nothing herein shall be construed to create or imply a private cause of action for a violation of this regulation or to subject a producer to civil liability under the best interest standard of care outlined in Section 5 of this regulation or under standards governing the conduct of a fiduciary or a fiduciary relationship.

Section 3. Definitions.

(a) "Annuity," as set forth in W.S. § 26-1-102(iv), means an annuity that is an insurance product that is individually solicited, whether the product is classified as an individual or group annuity.

(b) "Cash compensation" means any discount, concession, fee, service fee, commission, sales charge, loan, override, or cash benefit received by a producer in connection with the recommendation or sale of an annuity from an insurer, intermediary, or directly from the consumer.

(c) "Consumer profile information" means information that is reasonably appropriate to determine whether a recommendation addresses the consumer's financial situation, insurance needs and financial objectives, including, at a minimum, the following:

(i) Age;

(ii) Annual income;

(iii) Financial situations and needs, including debts and other obligations;

(iv) Financial experience;

(v) Insurance needs;

(vi) Financial objectives;

(vii) Intended use of the annuity;

(viii) Financial time horizon;

(ix) Existing assets or financial products, including investment, annuity and insurance holdings;

(x) Liquidity needs;

(xi) Liquid net worth;

(xii) Risk tolerance, including but not limited to, willingness to accept non-guaranteed elements in the annuity;

(xiii) Financial resources used to fund the annuity; and

(xiv) Tax status.

(d) "Continuing education credit" or "CE credit" means one continuing education credit as defined in W.S. § 26-9-231 et seq.

(e) "Continuing Education Provider" or "CE Provider" means an individual or entity that is approved to offer continuing education courses pursuant to Wyoming Department of Insurance Rules and Regulations, Chapter 20.

(f) "FINRA" means the Financial Industry Regulatory Authority or a successor agency.

(g) "Insurer" means a company required to be licensed under the laws of this state to provide insurance products, including annuities.

(h) "Intermediary" means an entity contracted directly with an insurer or with another entity contracted with an insurer to facilitate the sale of the insurer's annuities by producers.

(i) "Material conflict of interest" means a financial interest of the producer in the sale of an annuity that a reasonable person would expect to influence the impartiality of a recommendation. "Material conflict of interest" does not include cash compensation or non-cash compensation.

(j) "Non-cash compensation" means any form of compensation that is not cash compensation, including, but not limited to, health insurance, office rent, office support and retirement benefits.

(k) "Non-guaranteed elements" means the premiums, credited interest rates (including any bonus), benefits, values, dividends, non-interest based credits, charges or elements of formulas used to determine any of these that are subject to company discretion and are not guaranteed at issue. An element is considered non-guaranteed if any of the underlying non-guaranteed elements are used in its calculation.

(l) "Producer" means a person or entity required to be licensed under the laws of this state to sell, solicit, or negotiate insurance, including annuities. For purposes of this regulation, "producer" includes an insurer where no producer is involved.

(m) "Recommendation" means advice provided by a producer to an individual consumer that was intended to result or does result in a purchase, an exchange or a replacement of an annuity in accordance with that advice. Recommendation does not include general communication to the public, generalized customer services assistance or administrative support, general educational information and tools, prospectuses, or other product and sales material.

(n) "Replacement" means a transaction in which a new annuity is to be purchased, and it is known or should be known to the proposing producer, or the proposing insurer whether or not a producer is involved, that by reason of the transaction, an existing annuity or other insurance policy has been or is to be any of the following:

(i) Lapsed, forfeited, surrendered or partially surrendered, assigned to the replacing insurer, or otherwise terminated;

(ii) Converted to reduced paid-up insurance, continued as extended term insurance, or otherwise reduced in value by the use of nonforfeiture benefits or other policy values;

(iii) Amended so as to effect either a reduction in benefits or in the term for which coverage would otherwise remain in force or for which benefits would be paid;

(iv) Reissued with any reduction in cash value; or

(v) Used in a financed purchase.

(o) "SEC" means the United States Securities and Exchange Commission.

Section 4. Exemptions. Unless otherwise specifically included, this regulation shall not apply to transactions involving:

(a) Direct response solicitations where there is no recommendation based on information collected from the consumer pursuant to this regulation;

(b) Contracts used to fund:

(i) An employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act (ERISA);

(ii) A plan described by sections 401(a), 401(k), 403(b), 408(k) or 408(p) of the Internal Revenue Code (IRC), as amended, if established or maintained by an employer;

(iii) A government or church plan defined in section 414 of the IRC, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under section 457 of the IRC;

(iv) A nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor.

(c) Settlements of or assumptions of liabilities associated with personal injury litigation or any dispute or claim resolution process; or

(d) Formal prepaid funeral contracts.

Section 5. Duties of Insurers and Producers.

(a) Best Interest Obligations. A producer, when making a recommendation of an annuity, shall act in the best interest of the consumer under the circumstances known at the time of the recommendation is made, without placing the producer's or the insurer's financial interest ahead of the consumer's interest. A producer has acted in the best interest of the consumer if they have satisfied the following obligations regarding care, disclosure, conflict of interest and documentation:

(i) Care obligation.

(A) The producer, in making a recommendation shall exercise reasonable diligence, care and skill to:

(I) Know the consumer's financial situation, insurance needs and financial objectives;

(II) Understand the available recommendation options after making a reasonable inquiry into options available to the producer;

(III) Have a reasonable basis to believe the recommended option effectively addresses the consumer's financial situation, insurance needs and financial objectives over the life of the product, as evaluated in light of the consumer profile information; and

(IV) Communicate the basis or bases of the recommendation.

(B) The requirements under paragraph (a)(i) of this section include making reasonable efforts to obtain consumer profile information from the consumer prior to the recommendation of an annuity.

(C) The requirements under paragraph (a)(i) of this section require a producer to consider the types of products the producer is authorized and licensed to recommend or sell that address the consumer's financial situation, insurance needs and financial objectives. This does not require analysis or consideration of any products outside the authority and license of the producer or other possible alternative products or strategies available in the market at the time of the recommendation. Producers shall be held to standards applicable to producers with similar authority and licensure.

(D) The requirements under this subsection do not create a fiduciary obligation or relationship and only create a regulatory obligation as established in this regulation.

(E) The consumer profile information, characteristics of the insurer, and product costs, rates, benefits and features are those factors generally relevant in making a determination whether an annuity effectively addresses the consumer's financial situation, insurance needs and financial objectives, but the level of importance of each factor under the care obligation of this paragraph may vary depending on the facts and circumstances of a particular case. However, each factor may not be considered in isolation.

(F) The requirements under paragraph (a)(i) of this section include having a reasonable basis to believe the consumer would benefit from certain features of the annuity, such as annuitization, death or living benefit or other insurance-related features.

(G) The requirements under paragraph (a)(i) of this section apply to the particular annuity as a whole and the underlying subaccounts to which funds are allocated at the time of purchase or exchange of an annuity, and riders and similar product enhancements, if any.

(H) The requirements under paragraph (a)(i) of this section do not mean the annuity with the lowest one-time or multiple occurrence compensation structure shall necessarily be recommended.

(I) The requirements under paragraph (a)(i) of this section do not mean the producer has ongoing monitoring obligations under the care obligation under this paragraph, although such an obligation may be separately owed under the terms of a fiduciary, consulting, investment advising or financial planning agreement between the consumer and the producer.

(J) In the case of an exchange or replacement of an annuity, the producer shall consider the whole transaction, which includes taking into consideration whether:

(I) The consumer will incur a surrender charge, be subject to the commencement of a new surrender period, lose existing benefits, such as death, living or other contractual benefits, or be subject to increased fees, investment advisory fees or charges for riders and similar product enhancements;

(II) The replacing product would substantially benefit the consumer in comparison to the replaced product over the life of the product; and

(III) The consumer has had another annuity exchange or replacement and, in particular, an exchange or replacement within the preceding 60 months.

(K) Nothing in this regulation should be construed to require a producer to obtain any license other than a producer license with the appropriate line of authority to sell, solicit or negotiate insurance in this state, including but not limited to any securities license, in order to fulfill the duties and obligations contained in this regulation; provided the producer does not give advice or provide services that are otherwise subject to securities laws or engage in any other activity requiring other professional licenses.

(ii) Disclosure obligation.

(A) Prior to the recommendation or sale of an annuity, the producer shall prominently disclose to the consumer on a form substantially similar to Disclosure A (located at the Department of Insurance website, doi.wyo.gov):

(I) A description of the scope and terms of the relationship with the consumer and the role of the producer in the transaction;

(II) An affirmative statement on whether the producer is licensed and authorized to sell the following products:

(1.) Fixed annuities;

(2.) Fixed indexed annuities;

(3.) Variable annuities;

(4.) Life insurance;

(5.) Mutual funds;

(6.) Stocks and bonds; and

(7.) Certificates of deposit.

(III) An affirmative statement describing the insurers the producer is authorized, contracted (or appointed), or otherwise able to sell insurance products for, using the following descriptions:

(1.) From one insurer;

(2.) From two or more insurers; or

(3.) From two or more insurers although primarily contracted with one insurer.

(IV) A description of the sources and types of cash compensation and non-cash compensation to be received by the producer, including whether the producer is to be compensated for the sale of a recommended annuity by commission as part of premium or other remuneration received from the insurer, intermediary or other producer or by fee as a result of a contract for advice or consulting services; and

(V) A notice of the consumer's right to request additional information regarding cash compensation described in subparagraph (B) of this paragraph;

(B) Upon request of the consumer or the consumer's designated representative, the producer shall disclose:

(I) A reasonable estimate of the amount of cash compensation to be received by the producer, which may be stated as a range of amounts or percentages; and

(II) Whether the cash compensation is a one-time or multiple occurrence amount, and if a multiple occurrence amount, the frequency and amount of the occurrence, which may be stated as a range of amounts or percentages; and

(C) Prior to or at the time of the recommendation or sale of an annuity, the producer shall have a reasonable basis to believe the consumer has been informed of various features of the annuity, such as the potential surrender period and surrender charge, potential tax penalty if the consumer sells, exchanges, surrenders or annuitizes the annuity, mortality and expense fees, investment advisory fees, any annual fees, potential charges for and features of riders or other options of the annuity, limitations on interest returns, potential changes in non-guaranteed elements of the annuity, insurance and investment components and market risk;

(iii) Conflict of Interest Obligation. A producer shall identify and avoid or reasonably manage and disclose material conflicts of interest, including material conflicts of interest related to an ownership interest.

(iv) Documentation obligation. A producer shall at the time of recommendation or sale:

(A) Make a written record of any recommendation and the basis for the recommendation subject to this regulation;

(B) Obtain a consumer signed statement on a form substantially similar to Disclosure B (located at the Department of Insurance website, doi.wyo.gov) documenting:

(I) A customer's refusal to provide the consumer profile information, if any; and

(II) A customer's understanding of the ramifications of not providing his or her consumer profile information or providing insufficient consumer profile information; and

(C) Obtain a consumer signed statement on a form substantially similar to Disclosure C (located at the Department of Insurance website, doi.wyo.gov) acknowledging the annuity transaction is not recommended if a customer decides to enter into an annuity transaction that is not based on the producer's recommendation.

(v) Application of the best interest obligation. Any requirement applicable to a producer under Section 5 of this regulation shall apply to every producer who has exercised material control or influence in the making of a recommendation and has received direct compensation as a result of the recommendation or sale, regardless of whether the producer has had any direct contact with the consumer. Activities such as providing or delivering marketing or educational materials, product wholesaling or other back office product support, and general supervision of a producer do not, in and of themselves, constitute material control or influence.

(b) Transactions not based on a recommendation.

(i) Except as provided under paragraph (b)(ii) of this section, a producer shall have no obligation to a consumer under paragraph (a)(i) of this section related to any annuity transaction if:

(A) No recommendation is made;

(B) A recommendation was made and was later found to have been prepared based on materially inaccurate information provided by the consumer;

(C) A consumer refuses to provide relevant consumer profile information and the annuity transaction is not recommended; or

(D) A consumer decides to enter into an annuity transaction that is not based on a recommendation of the producer.

(ii) An insurer's issuance of an annuity subject to paragraph (b)(i) of this section shall be reasonable under all the circumstances actually known to the insurer at the time the annuity is issued.

(c) Supervision system.

(i) Except as permitted under subsection (b) an insurer may not issue an annuity recommended to a consumer unless there is a reasonable basis to believe the annuity would effectively address the particular consumer's financial situation, insurance needs and financial objectives based on the consumer's consumer profile information.

(ii) An insurer shall establish and maintain a supervision system that is reasonably designed to achieve the insurer's and its producers' compliance with this regulation, including, but not limited to, the following:

(A) The insurer shall establish and maintain reasonable procedures to inform its producers of the requirements of this regulation and shall incorporate the requirements of this regulation into relevant producer training manuals;

(B) The insurer shall establish and maintain standards for producer product training and shall establish and maintain reasonable procedures to require its producers to comply with the requirements of Section 6 of this regulation;

(C) The insurer shall provide product-specific training and materials which explain all material features of its annuity products to its producers;

(D) The insurer shall establish and maintain procedures for the review of each recommendation prior to issuance of an annuity that are designed to ensure there is a reasonable basis to determine the recommended annuity would effectively address the particular consumer's financial situation, insurance needs and financial objectives. Such review procedures may apply a screening system for the purpose of identifying selected transactions for additional review and may be accomplished electronically or through other means including, but not limited to, physical review. Such an electronic or other system may be designed to require additional review only of those transactions identified for additional review by the selection criteria;

(E) The insurer shall establish and maintain reasonable procedures to detect recommendations that are not in compliance with subsections (a), (b), (d) and (e) of this section. This may include, but is not limited to, confirmation of the consumer's consumer profile information, systematic customer surveys, producer and consumer interviews, confirmation letters, producer statements or attestations and programs of internal monitoring. Nothing in this subparagraph prevents an insurer from complying with this subparagraph by applying sampling procedures, or by confirming the consumer profile information or other required information under this section after issuance or delivery of the annuity;

(F) The insurer shall establish and maintain reasonable procedures to assess, prior to or upon issuance or delivery of an annuity, whether a producer has provided to the consumer the information required to be provided under this section;

(G) The insurer shall establish and maintain reasonable procedures to identify and address suspicious consumer refusals to provide consumer profile information;

(H) The insurer shall establish and maintain reasonable procedures to identify and eliminate any sales contests, sales quotas, bonuses, and non-cash compensation that are based on the sales of specific annuities within a limited period of time. The requirements of this subparagraph are not intended to prohibit the receipt of health insurance, office rent, office support, retirement benefits or other employee benefits by employees as long as those benefits are not based upon the volume of sales of a specific annuity within a limited period of time; and

(I) The insurer shall annually provide a written report to senior management, including to the senior manager responsible for audit functions, which details a review, with appropriate testing, reasonably designed to determine the effectiveness of the supervision system, the exceptions found, and corrective action taken or recommended, if any.

(iii) Nothing in this subsection restricts an insurer from contracting for performance of a function (including maintenance of procedures) required under this subsection.

(A) An insurer is responsible for taking appropriate corrective action and may be subject to sanctions and penalties pursuant to section 7 of this regulation regardless of whether the insurer contracts for performance of a function and regardless of the insurer's compliance with subparagraph (c)(iii)(B) of this section.

(B) An insurer's supervision system under this paragraph shall include supervision of contractual performance. This includes, but is not limited to, the following:

(I) Monitoring and, as appropriate, conducting audits to assure that the contracted function is properly performed; and

(II) Annually obtaining a certification from a senior manager who has responsibility for the contracted function that the manager has a reasonable basis to represent, and does represent, that the function is properly performed.

(iv) An insurer is not required to include in its system of supervision:

(A) A producer's recommendations to consumers of products other than the annuities offered by the insurer; or

(B) Consideration of or comparison to options available to the producer or compensation relating to those options other than annuities or other products offered by the insurer.

(d) Prohibited practices. Neither a producer nor an insurer shall dissuade, or attempt to dissuade, a consumer from:

(i) Truthfully responding to an insurer's request for confirmation of the consumer profile information;

(ii) Filing a complaint; or

(iii) Cooperating with the investigation of a complaint.

(e) Safe harbor.

(i) Recommendations and sales of annuities made in compliance with comparable standards shall satisfy the requirements under this regulation. This subsection applies to all recommendations and sales of annuities made by financial professionals in compliance with business rules, controls and procedures that satisfy a comparable standard even if such standard would not otherwise apply to the product or recommendation at issue. However, nothing in this subsection shall limit the insurance commissioner's ability to investigate and enforce the provisions of this regulation.

(ii) Nothing in paragraph (e)(i) of this section shall limit the insurer's obligation to comply with section 5(c) of this regulation, although the insurer may base its analysis on information received from either the financial professional or the entity supervising the financial professional.

(iii) For paragraph (e)(i) of this section to apply, an insurer shall:

(A) Monitor the relevant conduct of the financial professional seeking to rely on paragraph (e)(i) or the entity responsible for supervising the financial professional, such as the financial professional's broker dealer or an investment adviser registered under federal or state securities laws using information collected in the normal course of an insurer's business; and

(B) Provide to the entity responsible for supervising the financial professional seeking to rely on paragraph (e)(i) of this section, such as the financial professional's broker dealer or investment adviser registered under federal or state securities laws information and reports that are reasonably appropriate to assist such entity to maintain its supervision system.

