Licensing
Any individual applying for a West Virginia resident producer’s license must be at least 18 years old and be a resident of West Virginia prior to submitting an application.
Required Pre-licensing Course and Exam
Before sitting for the Pre-licensing exam, West Virginia requires the successful completion of a pre-licensing course that has been approved by the Department of Insurance.
Fingerprints/Background Check
As part of the application process, you must submit fingerprints to the West Virginia Department of Insurance. You should seek to get fingerprinted after passing the state exam and at least one day before applying for the license.
Controlled Business
Controlled business is written solely in the interest of the producer or their family members. Producers are prohibited from securing a West Virginia insurance license to provide this form of business. Of course, as a producer you can sell a policy to yourself or your family members but you cannot obtain a license for this sole purpose.
Non-Resident License
A licensed producer will need to meet the following requirements to obtain a nonresident license:
The individual must have a West Virginia resident producer license in good standing.
The individual must complete the appropriate application and submit the required fees to the insurance department/commission in each state they wish to become licensed in.
The individual’s home state must offer equal reciprocity for the state you are attempting to obtain a non-resident license in. Currently, West Virginia has reciprocation agreements with all other states.
Temporary License
A Temporary Producer license is only valid if the temporary producer is sponsored and appointed by an insurance company. A Temporary Producer license is a once in a lifetime license per line of authority and is valid for a maximum of 6 months from the date the license is issued.
Inactive Status
A West Virginia resident producer who is ordered to active military duty may place his/her license on inactive status until he/she is discharged. While a license is inactive the producer may continue to receive residual or “trailing” commissions, but may not solicit or transact any new business.
Renewal Maintenance
West Virginia Insurance licenses are initially issued for 2 years. Producer must renew their license every 2 years, by the last day of the birth month of the licensee. There is a 30 day grace period for those failing to renew prior to expiration; renewing during this grace period will result in a $50 late fee. If the license is not renewed at this time, the license expires and all company appointments are canceled.
A producer may have their license reissued within 12 months of expiration without having to test again. When former producers have been without a license over 12 months, they must take the pre-licensing course, retest, and get fingerprinted before applying for a new license.
Continuing Education
All states, including West Virginia, have continuing education requirements that must be met to renew any major lines (life, health, property, liability) insurance license. Individuals licensed in the state of West Virginia must complete 24 hours of CE prior to renewing their license.
Notice of Change of Name or Address
Any change of name or address (residential or business) must be reported by the licensee to the West Virginia Department of Insurance within 30 days of relocation. Failure to do so may result in monetary fines and/or the suspension of a license.
Company Regulations
An insurance company must be authorized by the Department of Insurance to conduct business in West Virginia. To receive authorization, the insurance company must present their rate tables and articles of incorporation which include the nature and purpose of the company’s business intentions, along with the appropriate bylaws for their corporation and appropriate fees.
Place of Business
Every resident insurance producer authorized to conduct business in West Virginia must maintain a place of business (with public access) within the state.
Capital and Surplus Requirement
A company that has been authorized to conduct insurance business in West Virginia must maintain minimum standards as a corporation. The certificate of authority will allow the insurer to conduct business in the state only if it maintains the minimum capital or permanent surplus required.
LTC Policies
No insurer may offer an LTC policy in West Virginia unless the insurer offers, at the time of application, the option to buy inflation protection. The policy must plainly state that premiums may increase.
While LTC policies are generally designed to pay for life, they are required by state law to be issued with a benefit period of at least 24 months.
Medigap Policies
To eliminate the confusion surrounding the many different types of Medicare supplement policies available, federal law mandates national standardization of Medigap policies. The law requires that insurers offer no more than 12 “standardized” Medigap plans developed by the National Association of Insurance Commissioners (NAIC).
The 12 standard plans include a basic policy offering “core” benefits called Plan A (Parts A and B co-payments, 365 additional days of hospitalization, and the first 3 pints of blood). Each of the other 11 plans has a different combination of additional benefits, which are identified by letters B through L.
If an insurer sells ANY Medigap policies in West Virginia, they MUST offer Plan A. A Buyer’s Guide and an Outline of Coverage are delivered at time of application, prior to accepting any premium payment.
