Chapter 18

22 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 1 CHAPTER 18 THE CONTRACT OF INSURANCE Article 1. Classes of Insurance. Article 2. Parties, Events and Interests. Article 3. The Policy. Article 4. The Premium. Article 5. Rates. Article 6. Loss. Article 7. Double Insurance. Article 8. Reinsurance. Article 9. Health Insurance Coverage. Article 10. Health Insurance Coverage; Screenings. Article 11. Health Insurance Coverage for Autism Sp ectrum Disorder. ARTICLE 1 CLASSES OF INSURANCE § 18101. Limitations. § 18102. Fire Insurance. § 18103. Marine Insurance. § 18104. Life Insurance. § 18105. Accident, Sickness, Health, Property Damag e and Liability Insurance. § 18106. Fidelity and Surety Insurance. § 18107. Motor Vehicle Insurance. § 18108. Title Insurance. § 18109. Workers' Compensation Insurance. § 18110. Miscellaneous. § 18101. Limitations. An insurer authorized to do business in Guam may on ly write classes of insurance authorized by this artic le and by the insurer's certificate of authority. SOURCE : GC § 43300. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 2 § 18102. Fire Insurance.

nce authorized by this artic le and by the insurer's certificate of authority. SOURCE : GC § 43300. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 2 § 18102. Fire Insurance. Fire insurance includes insurance upon buildings an d other property against loss or damage by fire, lightning, windstorms, cyclones, tornadoes, typhoons, hail or earthquakes, water from the breakage or leakage of sprinklers, pumps, or ot her apparatus erected for extinguishing fires, and water pipes; a nd against loss or damage arising from the prevention or suspension of rent or use and occupation of any building, plant or manufa cturing establishment, due to the hazard or peril against w hich the insurance is carried. SOURCE : GC § 43301. § 18103. Marine Insurance. Marine insurance includes insurance upon ocean and inland risks, and transportation, but not including any ot her casualty insurance as hereinafter provided. SOURCE : GC § 43302. § 18104. Life Insurance. Life insurance includes insurance in all forms of l ife, endowments and annuities, but does not include heal th, accident or sickness insurance or any other casualty insuran ce as hereinafter provided.

fe insurance includes insurance in all forms of l ife, endowments and annuities, but does not include heal th, accident or sickness insurance or any other casualty insuran ce as hereinafter provided. SOURCE : GC § 43303. § 18105. Accident, Sickness, Health, Health Mainten ance Organization, Property Damage and Liability Insuran ce. (a) Accident insurance and sickness or health insur ance includes insurance against injury, disablement resu lting from sickness, and every insurance appertaining thereto. Property damage insurance includes all types of insurance ag ainst loss or damage to property and liability therefore. Liabili ty insurance includes all insurance against loss or damage resul ting from accident to, or injury, fatal or non-fatal, suffere d by any person, and for which the insurer is liable. (b) A Health Maintenance Organization (HMO) is an insurer that is licensed to engage in the business of insurance on Guam that provides individual or group health care plans; or COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 3 health care services which an enrolled population m ight reasonably require to maintain good health, includi ng, as a minimum,

L6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 3 health care services which an enrolled population m ight reasonably require to maintain good health, includi ng, as a minimum, emergency care, inpatient hospital and med ical services, and outpatient medical services on a prep aid basis and regulated under Guam law for solvency. An HMO opera ting in such manner shall be issued by the Commissioner a H ealth Maintenance Organization Certificate of Authority. SOURCE : GC § 43304. Amended by P.L. 28-168:2 (Jan. 10, 20 07). § 18106. Fidelity and Surety Insurance. Fidelity and surety insurance includes all guarante eing of persons holding places of public trust, and of the performance of contracts other than insurance policies. It also in cludes the execution of all bonds, undertakings and contracts of suretyship. SOURCE : GC § 43305. § 18107. Motor Vehicle Insurance. Motor vehicle insurance includes all insurance on m otor or power driven vehicles, except those operating on wa ter or on rails, against loss or damage to or loss of use of the vehicle or its tools, appliances or equipment, against legal liabi lity for loss or damage to persons or property resulting

ting on wa ter or on rails, against loss or damage to or loss of use of the vehicle or its tools, appliances or equipment, against legal liabi lity for loss or damage to persons or property resulting through the operation of the vehicle caused by fire, self-ignition, explosio n, theft, collision or other insurance hazards, including haz ards incident to transporting such vehicle by land or water. SOURCE : GC § 43306. § 18108. Title Insurance. Title insurance includes insurance or guaranty of t itle to real or personal property or any interest or encumbrance thereon, or of information relative to real property, against l oss by reason of defective titles, encumbrances, or adverse claims o f title, or otherwise. SOURCE : GC § 43307. § 18109. Worker’s Compensation Insurance. Worker's compensation insurance includes insurance against loss from liability imposed by law upon emp loyers to compensate employees and their dependents for injur y sustained COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 4 by employees arising out of and in the course or sc ope of their employment. SOURCE : GC § 43308. § 18110. Miscellaneous.