(iv) For purposes of this subsection, "financial professional" means a producer that is regulated and acting as:

(A) A broker-dealer registered under federal or state securities laws or a registered representative of a broker-dealer;

(B) An investment adviser registered under federal or state securities laws or an investment adviser representative associated with the federal or state registered investment adviser; or

(C) A plan fiduciary under Section 3(21) of the Employee Retirement Income Security Act of 1974 (ERISA) or fiduciary under Section 4975(e)(3) of the Internal Revenue Code (IRC) or any amendments or successor statutes thereto.

(v) For purposes of this subsection, "comparable standards" means:

(A) With respect to broker-dealers and registered representatives of broker-dealers, applicable SEC and FINRA rules pertaining to best interest obligations and supervision of annuity recommendations and sales, including, but not limited to, Regulation Best Interest and any amendments or successor regulations thereto;

(B) With respect to investment advisers registered under federal or state securities laws or investment adviser representatives, the fiduciary duties and all other requirements imposed on such investment advisers or investment adviser representatives by contract or under the Investment Advisers Act of 1940 or applicable state securities law, including but not limited to, the Form ADV and interpretations; and

(C) With respect to plan fiduciaries or fiduciaries, the duties, obligations, prohibitions and all other requirements attendant to such status under ERISA or the IRC and any amendments or successor statutes thereto.

Section 6. Producer Training.

(a) A producer shall not solicit the sale of an annuity product unless the producer has adequate knowledge of the product to recommend the annuity and the producer is in compliance with the insurer's standards for product training. A producer may rely on insurer-provided product-specific training standards and materials to comply with this section.

(b) One time training course.

(i) A producer who engages in the sale of annuity products shall:

(A) Complete a one-time four (4) credit training course approved by the department of insurance and provided by the department of insurance-approved education provider.

(B) Producers who hold a life insurance line of authority on the effective date of this regulation and who desire to sell annuities shall complete the requirements of this subsection within six (6) months after the effective date of this regulation. Individuals who obtain a life insurance line of authority on or after the effective date of this regulation may not engage in the sale of annuities until the annuity training course required under this subsection has been completed.

(ii) The minimum length of training required under this subsection shall be sufficient to qualify for at least four (4) continuing education credits but may be longer.

(iii) The training required under this subsection shall include information on the following topics:

(A) The types of annuities and various classifications of annuities;

(B) Identification of the parties to an annuity;

(C) How product specific annuity contract provisions affect consumers;

(D) The application of income taxation of qualified and non-qualified annuities;

(E) The primary uses of annuities; and

(F) Appropriate standard of conduct, sales practices, replacement and disclosure requirements.

(iv) Providers of courses intended to comply with this subsection shall cover all topics listed in the prescribed outline and shall not present any marketing information or provide training on sales techniques or provide specific information about a particular insurer's products. Additional topics may be offered in conjunction with and in addition to the required outline.

(v) A provider of an annuity training course intended to comply with this subsection shall register as a CE provider in this state and comply with the rules and guidelines applicable to producer continuing education courses as set forth in Wyoming Department of Insurance Regulations Chapter 20.

(vi) A producer who has completed an annuity training course approved by the department of insurance prior to the effective date of this regulation shall, within six (6) months after the effective date of this regulation, complete either:

(A) A new four (4) credit training course approved by the department of insurance after the effective date of this regulation; or

(B) An additional one-time one (1) credit training course approved by the department of insurance and provided by the department of insurance-approved education provider on appropriate sales practices, replacement and disclosure requirements under this amended regulation.

(vii) Annuity training courses may be conducted and completed by classroom or home-study methods in accordance with Wyoming Department of Insurance Regulations Chapter 20.

(viii) Providers of annuity training shall comply with the reporting requirement and shall issue certificates of completion in accordance with Wyoming Department of Insurance Regulations Chapter 20.

(ix) The satisfaction of the training requirements of another state that are substantially similar to the provisions of this subsection shall be deemed to satisfy the training requirements of this subsection in this state.

(x) The satisfaction of the components of the training requirements of any course or courses with components substantially similar to the provisions of this subsection shall be deemed to satisfy the training requirements of the subsection in this state.

(xi) An insurer shall verify that a producer has completed the annuity training course required under this subsection before allowing the producer to sell an annuity product for that insurer. An insurer may satisfy its responsibility under this subsection by obtaining certificates of completion of the training course or obtaining reports provided by commissioner-sponsored database systems of vendors or from a reasonably reliable commercial database vendor that has a reporting arrangement with approved insurance education providers.

Section 7. Compliance, Mitigation, Penalties, Enforcement.

(a) Failure to comply with the provisions of this Regulation is subject to the penalties identified in the insurance code, W.S. § 26-1-101 et seq.

(b) An insurer is responsible for compliance with this regulation. If a violation occurs, either because of the action or inaction of the insurer or its producer, the commissioner may order:

(i) An insurer to take reasonable appropriate corrective action for any consumer harmed by a failure to comply with this regulation by the insurer, an entity contracted to perform the insurer's supervisory duties or by the producer;

(ii) A general agency, independent agency or the producer to take reasonable appropriate corrective action for any consumer harmed by the producer's violation of this regulation; and

(iii) Appropriate penalties and sanctions.

(c) Any applicable penalty under W.S. §26-1-101 et. seq. for a violation of this regulation may be reduced or eliminated according to a schedule adopted by the commissioner if corrective action for the consumer was taken promptly after a violation was discovered or the violation was not part of a pattern of practice.

(d) The authority to enforce compliance with this regulation is vested exclusively with the commissioner.

Section 8. Recordkeeping.

(a) Insurers, general agents, independent agencies and producers shall maintain or be able to make available to the commissioner records of the information collected from the consumer, disclosure made to the consumer, including summaries of oral disclosures, and other information used in making the recommendations that were the basis for insurance transactions for three (3) years after the insurance transaction is completed by the insurer. An insurer is permitted, but shall not be required, to maintain documentation on behalf of a producer.

(b) Records required to be maintained by this regulation may be maintained in paper, photographic, micro-process, magnetic, mechanical or electronic media or by any process that accurately reproduces the actual document.

Section 9. Effective Date. This regulation shall be effective ninety (90) calendar days after filing with the Secretary of State.

History

• Effective 2023-04-05

Chapter 65 Regulation Governing the Sale of Out-of-State Health Insurance Policies

Wyo. Code R. 044.0002.65.01082015 Regulation Governing the Sale of Out-of-State Health Insurance Policies

CHAPTER 65

REGULATION GOVERNING THE SALE OF OUT-OF-STATE HEALTH INSURANCE POLICIES

Section 1. Authority

This regulation governing the sale of out-of-state health insurance policies in the state of Wyoming supplements the provisions of W.S. 26-18-301, et seq. This regulation is promulgated by authority of and pursuant to the provisions in W.S. 26-18-305 directing the Wyoming insurance commissioner to adopt rules and regulations necessary for filing, approval, and sale of health insurance policies that have been approved for sale in other states, the Wyoming Administrative Procedure Act (W.S. 16-3-101 through W.S. 16-3- 115) and the Wyoming Insurance Code (W.S. 26-2-110 and W.S. 26-2-125).

Section 2. Purpose

The purpose of this Regulation is:

(a) To establish standards for the sale of out-of-state health insurance policies, to develop a method of overseeing insurers selling out-of-state health insurance policies in Wyoming, and to protect the interests of Wyoming consumers who purchase out-of- state health insurance policies.

(b) To declare that failure to comply with the provisions of this regulation will be deemed an unfair method of competition and an unfair trade practice.

Section 3. Scope

This regulation shall apply to the sale of health insurance policies including individual disability policies, small group disability policies, or high deductible health policies approved for sale in other states pursuant to W.S. 26-18-301, et seq.

Section 4. Definitions

(a) As used in this regulation:

(i) "Domicile state" means the state that originally approved for sale the health insurance policies that the insurer intends to sell in Wyoming pursuant to W. S.26-18-301, et seq.

(ii) "Essential community provider" means a provider that serves predominantly low-income or medically underserved individuals.

(iii) "Health insurance" means individual disability policies, small group disability policies, or high deductible health policies as defined by W.S. § 26-1- 102(a)(xxxiii).

(iv) "Out-of-state health insurance policy" means a plan sold pursuant to W.S.§ 26-18-301, et seq. by a Wyoming licensed insurer that has been approved for sale in another state.

(v) "Provider network" means the facilities, providers, and supplier the insurer has contracted with to provide health care services.

(vi) "SERFF" means the system for electronic rate and form filing as developed and implemented by the National Association of Insurance Commissioners.

(vii) "Wyoming mandated benefits" means benefits required for individual and group plans including adult wellness benefits pursuant to W.S. § 26-18-103(b) and W.S.§ 26-19-107(h); mandated coverage pursuant to W.S. § 26-20-101, W.S. §26-20-201, W.S. § 26-20-301, and W.S. § 26-20-401; for group plans only, public health screenings pursuant to W.S. § 26-19-107(j); and any other benefits mandated in Wyoming by statute after the date of adoption of this regulation.

Section 5. Application

(a) Application Contents. Prior to the sale of out-of-state health insurance policies in Wyoming, the insurer must file an application as prescribed by the Wyoming insurance commissioner and are subject to the applicable SERFF filing fees. The application must include at a minimum the following:

(i) Proof of current approval and product line authority in domicile state including health policy form number and date approved in the domicile state;

(ii) Proof of authorization to transact insurance in Wyoming;

(iii) The price of the health policy as sold in the domicile state and whether the health policy will be at the same price or at a Wyoming specific price;

(iv) A network provider directory that must, at a minimum, include providers' specialties, locations of providers, acceptance of new patient status, the total unduplicated providers, and the total number of essential community providers in the provider network; and

(v) A description of the relationship between the insurer making the filing and the affiliate insurer, if any, which currently has approval for the issuance of health insurance policies in another state, the original state where the proposed product was approved, and the date of such approval.

(b) Policy Filing Requirements

(i) All health insurance policies offered or intended to be sold pursuant to W.S. 26-18-301, et seq. shall be filed for prior review and approval and are subject to the applicable SERFF filing and policy form filing fees.

(ii) For each out-of-state health insurance policy sold or intended to be sold in Wyoming, the insurer must file an outline of coverage with the health policy form filings and are subject to the applicable SERFF filing fees. The outline of coverage must have a section defining the benefits the health insurance policy provides. The outline of coverage must state whether the policy offers any Wyoming mandated benefits, and, if so, what Wyoming mandated benefits the policy offers. The Wyoming insurance commissioner can require additional information be disclosed in the outline of coverage.

(c) Agreement Between Carrier and Commissioner

(i) Pursuant to W.S. 26-18-302(a)(iv) the insurer seeking to offer out-of-state health insurance policies in Wyoming must agree that the Wyoming insurance commissioner may enforce the provisions of the insurance policy and resolve disputes between the insurer and the policyholder.

(ii) The agreement will be a written agreement signed by the insurer. The agreement shall be on a form as prescribed by the Wyoming insurance commissioner.

(d) Should the insurer fail to comply with the application and filing procedures as prescribed by this regulation and as otherwise prescribed by the Wyoming insurance commissioner pursuant to Wyoming law, the insurer's application may be rejected and the insurer may be denied the authority to issue out-of-state health insurance policies.

Section 6. Policy Requirements

(a) Network Adequacy

(i) Pursuant to W.S. 26-18-302(a)(vii), the Wyoming insurance commissioner shall review any provider network requirements in the out-of-state health insurance policy and may require modification of those requirements if the policy lacks sufficient network providers in Wyoming.

(ii) Provider networks are sufficient so long as:

(A) The insurer maintains a network that is sufficient in number and types of providers in Wyoming so as to assure that all services will be accessible without unreasonable delay as proven by submitting a network provider list to the Wyoming Department of Insurance; and

(B) The network has at least thirty percent (30%) of available essential community providers in the policy's service area. A network that has at least five percent (5%) of available essential community providers in the policy's service area may be considered sufficient so long as the insurer includes as part of its application a satisfactory narrative describing how the insurer's provider network(s), as currently designed, provides an adequate level of service for low-income and medically underserved enrollees.

(iii) If the insurer has insufficient number or type of participating providers to provide a covered benefit, the insurer shall ensure that the covered person obtains the covered benefit at no greater cost to the covered person than if the benefit were obtained from participating providers, or shall make arrangements acceptable to the Wyoming insurance commissioner.

(iv) The insurer shall include a provider directory with the application form.

The directory must at a minimum list providers' specialties, locations of providers, acceptance of new patient status, the total unduplicated providers, and the total number of essential community providers in the provider network. The Wyoming insurance commissioner can require that more categories of disclosure be included in the provider directory. The Wyoming insurance commissioner may terminate the insurer's ability to issue out-of-state health insurance policies in Wyoming should the network fail to meet the network adequacy standards set forth in this regulation.

(v) The insurer shall give the Wyoming insurance commissioner prompt notice of a potential loss of a material provider. Upon such notice the Wyoming insurance commissioner has the authority to initiate an interim network adequacy review.

(vi) Should the state of Wyoming adopt statutory standards for network adequacy for health insurance policies sold in Wyoming, those statutory provisions will preempt this regulatory guidance on network adequacy. Policies sold pursuant to W.S.26-18-301, et seq. will then be required to meet the statutory standards for network adequacy.

Section 7. Reporting Requirements.

(a) All reporting requirements shall be submitted annually by March 1 every year through SERFF, and are subject to the applicable SERFF filing fees.

(b) Annual Network Report.

(i) An insurer shall file with the Wyoming Department of Insurance an updated network provider directory on an annual basis.

(ii) The directory at a minimum must list providers' specialties, locations of providers, acceptance of new patient status, the total unduplicated providers, and the total number of essential community providers. If the network has under thirty percent (30%) of the essential community providers available in Wyoming, the insurer must give a narrative justification describing how the provider network(s) provides an adequate level of service for low-income and medically underserved enrollees.

(iii) The Wyoming insurance commissioner may terminate an insurer's ability to issue out-of-state health insurance policies in Wyoming should the network not meet the network adequacy standards set forth in this regulation.

(iv) The Wyoming insurance commissioner may terminate an insurer's ability to issue out-of-state health insurance policies in Wyoming should the insurer fail to file an annual network report pursuant to the Commissioner's authority to establish network provider requirements as authorized under W.S. §26-18-302(a)(vii).

(c) Annual Rating Report

(i) An insurer shall file with the Wyoming Department of Insurance a rating report on an annual basis.

(ii) The rating report at a minimum must list every product sold in Wyoming pursuant to W.S. 26-18-301, et seq., the rates of each product sold in Wyoming, and the rates of each product sold in the domicile state. Should the rate of any products sold in Wyoming exceed ten percent (10%) of the cost of the same product sold in the domicile state, the insurer must attach a narrative explaining the difference in rate.

Section 8. Separability

If any provision of this rule or its application to any person or circumstances is for any reason held to be invalid, the remainder of the regulation and the application of its provisions to other persons or circumstances shall not be affected.

Section 9. Effective Date

This regulation shall be effective immediately upon filing with the Secretary of State.

History

• Effective 2015-01-08

Chapter 66 Variable Annuity Contract Regulation

Wyo. Code R. 044.0002.66.07252016 Variable Annuity Contract Regulation

CHAPTER 66

VARIABLE ANNUITY CONTRACT REGULATION

Section 1. Authority

These regulations governing variable annuity contracts. They are promulgated by the authority of and pursuant to the Wyoming Administrative Procedure Act, W.S. §§ 16-3-101 through 16-3-115, and the Wyoming Insurance Code, W.S. §§ 26-2-110, 26-9-217 and 26-16- 502.

Section 2. Definitions

"Variable annuity," as used in this regulation shall mean any policy or contract which provides for annuity benefits which may vary according to the investment experience of any separate account or accounts maintained by the insurer for such policy or contract.

Section 3. Qualification of Insurance Companies To Issue Variable Annuities

(a) A company shall not deliver or issue for delivery variable annuities within this state unless it is licensed or organized to do a life insurance or annuity business in this state and the commissioner is satisfied that its condition or method of operation in connection with the issuance of these contracts will not render its operation hazardous to the public or its policyholders. In this connection, the commissioner shall consider among other things:

(i) The history and financial condition of the company;

(ii) The character, responsibility and fitness of the officers and directors of the company; and

(iii) In the case of an insurer other than a domestic insurer, whether the statutes or regulations of the jurisdiction of its incorporation provide a degree of protection to policyholders and the public which is substantially equal to that provided by the Wyoming Insurance Code and such rules and regulations as are promulgated.

(b) If the company is a subsidiary of an admitted life insurance company, or affiliated with a company by common management or ownership, it may be deemed by the commissioner to have satisfied the provisions of subsection (a)(ii) if either it or the admitted life company satisfies the provisions of subsection (a)(ii). Companies licensed and having a satisfactory record of doing business in this state for a period of at least three (3) years may be deemed to have satisfied the commissioner with respect to subsection (a)(ii) above.

