(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 of requiring an administrator to file a letter of certification with the uniform application, the commissioner may verify the nonresident administrator's home state certificate of authority or license status through an electronic database maintained by the national association of Insurance Commissioners, its affiliates or subsidiaries.
(b) An administrator is not eligible for a nonresident administrator license under this section if it does not hold a certificate of authority or license as a resident in a home state that has adopted the national association of Insurance Commissioners' model third-party administrator act or a substantially similar law governing administrators.
(c) Except as provided in subsections (b) and (h) of this section, the commissioner shall issue to the administrator a nonresident administrator license promptly upon receipt of a complete application and the application fee.
(d) Unless notified by the commissioner that the commissioner is able to verify the nonresident administrator's home state certificate of authority or license status through an electronic database maintained by the national association of Insurance Commissioners, its affiliates or subsidiaries, each nonresident administrator shall annually file a statement that its home state administrator certificate of authority or license remains in force and has not been revoked or suspended by its home state during the preceding year.
(e) At the time of filing the statement required under subsection (d) of this section or, if the commissioner has notified the nonresident administrator that the commissioner is able to verify the nonresident administrator's home state certificate of authority or license status through an electronic database, on or before October 1, the nonresident administrator shall pay the fee set forth in section fifteen of this article.
(f) An administrator 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.
(g) A nonresident administrator is not required to hold a nonresident administrator license in this state if the administrator's duties in this state are limited to the administration of a group policy or plan of insurance and no more than a total of one hundred lives for all plans reside in this state. This subsection applies only to multistate administrators. The administrator must be licensed in its home state regardless of the number of lives under a group policy or plan.
(h) The commissioner may refuse to issue a nonresident administrator license, or may delay the issuance of a nonresident administrator license, if the commissioner determines that, due to events or information obtained subsequent to the home state's licensure of the administrator, the nonresident administrator cannot satisfy the requirements of this article or that grounds exist for the home state's revocation or suspension of the administrator's home state certificate of authority or license. In that event, the commissioner shall give written notice of its determination to the commissioner of the home state and the commissioner may delay the issuance of a nonresident administrator license to the nonresident administrator until such time, if at all, that the commissioner determines that the administrator can satisfy the requirements of this article and that no grounds exist for the home state's revocation or suspension of the administrator's home state certificate of authority or license.
Structure West Virginia Code
Article 46. Third-Party Administrator Act
§33-46-3. Written Agreement Necessary
§33-46-4. Payment to Administrator
§33-46-5. Maintenance of Information
§33-46-6. Approval of Advertising
§33-46-7. Responsibilities of the Insurer
§33-46-8. Premium Collection and Payment of Claims
§33-46-9. Compensation to the Administrator
§33-46-10. Notice to Covered Individuals; Disclosure of Charges and Fees
§33-46-11. Delivery of Materials to Covered Individuals
§33-46-12. Home State Certificate of Authority or License
§33-46-13. Registration Requirement
§33-46-14. Nonresident Administrator
§33-46-16. Annual Report and Filing Fee
§33-46-17. Grounds for Denial, Suspension or Revocation of License
§33-46-18. Exemption for Administrators of Public Health Programs