ed COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 4 by employees arising out of and in the course or sc ope of their employment. SOURCE : GC § 43308. § 18110. Miscellaneous. Miscellaneous insurance includes insurance upon any risk not included within or under any of the foregoing c lasses and which is a proper subject for insurance, not prohib ited by law or contrary to sound public policy. SOURCE : GC § 43309. ---------- ARTICLE 2 PARTIES , EVENTS AND INTERESTS § 18201. Capacity to Insure. § 18202. Capacity to be Insured. § 18203. Events Subject to Insurance. § 18204. Insurable Interest. § 18205. Insurable Interest: Measure. § 18206. Insurable Interest: Carrier or Depository. § 18207. Insurable Interest: Type of Existence. § 18208. Insurable Interest: Change. § 18209. Insurable Interest: Transfer § 18201. Capacity to Insure. Any person capable of making a contract may be an i nsurer, subject to the restrictions imposed by this Title. SOURCE : GC § 43325. § 18202. Capacity to be Insured. Any person except a public enemy may be insured or may be a beneficiary. SOURCE : GC § 43326. § 18203. Events Subject to Insurance.

y this Title. SOURCE : GC § 43325. § 18202. Capacity to be Insured. Any person except a public enemy may be insured or may be a beneficiary. SOURCE : GC § 43326. § 18203. Events Subject to Insurance. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 5 Except as provided in this article, any contingent or unknown event, whether past or future, which may da mnify a person having an insurable interest, or create a li ability against him, may be insured against, subject to the provisi ons of this Title. SOURCE : GC § 43327. § 18204. Insurable Interest. (a) Every interest in property, or any relation the reto, or any liability in respect thereto, of such a nature that a contemplated peril might directly damnify the insured, is an ins urable interest. A mere contingent or expectant interest in anything , not founded upon an actual right to or in the thing, nor upon a ny valid contract for it, is not insurable. (b) Every person has an insurable interest in the l ife and health of: (1) Himself; (2) Any person upon whom he depends wholly or in part for education or support; (3) Any person under a legal obligation to him for the payment of money or respecting property

health of: (1) Himself; (2) Any person upon whom he depends wholly or in part for education or support; (3) Any person under a legal obligation to him for the payment of money or respecting property or services , of which death or illness might delay or prevent perfo rmance; (4) Any person upon whose life any estate or intere st vested in him depends. (c) If the insured has no insurable interest, the c ontract is void. SOURCE : GC § 43328. § 18205. Insurable Interest: Measure. Except in the case of property held by the insured as a carrier or depository, the measure of an insurable interest in property is the extent to which the insured might b e damnified by loss of, or injury to, the property. SOURCE : GC § 43329. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 6 § 18206. Insurable Interest: Carrier or Depository. A carrier or depository of any kind has an insurabl e interest in a thing held by him as such to the extent of its value. SOURCE : GC § 43330. § 18207. Insurable Interest: Type of Existence. An interest in property insured must exist when the insurance takes effect and when the loss occurs but need not exist in the meantime; an interest in the

8207. Insurable Interest: Type of Existence. An interest in property insured must exist when the insurance takes effect and when the loss occurs but need not exist in the meantime; an interest in the life or h ealth of a person insured must exist when the insurance takes effect but need not exist thereafter or when the loss occurs. SOURCE : GC § 43331. § 18208. Insurable Interest: Change. Except in the cases herein specified, and in the ca ses of life and disability insurance, a change of interest in a ny part of a subject insured, unaccompanied by a corresponding c hange of interest in the insurance, suspends the insurance t o an equivalent extent until the interest in the subject and the in terest in the insurance are vested in the same person. (a) A change of interest in a subject insured after the occurrence of an injury which results in a loss doe s not affect the right of the insured to indemnity for th e loss. (b) A change of interest in one or more of several distinct subjects separately insured by one policy does not avoid the insurance as to the others. (c) A change of interest by will or succession, on the death of the insured, does not avoid insurance; and his interest

separately insured by one policy does not avoid the insurance as to the others. (c) A change of interest by will or succession, on the death of the insured, does not avoid insurance; and his interest in the insurance passes to the person taki ng his interest in the subject matter insured. (d) In the case of partners, joint owners, or owner s in common, who are jointly insured, a transfer of inte rest by one to another thereof does not avoid insurance eve n though it has been agreed that the insurance shall cease u pon an alienation of the subject insured. SOURCE : GC § 43332. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 7 § 18209. Insurable Interest: Transfer. The mere transfer of subject matter insured does no t transfer the insurance, but suspends it until the same perso n become the owner of both the insurance and the subject matter insured. SOURCE : GC § 43333. ---------- ARTICLE 3 THE POLICY § 18301. Contents. § 18302. Signature. § 18303. Coverage. § 18304. Subsequent Owner of Interest. § 18305. Liability Policy: Direct Action. § 18306. Liability Policy: Insolvency or Bankruptcy . § 18307. Open or Valued. § 18308. Form Approval. § 18308.1.

age. § 18304. Subsequent Owner of Interest. § 18305. Liability Policy: Direct Action. § 18306. Liability Policy: Insolvency or Bankruptcy . § 18307. Open or Valued. § 18308. Form Approval. § 18308.1. Form: Approval Health Insurance. § 18309. Coinsurance Clause Explanation. § 18310. Coinsurance Clause Explanation: Notificati on. § 18311. Penalty. § 18301. Contents. The written instrument in which a contract of insur ance is set forth is the policy and it shall contain the in formation required herein: (a) The parties between whom the contract is made; (b) A description of the property, life or interest insured; (c) The interest of the insured; (d) The risk insured against; (e) The period during which such insurance is to continue; COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 8 (f) Either the statement of the Premium or if the insurance is of a character where the exact premium is only determinable upon the termination of the contract, a statement of the basis and rates upon which the fin al premium is to be determined and paid. Such premium shall exclude as a basis, the appraised value of the land . SOURCE : GC § 43350. Subsection (f) amended by P.L.