(c) Before any company shall deliver or issue for delivery variable annuities within this state it shall submit to the commissioner:

(i) A general description of the kinds of variable annuities it intends to issue;

(ii) If requested by the commissioner, a copy of the statutes and regulations of its state of domicile under which it is authorized to issue variable annuities; and

(iii) If requested by the commissioner, biographical data with respect to officers and directors of the company on the NAIC uniform biographical data forms.

Section 4. Separate Account

(a) A domestic company issuing variable annuities shall establish one or more separate accounts pursuant to W.S. § 26-16-502, subject to the following provisions:

(i) Except as may be provided with respect to reserves for guaranteed benefits and funds referred to in subsection (a)(ii):

(A) Amounts allocated to a separate account and its accumulations may be invested and reinvested without regard to any requirements or limitations prescribed by the laws of this state governing the investments of life insurance companies; and

(B) The investments in the separate account or accounts shall not be taken into account in applying the investment limitations otherwise applicable to the investments of the company.

(ii) Reserves for benefits guaranteed as to dollar amount and duration and funds guaranteed as to principal amount or stated rate of interest may be maintained in a separate account if a portion of the assets of the separate account at least equal to the reserve liability is invested in accordance with the laws and regulations of this state governing the investments of life insurance companies. That portion of the assets also shall not be taken into account in applying the investment limitations otherwise applicable to the investments of the company.

(iii) With respect to seventy-five percent (75%) of the market value of the total assets in a separate account a company shall not purchase or otherwise acquire the securities of an issuer, other than securities issued or guaranteed as to principal or interest by the United States, if immediately after the purchase or acquisition the market value of the investment, together with prior investments of the separate account in the security taken at market, would exceed ten percent (10%) of the market value of the assets of the separate account. The commissioner, may waive this limitation if, in the opinion of the commissioner, the waiver will not render the operation of the separate account hazardous to the public or policyholders in this state.

(iv) Unless otherwise permitted by law or approved by the commissioner, a company shall not purchase or otherwise acquire for its separate accounts the voting securities of an issuer if, as a result of the acquisition, the insurance company and its separate accounts, in the aggregate, will own more than ten percent (10%) of the total issued and outstanding voting securities of the issuer. This shall not apply with respect to securities held in separate accounts where the voting rights are exercisable only in accordance with instructions from persons having interest in the accounts.

(v) The limitations provided in Paragraphs (iii) and (iv) of this subsection shall not apply to investments with respect to a separate account in the securities of an investment company registered under the Investment Company Act of 1940, if the investments of the investment company comply in substance with Paragraphs (iii) and (iv).

(b) Unless otherwise approved by the commissioner, assets allocated to a separate account shall be valued at their market value on the date of valuation, or if there is no readily available market, then as provided under the terms of the contract or the rules or other written agreement applicable to the separate account. Unless otherwise approved by the commissioner, the portion, if any, of the assets of the separate account equal to the company's reserve liability with regard to the benefits and funds referred to in Subsection a(ii) shall be valued in accordance with the rules otherwise applicable to the company's assets.

(c) To the extent provided under the applicable contracts, that portion of the assets of a separate account equal to the reserves and other contract liabilities with respect to the account shall not be chargeable with liabilities arising out of any other business the company may conduct.

(d) Notwithstanding any other provisions of law, a company may:

(i) With respect to a separate account registered with the Securities and Exchange Commission as a unit investment trust, exercise voting rights in connection with securities of a regulated investment company registered under the Investment Company Act of 1940 and held in such separate accounts in accordance with instructions from persons having interests in such accounts ratably as determined by the company; or

(ii) With respect to a separate account registered with the Securities and Exchange Commission as a management investment company, establish for the account a committee, board or other body, whose members may or may not be otherwise affiliated with the company and may be elected to membership by the vote of persons having interests in the account ratably as determined by the company. The committee, board or other body may have the power, exercisable alone or in conjunction with others, to manage the separate account and the investment of its assets.

(iii) A company, committee, board or other body may make other provisions in respect to a separate account as may be deemed appropriate to facilitate compliance with requirements of any federal or state law now or hereafter in effect if the commissioner approves the provisions as not hazardous to the public or the company's policyholders in this state.

(e) No sale, exchange or other transfer of assets may be made by a company between any of its separate accounts or between any other investment account and one or more of its separate accounts unless, in the case of a transfer into a separate account, the transfer is made solely to establish the account or to support the operation of the contracts with respect to the separate account to which the transfer is made, and unless the transfer, whether into or from a separate account, is made:

(i) By a transfer of cash; or

(ii) By a transfer of securities having a valuation which could be readily determined in the marketplace, if that transfer of securities is approved by the commissioner.

(iii) The commissioner may authorize other transfers among such accounts, if, in his opinion, such transfers would not be inequitable.

(f) The company shall maintain in each such separate account assets with a value at least equal to the reserves and other contract liabilities with respect to the account, except as may otherwise be approved by the commissioner.

(g) Rules under any provision of the insurance laws of this state or any regulation applicable to the officers and directors of insurance companies with respect to conflict of interest shall also apply to members of a separate accounts committee, board or other similar body. No officer or director of the company nor a member of the committee, board or body of a separate account shall receive directly or indirectly any commission or any other compensation with respect to the purchase or sale of assets of the separate account.

Section 5. Filing of Contracts

The filing requirements applicable to variable annuities shall be those filing requirements otherwise applicable under existing statutes and regulations of this state with respect to individual and group life insurance and annuity contract form filings, to the extent appropriate. Contract form filings shall also include a certification by a member of the American Academy of Actuaries as to the compliance with Section 7. In addition, each insurer shall file with the Commissioner a copy of each prospectus adopted by it for use in conjunction with the sale of any contract offered for sale in this state.

Section 6. Variable Annuity Contracts

(a) A variable annuity providing benefits payable in variable amounts delivered or issued for delivery in this state shall contain a statement of the essential features of the procedures to be followed by the insurance company in determining the dollar amount of variable benefits. A contract, including a group contract and a certificate in evidence of variable benefits issued under the contract, shall state that the dollar amount will vary to reflect investment experience and shall contain on its first page a clear statement to the effect that the benefits of the contract are on a variable basis.

(b) Illustrations of benefits payable under any variable annuity shall not include projections of past investment experience into the future or attempted predictions of future investment experience. Nothing contained herein is intended to prohibit use of hypothetical assumed rates of return to illustrate possible levels of benefits.

(c) No individual variable annuity contract calling for the payment of periodic stipulated payments shall be delivered or issued for delivery in this state unless it contains in substance the following provision or provisions which in the opinion of the commissioner are more favorable to the holders of contracts:

(i) A provision that there shall be a grace period of thirty (30) days, within which any stipulated payment to the insurer falling due after the first may be made, during which grace period the contract shall continue in force. The contract may include a statement of the basis for determining the date as of which a payment received during the grace period shall be applied to produce the values arising under the contract; and

(ii) A provision that there shall be a reinstatement period in accordance with W.S. 26- 16-110.

(d) A variable annuity contact delivered or issued for delivery in this state shall stipulate the investment increment factors to be used in computing the dollar amount of variable benefits or other variable contractual payments or values thereunder, and may guarantee that expense and mortality results shall not adversely affect the dollar amounts.

(i) In the case of an individual variable annuity contract under which the expense and/or mortality results may adversely affect the dollar amount of benefits.

(A) The expense and mortality factors used in computing the dollar amount of variable benefits or other contractual payments or values shall be stipulated in the contract.

(B) Actual emerging expense and mortality results may be reflected in the dollar amount of benefits only through a mortality and expense charge that may vary only within a specified range indicated in the policy.

(ii) In computing the dollar amount of variable benefits or other contractual payments or values under an individual variable annuity contract:

(A) The annual net investment increment assumption shall not exceed five percent (5%) except with the approval of the commissioner.

(B) To the extent that the level of benefits may be affected by future mortality results, the mortality factor shall be determined from the Annuity 2000 Mortality Table, or any modification of that table not having a lower life expectancy at any age, or any annuity mortality table adopted after 1996 by the National Association of Insurance Commissioners that is approved by the commissioner for this purpose.

(C) "Expense" as used in this subsection, may exclude some or all taxes, as stipulated in the contract.

(e) The reserve liability for variable annuities shall be established pursuant to the requirements of W.S. § 26-6-201 et seq. in accordance with actuarial procedures that recognize the variable nature of the benefits provided and any mortality guarantees.

Section 7. Nonforfeiture Benefits

(a) This section shall not apply to any:

(i) Reinsurance;

(ii) Group annuity contract purchases in connection with one or more retirement plans or plans of deferred compensation established or maintained by or for one or more employers (including partnerships or sole proprietorships), employee organizations, or any combination thereof, or other than plans providing individual retirement accounts or individual retirement annuities under Section 408 of the Internal Revenue Code, as now or hereafter amended;

(iii) Premium deposit fund;

(iv) Investment annuity;

(v) Immediate annuity;

(vi) Deferred annuity contract after annuity payments have commenced;

(vii) Reversionary annuity; or

(viii) To any contract which is to be delivered outside this state through an insurance producer or other representative of the company issuing the contract.

(b) To the extent that a variable annuity contract provides benefits that do not vary in accordance with the investment performance of a separate account before the annuity commencement date, the contract shall contain provisions that satisfy the requirements of W.S. §§ 26-16-401 et seq. and shall not otherwise be subject to this section.

(c) For contracts issued on or after the effective date of this regulation no variable annuity contract, except as stated in Subsections (a) and (b), shall be delivered or issued for delivery in this state unless it contains in substance the following provisions, or provisions which in the opinion of the commissioner are at least as favorable to the contractholder, upon cessation of payment of considerations under the contract:

(i) That upon cessation of payment of considerations under a contract, the company will grant a paid-up annuity benefit on a plan described in the contract that complies with Subsection (g). The description will include a statement of the mortality table, if any, and guaranteed or assumed interest rates used in calculating annuity payments.

(ii) If a contract provides for a lump sum settlement at maturity or at any other time, that upon surrender of the contract at or prior to the commencement of annuity payments, the company will pay in lieu of a paid-up annuity benefit a cash surrender benefit described in the contract that complies with Subsection (h). The contract may provide that the company reserves the right, at its option, to defer the determination and payment of a cash surrender benefit for any period during which the New York Stock Exchange is closed for trading (except for normal holiday closing) or when the Securities and Exchange Commission has determined that a state of emergency exists that may make determination and payment impractical.

(iii) A statement that a paid-up annuity, cash surrender or death benefits that may be available under the contract are not less than the minimum benefits required by any statute of the state in which the contract is delivered and an explanation of the manner in which benefits are altered by the existence of any additional amounts credited by the company to the contract, any indebtedness to the company on the contract or any prior withdrawals from or partial surrenders of the contract.

(d) The minimum values as specified in this section of paid-up annuity, cash surrender or death benefits available under a variable annuity contract shall be based upon nonforfeiture amounts meeting the requirements of this subsection.

(i) The minimum nonforfeiture amount at any time at or prior to the commencement of any annuity payments shall be equal to an accumulation up to that time at rates of interest equal to the net investment return (as hereinafter defined) of the net considerations (as defined in Subsection (e)) paid prior to that time, decreased by the sum of Paragraphs (A) through (D) below:

(A) Any prior withdrawals from or partial surrenders of the contract accumulated at rates of interest equal to the net investment return;

(B) An annual contract charge of $50, accumulated at rates of interest equal to the net investment return;

(C) Any premium tax paid by the company for the contract, accumulated at rates of interest equal to the net investment return; and

(D) The amount of any indebtedness to the company on the contract, including interest due and accrued.

(ii) "Net investment return" means that the rate of investment return to be credited to the variable annuity contract in accordance with the terms of the contract after deductions for tax charges, if any, and for asset charges either at a rate not in excess of that stated in the contract, or in the case of a contract issued by a nonprofit corporation under which the contractholder participates fully in the investment, mortality and expense experience of the account, in an amount not in excess of the actual expense not offset by other deductions. The net investment return to be credited to a contract shall be determined at least monthly.

(e) The net considerations for a given contract year used to define the minimum nonforfeiture amount in Subsection (d) shall be an amount equal to eighty-seven and one-half percent (87.5%) of the gross considerations credited to the contract during that contract year.

(f) Demonstration that a contract's nonforfeiture amounts comply with this section shall be based on the following assumptions:

(i) Values should be tested at the end of each of the first twenty (20) contract years;

(ii) A net investment return of seven percent (7%) per year should be used;

(iii) If the contract provides for transfers to another separate account or to another investment division within the same separate account, one transfer per contract year should be assumed;

(iv) In determining the state premium tax applicable to the contract, the state of residence should be assumed to equal the state of delivery;

(v) With respect to contracts providing for periodic considerations, monthly considerations of $100 should be assumed for each of the first 240 months;

(vi) With respect to contracts providing for a single consideration, a $10,000 single consideration should be assumed; and

(g) Any paid-up annuity benefit available under a variable annuity contract shall be such that its present value on the annuity commencement date is at least equal to the minimum nonforfeiture amount on that date. The present value shall be computed using the mortality table, if any, and the guaranteed or assumed interest rates used in calculating the annuity payments.

(h) For variable annuity contracts that provide cash surrender benefits, the cash surrender benefit at any time prior to the annuity commencement date shall not be less than the minimum nonforfeiture amount computed after the request for surrender is received by the company. The death benefit under such contracts shall be at least equal to the cash surrender benefit.

(i) A variable annuity contract that does not provide cash surrender benefits or does not provide death benefits at least equal to the minimum nonforfeiture amount prior to the annuity commencement date shall include a statement in a prominent place in the contract that these benefits are not provided.

(j) Notwithstanding the requirements of this section, a variable annuity contract may provide under the situations specified in Paragraph (i) or (ii) of this subsection that the company, at its option, may cancel the annuity and pay the contractholder its accumulated value and by such payment be released of any further obligation under the contract:

(i) If, at the time the annuity becomes payable, the accumulated value is less than $2,000, or would provide an initial income of less than $20 per month; or

(ii) If, prior to the time the annuity becomes payable under a periodic payment variable annuity contract, no considerations have been received under the contract for a period of two (2) full years and the total considerations paid prior to such period, reduced to reflect any partial withdrawals from or partial surrenders of the contract, and the accumulated value amount to less than $2,000.

(k) For a variable annuity contract that provides, within the same contract by rider or supplemental contract provision, both annuity benefits and life insurance benefits that are in excess of the greater of cash surrender benefits or a return of the gross considerations with interest, the minimum nonforfeiture benefits shall be equal to the sum of the minimum nonforfeiture benefits for the annuity portion and the minimum nonforfeiture benefits, if any, for the life insurance portion computed as if each portion were a separate contract. Notwithstanding the provisions of Subsection (d) of this section, additional benefits payable in the event of total and permanent disability, as reversionary annuity or deferred reversionary annuity benefits, or as other policy benefits additional to life insurance, endowment and annuity benefits, and considerations for all such additional benefits shall be disregarded in ascertaining the minimum nonforfeiture amounts, paid-up annuity, cash surrender and death benefits that may be required by this section. The inclusion of additional benefits shall not be required in any paid-up benefits, unless the additional benefits separately would require minimum nonforfeiture amounts, paid-up annuity, cash surrender and death benefits.

Section 8. Required Reports

(a) A company issuing individual variable annuities shall mail to the contractholder at least once in each contract year after the first at his or her last address known to the company, a statement or statements reporting the investments held in the separate account. The company shall submit annually to the insurance commissioner a statement of business of its separate account or accounts in such form as may be prescribed by the National Association of Insurance Commissioners.

(b) A company issuing individual variable annuities shall mail to the contractholder at least once in each contract year after the first at his or her last address known to the company a statement reporting as of a date not more than four (4) months previous to the date of mailing. In the case of an annuity contract under which payments have not yet commenced, the statement shall contain:

(i) The number of accumulation units credited to the contract and the dollar value of a unit; or

(ii) The value of the contractholder's account.

Section 9. Foreign Companies

If the law or regulation in the place of domicile of a foreign company provides a degree of protection to the policyholders and the public substantially equal to that provided by these regulations, the commissioner, to the extent deemed appropriate by the commissioner, may consider compliance with that law or regulation as compliance with these regulations.

Section 10. Qualifications of Insurance Producers for the Sale of Variable Annuities

Any person selling or offering for sale a variable annuity contract shall have a valid license under W.S. § 26-9-206, authorizing the solicitation of variable life and variable annuity products as defined in W.S. § 26-9-207(a)(v), and shall provide verification of required registration by the Financial Industry Regulatory Authority (FINRA) and have successfully completed the Series 6 or Series 7 and Series 63 examinations, or successfully completed the examination for other applicable FINRA licenses.

Section 11. Effective Date.

This Rule shall become effective immediately upon filing with the Secretary of State.

