title26.docx - TITLE 26 INSURANCE CODE CHAPTER 1 SCOPE OF CODE Short title This act constitutes the Wyoming Insurance Code(a Definitions As used in this

title26.docx - TITLE 26 INSURANCE CODE CHAPTER 1 SCOPE OF...

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Unformatted text preview: TITLE 26 - INSURANCE CODE CHAPTER 1 - SCOPE OF CODE 26-1-101. Short title. This act constitutes the Wyoming Insurance Code. 26-1-102. (a) Definitions. As used in this act: (i) "Adjuster" means any individual who, for compensation as an independent contractor, or as the employee of an independent contractor, or as a salaried employee of an insurer, or for fee or commission, on behalf of the insurer investigates and negotiates settlement of claims arising under insurance contracts, except that an attorney-at-law who is licensed to practice law in this state, or a licensed agent or broker who adjusts or assists in adjustment of losses arising under policies issued through that broker or by the insurer represented by that agent, is not an adjuster for the purposes of chapter 9 of this code; (ii) "Agent" means any individual, firm or corporation appointed by an insurer to solicit applications for insurance or annuities or to negotiate insurance or annuities on its behalf; (iii) "Alien" insurer means an insurer formed under the laws of any country other than the United States of America or any of its states; (iv) "Annuity" means a contract under which obligations are assumed with respect to periodic payments where the making or continuance of all or some of the payments, or the amount of the payments, is dependent upon the continuance of human life, and a contract which includes extra benefits of the kinds set forth in W.S. 26-5-102 and 26-5-103 is an annuity if the extra benefits constitute a subsidiary or incidental part of the entire contract; (v) "Authorized" insurer means an insurer authorized by a subsisting certificate of authority issued by the commissioner to transact insurance in this state; (vi) "Broker", except as used in chapter 11 of this code, means a resident individual, firm or corporation organized under the laws of the state of Wyoming who, not being an agent of the insurer, as an independent contractor and on behalf of the insured, for compensation or fee solicits, negotiates or procures insurance or the renewal or continuance thereof for insureds or prospective insureds, other than himself; (vii) "Charter" means articles of incorporation, agreement or association, charter granted by legislative act, or other basic constituent document of a corporation or the power of attorney of the attorney-in-fact of a reciprocal insurer; (viii) of this state; "Commissioner" means the insurance commissioner (ix) "Department" means the department of insurance of this state, unless the context otherwise requires; (x) "Domestic" insurer means an insurer formed under the laws of Wyoming; (xi) "Domicile" of an insurer means: (A) As to Canadian insurers, Canada and the province in which the insurer's head office is located; (B) As to other alien insurers authorized to transact insurance in one (1) or more states as provided in W.S. 26-3-130; (C) As to alien insurers not authorized to transact insurance in one (1) or more states, the country under the laws of which the insurer was formed; (D) As to all other insurers, the state under the laws of which the insurer was formed. (xii) "Foreign insurer" means an insurer formed under the laws of any jurisdiction other than this state and includes an "alien" insurer unless otherwise distinguished by the context; (xiii) "General lines agent" means an agent who transacts any of the following kinds of insurance: (A) Property insurance; (B) Casualty insurance; (C) Surety insurance; (D) Marine and transportation insurance; (E) Disability insurance, if transacted for an insurer also represented by the same agent as to property or casualty insurance. (xiv) "Industrial life insurance" means life insurance written under policies of face amount of one thousand dollars ($1,000.00) or less bearing the words "industrial policy" imprinted on the face of the policy and under which premiums are payable monthly or more often; (xv) "Insurance" means a contract in which one undertakes to indemnify another against loss, damage or liability arising from determinable hazards or fortuitous occurrences or to pay or allow a specified amount or determinable benefit in connection with ascertainable risk contingencies; (xvi) Except as otherwise provided in W.S. 26-22-501 through 26-22-503, "insurer" means any person engaged as indemnitor, surety or contractor in the business of entering into contracts of insurance or of annuity; (xvii) "Life agent" means an agent who transacts life insurance or annuity business and includes also the transaction of disability insurance on behalf of an insurer for whom the agent is also licensed as to life insurance; (xviii) "Managing general agent" means a person, firm, association or corporation meeting the