asis and rates upon which the fin al premium is to be determined and paid. Such premium shall exclude as a basis, the appraised value of the land . SOURCE : GC § 43350. Subsection (f) amended by P.L. 24-144 :2. § 18302. Signature. All policies issued on risks in Guam shall be signe d and subscribed as provided in this section: (a) If the insurer is an admitted domestic insurer, each policy shall be signed and subscribed by two (2) of the major officers of the insurer designated in its art icles of incorporation or in its by-laws to do so. (b) If the insurer is an admitted foreign insurer, it shall be signed and subscribed by two (2) of the major of ficers of the insurer authorized to do so and in all cases it shall be counter-signed by such insurer's authorized residen t general agent, or shall have attached thereto an appropriat e countersignature endorsement signed by such residen t general agent. (c) If the insurer is an admitted alien insurer, it shall be signed by its United States general manager or othe r person in charge of its United States business if it has s uch official, or if it does not, by two (2) of the major officers of the insurer authorized to do so, and in all

s general manager or othe r person in charge of its United States business if it has s uch official, or if it does not, by two (2) of the major officers of the insurer authorized to do so, and in all cases it sh all be countersigned by such insurer's authorized resident general agent, or shall have attached thereto an appropriat e countersignature endorsement signed by such residen t general agent. (d) Countersignature, by an authorized resident gen eral agent of the insurer originating a contract of insu rance participated in by other insurers as co-sureties or co- indemnitors, shall satisfy all countersignature req uirements in respect of such contract of insurance. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 9 (e) The provisions of this section relating to countersignature by an insurer's authorized general agent shall not apply to: (1) any contract of insurance covering the rolling stock of any railroad, or covering any vessel, airc raft, or motor carrier used in interstate or foreign comm erce, or covering any liability or other risks incident t o the ownership, maintenance or operation thereof; (2) any contract of reinsurance between any

tor carrier used in interstate or foreign comm erce, or covering any liability or other risks incident t o the ownership, maintenance or operation thereof; (2) any contract of reinsurance between any insurance companies or other insurers; (3) any contract of insurance covering any property in interstate or foreign commerce, or any liability or risks incident thereto. SOURCE : GC § 43351. § 18303. Coverage. When the name of the person intended to be insured is specified in a policy, it can be applied only to hi s own interest. SOURCE : GC § 43352. § 18304. Subsequent Owner of Interest. A policy may be so framed that it will inure to the benefit of whosoever, during the continuance of the risk, beco mes the owner of the interest insured. SOURCE : GC § 43353. § 18305. Liability Policy: Direct Action. On any policy of liability insurance the injured pe rson or his heirs or representatives shall have a right of dire ct action against the insurer within the terms and limits of the poli cy, whether or not the policy of insurance sued upon was written o r delivered in Guam, and whether or not such policy contains a pro vision forbidding such direct action, provided that the ca use of

cy, whether or not the policy of insurance sued upon was written o r delivered in Guam, and whether or not such policy contains a pro vision forbidding such direct action, provided that the ca use of action arose in Guam. Such action may be brought against t he insurer alone, or against both the insured and insurer. SOURCE : GC § 43354. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 10 § 18306. Liability Policy: Insolvency or Bankruptcy . No policy of liability insurance shall be issued or delivered in Guam, unless it contains provisions to the effec t that the insolvency or bankruptcy of the insured shall not r elease the insurer from the payment of damages for injuries su stained or loss occasioned during the term of such policy, and that in case execution against the insured is returned unsatisfi ed in any action brought by the injured person or his heirs, because of such insolvency or bankruptcy, an action may be maintain ed by the injured person or his heirs or representatives agai nst such insurer within the terms and limits of the policy for the a mount of the judgment not exceeding the amount of the policy. SOURCE : GC § 43355. § 18307.

n or his heirs or representatives agai nst such insurer within the terms and limits of the policy for the a mount of the judgment not exceeding the amount of the policy. SOURCE : GC § 43355. § 18307. Open or Valued. A policy is either: (a) An open policy which is one wherein the value o f the subject matter is not agreed upon but is left t o be ascertained in case of loss. An open policy shall n ot be written on real property for fire insurance or misc ellaneous insurance. (b) A valued policy which is one containing on its face an expressed agreement that the thing insured shall be valued at a specified sum. SOURCE : GC § 43356. § 18308. Form: Approval. It shall be unlawful for an insurer to use a policy form in affecting insurance except health insurance as appr oved pursuant to § 18308.1 without first obtaining the Commission er's approval thereof as provided herein: (a) The Commissioner shall study each form for the purpose of guarding against any fraud, misrepresent ations or other forms of unfairness to the writings of the insured; if he shall approve a form, he shall endorse his appro val on the face of both duplicates and transmit one to the insured and keep one in his