History

• Effective 2016-07-25

Chapter 67 Variable Life Insurance Contract Regulation

Wyo. Code R. 044.0002.67.07252016 Variable Life Insurance Contract Regulation

CHAPTER 67

VARIABLE LIFE INSURANCE CONTRACT REGULATION

Section 1. Authority

These regulations governing variable life insurance contracts. They are promulgated by the authority of and pursuant to the Wyoming Administrative Procedure Act, W.S. §§ 16-3-101 through 16-3-115, and the Wyoming Insurance Code, W.S. §§ 26-2-110, 26-9-217 and 26-16-502.

Section 2. Definitions

As used in this regulation:

(a) "Affiliate" of an insurer means a person, directly or indirectly, controlling, controlled by, or under common control with the insurer; a person who regularly furnishes investment advice to the insurer with respect to its separate accounts for which a specific fee or commission is charged; or any director, officer, partner or employee of the insurer, controlling or controlled person, or person providing investment advice or any member of the immediate family of such person.

(b) "Assumed investment rate" means the rate of investment return that would be required to be credited to a variable life insurance policy, after deduction of charges for taxes, investment expenses and mortality and expense guarantees to maintain the variable death benefit equal at all times to the amount of death benefit, other than incidental insurance benefits, which would be payable under the plan of insurance if the death benefit did not vary according to the investment experience of the separate account.

(c) "Benefit base" means the amount to which the net investment return is applied.

(d) "Control" (including the terms "controlling," "controlled by" and "under common control with") means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or non-management services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. Control shall be presumed to exist if a person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing more than ten percent (10%) of the voting securities of any other person. This presumption may be rebutted by a showing made to the satisfaction of the commissioner that control does not exist in fact. The commissioner may determine, after furnishing to all persons in interest notice and opportunity to be heard and making specific findings of fact to support such determination, that control exists in fact, notwithstanding the absence of a presumption to that effect.

(e) "Flexible premium policy" means any variable life insurance policy other than a scheduled premium policy as specified in Subsection (o) of this section.

(f) "General account" means all assets of the insurer other than assets in separate accounts established pursuant to W.S. § 26-16-502 of the insurance laws of this state or pursuant to the corresponding section of the insurance laws of the state of domicile of a foreign or alien insurer, whether or not for variable life insurance.

(g) "Incidental insurance benefit" means all insurance benefits in a variable life insurance policy, other than the variable death benefit and the minimum death benefit, including but not limited to, accidental death and dismemberment benefits, disability benefits, guaranteed insurability options, family income or term riders.

(h) "Minimum death benefit" means the amount of the guaranteed death benefit, other than incidental insurance benefits, payable under a variable life insurance policy regardless of the investment performance of the separate account.

(i) "Net investment return" means the rate of investment return in a separate account to be applied to the benefit base.

(j) "Person" means an individual, corporation, partnership, association, trust or fund.

(k) "Policy processing day" means the day on which charges authorized in the policy are deducted from the policy's cash value.

(l) "Scheduled premium policy" means a variable life insurance policy under which both the amount and timing of premium payments are fixed by the insurer.

(m) "Separate account" means a separate account established pursuant to W.S. § 26-16-502 or pursuant to the corresponding section of the insurance laws of the state of domicile of a foreign or alien insurer.

(n) "Variable death benefit" means the amount of the death benefit, other than incidental insurance benefits, payable under a variable life insurance policy dependent on the investment performance of the separate account, which the insurer would have to pay in the absence of any minimum death benefit.

(o) "Variable life insurance policy" means an individual policy that provides for life insurance the amount or duration of which varies according to the investment experience of any separate account or accounts established and maintained by the insurer as to the policy, pursuant to W.S. § 26-16-502 or pursuant to the corresponding section of the insurance laws of the state of domicile of a foreign or alien insurer.

Section 3. Qualification of Insurer to Issue Variable Life Insurance

The following requirements are applicable to all insurers either seeking authority or having authority to issue variable life insurance in Wyoming.

(a) Licensing and Approval to do Business in Wyoming. An insurer shall not deliver or issue for delivery in this state any variable life insurance policies unless:

(i) The insurer is licensed to transact life insurance business in Wyoming;

(ii) The insurer has obtained the written approval of the commissioner for the issuance of variable life insurance policies in Wyoming. The commissioner shall grant written approval only after the commissioner has found that:

(A) The plan of operation for the issuance of variable life insurance policies is not unsound;

(B) The general character, reputation and experience of the management and those persons or firms proposed to supply consulting, investment, administrative or custodial services to the insurer are such as to reasonably assure competent operation of the variable life insurance business of the insurer in Wyoming; and

(C) The present and foreseeable future financial condition of the insurer and its method of operation in connection with the issuance of such policies is not likely to render its operation hazardous to the public or its policyholders in Wyoming. The commissioner shall consider, among other things:

(I) The history of operation and financial condition of the insurer;

(II) The qualifications, fitness, character, responsibility, reputation and experience of the officers and directors and other management of the insurer and those persons or firms proposed to supply consulting, investment, administrative or custodial services to the insurer;

(III) The law and regulations under which the insurer is authorized in its state of domicile to issue variable life insurance policies. The state of entry of an alien insurer shall be deemed its state of domicile for this purpose; and

(IV) If the insurer is a subsidiary of, or is affiliated by common management or ownership with another company, its relationship to such other company and the degree to which the requesting insurer, as well as the other company, meets these standards.

(b) Filing for Approval to do Business in Wyoming. The commissioner may, at his discretion, require that an insurer, before it delivers or issues for delivery any variable life insurance policy in Wyoming, file with the department the following information for the consideration of the commissioner in making the determination required by Subsection a(ii) of this section:

(i) Copies of and a general description of the variable life insurance policies it intends to issue;

(ii) A general description of the methods of operation of the variable life insurance business of the insurer, including methods of distribution of policies and the names of those persons or firms proposed to supply consulting, investment, administrative, custodial or distribution services to the insurer;

(iii) With respect to any separate account maintained by an insurer for a variable life insurance policy, a statement of the investment policy the issuer intends to follow for the investment of the assets held in the separate account and a statement of procedures for changing the investment policy. The statement of investment policy shall include a description of the investment objectives intended for the separate account;

(iv) A description of any investment advisory services contemplated as required by Section 6(j);

(v) A copy of the statutes and regulations of the state of domicile of the insurer under which it is authorized to issue variable life insurance policies;

(vi) Biographical data with respect to officers and directors of the insurer on the NAIC Uniform Biographical Data Form; and

(vii) A statement of the insurer's actuary describing the mortality and expense risks which the insurer will bear under the policy.

(c) Use of Sales Materials. An insurer authorized to transact variable life insurance business in Wyoming shall file with the commissioner all sales material, advertising material, or descriptive literature or other materials of any kind in connection with its variable life insurance business as required by W.S. § 26-15-110(b), and shall not use any of these materials which are false, misleading, deceptive or inaccurate.

(d) Requirements Applicable to Contractual Services. Any material contract between an insurer and suppliers of consulting, investment, administrative, sales, marketing, custodial or other services with respect to variable life insurance operations shall be in writing and provide that the supplier of such services shall furnish the commissioner with any information or reports in connection with the services which the commissioner may request in order to ascertain whether the variable life insurance operations of the insurer are being conducted in a manner consistent with these regulations, and any other applicable law or regulations.

(e) Reports to the Commissioner.

(i) An insurer authorized to transact the business of variable life insurance in Wyoming shall submit to the commissioner, in addition to any other materials that may be required by this regulation or any other applicable laws or regulations:

(A) An annual statement of the business of its separate account or accounts in such forms as may be prescribed by the NAIC; and

(B) Prior to the use in Wyoming any information furnished to applicants as provided for in Section 7; and

(C) Prior to the use in Wyoming the form of any of the reports to policyholders as provided for in Section 9; and

(D) Such additional information concerning its variable life insurance operations or its separate accounts as the commissioner shall deem necessary.

(ii) Any material submitted to the commissioner under this section shall be disapproved if it is found to be false, misleading, deceptive or inaccurate in any material respect and, if previously distributed, the commissioner shall require the distribution of amended material.

(iii) Authority of Commissioner to Disapprove. Any material required to be filed with and approved by the commissioner shall be subject to disapproval if at any time it is found not to comply with the standards established in this regulation.

Section 4. Insurance Policy Requirements

(a) Filing of Variable Life Insurance Policies. All variable life insurance policies, and all riders, endorsements, applications and other documents that are to be made a part of the policy and which relate to the variable nature of the policy, shall be filed with the commissioner and approved by him or her prior to delivery or issuance for delivery in Wyoming. In addition, each insurer shall file with the Commissioner a copy of each prospectus adopted by it for use in conjunction with the sale of any contract offered for sale in Wyoming.

(i) The procedures and requirements for filing and approval shall be the same as those otherwise applicable to other life insurance policies.

(ii) The commissioner may approve variable life insurance policies and related forms with provisions the commissioner deems to be not less favorable to the policyholder and the beneficiary than those required by this regulation.

(b) Mandatory Policy Benefit and Design Requirements. Variable life insurance policies delivered or issued for delivery in this state shall comply with the following minimum requirements.

(i) Mortality and expense risks shall be borne by the insurer. The mortality and expense charges shall be subject to the maximums stated in the contract.

(ii) For scheduled premium policies, a minimum death benefit shall be provided in an amount at least equal to the initial face amount of the policy so long as premiums are duly paid (subject to the provisions of Subsection (d)of this section);

(iii) The policy shall reflect the investment experience of one or more separate accounts established and maintained by the insurer. The insurer shall demonstrate that the reflection of investment experience in the variable life insurance policy is actuarially sound.

(iv) Each variable life insurance policy shall be credited with the full amount of the net investment return applied to the benefit base.

(v) Any changes in variable death benefits of each variable life insurance policy shall be determined at least annually.

(vi) The cash value of each variable life insurance policy shall be determined at least monthly. The method of computation of cash values and other nonforfeiture benefits, as described either in the policy or in a statement filed with the commissioner of the state in which the policy is delivered, or issued for delivery, shall be in accordance with actuarial procedures that recognize the variable nature of the policy. The method of computation shall be such that, if the net investment return credited to the policy at all times from the date of issue should be equal to the assumed investment rate with premiums and benefits determined accordingly under the terms of the policy, then the resulting cash values to the minimum values required by W.S. § 26-16-201, et seq, for a general account policy with such premiums and benefits. The assumed investment rate shall not exceed the maximum interest rate permitted under the Standard Nonforfeiture Law of Wyoming. If the policy does not contain an assumed investment rate this demonstration shall be based on the maximum interest rate permitted under the Standard Nonforfeiture Law. The method of computation may disregard incidental minimum guarantees as to the dollar amounts payable. Incidental minimum guarantees include, for example, but are not limited to, a guarantee that the amount payable at death or maturity shall be least equal to the amount that otherwise would have been payable if the net investment return credited to the policy at all times from the date of issue had been equal to the assumed investment rate.

(vii) The computation of values required for each variable life insurance policy may be based upon such reasonable and necessary approximations as are acceptable to the commissioner.

(c) Mandatory Policy Provisions. Every variable life insurance policy filed for approval in this state shall contain at least the following:

(i) The cover page or pages corresponding to the cover page of each policy shall contain:

(A) A prominent statement in either contrasting color or in bold-faced type that the amount or duration of death benefit may be variable or fixed under specified conditions;

(B) A prominent statement in either contrasting color or in bold-faced type that cash values may increase or decrease in accordance with the experience of the separate account subject to any specified minimum guarantees;

(C) A statement describing any minimum death benefit required pursuant to Subsection (b)(ii) of this section;

(D) The method, or a reference to the policy provision which describes the method, for determining the amount of insurance payable at death;

(E) To the extent permitted by state law, a captioned provision that the policyholder may return the variable life insurance policy within ten (10) days of receipt of the policy by the policyholder and receive a refund equal to the sum of the difference between the premiums paid including any policy fees or other charges and the amounts allocated to any separate accounts under the policy and the value of the amounts allocated to any separate accounts under the policy, on the date the returned policy is received by the insurer or its insurance producer. Until such time as state law authorizes the return of payments as calculated in the preceding sentence, the amount of the refund shall be the total of all premium payments for such policy.

(F) Such other items as are currently required for fixed benefit life insurance policies and which are not inconsistent with this regulation.

(ii) Policy premiums

(A) For scheduled premium policies, a provision for a grace period of not less than thirty-one (31) days from the premium due date which shall provide that when the premium is paid within the grace period, policy values will be the same, except for the deduction of any overdue premium, as if the premium were paid on or before the due date.

(B) For flexible premium policies, a provision for a grace period beginning on the policy processing day when the total charges authorized by the policy that are necessary to keep the policy in force until the next policy processing day exceed the amounts available under the policy to pay such charges in accordance with the terms of the policy. The grace period shall end on a date not less than sixty-one (61) days after the mailing date of the Report to Policyholders required by Section 9(c).

(C) The death benefit payable during the grace period will equal the death benefit in effect immediately prior to such period less any overdue charges. If the policy processing days occur monthly, the insurer may require the payment of not more than three (3) times the charges that were due on the policy processing day on which the amounts available under the policy were insufficient to pay all charges authorized by the policy that are necessary to keep the policy in force until the next policy processing day.

(iii) For scheduled premium policies, a provision that the policy will be reinstated at any time within three (3) years from the date of default upon the written application of the insured and evidence of insurability, including good health, satisfactory to the insurer, unless the cash surrender value has been paid or the period of extended insurance has expired, upon the payment of any outstanding indebtedness arising subsequent to the end of the grace period following the date of default together with accrued interest thereon to the date of reinstatement and payment of an amount not exceeding all overdue premiums with interest at a rate not exceeding six percent (6%)  per annum compounded annually and any indebtedness in effect at the end of the grace period following the date of default with interest at a rate not exceeding six percent (6%) per annum compounded annually.

(iv) A full description of the benefit base and of the method of calculation and application of any factors used to adjust variable benefits under the policy;

(v) A provision specifying what documents constitute the entire insurance contract under Wyoming law;

(vi) A designation of the officers who are empowered to make an agreement or representation on behalf of the insurer and an indication that statements by the insured, or on his or her behalf, shall be considered as representations and not warranties;

(vii) An identification of the owner of the insurance contract;

(viii) A provision setting forth conditions or requirements as to the designation, or change of designation, of a beneficiary and a provision for disbursement of benefits in the absence of a beneficiary designation;

(ix) A statement of any conditions or requirements concerning the assignment of the policy;

(x) A description of any adjustments in policy values to be made in the event of misstatement of age of the insured;

(xi) A provision that the policy shall be incontestable by the insurer after it has been in force for two (2) years during the lifetime of the insured. However, any increase in the amount of the policy's death benefits subsequent to the policy issue date, which occurred upon a new application or request of the owner and was subject to satisfactory proof of the insured's insurability, shall be incontestable after the increase has been in force, during the lifetime of the insured, for two (2) years from the date of issue of increase;

(xii) A provision stating that the investment policy of the separate account shall not be changed without the approval of the insurance commissioner of the state of domicile of the insurer, and that the approval process is on file with the commissioner of Wyoming;

(xiii) A provision that payment of variable death benefits in excess of any minimum death benefits, cash values, policy loans or partial withdrawals (except when used to pay premiums) or partial surrenders may be deferred:

(A) For up to six (6) months from the date of request, if the payments are based on policy values which do not depend on the investment performance of the separate account after making a written request and receiving written approval of the commissioner; or

(B) Otherwise, for any period during which the New York Stock Exchange is closed for trading (except for normal holiday closing) or when the Securities and Exchange Commission has determined that a state of emergency exists which may make such payment impractical;

(xiv) If settlement options are provided, at least one option shall be provided on a fixed basis only;

(xv) A description of the basis for computing the cash value and the surrender value under the policy shall be included;

(xvi) Premiums or charges for incidental insurance benefits shall be stated separately;

(xvii) Any other policy provision required by this regulation;

(xviii) Such other items as are currently required for fixed benefit life insurance policies and are not inconsistent with this regulation; and

(xix) A provision for nonforfeiture insurance benefits. The insurer may establish a reasonable minimum cash value below which any nonforfeiture insurance options will not be available.

(d) Policy Loan Provisions. Every variable life insurance policy, other than term insurance policies and pure endowment policies delivered or issued for delivery in this state shall contain provisions which are not less favorable to the policyholder than a provision for policy loans after the policy has been in force for three (3) full years which provides the following:

(i) The policy's cash surrender value may be borrowed in accordance with W.S. 26- 16-108(b).

(ii) The amount borrowed shall bear interest at a rate not to exceed that permitted by W.S. 26-16-108(g).

(iii) Any indebtedness shall be deducted from the proceeds payable on death.

(iv) Any indebtedness shall be deducted from the cash surrender value upon surrender or in determining any nonforfeiture benefit.

(v) For scheduled premium policies, whenever the indebtedness exceeds the cash surrender value, the insurer shall give notice of any intent to cancel the policy in accordance with W.S. 26-16-108(c)(ii). For flexible premium policies, whenever the total charges authorized by the policy that are necessary to keep the policy in force until the next following policy processing day exceed the amounts available under the policy to pay the charges, a report must be sent to the policyholder containing the information specified by Section 9(c).