definition of managing general agent under W.S. 26-46-101; (xix) "Mutual insurer" means an incorporated insurer without capital stock and the governing body of which is elected by its policyholders, except certain foreign insurers which the commissioner finds to be organized on the mutual plan under the laws of their state or province of domicile, but having temporary share capital or providing for election of the insurer's governing body on a reasonable basis by members or by policyholders and others are not excluded as mutual insurers; (xx) Except as used in chapter 31 of this code, "person" means an individual, insurer, company, association, organization, Lloyd's insurer, society, reciprocal insurer or interinsurance exchange, partnership, syndicate, business trust, corporation, agent, general agent, broker, adjuster and any legal entity; (xxi) "Policy" means the written contract of or written agreement for or effecting insurance, by whatever name called, and includes all clauses, riders, endorsements and papers which are a part thereof; (xxii) "Premium" means the consideration for insurance, by whatever name called, and any assessment, membership, policy, survey, inspection, service or similar fee or other charge in consideration for an insurance contract is part of the premium; (xxiii) "Reciprocal insurance" means insurance from an interexchange among persons, known as subscribers, of reciprocal agreements of indemnity, the interexchange being carried out through an attorney-in-fact common to all persons involved; (xxiv) "Reciprocal insurer" means an unincorporated aggregation of subscribers operating individually and collectively through an attorney-in-fact to provide reciprocal insurance among themselves; (xxv) Repealed By Laws 2011, Ch. 60, § 3. (xxvi) Repealed by Laws 2001, Ch. 201, § 5. (xxvii) "State" means any state, district, territory, commonwealth or possession of the United States of America and the Panama Canal Zone if used in a context signifying a jurisdiction other than the state of Wyoming; (xxviii) "Stock insurer" means an incorporated insurer with its capital divided into shares and owned by its stockholders; (xxix) "Surplus" in any determination or statement of an insurer's financial condition means the excess of the insurer's assets over its liabilities as ascertained in accordance with chapter 6 of this code; (xxx) "Transact" with respect to a business of insurance means: (A) Solicitation or inducement; (B) Negotiations; (C) Carrying out of a contract of insurance; (D) Transaction of matters subsequent to the carrying out and arising out of a contract of insurance; or (E) Any other aspects of insurance operations to which this code applies. (xxxi) "Unauthorized" insurer means an insurer not authorized as provided in paragraph (a)(v) of this section; (xxxii) "This act" or "this code" means title 26 of the Wyoming statutes; (xxxiii) "Private 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. "Private health benefit plan" does not include accident only, credit, dental, vision, Medicare supplement, long-term care or disability income insurance, policies or certificates providing coverage for a specified disease or hospital confinement indemnity or limited benefit health insurance, coverage issued as a supplement to liability insurance, worker's compensation or similar insurance, automobile medical payment insurance or any hospital or medical policy, major medical expense insurance, hospital or medical service plan or contract which by contract or product design is intended to provide coverage for six (6) months or less. Notwithstanding other provisions of this section, the Medicaid program shall continue to obtain reimbursement recovery from all types of insurance included in this section prior to July 2, 2011; (xxxiv) "Public health benefit plan" means medicare, medicaid or other health benefit programs or coverages operated or maintained by any governmental entity; (xxxv) "Insurance producer" means a person required to be licensed under the laws of this state to sell, solicit or negotiate insurance, including, but not limited to, agents and brokers; (xxxvi) "Fair value", "fair market value" or "market value" mean fair value as determined pursuant to the most recent National Association of Insurance Commissioners' accounting practices and procedures manual; (xxxvii) "Consumer reporting agency" means any person who does any of the following: (A) Regularly engages, in whole or in part, in the practice of assembling or preparing consumer reports for a monetary fee; (B) Obtains information primarily from sources other than insurers; (C) (xxxviii) Furnishes consumer reports to other persons. "Insurance support organization" means: (A) Any person who regularly engages, in whole or in part, in the practice of assembling or collecting information about natural persons for the primary purpose of providing the information to an insurance institution or insurance producer for insurance transactions, including the furnishing of