other forms of unfairness to the writings of the insured; if he shall approve a form, he shall endorse his appro val on the face of both duplicates and transmit one to the insured and keep one in his permanent files; if he shall di sapprove a COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 11 form, he shall issue an order of disapproval statin g therein his reasons and transmit a copy of the same to the insurer. (b) All policies and provisions therein shall be p rinted in a type of which the face is not smaller than ten -point. (c) Every policy form filed with the Commissioner for approval shall be accompanied by a filing fee of Tw enty Dollars ($20.00). SOURCE : GC § 43357. Subsection (c) added by P.L. 29-002: V:I:97 (May 18, 2007). Amended by P.L. 29-121:4 (Dec. 2, 2 008). NOTE : GC § 43357 contained subsections (b) and (c) with out a subsection (a). GC § 43357 (b) and (c) changed to ( a) and (b) respectively to reflect correct citation. § 18308.1 Form Approval: Health Insurance. (a) No health insurance policy or endorsement shall be delivered or issued for delivery in Guam unless the policy or endorsement form is filed for approval with the Com

rm Approval: Health Insurance. (a) No health insurance policy or endorsement shall be delivered or issued for delivery in Guam unless the policy or endorsement form is filed for approval with the Com missioner at least forty-five (45) days prior to its effective d ate. (b) The Commissioner shall review each health insu rance policy or endorsement filed for the purpose of dete rmining the following about the policy or endorsement: (1) Whether it is in violation of this Chapter; (2) Whether it contains any title, heading, or pro vision that is misleading; (3) Whether it contains provisions that are so uncl ear or deceptively worded that they encourage misrepresentation; or (4) Whether it provides coverage of such a limited nature that it is contrary to the public interest o f Guam. (c) Within forty-five (45) days after the filing o f any health insurance policy form or endorsement requiring appr oval pursuant to this Section, the Commissioner will ind icate approval by signing or giving explanation for disap proval in writing. The Commissioner, for good cause, may ext end, for up to an additional forty-five (45) days, the period w ithin which he shall approve or disapprove the

iving explanation for disap proval in writing. The Commissioner, for good cause, may ext end, for up to an additional forty-five (45) days, the period w ithin which he shall approve or disapprove the policy form or endo rsement. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 12 Good cause may include written notification to the insurer within the first forty-five (45) days that its submission is incomplete, and the items necessary to complete the submission. Any policy form or endorsement received but neither approved n or disapproved by the Commissioner shall be deemed app roved at the end of the forty-five (45) days if the period i s not extended, or at the end of the extended period, if any; howev er, no policy form or endorsement shall be deemed approved under the provisions of this Section unless written notice of the intent to use the policy form or endorsement has been filed w ith the Commissioner. (d) If the Commissioner proposes to withdraw appro val previously given or deemed given to the policy form or endorsement to which this Section applies, he shall notify the insurer in writing at least ninety (90) days prior to the proposed effective date

previously given or deemed given to the policy form or endorsement to which this Section applies, he shall notify the insurer in writing at least ninety (90) days prior to the proposed effective date of withdrawal giving his reasons for withdrawal. (e) The policy and endorsement forms approved unde r this Section shall be open to public inspection. Copies may be obtained by any person on request and upon payment of a reasonable charge for the copies. (f) Every health insurance policy form filed with the Commissioner for approval shall be accompanied by a filing fee of Twenty Dollars ($20.00). An application for ins urance and other collateral documents which are not incorporat ed by reference into a policy of insurance are not insura nce policy forms for the purpose of determining the filing fee . SOURCE : Added by P.L. 29-121:5 (Dec. 2, 2008) § 18309. Coinsurance Clause Explanation. Where a policy contains a coinsurance clause, the i nsurer shall notify the policy-holder of its existence, su ch notification to include the following information: (a) The name of the Insured; (b) The policy number of the policy and the effecti ve date thereof; (c) The following notice in type of

istence, su ch notification to include the following information: (a) The name of the Insured; (b) The policy number of the policy and the effecti ve date thereof; (c) The following notice in type of which the face is not smaller than six (6) points: COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 13 'Important, this policy contains a coinsurance clause. If the amount of insurance purchased is not equal to the cash or replacement cost of your insured property then the settlement you received arising from future losses will not be sufficient to replace the loss you have suffered. I t is your responsibility as the insured to make certain the insured value, as stated below, is equa l to cash value or full replacement cost of your insured property if you desire full protection.' (d) The coinsurance clause in its entirety is a typ e of which the face is not smaller than six (6) points; (e) The insured value of the property. SOURCE : GC § 43358. Repealed by P.L. 13-187:218; Added by P.L. 14-71:1. § 18310. Coinsurance Clause Explanation: Notificati on. Notification of the coinsurance clause, as required by § 18309, shall be made in the manner and at such inte

13-187:218; Added by P.L. 14-71:1. § 18310. Coinsurance Clause Explanation: Notificati on. Notification of the coinsurance clause, as required by § 18309, shall be made in the manner and at such inte rvals in time as shall be prescribed by the Commissioner of Banki ng and Insurance. SOURCE : GC § 43359. Added by P.L. 14-71:1. 2011 NOTE: Reference to the 'Insurance Commissioner' changed to the 'Commissioner of Banking and Insurance' pursuant to P.L. 27-088:10 (May 6, 2004). § 18311. Penalty. Any person violating any of the provisions of this article shall be guilty of a misdemeanor, and shall, upon c onviction, be subject to a fine of not more than one thousand dol lars ($1,000.00) if the person convicted is not a natura l person, or if the person convicted is a natural person, a fine of not more than five hundred dollars ($500.00) or imprisonment of n ot more than six (6) months, or both such fine and imprisonment. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 14 SOURCE : GC § 43360. Renumbered by P.L. 14-71:1. ---------- ARTICLE 4 THE PREMIUM § 18401. Accrual of Premium. § 18402. Right to Return of Premium. § 18403. Acknowledgment of Receipt of Premium.