(vi) The policy may provide that if, at any time, so long as premiums are duly paid, the variable death benefit is less than it would have been if no loan or withdrawal had ever been made, the policyholder may increase the variable death benefit up to what it would have been if there had been no loan or withdrawal by paying an amount not exceeding 110% of the corresponding increase in cash value and by furnishing such evidence of insurability as the insurer may request.

(vii) The policy may specify a reasonable minimum amount that may be borrowed at any time but the minimum shall not apply to any automatic premium loan provision.

(viii) No policy loan provision is required if the policy is under extended insurance nonforfeiture option.

(ix) The policy loan provisions shall be constructed so that variable life insurance policyholders who have not exercised such provisions are not disadvantaged by the exercise thereof.

(x) Amounts paid to the policyholders upon the exercise of any policy loan provision shall be withdrawn from the separate account and shall be returned to the separate account upon repayment except that a stock insurer may provide the amounts for policy loans from the general account.

(e) Other Policy Provisions. The following provision may in substance be included in a variable life insurance policy or related form delivered or issued for delivery in this state:

(i) An exclusion for suicide, in accordance with W.S. 26-16-119(a)(ii)(E); provided, however, that to the extent of the increased death benefits only, the policy may provide an exclusion for suicide within two (2) years of any increase in death benefits which result from an application of the owner subsequent to the policy issue date;

(ii) Incidental insurance benefits may be offered on a fixed or variable basis;

(iii) Policies issued on a participating basis shall offer to pay dividend amounts in cash.

In addition, such policies may offer the following dividend options:

(A) The amount of the dividend may be credited against premium payments;

(B) The amount of the dividend may be applied to provide amounts of additional fixed or variable benefit life insurance;

(C) The amount of the dividend may be deposited in the general account at a specified minimum rate of interest;

(D) The amount of the dividend may be applied to provide paid-up amounts of fixed benefit one-year term insurance;

(E) The amount of the dividend may be deposited as a variable deposit in a separate account.

(iv) A provision allowing the policyholder to elect in writing in the application for the policy or thereafter an automatic premium loan on a basis not less favorable than that required of policy loans under Subsection (d) of this section, except that a restriction that no more than two (2) consecutive premiums can be paid under this provision may be imposed;

(v) A provision allowing the policyholder to make partial withdrawals; and

(vi) Any other policy provision approved by the commissioner.

Section 5. Reserve Liabilities For Variable Life Insurance

(a) Reserve Liabilities Under Standard Valuation Law. Reserves liabilities for variable life insurance policies shall be established under W.S. § 26-6-201 et seq. in accordance with actuarial procedures that recognize the variable nature of the benefits provided and any mortality guarantees.

(b) Reserve Liabilities for the Guaranteed Minimum Death Benefit. Reserve liabilities for the guaranteed minimum death benefit shall be the reserve needed to provide for the contingency of death occurring when the guaranteed minimum death benefit exceeds the death benefit that would be paid in the absence of the guarantee, and shall be maintained in the general account of the insurer and shall not be less than the greater of the following minimum reserves:

(i) The aggregate total of the term costs, if any, covering a period of one full year from the valuation date or, if less, covering the period provided for in the guarantee not otherwise provided for by the reserves held in the separate account, on each variable life insurance contract, assuming an immediate one-third depreciation in the current value of the assets in the separate account followed by a net investment return equal to the assumed investment rate; or

(ii) The aggregate total of the "attained age level" reserves on each variable life insurance contract. The "attained age level" reserve on each variable life insurance contract shall not be less than zero and shall equal the "residue," as described in Subparagraph (A) below, of the prior year's "attained age level" reserve on the contract, with any such "residue," increased or decreased by a payment computed on an attained age basis as described in Subparagraph (B) below.

(A) The "residue" of the prior year's "attained age level" reserve on each variable life insurance contract shall not be less than zero and shall be determined by adding interest at the valuation interest rate to the prior year's reserve, deducting the tabular claims based on the "excess," if any, of the guaranteed minimum death benefit over the death benefit that would be payable in the absence of a guarantee, and dividing the net result by the tabular probability of survival. The "excess" referred to in the preceding sentence shall be based on the actual level of death benefits that would have been in effect during the preceding year in the absence of the guarantee, taking appropriate account of the reserve assumptions regarding the distribution of death claim payments over the year.

(B) The payment referred to in this paragraph shall be computed so that the present value of a level payment of that amount each year over the future period for which charges for this risk will be collected under the contract, is equal to (A) minus (B) minus (C), where (A) is the present value of the future guaranteed minimum death benefits, (B) is the present value of the future death benefits that would be payable in the absence of such guarantee, and (C) is any "residue," as described in Subparagraph (A), of the prior year's "attained age level" reserve on such variable life insurance contract. If no future charges for this risk will be collected under the contract, the payment shall equal (A) minus (B) minus (C). The amounts of the future death benefits referred to in (B) shall be computed assuming a net investment return of the separate account which may differ from the assumed investment rate or the valuation interest but in no event may exceed the maximum interest rate permitted for the valuation of life contracts.

(iii) The valuation interest rate and mortality table used in computing the two minimum reserves described in Paragraph (i) and (ii) of this subsection shall conform to permissible standards for the valuation of life insurance contracts. In determining such minimum reserves, the company may employ suitable approximations and estimates, including but not limited to groupings and averages.

(c) Incidental Insurance Benefit. Reserve liabilities for all fixed incidental insurance benefits and any guarantees associated with variable incidental insurance benefits shall be maintained in the general account and reserve liabilities for all variable aspects of the variable incidental insurance benefits shall be maintained in a separate account, in amounts determined in accordance with the actuarial procedures appropriate to the benefit.

Section 6. Separate Accounts

The following requirements apply to the establishment and administration of variable life insurance separate accounts by a domestic insurer:

(a) Establishment and Administration of Separate Accounts. A domestic insurer issuing variable life insurance shall establish one or more separate accounts pursuant to W.S. § 26-16-502.

(i) If no law or other regulation provides for the custody of separate account assets and if the insurer is not the custodian of the separate account assets, all contracts for custody of these assets shall be in writing and the commissioner shall have authority to review and approve of both the terms of the contract and the proposed custodian prior to the transfer of custody.

(ii) The insurer shall not without prior written approval of the commissioner employ in any material connection with the handling of separate account assets any person who:

(A) Within the last ten (10) years has been convicted of any felony or a misdemeanor arising out of such person's conduct involving embezzlement, fraudulent conversion, or misappropriation of funds or securities or involving violation of Sections 1341, 1342 or 1343 of Title 18, United States Code; or

(B) Within the last ten (10) years has been found by any state regulatory authority to have violated or has acknowledged violation of any provision of any state insurance law involving fraud, deceit or knowing misrepresentation; or

(C) Within the last ten (10) years has been found by federal or state regulatory authorities to have violated or has acknowledged violation of any provision of federal or state securities laws involving fraud, deceit or knowing misrepresentation.

(iii) All persons with access to the cash, securities, or other assets of the separate account shall be under bond in the amount of not less than ten percent (10%) of the insurer's previous year's gross premiums or other amount the commissioner prescribes.

(iv) The assets of separate accounts shall be valued at least as often as variable benefits are determined but in any event at least monthly.

(b) Amounts in the Separate Account. The insurer shall maintain in each separate account assets with a value at least equal to the greater of the valuation reserves for the variable portion of the variable life insurance policies or the benefit base for these policies.

(c) Investments by the Separate Account.

(i) No sale, exchange, or other transfer of assets may be made by an insurer or any of its affiliates between any of its separate accounts or between any other investment account and one or more of its separate accounts unless:

(A) In case of transfer into a separate account, the transfer is made solely to establish the account or to support the operation of the policies with respect to the separate account to which the transfer is made; and

(B) The transfer, whether into or from a separate account, is made by a transfer of cash; but other assets may be transferred if approved by the commissioner in advance.

(ii) The separate account shall have sufficient net investment income and readily marketable assets to meet anticipated withdrawals under policies funded by the account.

(d) Limitations on Ownership.

(i) A separate account shall not purchase or otherwise acquire the securities of an issuer, other than securities issued or guaranteed as to principal and interest by the United States, if immediately after the purchase or acquisition the value of the investment, together with prior investments of the account in the security valued as required by these regulations, would exceed ten percent (10%) of the value of the assets of the separate account. The commissioner may waive this limitation in writing if the commissioner believes the waiver will not render the operation of the separate account hazardous to the public or the policyholders in this state.

(ii) No separate account shall purchase or otherwise acquire the voting securities of any issuer if as a result of the acquisition the insurer and its separate accounts in the aggregate, will own more than ten percent (10%) of the total issued and outstanding voting securities of the issuer. The commissioner may waive this limitation in writing if believes the waiver will not render the operation of the separate account hazardous to the public or the policyholders in this state or jeopardize the independent operation of the issuer of these securities.

(iii) The percentage limitation specified in Paragraph (i) of this subsection shall not be construed to preclude the investment of the assets of separate accounts in shares of investment companies registered pursuant to the Investment Company Act of 1940 or other pools of investment assets if the investments and investment policies of such investment companies or asset pools comply substantially with the provisions of Subsection (c) of this section and other applicable portions of this regulation.

(e) Valuation of Separate Account Assets. Investments of the separate account shall be valued at their market value on the date of valuation, or at amortized cost if it approximates market value.

(f) Separate Account Investment Policy. The investment policy of a separate account operated by a domestic insurer filed under Section 3(b)(iii) shall not be changed without first filing the change with the insurance commissioner.

(i) Any change filed pursuant to this section shall be effective sixty (60) days after the date it was filed with the commissioner, unless the commissioner notifies the insurer before the end of the sixty-day period of the Commissioner's disapproval of the proposed change. At any time the commissioner may, after notice and public hearing, disapprove any change that has become effective pursuant to this section.

(ii) The commissioner may disapprove the change if he or she determines that the change would be detrimental to the interests of the policyholders participating in the separate accounts.

(g) Charges Against Separate Account. The insurer shall disclose in writing, prior to or contemporaneously with delivery of the policy, all charges that may be made against the separate account, including, but not limited to, the following:

(i) Taxes or reserves for taxes attributable to investment gains and income of the separate account;

(ii) Actual cost of reasonable brokerage fees and similar direct acquisition and sale costs incurred in the purchase or sale of separate account assets;

(iii) Actuarially determined costs of insurance (tabular costs) and the release of separate account liabilities;

(iv) Charges for administrative expenses and investment management expenses, including internal costs attributable to the investment management of assets of the separate account;

(v) A charge, at a rate specified in the policy, for mortality and expense guarantees;

(vi) Any amounts in excess of those required to be held in the separate accounts; and

(vii) Charges for incidental insurance benefits.

(h) Standards of Conduct. Every insurer seeking approval to enter into the variable life insurance business in this state shall adopt by formal action of its board of directors a written statement specifying the standards of conduct of the insurer, its officers, directors, employees and affiliates with respect to the purchase or sale of investments of separate accounts. The standards of conduct shall be binding on the insurer and those to whom it refers. A code or codes of ethics meeting the requirements of Section 17(j) under the Investment Company Act of 1940 and its applicable rules and regulations shall satisfy the provisions of this section.

(i) Conflicts of Interest. Rules under any provision of the insurance laws of this state or any regulation applicable to the officers and directors of insurance companies with respect to conflicts of interest shall also apply to members of any separate account's committee or other similar body.

(j) Investment Advisory Services to a Separate Account.

(i) An insurer shall not enter into a contract under which any person undertakes, for a fee, to regularly furnish investment advice to such insurer with respect to its separate accounts maintained for variable life insurance policies unless:

(A) The person providing advice is registered as an investment adviser under the Investment Advice Act of 1940; or

(B) The person providing advice is an investment manager under the Employee Retirement Income Security Act of 1974 with respect to the assets of each employee benefit plan allocated to the separate account; or

(C) The insurer has filed with the commissioner and continues to file annually the following information and statements concerning the proposed advisor:

(I) The name and form of organization, state of organization, and its principal place of business;

(II) The names and addresses of its partners, officers, directors and persons performing similar functions or, if the investment advisory is an individual, of the individual;

(III) A written standard of conduct complying in substance with the requirements of Subsection (h) of this section which has been adopted by the investment advisor and is applicable to the investment advisor, its officers, directors, and affiliates;

(IV) A statement provided by the proposed advisor as to whether the advisor or any person associated therewith:

(1.)  Has been convicted within ten (10) years of a felony or misdemeanor arising out of the person's conduct as an employee, salesman, officer or director of an insurance company, a banker, an insurance producer, a securities broker or an investment advisor involving embezzlement, fraudulent conversion or misappropriation of funds or securities, or involving the violation of Sections 1341, 1342, or 1343 of Title 18 of United States Code;

(2.)  Has been permanently or temporarily enjoined by an order, judgment or decree of a court of competent jurisdiction from acting as an investment advisor, underwriter, broker or dealer, or as an affiliated person or as an employee of an investment company, bank or insurance company, or from engaging in or continuing any conduct or practice in connection with any such activity;

(3.)  Has been found by federal or state regulatory authorities to have willfully violated or have acknowledged willful violation of any provision of federal or state securities laws or state insurance laws or of any rule or regulation under these laws; or

(4.)  Has been censured, denied an investment advisor registration, had a registration as an investment advisor revoked or suspended, or been barred or suspended from being associated with an investment advisor by order of federal or state regulatory authorities; and

(D) The investment advisory contract shall be in writing and provide that it may be terminated by the insurer without penalty to the insurer or the separate account upon no more than sixty (60) days' written notice to the investment advisor.

(ii) The commissioner may, after notice and opportunity for hearing, by order require the investment advisory contract to be terminated if the commissioner deems continued operation under the contract to be hazardous to the public or the insurer's policyholders.

Section 7. Information Furnished To Applicants

An insurer delivering or issuing for delivery in this state a variable life insurance policy shall deliver the following to the applicant for the policy, and obtain a written acknowledgment of receipt from the applicant coincident with or prior to the execution of the application. The requirements of this section shall be deemed to have been satisfied to the extent that a disclosure containing information required by this section is delivered, either in the form of a prospectus included in the requirements of the Securities Act of 1933 and which was declared effective by the Securities and Exchange Commission; or all information and reports required by the Employee Retirement Income Security Act of 1974 if the policies are exempted from the registration requirements of the Securities Act of 1933 pursuant to Section 3(a)(2) thereof.

(a) A summary explanation, in non-technical terms, of the principal features of the policy, including a description of the manner in which the variable benefits will reflect the investment experience of the separate account and the factors that affect the variation. The explanation shall include notices of the provision required by Sections 4(c)(i)(E) and 4(c)(v);

(b) A statement of the investment policy of the separate account, including:

(i) A description of the investment objectives intended for the separate account and the principal types of investments intended to be made; and

(ii) Any restrictions or limitations on the manner in which the operations of the separate account are intended to be conducted;

(c) A statement of the net investment return of the separate account for each of the last ten (10) years or such lesser period as the separate account has been in existence;

(d) A statement of the charges levied against the separate account during the previous year;

(e) A summary of the method to be used in valuing assets held by the separate account;

(f) A summary of the federal income tax aspects of the policy applicable to the insured, the policyholder and the beneficiary; and

(g) Illustrations of benefits payable under the variable life insurance contract. The illustrations shall be prepared by the insurer and shall not include projections of past investment experience into the future or attempted predictions of future investments experience, provided that nothing contained herein prohibits use of hypothetical assumed rates of return to illustrate possible levels of benefits if it is made clear that the assumed rates are hypothetical only.

Section 8. Applications

The application for a variable life insurance policy shall contain:

(a) A prominent statement that the death benefit may be variable or fixed under specified conditions;

(b) A prominent statement that cash values may increase or decrease in accordance with the experience of the separate account (subject to any specified minimum guarantees); and

(c) Questions designed to elicit information that enables the insurer to determine the suitability of variable life insurance for the applicant in accordance with applicable federal or state law.

Section 9. Reports to Policyholders

An insurer delivering or issuing for delivery in this state a variable life insurance policy shall mail to each variable life insurance policyholder's last known address the following reports:

(a) Within thirty (30) days after each anniversary of the policy, a statement or statements of the cash surrender value, death benefit, any partial withdrawal or policy loan, any interest charge, any optional payments allowed pursuant to Section 4(d) under the policy computed as of the policy anniversary date. However, the statement may be furnished within thirty (30) days after a specified date in each policy year so long as the information contained therein is computed as of a date not more than sixty (60) days prior to the mailing of the notice.

This statement shall state that, in accordance with the investment experience of the separate account, the cash values and the variable death benefit may increase or decrease, and shall prominently identify any value described therein which may be recomputed prior to the next statement required by this section. If the policy guarantees that the variable death benefit on the next policy anniversary date will not be less than the variable death benefit specified in the statement, the statement shall be modified to so indicate. For flexible premium policies, the report shall contain a reconciliation of the change since the previous report in cash value and cash surrender value, if different, because of payments made (less deductions for expense charges), withdrawals, investment experience, insurance charges and any other charges made against the cash value. In addition, the report shall show the projected cash value and cash surrender value, if different, as of one year from the end of the period covered by the report assuming that planned periodic premiums, if any, are paid as scheduled; guaranteed costs of insurance are deducted; and the net return is equal to the guaranteed rate or, in the absence of a guaranteed rate, is not greater than zero. If the projected value is less than zero, a warning message shall be included that states that the policy may be in danger of terminating without value in the next twelve (12) months unless additional premium is paid.

