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

1. (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.
2. (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.
3. (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.
4. (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.
5. (e) “Department of Insurance” for the purposes of these rules shall mean the Wyoming Insurance Department.
6. (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.
7. (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.
8. (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.

9. (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

1. (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.
2. (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

1. (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.

2. (b) No advertisement, as defined in these rules, shall contain any statistics which purport to represent or show:

   1. (i) the frequency with which cancer will strike certain areas of the body or certain organs of the body;
   2. (ii) that cancer insurance is a “bargain” or words of similar import that detract from the limited nature of cancer coverage;
   3. (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”;
   4. (iv) a comparison of the death rate of cancer with that of any other cause of death, including automobile accidents or war;
   5. (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;
   6. (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;
3. (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.
4. (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.”
5. (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:

1. (a) any applicable waiting period;
2. (b) the period of time within which the policy can be returned for a full refund;
3. (c) all exceptions, limitations, reductions and conditions of coverage; and
4. (d) a summarization of all benefits provided by the policy.

Section 4. Maximum or Lifetime Benefits

1. (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.
2. (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.

3. (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

1. (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.
2. (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.

3. (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

1. (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.
2. (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.
3. (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.