E 14 SOURCE : GC § 43360. Renumbered by P.L. 14-71:1. ---------- ARTICLE 4 THE PREMIUM § 18401. Accrual of Premium. § 18402. Right to Return of Premium. § 18403. Acknowledgment of Receipt of Premium. § 18401. Accrual of Premium. The insurer is entitled to payment of the premium a s soon as the subject matter insured is exposed to the peril insured against. SOURCE : GC § 43375. § 18402. Right to Return of Premium. Unless the insurance contract otherwise provides, a person insured is entitled to a return of premium after a policy is cancelled or rescinded as provided herein: (a) To the whole premium if no part of his interest in the thing insured is exposed to any of the perils i nsured against; (b) Where the insurance is for a definite term, and the insured surrenders his policy, to such proportion o f the premium as corresponds to the unexpired portion of the term after deducting from the whole premium any cla im for loss or damage which has previously accrued; (c) When the contract is void or voidable on accoun t of the fraud or misrepresentation of the insurer; (d) When the contract is void or voidable on accoun t of facts of the existence of which the insured was ign orant

ct is void or voidable on accoun t of the fraud or misrepresentation of the insurer; (d) When the contract is void or voidable on accoun t of facts of the existence of which the insured was ign orant without his fault; (e) When, by any default of the insured other than actual fraud, the insurer did not incur any liabili ty under the policy. SOURCE : GC § 43376. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 15 § 18403. Acknowledgment of Receipt of Premium. An acknowledgment in a policy of receipt of the pre mium is conclusive evidence of its payment, so far as to ma ke the policy binding, notwithstanding any stipulation in the pol icy that it shall not be binding until the premium is actually paid. SOURCE : GC § 43377. ---------- ARTICLE 5 RATES § 18501. Approval. § 18501.1. Rate Approval: Health Insurance. § 18502. Standards. § 18503. Rating bureaus. § 18504. Penalty. § 18501. Approval. (a) All rates, rate schedules, rate plans and metho ds of computing rates to be applied to any insurance tran sacted in Guam shall be filed with the office of the Commissi oner, and before any rates may be charged, advertised, public ized, or otherwise represented, they

es to be applied to any insurance tran sacted in Guam shall be filed with the office of the Commissi oner, and before any rates may be charged, advertised, public ized, or otherwise represented, they shall have the approval of the Commissioner. (b) It shall be unlawful for any insurer to use any rates in violation of the provisions of this section, or to alter, amend or otherwise change any rates without the approval of the Commissioner. (c) It shall be unlawful for any insurer to charge any rate for any insurance transacted in Guam other than the rat e approved by the Commissioner for such insurer for such risk and class of insurance. (d) A filing fee of Two Hundred Dollars ($200.00) s hall be paid for every rate plan or request for the Commiss ioner’s approval that is filed with the Commissioner. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 16 SOURCE : GC § 43385. Subsection (d) added by P.L. 29-002: V:I:98 (May 18, 2007). Subsection (a) amended by P.L. 29- 121:6 (Dec. 2, 2008). § 18501.1 Rate Approval: Health Insurance. (a) No insurance rate, rate schedule, rate plans o r methods of computing rates to be applied to any insurance t ransacted in Guam

29- 121:6 (Dec. 2, 2008). § 18501.1 Rate Approval: Health Insurance. (a) No insurance rate, rate schedule, rate plans o r methods of computing rates to be applied to any insurance t ransacted in Guam shall be advertised, publicized, charged or ot herwise represented in Guam unless the rate, rate schedule, rate plan or method of computing rates is filed for approval wit h the Commissioner at least forty-five (45) days prior to its effective date, whichever occurs first. (b) The Commissioner shall review each rate, rate schedule, rate plan or method of computing rates fo r the purpose of determining the following about the rate, rate s chedule, rate plan or method of computing rates: (1) whether it is in violation of this Chapter; (2) whether it is unreasonable in relation to the benefits provided; or (3) whether it exceeds those amounts established b y rule or regulation. (c) Within forty-five (45) days after the filing o f any insurance rate, rate schedule, rate plan or method of computing rates requiring approval pursuant to this Section, the Commissioner will indicate approval by signing or g iving explanation for disapproval in writing.

ate schedule, rate plan or method of computing rates requiring approval pursuant to this Section, the Commissioner will indicate approval by signing or g iving explanation for disapproval in writing. The Commis sioner, for good cause, may extend, for up to an additional for ty-five (45) days, the period within which he shall approve or d isapprove the rate, rate schedule, rate plan or method of computi ng rates. Good cause may include written notification to the insurer within the first forty-five (45) days that its rate submis sion is incomplete, and the items necessary to complete the submission. Any rate, rate schedule, rate plan or method of com puting rates received but neither approved nor disapproved by th e Commissioner shall be deemed approved at the end of the forty- five (45) days if the period is not extended, or at the end of the extended period, if any; however, no rate, rate sch edule, rate plan or method of computing rates policy form or endorse ment shall COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 17 be deemed approved under the provisions of this Sec tion unless written notice of the intent to use the rate, rate schedule, rate plan