(b) Annually, a statement or statements including:

(i) A summary of the financial statement of the separate account based on the last annual statement filed with the commissioner;

(ii) The net investment return of the separate account for the last year and, for each year after the first, a comparison of the investment rate of the separate account during the last year with the investment rate during prior years, up to a total of not less than five (5) years when available;

(iii) A list of investments held by the separate account as of a date not earlier than the end of the last year for which an annual statement was filed with the commissioner;

(iv) Any charges levied against the separate account during the previous year; and

(v) A statement of any change, since the last report, in the investment objective and orientation of the separate account, in any investment restriction or material quantitative or qualitative investment requirement applicable to the separate account or in the investment advisor of the separate account.

(c) For flexible premium policies, a report shall be sent to the policyholder if the amounts available under the policy on any policy processing day to pay the charges authorized by the policy are less than the amount necessary to keep the policy in force until the next following policy processing day. The report shall indicate the minimum payment required under the terms of the policy to keep it in force and the length of the grace period for payment of the amount.

Section 10. Foreign Companies

If the law or regulation in the place of domicile of a foreign company provides a degree of protection to the policyholders and the public that is substantially similar to that provided by these regulations, the commissioner may consider compliance with such law or regulation as compliance with these regulations.

Section 11. Qualifications Of Insurance Producers For The Sale Of Variable Life Insurance

Any person selling or offering for sale a variable annuity contract shall have a valid license under W.S. § 26-9-206, authorizing the solicitation of variable life and variable annuity products as defined in W.S. § 26-9-207(a)(v), and shall provide verification of required registration by the Financial Industry Regulatory Authority (FINRA) and have successfully completed the Series 6 or Series 7 and Series 63 examinations, or successfully completed the examination for other applicable FINRA licenses.

Section 12. Effective Date

These regulations shall become effective immediately upon filing with the Secretary of State.

History

• Effective 2016-07-25

Chapter 68 Regulation Governing Opt-Out Provisions of the Interstate Insurance Product Regulation Compact (IIPRC)

Wyo. Code R. 044.0002.68.09252023 § 1 Authority

This regulation is promulgated pursuant to W.S. §§ 26-2-110, 26-15-201 and 16‑3-101, et seq.

History

• Effective 2023-09-25

Wyo. Code R. 044.0002.68.09252023 § 2 Purpose

The purpose of this regulation is to exercise the opt-out provisions of the Interstate Insurance Product Regulation Compact (IIPRC) pursuant to W.S § 26-15-201, Article VII.

History

• Effective 2023-09-25

Wyo. Code R. 044.0002.68.09252023 § 3 Uniform Standards as Applied

(a) Group Disability:

(i) The Commissioner has considered the Uniform Standards as applied to the Group Disability Income Insurance Product Line adopted by the IIPRC on June 8, 2016 and finds the protections offered to Wyoming citizens are not adequate.

(ii) The Wyoming Insurance Department declines to participate in the IIPRC Uniform Standards as applied to the Group Disability Income Insurance Product Line.

(b) Individual Disability:

(i) The commissioner has considered the Uniform Standards as applied to the Individual Disability Income Insurance Product Line adopted by the IIPRC on August 3, 2018 and finds the protections offered to Wyoming citizens are not adequate.

(ii) The Wyoming Insurance Department declines to participate in the IIPRC Uniform standards as applied to the Individual Disability Income Insurance Product Line.

(c) Individual Disability Income Buy-Sell Policy Insurance Policies:

(i) The commissioner has considered the Uniform Standards as applied to the Individual Disability Income Buy-Sell Policy Insurance Policies adopted by the IIPRC on March 24, 2023, and finds the protections offered to Wyoming citizens are not adequate.

(ii) The Wyoming Insurance Department declines to participate in the IIPRC Uniform standards as applied to the Individual Disability Income Buy-Sell Policy Insurance Policies.

(d) Individual Disability Income Key Person Replacement Insurance Policies:

(i) The commissioner has considered the Uniform Standards as applied to the Individual Disability Income Key Person Replacement Insurance Policies adopted by the IIPRC on March 24, 2023, and finds the protections offered to Wyoming citizens are not adequate.

(ii) The Wyoming Insurance Department declines to participate in the IIPRC Uniform standards as applied to the Individual Disability Income Key Person Replacement Insurance Policies.

History

• Effective 2023-09-25

Wyo. Code R. 044.0002.68.09252023 § 4 Effective Date

This regulation becomes effective immediately upon filing with the Secretary of State.

History

• Effective 2023-09-25

Chapter 69 Term and Universal Life Insurance Reserve Financing

Wyo. Code R. 044.0002.69.02212018 § 1 Authority

This regulation is promulgated pursuant to W.S. 16‑3‑101 et seq. 26‑2‑110, 26-5-112, 26-5-113, and 26-5-116.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.69.02212018 § 2 Purpose and Intent

The purpose and intent of this regulation is to establish uniform, national standards governing reserve financing arrangements pertaining to life insurance policies containing guaranteed nonlevel gross premiums, guaranteed nonlevel benefits and universal life insurance policies with secondary guarantees; and to ensure that, with respect to each such financing arrangement, funds consisting of Primary Security and Other Security, as defined in Section 5, are held by or on behalf of ceding insurers in the forms and amounts required herein. In general, reinsurance ceded for reserve financing purposes has one or more of the following characteristics: some or all of the assets used to secure the reinsurance treaty or to capitalize the reinsurer (1) are issued by the ceding insurer or its affiliates; or (2) are not unconditionally available to satisfy the general account obligations of the ceding insurer; or (3) create a reimbursement, indemnification or other similar obligation on the part of the ceding insurer or any of its affiliates (other than a payment obligation under a derivative contract acquired in the normal course and used to support and hedge liabilities pertaining to the actual risks in the policies ceded pursuant to the reinsurance treaty).

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.69.02212018 § 3 Applicability

This regulation shall apply to reinsurance treaties that cede liabilities pertaining to Covered Policies, as that term is defined in Section 5(b), issued by any life insurance company domiciled in this state. This regulation and Chapter 50 of the Wyoming Insurance Department regulations shall both apply to reinsurance treaties; provided, that in the event of a direct conflict between the provisions of this regulation and Chapter 50 of the Wyoming Insurance Department regulations, the provisions of this regulation shall apply, but only to the extent of the conflict.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.69.02212018 § 4 Exemptions

This regulation does not apply to the situations described in subsections (a) through (f).

(a) Reinsurance of:

(i) Policies that satisfy the criteria for exemption set forth in section 6F of the NAIC Valuation of Life Insurance Policies Model Regulation or section 6G of the NAIC Valuation of Life Insurance Policies Model Regulation; and which are issued before the later of:

(A) The effective date of this regulation, and

(B) The date on which the ceding insurer begins to apply the provisions of VM-20 to establish the ceded policies' statutory reserves, but in no event later than January 1, 2020;

(ii) Portions of policies that satisfy the criteria for exemption set forth in section 6E of the NAIC Valuation of Life Insurance Policies Model Regulation and which are issued before the later of:

(A) The effective date of this regulation, and

(B) The date on which the ceding insurer begins to apply the provisions of VM-20 to establish the ceded policies' statutory reserves, but in no event later than Jan. 1, 2020;

(iii) Any universal life policy that meets all of the following requirements:

(A) Secondary guarantee period, if any, is five (5) years or less;

(B) Specified premium for the secondary guarantee period is not less than the net level reserve premium for the secondary guarantee period based on the Commissioners Standard Ordinary (CSO) valuation tables and valuation interest rate applicable to the issue year of the policy; and

(C) The initial surrender charge is not less than one hundred percent (100%) of the first year annualized specified premium for the secondary guarantee period;

(iv) Credit life insurance;

(v) Any variable life insurance policy that provides for life insurance, the amount or duration of which varies according to the investment experience of any separate account or accounts; or

(vi) Any group life insurance certificate unless the certificate provides for a stated or implied schedule of maximum gross premiums required in order to continue coverage in force for a period in excess of one year.

(b) Reinsurance ceded to an assuming insurer that meets the applicable requirements of W.S. 26-5-112(a)(v); or

(c) Reinsurance ceded to an assuming insurer that meets the applicable requirements of W.S. 26-5-112(a)(i), (ii), or (iii), and that, in addition:

(i) Prepares statutory financial statements in compliance with the NAIC Accounting Practices and Procedures Manual without any departures from NAIC statutory accounting practices and procedures pertaining to the admissibility or valuation of assets or liabilities that increase the assuming insurer's reported surplus and are material enough that they need to be disclosed in the financial statement of the assuming insurer pursuant to Statement of Statutory Accounting Principles No. 1 (SSAP 1); and

(ii) Is not in a Company Action Level Event, Regulatory Action Level Event, Authorized Control Level Event, or Mandatory Control Level Event as those terms are defined in W.S. 26-48-101 when its RBC is calculated in accordance with the life risk-based capital report including overview and instructions for companies, as the same may be amended by the NAIC from time to time, without deviation; or

(d) Reinsurance ceded to an assuming insurer that meets the applicable requirements of W.S. 26-5-112(a)(i), (ii), or (iii), and that, in addition:

(i) Is not an affiliate, as that term is defined in W.S. 26-44-101, of:

(A) The insurer ceding the business to the assuming insurer; or

(B) Any insurer that directly or indirectly ceded the business to that ceding insurer;

(ii) Prepares statutory financial statements in compliance with the NAIC Accounting Practices and Procedures Manual;

(iii) Is both:

(A) Licensed or accredited in at least ten (10) states (including its state of domicile); and

(B) Not licensed in any state as a captive, special purpose vehicle, special purpose financial captive, special purpose life reinsurance company, limited purpose subsidiary, or any other similar licensing regime; and

(iv) Is not, or would not be, below five hundred percent (500%) of the Authorized Control Level RBC as that term is defined in W.S. 26-48-101 when its Risk-Based Capital (RBC) is calculated in accordance with the life risk-based capital report including overview and instructions for companies, as the same may be amended by the NAIC from time to time, without deviation, and without recognition of any departures from NAIC statutory accounting practices and procedures pertaining to the admission or valuation of assets or liabilities that increase the assuming insurer's reported surplus; or

(e) Reinsurance ceded to an assuming insurer that meets the requirements of either W.S. 26-5-116(f)(i) or W.S. 26-5-116(f)(ii); or

(f) Reinsurance not otherwise exempt under subsections (a) through (e) if the commissioner, after consulting with the NAIC Financial Analysis Working Group (FAWG) or other group of regulators designated by the NAIC, as applicable, determines under all the facts and circumstances that all of the following apply:

(i) The risks are clearly outside of the intent and purpose of this regulation (as described in section 2 above);

(ii) The risks are included within the scope of this regulation only as a technicality; and

(iii) The application of this regulation to those risks is not necessary to provide appropriate protection to policyholders. The commissioner shall publicly disclose any decision made pursuant to this section 4(f) to exempt a reinsurance treaty from this regulation, as well as the general basis therefor (including a summary description of the treaty).

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.69.02212018 § 5 Definitions

(a) "Actuarial Method" means the methodology used to determine the Required Level of Primary Security, as described in section 6.

(b) "Covered Policies" means the following: Subject to the exemptions described in section 4, Covered Policies are those policies, other than Grandfathered Policies, of the following policy types:

(i) Life insurance policies with guaranteed nonlevel gross premiums and/or guaranteed nonlevel benefits, except for flexible premium universal life insurance policies; or,

(ii) Flexible premium universal life insurance policies with provisions resulting in the ability of a policyholder to keep a policy in force over a secondary guarantee period.

(c) "Grandfathered Policies" means policies of the types described in subsections (b)(i) and (b)(ii) above that were:

(i) Issued prior to January 1, 2015; and

(ii) Ceded as of December 31, 2014, as part of a reinsurance treaty that would not have met one of the exemptions set forth in section 4 had that section then been in effect.

(d) "Non-Covered Policies" means any policy that does not meet the definition of Covered Policies, including Grandfathered Policies.

(e) "Required Level of Primary Security" means the dollar amount determined by applying the Actuarial Method to the risks ceded with respect to Covered Policies, but not more than the total reserve ceded.

(f) "Primary Security" means the following forms of security:

(i) Cash pursuant to W.S. 26-5-113(a)(i);

(ii) Securities listed by the Securities Valuation Office meeting the requirements of W.S. 26-5-113(a)(ii), but excluding any synthetic letter of credit, contingent note, credit-linked note, or other similar security that operates in a manner similar to a letter of credit, and excluding any securities issued by the ceding insurer or any of its affiliates; and

(iii) For security held in connection with funds-withheld and modified coinsurance reinsurance treaties:

(A) Commercial loans in good standing of CM3 quality and higher;

(B) Policy Loans; and

(C) Derivatives acquired in the normal course and used to support and hedge liabilities pertaining to the actual risks in the policies ceded pursuant to the reinsurance treaty.

(g) "Other Security" means any security acceptable to the commissioner other than security meeting the definition of Primary Security.

(h) "Valuation Manual" means the valuation manual adopted by the NAIC as described in section 11B(1) of the Standard Valuation Law, with all amendments adopted by the NAIC that are effective for the financial statement date on which credit for reinsurance is claimed.

(i) "VM-20" means "Requirements for Principle-Based Reserves for Life Products," including all relevant definitions, from the Valuation Manual.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.69.02212018 § 6 The Actuarial Method

(a) The Actuarial Method to establish the Required Level of Primary Security for each reinsurance treaty subject to this regulation shall be VM-20, applied on a treaty-by-treaty basis, including all relevant definitions, from the Valuation Manual as then in effect, applied as follows:

(i) For Covered Policies described in section 5(b)(i) above, the Actuarial Method is the greater of the Deterministic Reserve or the Net Premium Reserve (NPR) regardless of whether the criteria for exemption testing can be met. However, if the Covered Policies do not meet the requirements of the Stochastic Reserve exclusion test in the Valuation Manual, then the Actuarial Method is the greatest of the Deterministic Reserve, the Stochastic Reserve, or the NPR. In addition, if such Covered Policies are reinsured in a reinsurance treaty that also contains Covered Policies described in section 5(b)(ii) above, the ceding insurer may elect to instead use paragraph (ii) below as the Actuarial Method for the entire reinsurance agreement. Whether paragraph (i) or (ii) are used, the Actuarial Method shall comply with any requirements or restrictions that the Valuation Manual imposes when aggregating these policy types for purposes of principle-based reserve calculations.

(ii) For Covered Policies described in section 5(b)(ii) above, the Actuarial Method is the greatest of the Deterministic Reserve, the Stochastic Reserve, or the NPR, regardless of whether the criteria for exemption testing can be met.

(iii) Except as provided in paragraph (iv) below, the Actuarial Method shall be applied on a gross basis to all risks with respect to the Covered Policies as originally issued or assumed by the ceding insurer.

(iv) If the reinsurance treaty cedes less than one hundred percent (100%) of the risk with respect to the Covered Policies then the Required Level of Primary Security may be reduced as follows:

(A) If a reinsurance treaty cedes only a quota share of some or all of the risks pertaining to the Covered Policies, the Required Level of Primary Security, as well as any adjustment under subparagraph (C) below, may be reduced to a pro rata portion in accordance with the percentage of the risk ceded;

(B) If the reinsurance treaty in a non-exempt arrangement cedes only the risks pertaining to a secondary guarantee, the Required Level of Primary Security may be reduced by an amount determined by applying the Actuarial Method on a gross basis to all risks, other than risks related to the secondary guarantee, pertaining to the Covered Policies, except that for Covered Policies for which the ceding insurer did not elect to apply the provisions of VM-20 to establish statutory reserves, the Required Level of Primary Security may be reduced by the statutory reserve retained by the ceding insurer on those Covered Policies, where the retained reserve of those Covered Policies should be reflective of any reduction pursuant to the cession of mortality risk on a yearly renewable term basis in an exempt arrangement;

(C) If a portion of the Covered Policy risk is ceded to another reinsurer on a yearly renewable term basis in an exempt arrangement, the Required Level of Primary Security may be reduced by the amount resulting by applying the Actuarial Method including the reinsurance section of VM-20 to the portion of the Covered Policy risks ceded in the exempt arrangement, except that for Covered Policies issued prior to January 1, 2017, this adjustment is not to exceed [cx/(2 * number of reinsurance premiums per year)] where cx is calculated using the same mortality table used in calculating the Net Premium Reserve; and

(D) For any other treaty ceding a portion of risk to a different reinsurer, including but not limited to stop loss, excess of loss, and other non-proportional reinsurance treaties, there shall be no reduction in the Required Level of Primary Security.

(v) It is possible for any combination of subparagraphs (A), (B), (C), and (D) above to apply. Adjustments to the Required Level of Primary Security shall be done in the sequence that accurately reflects the portion of the risk ceded via the treaty. The ceding insurer shall document the rationale and steps taken to accomplish the adjustments to the Required Level of Primary Security due to the cession of less than one hundred percent (100%) of the risk.