Duties of the Commissioner of Insurance
The West Virginia Commissioner of Insurance is a state executive position in the West Virginia government. The Commissioner is the chief executive of the West Virginia Department of Insurance, which regulates insurance companies operating in West Virginia.
The commissioner of insurance is an appointed position in West Virginia. The governor nominates a candidate to the state Senate, and the state Senate confirms the nominee. The commissioner serves at the will and pleasure of the governor for the term for which the governor was elected and remains in office until their successor has been appointed and qualified. The commissioner’s initial appointment is for a period of six years.
The Commissioner is responsible for establishing and enforcing regulations in the West Virginia insurance market in a manner that protects consumers and encourages economic development.
Duties of the Commissioner include:
Investigate all claims and complaints of legal violations relating to insurance.
If the Commissioner finds that laws have been violated, their findings and supporting documents will be forwarded to the state attorney general to pursue prosecution.
Monitor transactions of all companies including domestic, foreign, and alien insurance companies.
Audit the books and records of any resident producer as frequently as necessary.
Collect all fees associated with producers and insurers.
Determine and administer fines associated with violations for insurers and producers.
Issue reports pertaining to the suspension and revocation of licenses of producers and certificates of authority for insurers.
Approve documentation used by insurance companies such as forms and rates.
Suspend, Revoke or Non-renew
The Commissioner has the authority to suspend, revoke, or refuse to renew a license for:
Providing false information on the application for an insurance license.
Omitting any relevant information on an application that would have disqualified the individual from being eligible to receive a license.
Being found guilty of a violation or the noncompliance of insurance regulations and laws…
Committing fraud while attempting to obtain an insurance license.
Commingling policy owners’, insurers’, and beneficiaries’ money with the producer’s own money.
Providing false information in reference to the terms and conditions of an insurance contract.
Having been found guilty of a felony (or misdemeanor involving activities related to the individual’s moral character.)
Having been convicted of violations in reference to unfair trade practices or fraud.
Having engaged in activities of a fraudulent nature which allowed the person to involve themselves in dishonest, coercive, untrustworthy, and financially irresponsible practices.
Having had a prior insurance license revoked or suspended in a state other than West Virginia.
Using another person’s identity and forging their name on an insurance application.
Being found guilty of using unethical practices or cheating on an examination for an insurance license.
Cease and Desist
If the Commissioner believes that a producer has (or is about to) violate any insurance regulation in West Virginia they may issue a cease and desist order. The recipient of a cease and desist order has not had his/her registration suspended or revoked, but is required to stop or limit the activity addresses in the order.
Hearing
While the recipient of a cease and desist order must comply immediately, actions taken by the Commissioner are not “final and binding”. Any West Virginia resident producer being subjected to disciplinary action has the right to request a hearing to discuss the merits of the situation.
Likewise, the Commissioner has the authority to conduct an investigation into any producer doing business in West Virginia to determine if a hearing is required. Upon finding sufficient evidence, the Commissioner will issue a notice with the date and time of the hearing which will be sent to interested parties at least 20 days prior to the hearing.
If a hearing results in the finding of a known violation of West Virginia insurance law, the Commissioner may, in addition to the issuance of a cease and desist order, impose a civil penalty of up to $15,000 per violation.
Unfair Claims Settlement Practices
The intentional obstruction and delay of claims payment or the delay of a claims investigation is a violation of regulation.
Neglecting to provide a prompt response and written explanation of insurance policy terms, conditions, and laws related to the contract are examples of unfair claims settlement practices.
Failure to provide claims without launching a thorough investigation is a violation of regulation.
Making settlement claims based on information contained on an application that has been altered without the insured’s consent is a violation of regulation.
Denying a claim without conducting a thorough investigation.
Attempting to settle a claim for less than fair market value.
Policy Forms
West Virginia is a “file and use” state. A File and Use filing is a submission that just has to be filed with the Department but the insurer can begin using it as soon as they file it. They do not have to wait for an approval from the Department before using it. A File and Use filing does not mean that the company can submit anything they want to; the submission still has to be in compliance with the Law, Regulations and Bulletins.