122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 17 be deemed approved under the provisions of this Sec tion unless written notice of the intent to use the rate, rate schedule, rate plan or method of computing rates has been filed with th e Commissioner. (d) It shall be unlawful for any insurer to use an y rate in violation of the provisions of this Section, or to alter, amend or otherwise change any rate without the approval of t he Commissioner. (e) It shall be unlawful for any insurer to charge any rate for insurance transacted in Guam other than the rat e approved by the Commissioner for such insurer for such risk and class of insurance. (f) If the Commissioner proposes to withdraw appro val of a rate, rate schedule, rate plan or method of computi ng rates previously given or deemed given to which this Sect ion applies, he shall notify the insurer in writing at least nin ety (90) days prior to the proposed effective date of withdrawal giving his reasons for withdrawal. (g) The rate, rate schedule, rate plan or method o f computing rates approved under this Section shall b e open to public inspection.

d effective date of withdrawal giving his reasons for withdrawal. (g) The rate, rate schedule, rate plan or method o f computing rates approved under this Section shall b e open to public inspection. Copies may be obtained by any p erson on request and upon payment of a reasonable charge for the copies. (h) A filing fee of Two Hundred Dollars ($200.00) shall be paid for every rate plan or request filed for the C ommissioner’s approval. SOURCE : Added by P.L. 29-121:7 (Dec. 2, 2008). § 18502. Standards. An insurer in making rates, and the Commissioner in approving them, shall apply the standards prescribe d in this section: (a) Rates shall not be excessive or inadequate, as herein provided, nor shall they be unfairly discrim inatory. (b) No rate shall be held excessive unless such rat e is unreasonably high for the insurance provided and reasonable degree of competition does not exist in Guam COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 18 with respect to the classification to which such ra te is applicable. (c) No rate shall be held inadequate unless such ra te is unreasonably low for the insurance provided and the continued use of such rate endangers

he classification to which such ra te is applicable. (c) No rate shall be held inadequate unless such ra te is unreasonably low for the insurance provided and the continued use of such rate endangers the solvency o f the insurer; or unless such rate is unreasonably low fo r the insurance provided and the use of such rate by the insurer will have the effect of destroying competition in G uam (d) Consideration shall be given, to the extent applicable, to past and prospective loss experience s, to prevailing hazards, and to underwriting profits, contingencies, expenses and other normal business requirements and factors. SOURCE : GC § 43386. § 18503. Rating Bureaus. Insurers are authorized to become members or subscr ibers of rating bureaus, or advisory organizations of a l ike nature and may use the rates, rating systems, and underwriting rules and policy forms of such organizations, provided the sa me are not excessive, inadequate, nor unfairly discriminatory, conform to the provisions of this Title, and are approved by t he Commissioner prior to their use as provided. SOURCE : GC § 43357. § 18504. Penalty.

cessive, inadequate, nor unfairly discriminatory, conform to the provisions of this Title, and are approved by t he Commissioner prior to their use as provided. SOURCE : GC § 43357. § 18504. Penalty. Any person who is found violating any provision of this Article shall pay a fine of not more than Five Thou sand Dollars ($5,000.00). SOURCE : GC § 43388. Repealed by P.L. 13-187:219. Added b y P.L. 27-002:V:I:99 (May 18, 2007). ---------- COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 19 ARTICLE 6 LOSS § 18601. Peril not Insured Against: Rescue Efforts. § 18602. Wilful Act of Insured: Negligence. § 18603. Notice of Loss. § 18604. Preliminary Proof of Loss. § 18605. Waiver of Defects in Notice or Preliminary Proof. § 18606. Waiver of Delay. § 18607. Policy Requiring Proof by Third Person: Su fficiency of Compliance. § 18608. Failure to Pay Loss, Recovery of Amount Du e and Damages. § 18609. Total Loss by Fire or Miscellaneous Insura nce: Recovery of Full Amount. § 18601. Peril not Insured Against: Rescue Efforts. An insurer is liable: (a) Where the thing insured is rescued from a peril insured against and which would otherwise have caus ed a loss if in the

. § 18601. Peril not Insured Against: Rescue Efforts. An insurer is liable: (a) Where the thing insured is rescued from a peril insured against and which would otherwise have caus ed a loss if in the course of such rescue, the thing is exposed to a peril not insured against, and which permanently de prives the insured of its possession, in whole or in part. (b) If a loss is caused by efforts to rescue the th ing insured from a peril insured against. SOURCE : GC § 43400. § 18602. Wilful Act of Insured: Negligence. An insurer is not liable for a loss caused by the w ilful act of the insured; but he is not exonerated by the neglig ence of the insured or of the insured's agents or others. SOURCE : GC § 43401. § 18603. Notice of Loss. Failure to give notice of loss covered by marine or fire insurance within any period provided for by the pol icy or otherwise, shall not exonerate the insurer if the n otice is given within a reasonable time after the insured loss has or should have COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 20 first knowledge of said loss. In all other classes of insurance, the insured shall have at least twenty (20) days after the event