consumer reports or investigative consumer reports to an insurer or insurance producer for use in connection with an insurance transaction or the collection of personal information from insurers, insurance producers or other insurance support organizations for the purpose of detecting or preventing fraud, material misrepresentation or material nondisclosure in connection with insurance underwriting or insurance claim activity; (B) Notwithstanding subparagraph (A) of this paragraph the following persons are not considered insurance support organizations for purposes of this code: (I) (II) (III) (IV) (V) Insurance producers; Government institutions; Insurers; Medical care institutions; Medical professionals. (xxxix) "Insurance transaction" for the purposes of paragraph (xxxviii) of this subsection, means any transaction involving insurance primarily for personal, family or household needs rather than business or professional needs and which entails the determination of an individual's eligibility for an insurance coverage, benefit or payment or the servicing of an insurance application, policy, contract or certificate; (xl) "Investigative consumer report" means a consumer report or portion of a consumer report in which information about a natural person's character, general reputation, personal characteristics or mode of living is obtained through personal interviews with the person's neighbors, friends, associates, acquaintances or others who may have knowledge concerning those items of information; (xli) "NAIC" means the National Association of Insurance Commissioners; (xlii) A natural person who engages in or conducts the "business of insurance" means a person has duties that require licensure under this code or that are a major part of a person's duties and require specialized knowledge of insurance, which knowledge has been acquired through training and experience and is sufficient that close supervision from a person licensed under this code is not needed. A person is not engaged in the business of insurance who performs tasks often found in business offices not engaged in insurance and who requires close supervision from a person licensed under this code to engage in tasks requiring specialized insurance knowledge. A person in training who performs duties requiring specialized knowledge of insurance is not engaged in the business of insurance if that person is under close supervision from a person licensed under this code; (xliii) "Multiple employer welfare arrangement" means an employee welfare benefit plan, as defined in 29 U.S.C. § 1002, or any other arrangement which is established to provide hospital, medical or surgical benefits in the event of sickness, accident, disability or death to the employees of two (2) or more employers, which may include self employed individuals, meeting a commonality of interest test, or to the beneficiaries of these persons. This term shall include a bona fide group or association of employers authorized to establish an employee welfare benefit plan under federal law. (b) As used in W.S. 26-2-116 through 26-2-124: (i) "Examiner" means any individual or firm authorized by the commissioner to conduct an examination under W.S. 26-2-116 through 26-2-124; (ii) "Person" means as defined in W.S. 26-1-102(a)(xx) and includes all affiliates of the entities referred to in that definition. 26-1-103. Compliance with insurance code required. No person shall transact a business of insurance in Wyoming, or relative to a subject of insurance resident, located or to be performed in Wyoming, without complying with the applicable provisions of this code. 26-1-104. (a) Applicability of provisions. This code does not apply to: (i) Repealed by Laws 2018, ch. 21, § 2. (ii) Fraternal benefit societies as identified in chapter 29 of this code, except as stated in that chapter; (iii) Health maintenance organizations as identified in chapter 34 of this code, except as otherwise specifically provided in that chapter; (iv) Transactions in mechanical breakdown insurance as identified in chapter 37 of this code, except as otherwise provided in that chapter; (v) Health care sharing ministries. As used in this section, "health care sharing ministry" means a faith-based nonprofit organization that is tax exempt under the Internal Revenue Code and which: (A) Coordinates financial sharing for medical expenses among willing participants in accordance with criteria established by the health care sharing ministry; (B) Has annual audits performed by an independent certified public accountant that are available upon request; and (C) Includes a written disclaimer on or accompanying all applications and guideline materials distributed by or on behalf of the organization that reads in substance: "Notice: The organization facilitating the sharing of medical expenses is not an insurance company, and neither its guidelines nor plan of operation is an insurance policy. Any assistance with your medical bills is completely voluntary. No other