(vi) The Adjustments for other reinsurance will be made only with respect to reinsurance treaties entered into directly by the ceding insurer. The ceding insurer shall make no adjustment as a result of a retrocession treaty entered into by the assuming insurers.

(vii) In no event shall the Required Level of Primary Security resulting from application of the Actuarial Method exceed the amount of statutory reserves ceded.

(viii) If the ceding insurer cedes risks with respect to Covered Policies, including any riders, in more than one reinsurance treaty subject to this Regulation, in no event will the aggregate Required Level of Primary Security for those reinsurance treaties be less than the Required Level of Primary Security calculated using the Actuarial Method as if all risks ceded in those treaties were ceded in a single treaty subject to this Regulation;

(ix) If a reinsurance treaty subject to this Regulation cedes risk on both Covered and Non-Covered Policies, credit for the ceded reserves shall be determined as follows:

(A) The Actuarial Method shall be used to determine the Required Level of Primary Security for the Covered Policies, and section 7 shall be used to determine the reinsurance credit for the Covered Policy reserves; and

(B) Credit for the Non-Covered Policy reserves shall be granted only to the extent that security, in addition to the security held to satisfy the requirements of subparagraph (A), is held by or on behalf of the ceding insurer in accordance with W.S. 26-5-112 and 26-5-113. Any Primary Security used to meet the requirements of this subparagraph may not be used to satisfy the Required Level of Primary Security for the Covered Policies.

(b) Valuation used for Purposes of Calculations: For the purposes of both calculating the Required Level of Primary Security pursuant to the Actuarial Method and determining the amount of Primary Security and Other Security, as applicable, held by or on behalf of the ceding insurer, the following shall apply:

(i) For assets, including any assets held in trust, that would be admitted under the NAIC Accounting Practices and Procedures Manual if they were held by the ceding insurer, the valuations shall be determined according to statutory accounting procedures as if the assets were held in the ceding insurer's general account and without taking into consideration the effect of any prescribed or permitted practices; and

(ii) For all other assets, the valuations are to be those that were assigned to the assets for the purpose of determining the amount of reserve credit taken. In addition, the asset spread tables and asset default cost tables required by VM-20 shall be included in the Actuarial Method if adopted by the NAIC's Life Actuarial (A) Task Force no later than the December 31st on or immediately preceding the valuation date for which the Required Level of Primary Security is being calculated. The tables of asset spreads and asset default costs shall be incorporated into the Actuarial Method in the manner specified in VM-20.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.69.02212018 § 7 Requirements Applicable to Covered Policies to Obtain Credit for Reinsurance; Opportunity for Remediation

(a) Requirements: Subject to the exemptions described in section 4 and the provisions of section 7(b), credit for reinsurance shall be allowed with respect to ceded liabilities pertaining to Covered Policies pursuant to W.S. 26-5-112 or 26-5-113 if, and only if, in addition to all other requirements imposed by law or regulation, the following requirements are met on a treaty-by-treaty basis:

(i) The ceding insurer's statutory policy reserves with respect to the Covered Policies are established in full and in accordance with the applicable requirements of W.S. 26-6-201 et seq. and related regulations and actuarial guidelines, and credit claimed for any reinsurance treaty subject to this regulation does not exceed the proportionate share of those reserves ceded under the contract;

(ii) The ceding insurer determines the Required Level of Primary Security with respect to each reinsurance treaty subject to this regulation and provides support for its calculation as determined to be acceptable to the commissioner;

(iii) Funds consisting of Primary Security, in an amount at least equal to the Required Level of Primary Security, are held by or on behalf of the ceding insurer, as security under the reinsurance treaty within the meaning of W.S. 26-5-113, on a funds withheld, trust, or modified coinsurance basis;

(iv) Funds consisting of Other Security, in an amount at least equal to any portion of the statutory reserves as to which Primary Security is not held pursuant to paragraph (iii) above, are held by or on behalf of the ceding insurer as security under the reinsurance treaty within the meaning of W.S. 26-5-113; and

(v) Any trust used to satisfy the requirements of this section 7 shall comply with all of the conditions and qualifications of Chapter 50, Section 11, of the Wyoming Insurance Department regulations, except that:

(A) Funds consisting of Primary Security or Other Security held in trust, shall for the purposes identified in section 6(b), be valued according to the valuation rules set forth in section 6(b), as applicable;

(B) There are no affiliate investment limitations with respect to any security held in trust if the security is not needed to satisfy the requirements of section 7(a)(iii);

(C) The reinsurance treaty shall prohibit withdrawals or substitutions of trust assets that would leave the fair market value of the Primary Security within the trust (when aggregated with Primary Security outside the trust that is held by or on behalf of the ceding insurer in the manner required by section 7(a)(iii)) below one hundred two percent (102%) of the level required by section 7(a)(iii) at the time of the withdrawal or substitution; and

(D) The determination of reserve credit under Chapter 50, Section 11(e) of the Wyoming Insurance Department regulations shall be determined according to the valuation rules set forth in section 6(b), as applicable; and

(vi) The reinsurance treaty has been approved by the commissioner.

(b) Requirements at Inception Date and on an On-going Basis; Remediation.

(i) The requirements of section 7(a) shall be satisfied as of the date that risks under Covered Policies are ceded (if the date is on or after the effective date of this regulation) and on an ongoing basis thereafter. Under no circumstances shall a ceding insurer take or consent to any action or series of actions that would result in a deficiency under section 7(a)(iii) or 7(a)(iv) with respect to any reinsurance treaty under which Covered Policies have been ceded, and in the event that a ceding insurer becomes aware at any time that such a deficiency exists, it shall use its best efforts to arrange for the deficiency to be eliminated as expeditiously as possible.

(ii) Prior to the due date of each Quarterly or Annual Statement, each life insurance company that has ceded reinsurance within the scope of section 3 shall perform an analysis, on a treaty-by-treaty basis, to determine, as to each reinsurance treaty under which Covered Policies have been ceded, whether as of the end of the immediately preceding calendar quarter (the valuation date), the requirements of sections 7(a)(iii) and 7(a)(iv) were satisfied. The ceding insurer shall establish a liability equal to the excess of the credit for reinsurance taken over the amount of Primary Security actually held pursuant to section 7(a)(iii), unless either:

(A) The requirements of section 7(a)(iii) and 7(a)(iv) were fully satisfied as of the valuation date as to such reinsurance treaty; or

(B) Any deficiency has been eliminated before the due date of the Quarterly or Annual Statement to which the valuation date relates through the addition of Primary Security and/or Other Security, as the case may be, in an amount and in a form that would have caused the requirements of section 7(a)(iii) and 7(a)(iv) to be fully satisfied as of the valuation date.

(iii) Nothing in section 7(b)(ii) shall be construed to allow a ceding company to maintain any deficiency under section 7(a)(iii) or 7(a)(iv) for any period of time longer than is reasonably necessary to eliminate it.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.69.02212018 § 8 Severability

If any provision of this regulation is held invalid, the remainder shall not be affected.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.69.02212018 § 9 Prohibition against Avoidance

No insurer that has Covered Policies as to which this regulation applies (as set forth in section 3) shall take any action or series of actions, or enter into any transaction or arrangement or series of transactions or arrangements if the purpose of the action, transaction or arrangement or series thereof is to avoid the requirements of this regulation, or to circumvent its purpose and intent, as set forth in section 2.

History

• Effective 2018-02-21

Wyo. Code R. 044.0002.69.02212018 § 10 Effective Date

This regulation shall become effective upon filing with the Secretary of State and shall pertain to all Covered Policies in force as of and after that date.

69-1

History

• Effective 2018-02-21

Chapter 70 Corporate Governance Annual Disclosure

Wyo. Code R. 044.0002.70.04022019 Corporate Governance Annual Disclosure

Model 450 - Ins. Holding Company System Mod. Reg.

CHAPTER 70

CORPORATE GOVERNANCE ANNUAL DISCLOSURE

Section 1. Authority. This regulation is promulgated pursuant to Wyoming Statute §§ 16‑3‑101 et seq., 26-2-110, and 26-54-101 et seq.

Section 2. Purpose. The purpose of this regulation is to set forth the procedures for filing, and the required contents, of the Corporate Governance Annual Disclosure (CGAD) as deemed necessary by the Commissioner to carry out the provisions of W. S. § 26-54-101 et seq.

Section 3. Definitions.

(a) "Commissioner." The Wyoming Insurance Commissioner.

(b) "Insurance group." For the purpose of this Act, the term "insurance group" shall mean those insurers and affiliates included within an insurance holding company system as defined in W. S. § 26-44-101(a)(iv).

(c) "Insurer." The term "insurer" shall have the same meaning as set forth in W. S. § 26‑54‑102(a)(iv), except that it shall not include agencies, authorities, or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state.

(d) "Senior Management." The term "senior management" shall mean any corporate officer responsible for reporting information to the board of directors at regular intervals or providing this information to shareholders or regulators and shall include, for example and without limitation, the Chief Executive Officer ("CEO"), Chief Financial Officer ("CFO"), Chief Operations Officer ("COO"), Chief Procurement Officer ("CPO"), Chief Legal Officer ("CLO"), Chief Information Officer ("CIO"), Chief Technology Officer ("CTO"), Chief Revenue Officer ("CRO"), Chief Visionary Officer ("CVO"), or any other "C" level executive.

Section 4. Filing Procedures.

(a) An insurer, or the insurance group of which the insurer is a member, required to file a CGAD by W. S. § 26-54-101 et seq, shall, no later than June 1 of each calendar year, submit to the Commissioner a CGAD containing the information described in Section 5 of this regulation.

(b) The CGAD must include a signature of the insurer's or insurance group's chief executive officer or corporate secretary attesting that to the best of that individual's belief and knowledge that the insurer or insurance group has implemented the corporate governance practices and that a copy of the CGAD has been provided to the insurer's or insurance group's Board of Directors (hereafter "Board") or the appropriate committee thereof.

(c) The insurer or insurance group shall have discretion regarding the appropriate format for providing the information required by these regulations and is permitted to customize the CGAD to provide the most relevant information necessary to permit the Commissioner to gain an understanding of the corporate governance structure, policies, and practices utilized by the insurer or insurance group.

(d) For purposes of completing the CGAD, the insurer or insurance group may choose to provide information on governance activities that occur at the ultimate controlling parent level, an intermediate holding company level and/or the individual legal entity level, depending upon how the insurer or insurance group has structured its system of corporate governance. The insurer or insurance group is encouraged to make the CGAD disclosures at the level at which the insurer's or insurance group's risk appetite is determined, or at which the earnings, capital, liquidity, operations, and reputation of the insurer are overseen collectively and at which the supervision of those factors are coordinated and exercised, or the level at which legal liability for failure of general corporate governance duties would be placed. If the insurer or insurance group determines the level of reporting based on these criteria, it shall indicate which of the three criteria was used to determine the level of reporting and explain any subsequent changes in level of reporting.

(e) Notwithstanding subparagraph (a) of this Section, and as outlined in W. S. § 26‑54‑103, if the CGAD is completed at the insurance group level, then it must be filed with the lead state of the group as determined by the procedures outlined in the most recent Financial Analysis Handbook adopted by the NAIC. In these instances, a copy of the CGAD must also be provided to the chief regulatory official of any state in which the insurance group has a domestic insurer, upon request.

(f) An insurer or insurance group may comply with this section by referencing other existing documents (e.g., ORSA Summary Report, Holding Company Form B or F Filings, Securities and Exchange Commission (SEC) Proxy Statements, foreign regulatory reporting requirements, etc.) if the documents provide information that is comparable to the information described in Section 5. The insurer or insurance group shall clearly reference the location of the relevant information within the CGAD and attach the referenced document if it is not already filed or available to the regulator.

(g) Each year following the initial filing of the CGAD, the insurer or insurance group shall file an amended version of the previously filed CGAD indicating where changes have been made. If no changes were made in the information or activities reported by the insurer or insurance group, the filing should so state.

Section 5. Contents of Corporate Governance Annual Disclosure.

(a) The insurer or insurance group shall be as descriptive as possible in completing the CGAD, with inclusion of attachments or example documents that are used in the governance process, since these may provide a means to demonstrate the strengths of their governance framework and practices.

(b) The CGAD shall describe the insurer's or insurance group's corporate governance framework and structure including consideration of the following:

(i) The Board and various committees thereof ultimately responsible for overseeing the insurer or insurance group and the level(s) at which that oversight occurs (e.g., ultimate control level, intermediate holding company, legal entity, etc.). The insurer or insurance group shall describe and discuss the rationale for the current Board size and structure; and

(ii) The duties of the Board and each of its significant committees and how they are governed (e.g., bylaws, charters, informal mandates, etc.), as well as how the Board's leadership is structured, including a discussion of the roles of Chief Executive Officer (CEO) and Chairman of the Board within the organization.

(c) The insurer or insurance group shall describe the policies and practices of the most senior governing entity and significant committees thereof, including a discussion of the following factors:

(i) How the qualifications, expertise, and experience of each Board member meet the needs of the insurer or insurance group.

(ii) How an appropriate amount of independence is maintained on the Board and its significant committees.

(iii) The number of meetings held by the Board and its significant committees over the past year as well as information on director attendance.

(iv) How the insurer or insurance group identifies, nominates, and elects members to the Board and its committees. The discussion should include, for example:

(A) Whether a nomination committee is in place to identify and select individuals for consideration.

(B) Whether term limits are placed on directors.

(C) How the election and re-election processes function.

(D) Whether a Board diversity policy is in place and if so, how it functions.

(v) The processes in place for the Board to evaluate its performance and the performance of its committees, as well as any recent measures taken to improve performance (including any Board or committee training programs that have been put in place).

(d) The insurer or insurance group shall describe the policies and practices for directing Senior Management, including a description of the following factors:

(i) Any processes or practices (i.e., suitability standards) to determine whether officers and key persons in control functions have the appropriate background, experience, and integrity to fulfill their prospective roles, including:

(A) Identification of the specific positions for which suitability standards have been developed and a description of the standards employed.

(B) Any changes in an officer's or key person's suitability as outlined by the insurer's or insurance group's standards and procedures to monitor and evaluate such changes.

(ii) The insurer's or insurance group's code of business conduct and ethics, the discussion of which considers, for example:

(A) Compliance with laws, rules, and regulations; and

(B) Proactive reporting of any illegal or unethical behavior.

(iii) The insurer's or insurance group's processes for performance evaluation, compensation, and corrective action to ensure effective senior management throughout the organization, including a description of the general objectives of significant compensation programs and what the programs are designed to reward. The description shall include sufficient detail to allow the Commissioner to understand how the organization ensures that compensation programs do not encourage and/or reward excessive risk taking. Elements to be discussed may include, for example:

(A) The Board's role in overseeing management compensation programs and practices;

(B) The various elements of compensation awarded in the insurer's or insurance group's compensation programs and how the insurer or insurance group determines and calculates the amount of each element of compensation paid;

(C) How compensation programs are related to both company and individual performance over time;

(D) Whether compensation programs include risk adjustments and how those adjustments are incorporated into the programs for employees at different levels;

(E) Any clawback provisions built into the programs to recover awards or payments if the performance measures upon which they are based are restated or otherwise adjusted;

(F) Any other factors relevant in understanding how the insurer or insurance group monitors its compensation policies to determine whether its risk management objectives are met by incentivizing its employees.

(iv) The insurer's or insurance group's plans for CEO and Senior Management succession.

(e) The insurer or insurance group shall describe the processes by which the Board, its committees, and Senior Management ensure an appropriate amount of oversight to the critical risk areas impacting the insurer's business activities, including a discussion of:

(i) How oversight and management responsibilities are delegated between the Board, its committees, and Senior Management;

(ii) How the Board is kept informed of the insurer's strategic plans, the associated risks, and steps that Senior Management is taking to monitor and manage those risks;

(iii) How reporting responsibilities are organized for each critical risk area. The description should allow the Commissioner to understand the frequency at which information on each critical risk area is reported to and reviewed by Senior Management and the Board. This description may include, for example, the following critical risk areas of the insurer:

(A) Risk management processes (an ORSA Summary Report filer may refer to its ORSA Summary Report pursuant to the Risk Management and Own Risk and Solvency Assessment Model Act);

(B) Actuarial function;

(C) Investment decision-making processes;

(D) Reinsurance decision-making processes;

(E) Business strategy/finance decision-making processes;

(F) Compliance function;

(G) Financial reporting/internal auditing; and

(H) Market conduct decision-making processes.

Section 6. Effective Date. This regulation shall be effective July 1, 2019.

History

• Effective 2019-04-02

Chapter 71 Multiple Employer Welfare Arrangments (MEWAs)

Wyo. Code R. 044.0002.71.02092022 Multiple Employer Welfare Arrangments (MEWAs)

CHAPTER 71

Multiple Employer Welfare Arrangements (MEWAs)

Section 1. Authority. This Chapter is promulgated pursuant to W.S. §§ 16-3-101 et seq., 26-2-110(a), 26-19-115, and 26-4-101.