4/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 20 first knowledge of said loss. In all other classes of insurance, the insured shall have at least twenty (20) days after the event within which to give notice of loss. No requirement of not ice within a lesser period is valid. SOURCE : GC § 43402. § 18604. Preliminary Proof of Loss. When preliminary proof of loss is required by a pol icy, the insured is not bound to give such proof as would be necessary in a court of justice, but it is sufficient for him to give the best evidence in his power at the time. SOURCE : GC § 43403. § 18605. Waiver of Defects in Notice or Preliminary Proof. All defects in a notice of loss, or in preliminary proof thereof, which the insured might remedy, and which the insurer omits to specify to him, without unnecessary delay, as grounds of objection, are waived. SOURCE : GC § 43404. § 18606. Waiver of Delay. Delay in the presentation to an insurer of notice, or preliminary proof of loss, is waived if caused by a n act of the insurer, or if he omits to make objection promptly and specifically upon that ground. SOURCE : GC § 43405. § 18607.

urer of notice, or preliminary proof of loss, is waived if caused by a n act of the insurer, or if he omits to make objection promptly and specifically upon that ground. SOURCE : GC § 43405. § 18607. Policy Requiring Proof by Third Person: Su fficiency of Compliance. If a policy requires, by way of preliminary proof o f loss, the certificate or testimony of a person other than the insured beneficiary, there is sufficient compliance with th e requirement if the insured or the beneficiary (a) uses reasonab le diligence to procure the certificate or testimony, and (b) in ca se of refusal to give it to him, furnishes reasonable evidence to th e insurer that the refusal was not induced by just grounds of disb elief in the facts necessary to be certified or testified to. SOURCE : GC § 43406. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 21 § 18608. Failure to Pay Loss, Recovery of Amount Du e and Damages. In all cases where loss occurs and the insurer liab le therefor shall fail to pay the same within the time specifie d in the policy, after demand made therefor, such insurer shall be l iable to pay the holder of such policy, in addition to the amoun t of such

for shall fail to pay the same within the time specifie d in the policy, after demand made therefor, such insurer shall be l iable to pay the holder of such policy, in addition to the amoun t of such loss, twelve percent (12%) damages upon the amount of suc h loss, together with all reasonable attorney's fees for th e prosecution and collection of said loss; said attorney's fees t o be taxed by the court where the same is heard on original action, b y appeal or otherwise, and to be taxed as a part of the costs t herein, and collected as other cost are or may be by law collec ted; and writs of attachment or garnishment filed or issued after proof of loss or death has been received by the insurer shall not de feat the provisions of this section, provided the insurer de siring to pay the amount of the claim as shown in the proof of lo ss or death may pay said amount into the registry of the court after issuance of writs of attachment and garnishment, in which ev ent there shall be no further liability on the part of said i nsurer. [U.S. for use of Getz Bros. & Co. v. Markowitz Bros. (1967), 383 F.2d. 595.] SOURCE : GC § 43407. § 18609.

rnishment, in which ev ent there shall be no further liability on the part of said i nsurer. [U.S. for use of Getz Bros. & Co. v. Markowitz Bros. (1967), 383 F.2d. 595.] SOURCE : GC § 43407. § 18609. Total Loss by Fire or Miscellaneous Insura nce: Recovery of Full Amount. A fire or miscellaneous insurance policy, in case o f a total loss of any risk insured under the classes specifie d in this Title as fire or miscellaneous insurance shall be held and c onsidered to be a liquidated demand against the insurer taking s uch risk for the full amount stated in such policy, or the full amount upon which the insurer charges, collects or receives a p remium; provided the provisions of this article shall not a pply to personal property. In the event of a total loss or destructi on of any personal property on which the amount of the apprai sal or agreed loss is less than the total amount insured thereon, the insurer shall return to the insured the unearned premium fo r the excess of insurance over the appraised or agreed loss, to be paid at the same time and in the same manner as the loss shall be paid; and the unearned premium shall be a just and legal clai m against the COL6/24/202122 GCA

er the appraised or agreed loss, to be paid at the same time and in the same manner as the loss shall be paid; and the unearned premium shall be a just and legal clai m against the COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 22 insurer. [ National Union Fire Ins. Co. v. Santos (1962), 303 F.2d. 309.] SOURCE : GC § 43408. ---------- ARTICLE 7 DOUBLE INSURANCE § 18701. Double Insurance. § 18702. Double Insurance: Contribution. § 18701. Double Insurance. Double insurance exists when the same person is ins ured by several insurers separately in respect to the same subject, interest and risk. SOURCE : GC § 43425. § 18702. Double Insurance: Contribution. In case of double insurance, the several insurers a re liable to pay losses thereon as follows: (a) Fire insurance. In fire and miscellaneous insur ance, each insurer shall contribute ratably without regar d to the dates of the several policies. (b) Marine insurance. In marine insurance, the liab ility of the several insurers for a total loss, whether a ctual or constructive, where the policies are not simultaneo us, is in the order of the dates of the several policies.

ne insurance, the liab ility of the several insurers for a total loss, whether a ctual or constructive, where the policies are not simultaneo us, is in the order of the dates of the several policies. No liability attaches to a second or other subsequent policy, ex cept as to the excess of the loss over the amount of all previ ous policies on the same interest. If two (2) or more p olicies bear the same date, they are deemed to be simultane ous, and each insurer on simultaneous policies shall contrib ute ratably, the insolvency of any of the insurers does not affect the proportionate liability of the other insurers. All insurers on the same marine interest shall contribute ratabl y for a partial or average loss. SOURCE : GC § 43426. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 23 ---------- ARTICLE 8 REINSURANCE § 18801. Definitions. § 18802. Authorization. § 18801. Definitions. A contract of reinsurance is one by which an insure r procures a third person to insure him against loss or liability by reason of such original insurance. SOURCE : GC § 43450. § 18802. Authorization.

