§33-46-1. Short Title
This article may be cited as the "Third-Party Administrator Act".
§33-46-10. Notice to Covered Individuals; Disclosure of Charges and Fees
(a) When the services of an administrator are used, the administrator shall provide a written notice approved by the insurer to covered individuals advising them of the identity of, and relationship among, the administrator, the policyholder and the insurer. (b) When an administrator collects funds, the reason for collection of each item shall be identified […]
§33-46-11. Delivery of Materials to Covered Individuals
Any policies, certificates, booklets, termination notices or other written communications delivered by the insurer to the administrator for delivery to insured parties or covered individuals shall be delivered by the administrator promptly after receipt of instructions from the insurer to deliver them.
§33-46-12. Home State Certificate of Authority or License
(a) Prior to conducting business in West Virginia an administrator or third-party administrator must be licensed in accordance with the requirements of this article. (b) If West Virginia is a person's home state, then the person may apply for licensure in this state by filing a uniform application with the Insurance Commissioner. The application shall […]
§33-46-13. Registration Requirement
A person who directly or indirectly underwrites, collects charges or premiums from, or adjusts or settles claims on residents of this state, in connection with life, annuity or accident and sickness coverage provided by a self-funded plan other than a governmental or church plan shall register with the commissioner annually, verifying its status as in […]
§33-46-14. Nonresident Administrator
(a) Unless an administrator has obtained a home state license in this state under section twelve of this article, any administrator who performs administrator duties in this state shall obtain a nonresident administrator license in accordance with this section by filing with the commissioner the uniform application, accompanied by a letter of certification. In lieu […]
§33-46-15. Fees and Charges
Except where it is otherwise specially provided, the commissioner shall assess third-party administrators the following fees: For annual fee for each license, $200; for receiving and filing annual reports, $100; for filing a certified copy of articles of incorporation, $50; for filing a copy of its charter, $50; for filing statements preliminary to admission, $100; […]
§33-46-16. Annual Report and Filing Fee
(a) Each administrator licensed under section twelve of this article shall file an annual report for the preceding calendar year with the commissioner on or before July 1, of each year or within an extension of time granted by the commissioner for good cause. The annual report shall include an audited financial statement performed by […]
§33-46-17. Grounds for Denial, Suspension or Revocation of License
(a) The license of an administrator shall be denied, suspended or revoked if the commissioner finds that the administrator: (1) Is in an unsound financial condition;
§33-46-18. Exemption for Administrators of Public Health Programs
Programs supervised by the Department of Health and Human Resources, pursuant to chapter nine of this code; the Public Employees Insurance Agency, pursuant to articles sixteen and sixteen-c, chapter five of this code; and the Department of Administration, pursuant to article sixteen-b, chapter five of this code, are exempted from the provisions of this article. […]
§33-46-19. Unauthorized Business
The unauthorized conduct of the business of an administrator shall be treated as unauthorized insurance business and shall be subject to the same criminal and civil penalties as provided in article forty-four for violation of the unauthorized insurers act.
§33-46-2. Definitions
(a) "Administrator" or "third-party administrator" means a person who directly or indirectly underwrites or collects charges or premiums from, or adjusts or settles claims on residents of this state, in connection with life, annuity or accident and sickness coverage offered or provided by an insurer, except any of the following: (1) An employer, or a […]
§33-46-20. Commissioner Authorized to Propose Rules
The Insurance Commissioner may propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code that are necessary to effectuate this article.
§33-46-3. Written Agreement Necessary
(a) No administrator may act as such without a written agreement between the administrator and the insurer and the written agreement shall be retained as part of the official records of both the insurer and the administrator for the duration of the agreement and for ten years thereafter. The agreement shall contain all provisions required […]
§33-46-4. Payment to Administrator
If an insurer uses the services of an administrator, the payment to the administrator of any premiums or charges for insurance by or on behalf of the insured party shall be considered to have been received by the insurer and the payment of return premiums or claim payments forwarded by the insurer to the administrator […]
§33-46-5. Maintenance of Information
(a) An administrator shall maintain and make available to the insurer complete books and records of all transactions performed on behalf of the insurer. The books and records shall be maintained in accordance with prudent standards of insurance recordkeeping and shall be maintained for a period of not less than ten years from the date […]
§33-46-6. Approval of Advertising
An administrator may use only advertising pertaining to the business underwritten by an insurer that has been approved in writing by the insurer in advance of its use.
§33-46-7. Responsibilities of the Insurer
(a) If an insurer uses the services of an administrator, the insurer is responsible for determining the benefits, premium rates, underwriting criteria and claims payment procedures applicable to the coverage and for securing reinsurance, if any. The rules pertaining to these matters shall be provided, in writing, by the insurer to the administrator. The responsibilities […]
§33-46-8. Premium Collection and Payment of Claims
(a) All insurance charges or premiums collected by an administrator on behalf of or for an insurer, and the return of premiums received from that insurer, shall be held by the administrator in a fiduciary capacity. The funds shall be immediately remitted to the person entitled to them or shall be deposited promptly in a […]
§33-46-9. Compensation to the Administrator
(a) An administrator may not enter into an agreement or understanding with an insurer in which the effect is to make the amount of the administrator's commissions, fees or charges contingent upon savings effected in the adjustment, settlement and payment of losses covered by the insurer's obligations. This provision shall not prohibit an administrator from […]