Section 2. Scope. This Chapter sets forth requirements, forms, and procedures regarding multiple employer welfare arrangements (MEWAs), as defined in W.S. § 26-1-102(a)(xliii).

Section 3. Definitions for purposes of this Chapter are as follows:

(a) "Administrative Services Only (ASO) Contract" means an arrangement in which an employer hires a third party to deliver administrative services to the employer such as claims processing and billing; the employer bears the risk for claims.

(b) "Carrier" shall be as defined in W.S. § 26-19-302(a)(v).

(c) "Commissioner" means the Wyoming Insurance Commissioner.

(d) "Department" means the Wyoming Department of Insurance.

(e) "Employee Welfare Benefit Plan," as used in this Chapter, has the same meaning as that contained in 29 U.S.C. § 1002(1).

(f) "Employer" for purposes of this Chapter means a group of employers that will be treated as the "employer" sponsor of a single multiple-employer employee welfare benefit plan, or "group health plan" as those terms are defined in Title I of the Employee Retirement Income Security Act (ERISA) of 1974, 29 U.S.C. § 1001 et seq., as amended.

(g) "Fully Insured Health Benefit Plan" means a health benefit plan in which the MEWA purchases health coverage from a state-licensed insurer and the insurer assumes the risk of paying the medical claims of the MEWA's enrolled members.

(h) "Health Benefit Plan" means any hospital or medical policy or certificate, major medical expense insurance, hospital or medical service plan contract or health maintenance organization subscriber contract. "Health benefit plan" does not include accident-only, credit, dental, vision, Medicare supplement, long-term care or disability income insurance, coverage issued as a supplement to liability insurance, worker's compensation or similar insurance or automobile medical-payment insurance, nor does it include policies or certificates of specified disease, hospital confinement indemnity or limited benefit health insurance if the carrier offering the policies or certificates certifies to the commissioner that policies or certificates described in this paragraph are being offered and marketed as supplemental health insurance and not as a substitute for hospital or medical expense insurance or major medical expense insurance as defined in W.S. § 26-19-302(a)(xii).

(i) "Insurer" shall be as defined in W.S. § 26-1-102(a)(xvi).

(j) "Member" means any employee or former employee of an employer, or any current or former participant of an employee organization, or eligible dependent of an employee who is or may become eligible to receive a benefit of any type from an employee welfare benefit plan which covers employees of such employer or members of such organization, or whose beneficiaries may be eligible to receive any such benefit.

(k) "Multiple Employer Welfare Arrangement" or "MEWA", for purposes of this Chapter, shall be as defined in W.S. § 26-1-102(a)(xliii).

(l) "Qualified Actuary" means an individual who is qualified to sign the applicable statement of actuarial opinion in accordance with the American Academy of Actuaries qualification standards for actuaries signing the statements and who meets the requirements specified in the valuation manual.

(m) "Self-Insured Health Benefit Plan" means a health benefit plan that is provided directly by the MEWA for its members by providing funds to pay for a health benefit plan directly and the MEWA bearing the risk for covering medical claims.

(n) "Third Party Administrator" or "TPA" 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 stop-loss coverage offered or provided by a MEWA.

Section 4. Third Party Administrator Requirements.

(a) MEWAs that offer fully insured health benefit plans and utilize a TPA shall use a TPA that holds a license issued by the Department.

(b) MEWAs that offer self-insured health benefit plans and utilize a TPA shall use a TPA that complies with all requirements of Chapter 4 of the Wyoming Insurance Regulations applicable to TPAs performing services on behalf of insurers.

Section 5. Licensing Requirements. A MEWA intending to offer a fully insured health benefit plan or a self-insured health benefit plan in this state shall be licensed by the Department prior to engaging in the business of insurance.

(a) All MEWA applications for license shall be on a form prescribed by the Department and shall include:

(i) A complete copy of the MEWA's most recently filed U.S. Department of Labor, Form M-1;

(ii) Mailing address, Employer Identification Number (EIN), contact person's name, email address, and telephone number at which communications are to be received;

(iii) Names and addresses of the employer members;

(iv) Total number of covered lives by employer;

(v) Eligibility requirements for employer membership in the MEWA;

(vi) Fees, if any, charged for membership;

(vii) A copy of the MEWA's by-laws, trust documents, articles of incorporation or other organizational documents;

(viii) All policies, certificates, and contracts of insurance for prior approval before use in accordance with W. S. § 26-15-110 et. seq.

(ix) Proof of registration for all names registered with the Wyoming Secretary of State or written confirmation from the Secretary of State that no registration is required;

(x) The name and contact information for the Wyoming registered agent;

(xi) A copy of all current contracts between the MEWA and insurers or third party administrators to provide coverage for health care benefits and services to be offered in Wyoming; and

(xii) A $500 annual fee as required in W.S. § 26-4-101.

(b) A MEWA offering a self-insured health benefit plan shall provide the following with an application for license, in addition to the required items in subsection (a) of this section:

(i) For MEWAs that have been in business three (3) years or less, a feasibility study, including, but not limited to, the methodology for establishing the contributions of its members. Such contributions shall be based on reasonable assumptions and certified by an actuary;

(ii) For MEWAs that have been in business for more than three (3) years, a written narrative that explains how member contributions are calculated and how loss reserves are established. Include details of who reviews these calculations (e. g. a qualified actuary, the stop-loss carrier, etc);

(iii) Evidence of stop-loss insurance coverage issued by an insurance company that is licensed in Wyoming;

(iv) A dissolution plan containing general provisions on how the MEWA will be wound down, including how any remaining funds would be handled if the MEWA is dissolved and who would make up any shortfall if the MEWA becomes insolvent;

(v) Most recent annual audited financial statement as defined in Section 6(b)(i) of this Chapter, showing that the MEWA is financially solvent; and

(vi) An Actuarial Opinion from a qualified actuary stating that the reserves for the MEWA are adequate and in compliance with actuarial standards. If the MEWA does not contract with a qualified actuary and does not receive an actuarial opinion in the ordinary course of business, provide supporting documentation showing that the MEWA's stop-loss carrier has reviewed and approved the MEWA's contribution levels and the MEWA's reported loss reserve.

(c) If the MEWA is domiciled outside of Wyoming, in addition to the requirements set forth in Sections 5(a) and (b), the MEWA shall provide copies of all materials used by the MEWA to secure approval in the domiciliary state, including evidence of approval by that domiciliary state.

Section 6. Renewal Requirements.

(a) MEWAs offering fully insured health benefit plans or self-insured health benefit plans in Wyoming, shall submit the following information annually, on or before June 1:

(i) The renewal form as prescribed by the Commissioner and posted on the Department's website and all supporting documentation of the information provided therein;

(ii) A copy of the MEWA's most recently filed U.S. Department of Labor, Form M-1;

(iii) Total number of covered lives by employer;

(iv) Any changes in information previously filed with the Commissioner; and

(v) A $500 filing fee.

(b) In addition to the required items in subparagraph (a), a MEWA offering a self-insured health benefit plan shall provide the following with an application for license renewal:

(i) An audited financial statement for the most recently completed fiscal year certified by an independent certified public accountant. The financial statement shall be prepared in accordance with Generally Accepted Accounting Principles (GAAP). At a minimum, the audited financial statement shall contain the following exhibits for the current and prior fiscal year:

(A) Balance sheet;

(B) Statement of gain or loss from operations;

(C) Statement of changes in financial position;

(D) Notes to financial statements; and

(E) Management and internal control letters.

(ii) A statement of opinion as to the loss and loss expense reserves certified by a qualified actuary. If the MEWA does not contract with a qualified actuary and does not receive an actuarial opinion in the ordinary course of business, provide supporting documentation showing that the MEWA's stop-loss carrier has reviewed and approved the MEWA's contribution levels and the MEWA's reported loss reserve.

(iii) Evidence of stop-loss insurance coverage issued by an insurance company that is licensed in Wyoming.

(iv) In addition to the annual audited financial statement, the Commissioner may require any MEWA to file additional financial information including, but not limited to, interim financial reports, additional financial reports or exhibits, or statements considered necessary to secure complete information concerning the condition, solvency, experience, transactions, or affairs of the MEWA. The Commissioner shall establish reasonable deadlines for filing these additional reports, exhibits, or statements. The Commissioner may require verification of any additional required information.

(c) All filings made under this Chapter shall be submitted by hand-delivery or mail to the Wyoming Department of Insurance.

Section 7. Application Review. If the commissioner finds that the MEWA meets the requirements under this Chapter, he shall issue the MEWA a proper license or renewal. If he finds that the MEWA does not meet the requirements, the commissioner shall issue his order refusing the license with a statement of the reason for refusal. The commissioner shall act upon an application for license or renewal after its complete submission.

Section 8. Policy and Form Filing Requirements.

(a) A MEWA operating in Wyoming shall file all health benefit plan documents including: policies, certificates, and contracts with the Department for prior approval before use in accordance with W.S. § 26- 15-110 et seq.

(b) Every health benefit plan offered by a MEWA shall include a process for subscribers to appeal adverse benefit determinations. The appeal process shall substantially conform with the procedural requirements of Wyoming Statute Title 26, Chapter 40, whether the basis for denial is medical necessity or any other similar basis.

(c) The following notice shall be provided on the face of the policy and any Certificate issued to Wyoming employers and employees who obtain coverage from a MEWA and shall be printed in no less than 12-point boldface type of uniform font:

"NOTICE: The Multiple Employer Welfare Arrangement

(MEWA) is not an insurance company. For additional

information about the MEWA, you should ask questions of

your MEWA administrator, your employer, or you may

contact the Wyoming Department of Insurance. Guaranty

Fund coverage is not available to the MEWA."

Section 9. Records Retention. A MEWA doing business in Wyoming shall maintain its books and records in accordance with the Wyoming Insurance Code.

Section 10. Enforcement.

(a) This Chapter shall not be construed to limit the enforcement authority of the Commissioner otherwise provided in the Wyoming Insurance Code.

(b) The Commissioner may, in his or her discretion, examine the business and financial affairs of a MEWA doing business in this State utilizing the powers granted under the Wyoming Insurance Code. The reasonable and proper expense of examination of the MEWA shall be borne by the MEWA.

(c) The MEWA must report any administrative actions against the MEWA taken by another jurisdiction or by another governmental entity to the Department within thirty (30) days of the final disposition of the matter.

(d) The Commissioner may decline to issue or renew a license issued pursuant to W.S. § 26-19-115(e) and this Chapter if the Commissioner finds that a MEWA does not satisfy any standard or requirement of this Chapter or any provision of other applicable State or federal law or regulation.

(e) The Commissioner may place on probation, suspend, revoke, or refuse to issue or renew a license issued by the Department, or may levy a civil penalty in accordance with W.S. § 26-1-107 or any combination of actions for a violation of any applicable Department rule or any provision of applicable State and federal law.

(f) When the Commissioner believes that a MEWA or any other person is operating in this State without being duly licensed or has violated the law, an administrative rule of the Department, or an Order of the Commissioner, the Commissioner may issue an order to cease and desist such violation or take any other action set forth in law or rule.

Section 11. Insurance Producers and Brokers. A person, including a licensed producer, a broker, or other individual, soliciting, offering, or selling a health benefit plan on behalf of a MEWA to a Wyoming employer or a Wyoming resident, prior to engaging in or assisting any person to engage in offering a MEWA, shall carry out and document appropriate due diligence to establish, at a minimum, the following:

(a) That the insurer or TPA is licensed in Wyoming;

(b) That the MEWA is licensed in Wyoming; and

(c) That the disclosure listed in subsection 8(c) is in the policy document.

History

• Effective 2022-02-09

Chapter 72 Prior Authorization

Wyo. Code R. 044.0002.72.11152024 Prior Authorization

Chapter 72

Prior Authorization

Section 1. Authority. This Chapter is promulgated by authority of and pursuant to W.S. §§16-3-101 through 16-3-106, W.S. §§ 26-55-101 et seq.

Section 2. Scope. This regulation sets forth the requirements and procedures for health insurers and contracted utilization review entities, as defined in W.S. § 26-55-102, that are conducting the business of insurance in this state for prior authorization requirements of W.S. §§ 26-55-101 et seq.

Section 3. Definitions. The definitions provided in W.S. 26-55-102 shall apply to the interpretation of this regulation.

Section 4. Reports.

(a) Each health insurer or contracted utilization review entity engaged in the business of insurance in this state which require some or all policy benefits to undergo prior authorization, shall provide a report containing the categories of information identified in W.S. § 26-55-103(d) by:

(i) Providing the report directly to the insurance commissioner upon request; and

(ii) Posting the report on the insurer's or contracted utilization review entity's website. The location of the report shall be clearly indicated on the home page of the reporting health insurer's or reporting contracted utilization review entity's website.

(b) The report required under Subsection (a) above shall be made on a form prescribed by the Commissioner. The required form, Prior Authorization Statistics Reporting Form, is located at http://doi.wyo.gov.

(c) Beginning with the initial report on January 30, 2025, the report shall be made available on the health insurer's or contracted utilization review entity's website on April 30, July 30, October 30, and January 30 of each calendar year.

(d) Each reporting health insurer or reporting contracted utilization review entity shall maintain and make available to the public on their website the most recent four (4) reports that have been filed.

(e) Every year all health insurers or contracted utilization review entities shall file an annual report with the Commissioner on or before March 1, indicating where the required reports can be found and the dates they were updated. The annual report shall be filed a form prescribed by the Commissioner. The required form, Annual Prior Authorization Reporting Form, is located at http://doi.wyo.gov.

Section 5. Disclosure Records Retention. Health insurers or contracted utilization review entities shall keep and maintain all records regarding compliance with W.S. § 26-55-101 et seq. and this regulation for a minimum of five (5) years and shall make that information available to the commissioner upon reasonable request.

History

• Effective 2024-11-15

Chapter 73 Provider Exemptions for Prior Authorization

Wyo. Code R. 044.0002.73.12032025 § 1 Authority

This Chapter is promulgated by authority of and pursuant to W.S. §§ 26-2-110, 26-5-103, 26-15-110, 16-3-101 through 16-3-106, 26-40-102, 26-40-201, and 26-55-101 et seq.

History

• Effective 2025-12-03

Wyo. Code R. 044.0002.73.12032025 § 2 Applicability

This regulation shall not apply to healthcare providers who have not entered into a written agreement with a health insurer or contracted utilization review entity as provided in W.S. § 26-22-503. Out of state providers are ineligible to receive provider exemptions.

History

• Effective 2025-12-03

Wyo. Code R. 044.0002.73.12032025 § 3 Definitions

The definitions provided in W.S. §§ 26-55-102 and 26-5-103 shall apply to the interpretation of this regulation.

History

• Effective 2025-12-03

Wyo. Code R. 044.0002.73.12032025 § 4 Initial Exemption

. Health Insurers or contracted utilization review entities shall establish a procedure to verify a healthcare provider's initial exemption from prior authorization requirements pursuant to W.S. § 26-55-112 on or before March 31, 2026. These procedures shall be made available to the Commissioner upon request.

History

• Effective 2025-12-03

Wyo. Code R. 044.0002.73.12032025 § 5 Appeals

Health insurers or contracted utilization review entities shall establish an appeal process in the event a healthcare service is denied for lack of provider exemption from prior authorization requirements or lack of prior authorization. This appeal process language shall be included in all insurance policies and contract forms subject to W.S.§ 26-15-110.

History

• Effective 2025-12-03

Wyo. Code R. 044.0002.73.12032025 § 6 Exemption review

. Every twelve (12) months a health insurer or contracted utilization entity may review the exemption status of a health care provider. The health care provider shall comply with the review. Failure to comply with the review may be grounds for an exemption to be revoked.

History

• Effective 2025-12-03

Wyo. Code R. 044.0002.73.12032025 § 7 Verification of Exemption

When prior authorization is required by a health insurer or contracted utilization review entity, a healthcare provider shall not perform a healthcare service without prior authorization unless the healthcare provider has received confirmation from the health insurer or contracted utilization review entity that the healthcare provider is exempt from prior authorization requirements pursuant to W.S.§ 26-55-112(h).

History

• Effective 2025-12-03

Wyo. Code R. 044.0002.73.12032025 § 8 Policy Disclosure Regarding Provider Exemptions from Prior Authorization Requirements

All disability policies delivered or issued for delivery in this state on or after January 1, 2026 shall contain a notice within the policy or contract form stating whether W.S. § 26-55-112 applies.

History

• Effective 2025-12-03

Wyo. Code R. 044.0002.73.12032025 § 9 Prior Authorization Requests in Addition to Exemptions

Nothing in W.S. § 26-55-112 or this regulation shall be interpreted to prevent or prohibit a healthcare provider from obtaining a prior authorization from the health insurer or contracted utilization review entity.

History

• Effective 2025-12-03

Wyo. Code R. 044.0002.73.12032025 § 10 Payment of Claim Under Medical Necessity Standard

Any adverse determination based on medical necessity as defined by W.S. 26-40-102(a)(iii) resulting from a prior authorization or claim processing error shall be subject to the internal and external review procedures described in W.S. 26-40-201.

History

• Effective 2025-12-03