If the wording on a health insurance policy (or other form) conflicts with West Virginia state law, the policy will be amended to minimum conformity with state statutes.
Record Maintenance
Complete and accurate records must be kept at the producer’s place of business for a minimum of 3 years. The records must show every contract placed, the named insured, changes or amendments, and premiums received with each transaction. Records may be inspected at any given point in time by the Department of Insurance or any representative appointed on their behalf.
Fraudulent Producer Representation
An insurance producer who represents to the public that he/she is licensed to conduct insurance business in West Virginia, but has not passed the appropriate licensing examination is in violation of regulation. Any means of public communication using advertisements, letterheads, circulars, business cards, and other methods of representation are included in the definition of impersonating a licensed producer.
A producer found guilty of conducting business in West Virginia in any line of insurance for which they are not properly licensed may have any other insurance license suspended or revoked.
Misrepresentation
Misrepresentation involving the creation or distribution of policies, quotes, and illustrations designed to provide inaccurate information about the terms and conditions of a policy is prohibited.
Providing inaccurate or incomplete information or comparisons regarding the benefits of a policy is an example of misrepresentation.
Providing inaccurate or incomplete information with the sole purpose of inducing lapse, exchange, conversion, forfeiture, or surrender is a violation as well (twisting).
False Advertising
Communication involving the publication of newspapers, magazines, radio, or television that is intended to deliver false information in reference to insurance is a violation of NAIC regulation.
Defamation
The intentional and malicious circulation of written or oral information intended for the direct or indirect dissemination of derogatory statements is prohibited.
Publishing and circulating inaccurate information regarding the financial condition of an insurer, person, or competitor in the insurance industry is a violation of NAIC regulation.
Boycott, Coercion and Intimidation
The participation in any boycott or activity involving coercion and intimidation for the sole purpose of retaining business or that results in the monopoly of insurance business is prohibited.
False Financial Statements
Any licensed producer who makes false statements containing any information that involves inaccurate material facts or false statements on an application for insurance is in violation of NAIC regulation.
Illegal Inducements
In West Virginia it is prohibited to induce the purchase of insurance by offering anything with a monetary value in excess of $10. It is also prohibited to accept anything with a monetary value in excess of $10 from a client. Any producer participating in this activity will be subject to suspension of his/her license and a monetary fine.
Unfair Discrimination
Discriminating on the basis of class, race, marital status or sexual preference is a violation of regulation. Any unfair discriminatory practices intended to directly or indirectly favor an applicant or insured is prohibited. Denying insurance coverage based on the blindness or partial blindness of an individual is considered discrimination and is a violation of NAIC regulation.
Errors & Omissions
Errors & Omissions (E&O) insurance is a type of professional liability insurance that protects insurance agents if they are sued for negligent performance of their duties. E&O only covers honest mistakes resulting in (financial) damage to customers/prospects. There is no coverage for violation of insurance regulation.
Small Group
In West Virginia, a “small group” is defined as 2-50 people, and may be exempted from certain restrictive federal laws governing group insurance. Small group market means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a small employer.
Children Covered as Dependents
Newborn children must be covered as a dependent from the moment of birth by their parent’s policy. Adopted children (even unborn) are covered by the adoptive parent’s policy from the moment the adoption becomes legal. The newborn or newly adopted child may be enrolled within 30 days without any pre-existing condition limitations.
A dependent child must be under age 19 (24 if they are a full-time student) at the end of the calendar year. However, a mentally or physically handicapped child (any age) can be covered as a dependent on his/her parents policy until he/she becomes self supporting.
Rebating
West Virginia licensed producers are prohibited from directly or indirectly giving any refund, discount, favor, or credit to reduce premiums to induce the purchase of insurance.
Furthermore, producers in West Virginia are also prohibited from receiving any payment for the sale, solicitation or negotiation of insurance outside of commissions and/or salary.
Sharing Commission
The splitting or sharing of commissions with a licensed producer is allowed. Both parties must be licensed in the line of business in which the proposed commission is to be split.
Twisting
Providing false information or expressing derogatory ideas about the financial conditions of a competitor company with the intent to lapse or surrender an existing policy is a violation of the law. Any written or oral statements used to induce the lapse, termination, exchange, or surrender of an insurance contract based on inaccurate information is prohibited.