participant is compelled by law or otherwise to contribute toward your medical bills. Participation in the organization or a subscription to any of its documents shall not be considered to be health insurance and is not subject to the regulatory requirements or consumer protections of the Wyoming insurance code. You are personally responsible for payment of your medical bills regardless of any financial sharing you may receive from the organization for medical expenses. You are also responsible for payment of your medical bills if the organization ceases to exist or ceases to facilitate the sharing of medical expenses." (vi) A direct primary care agreement. A direct primary care agreement means a written agreement that: (A) Is between a patient or their legal representative and a health care provider; (B) Allows either party to terminate the agreement in writing, without penalty or payment of a termination fee, at any time or after notice as specified in the agreement which notice shall not exceed sixty (60) days; (C) Describes the health care services to be provided in exchange for payment of a periodic fee; (D) Specifies the periodic fee required and any additional fees that may be charged; (E) May allow the periodic fee and any additional fees to be paid by a third party; (F) Prohibits the provider from charging or receiving additional compensation for health care services included in the periodic fee; and (G) Conspicuously and prominently states that the agreement is not health insurance and does not meet any individual health insurance mandate that may be required by federal law. 26-1-105. Provisions relating to particular insurance to prevail over general provisions. Provisions of this code relative to a particular kind of insurance or type of insurer or particular matter prevail over provisions relating to insurance in general or insurers in general or to the particular matter in general. 26-1-106. provisions. Captions or headings not to limit scope of The scope and meaning of any provision are not limited or otherwise affected by the caption or heading of any chapter, section or provision. 26-1-107. General criminal and civil penalties. (a) Each violation of this code for which a greater penalty is not provided by another provision of this code or by other applicable laws of this state, in addition to any applicable prescribed denial, suspension or revocation of certificate of authority or license, is a misdemeanor punishable upon conviction by a fine of not more than one thousand dollars ($1,000.00), or by imprisonment in the county jail for not more than six (6) months, or both. Each violation is a separate offense. (b) Any person who violates, or who instructs his agent or adjuster to violate, any provision of this code, any lawful rule or final order of the commissioner or any final judgment or decree made by any court, upon the commissioner's application, shall pay a civil penalty in an amount the commissioner determines of not more than five thousand dollars ($5,000.00) for each offense, or fifty thousand dollars ($50,000.00) in the aggregate for all offenses within any one (1) year period. In the case of individual agents or adjusters, the civil penalty shall be not more than one thousand dollars ($1,000.00) for each offense or ten thousand dollars ($10,000.00) in the aggregate for all offenses within any one (1) year period. The penalty shall be collected from the violator and paid by the commissioner, or the appropriate court, to the state treasurer and credited as provided in W.S. 8-1-109. (c) Before the commissioner imposes a civil penalty, he shall notify the person, agent or adjuster accused of a violation, in writing, stating specifically the nature of the alleged violation and fixing a time and place, at least ten (10) days from the date of the notice, when a hearing of the matter shall be held. After hearing or upon failure of the accused to appear at the hearing, the commissioner shall determine the amount of the civil penalty to be imposed in accordance with the limitations expressed in subsection (b) of this section. Each violation is a separate offense. (d) A civil penalty may be recovered in an action brought thereon in the name of the state of Wyoming in any court of appropriate jurisdiction, and the court may review the penalty as to both liability and reasonableness of amount. (e) The provisions of this section are in addition to and not instead of any other enforcement provisions contained in this code. 26-1-108. Jurisdiction of insurance department. (a) Notwithstanding any other provision of law, and except as provided in this section, any person or other entity which provides insurance coverage in this state for medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital or optometric expenses, whether the coverage is by direct payment, reimbursement, or otherwise, shall be subject to the jurisdiction of the state insurance department, unless the person o...
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