Unfair Marketing Practices
The Department of Insurance is responsible for establishing minimum standards for the full and fair disclosure of policy content. They also require the standardization and simplification of the terms used to describe insurance coverage. Advertising may not involve the following:
Any implication that policies are approved or that the financial condition of a company is endorsed by any government agency or by any independent group, individual, organization, or society.
Any statements regarding advertising that are false or untrue in reference to the time frame in which claims are paid.
Gramm-Leach Bliley Act (GLBA)
This law repealed the Glass-Steagall Act of 1933, allowing consolidation of commercial banks, investment institutions and insurance companies. GLBA established a framework of responsibilities of federal and state regulators for these financial industries. It permits financial services companies to merge and engage in a variety of new business activities, including insurance, while attempting to address the regulatory issues raised by such combinations.
McCarran-Ferguson Act
Federal law signed in 1945 in which Congress declared that the insurance industry would be regulated at the state level. Grants insurers a limited exemption from federal antitrust legislation.
National Association of Insurance Commissioners (NAIC)
The U.S. standard-setting and regulatory support organization is created and governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S.
Fair Credit Reporting Act of 1971
If an applicant is denied insurance, employment or credit due to information collected, this regulation grants access to the information and reasons for the denial. After receiving notice that an adverse underwriting decision has been made (which must be communicated within 3 days), an individual has 90 business days within which to request a copy of the report.
Privacy Act of 1974
This regulation was established to provide a system for the collection, use, and dissemination of information gathered during the underwriting process. When an applicant for insurance signs the application (notice regarding insurance information practices), they give the insurer the right to check driving records, MIB, and consumer investigative reports. A signed application authorizes the insurer to collect information for 30 months. If they have not done so by then a new authorization must be obtained.
Telemarketing
The DO NOT CALL registry is a list of telephone numbers, and the DO NOT CALL registry is intended to prevent calls from telemarketers. Unsolicited sales calls must be made in accordance with the following provisions:
No call may be placed outside of the hours of 8 am to 9 pm local time where the call is received.
The sales nature of the call must be disclosed and the nature of the product/service being offered must be disclosed.
The caller must identify themselves and the broker/dealer they represent.
If a prize is being offered, the prize cannot be contingent on purchase.
CAN-Spam
When an unsolicited e-mail is sent the sender must:
Use the word advertisement or the letters ADV on the subject line.
Notate the physical location from where the email originated.
Give the recipient the opportunity to opt out of ever receiving another email from the sender.
Insurance Guaranty Association
The West Virginia Insurance Guaranty Association is made up of authorized insurers and is controlled by a board. Joining the association is part of the authorization process that admits insurance companies to conduct business in West Virginia. This is not unique to West Virginia. Insurers must be authorized in every state they transact business in.
Once authorized, any insurer doing business in West Virginia must contribute to the West Virginia Insurance Guarantee Fund, which is intended to indemnify policy owners of insurance companies that have become insolvent (up to $100,000 cash and $300,000 total benefits).
Affordable Care Act
While the Affordable Care Act (aka Obamacare) was without question the most extensive overhaul of the healthcare system this country has seen in a generation, www.healthcare.gov and the state exchanges are not testable. As such, we do not discuss the real “meat and potatoes” of Obamacare in this course.
The most important and far reaching consequence of Obamacare is the elimination of pre-existing conditions; everybody, regardless of current or past medical conditions, is eligible to purchase health insurance. For the purpose of the pre-licensing exam, however, you want to be familiar with group policies being issued outside of www.healthcare.gov and/or the state exchanges.
When you see Affordable Care Act (45 CFR 144, 146, 147, 148, 150, 154, 155, 156, 157, 164…) in the exam content outline, this refers to the United States Code of Federal Regulation, Title 45. The parts identified refer to how the Public Health Service Act (PSHA) encompassed Health Insurance Portability and Accountability Act (HIPAA) and Consolidated Omnibus Budget Reconciliation Act (COBRA) into Obamacare, which is covered in the Group Health Insurance chapter.
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