contract of reinsurance is one by which an insure r procures a third person to insure him against loss or liability by reason of such original insurance. SOURCE : GC § 43450. § 18802. Authorization. No admitted insurer shall reinsure with any other i nsurer who has not been previously admitted in Guam, or wh o has not been approved by the Commissioner as a reinsurer. SOURCE : GC § 43451. ---------- ARTICLE 9 HEALTH INSURANCE COVERAGE SOURCE : Pursuant to P.L. 35-128:3 (Dec. 29, 2020), the ti tle of this article was amended from 'Health Insurance Coverage ; Blood and Blood Derivatives.' § 18901. Health Insurance Coverage; Blood and Blood Derivatives, Mandate Established. § 18902. Coverage of Routine Costs of Care During Approved Clinical Trials § 18901. Health Insurance Coverage; Blood and Blood Derivatives, Mandate Established. (a) No health insurance company or health care pro vider contracted to provide health care to employees in a small group or large group plan may deny coverage to the employ ee or dependent on the basis of blood or blood derivative s. Blood and blood derivatives shall be covered and may be subje ct to COL6/24/202122 GCA BUSINESS REGULATIONS CH.

eny coverage to the employ ee or dependent on the basis of blood or blood derivative s. Blood and blood derivatives shall be covered and may be subje ct to COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 24 maximum limitations per annum. (1) Guaranteed Availability. (A) Prohibition of Preexisting Condition Exclusions or Other Discrimination Based on Health Status. As a condition of conducting health insuran ce coverage on Guam, a group health plan and a health insurance issuer offering group or individual healt h insurance coverage shall not impose any preexisting condition exclusion with respect to such plan or coverage, pursuant to Subsection 2 of this Section. (B) Definition, for the purposes of this Part. Th e term 'preexisting condition exclusion' means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date. (2) Prohibition on Rescissions. For the purposes of this Section, and in conformance with SEC. 2712 [42 U.S.C.

ical advice, diagnosis, care, or treatment was recommended or received before such date. (2) Prohibition on Rescissions. For the purposes of this Section, and in conformance with SEC. 2712 [42 U.S.C. 300gg–12] Prohibition On Rescissions , a group health plan and a health insurance issuer offering group or individual health insurance coverage shall not resc ind such plan or coverage with respect to an enrollee once t he enrollee is covered under such plan or coverage inv olved, except that this Section shall not apply to a cover ed individual who has performed an act or practice tha t constitutes fraud or makes an intentional misrepres entation of material fact as prohibited by the terms of the plan or coverage. Such plan or coverage may not be cancelle d except with prior notice to the enrollee, and only as permitted under Sections 2702(c), 2703(b) or 2742(b ) of the Public Health Service Act. SOURCE: Added by P.L. 32-235:2 (Jan. 2, 2015) as 11 GCA § 103121. Codified to this section by the Compiler pursuant t o the authority granted by 1 GCA § 1606. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 25 § 18902.

) as 11 GCA § 103121. Codified to this section by the Compiler pursuant t o the authority granted by 1 GCA § 1606. COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 25 § 18902. Coverage of Routine Costs of Care During Approved Clinical Trials. (a) A health insurance company or healthcare plan s hall continue coverage of routine costs for any insured during the approved clinical trial. (b) For the purposes of this Section, routine costs of care include any treatments, procedures, and services th e insured may need while participating in the clinical trial that would normally be covered if the insured were not participating in a trial. (c) For the purposes of this Section, approved clin ical trials are designed to study new methods to prevent, detec t, or treat cancer or another life-threatening illness. An appr oved clinical trial must meet any of the following conditions: (1) be federally approved or funded - this means th at one (1) or more of the organizations listed below a pproved or funded the clinical trial: (A) the National Institutes of Health (NIH), including organizations under the NIH such as the National Cancer Institute (NCI); (B) organizations

listed below a pproved or funded the clinical trial: (A) the National Institutes of Health (NIH), including organizations under the NIH such as the National Cancer Institute (NCI); (B) organizations funded by the NIH or NCI, including academic institutions, designated cancer centers, and cooperative groups; (C) the Centers for Disease Control and Prevention (CDC); (D) the Agency for Health Care Research and Quality (ARHQ); (E) the Center for Medicare and Medicaid Services (CMS); (F) the Department of Defense, the Department of Veteran Affairs, or the Department of Energy, if th e trial is subject to unbiased, scientific review tha t is similar to NIH requirements; (2) have an investigational new drug application; o r COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 26 (3) be excused from investigational new drug application requirements. (d) Health insurance companies or healthcare plans are not required to cover the cost of any clinical trials. SOURCE: Added by P.L. 35-128:2 (Dec. 29, 2021). --------- ARTICLE 10 HEALTH INSURANCE COVERAGE ; SCREENINGS § 181001. Coverage for Prostate and Cervical Cancer Detection. § 181002.

y clinical trials. SOURCE: Added by P.L. 35-128:2 (Dec. 29, 2021). --------- ARTICLE 10 HEALTH INSURANCE COVERAGE ; SCREENINGS § 181001. Coverage for Prostate and Cervical Cancer Detection. § 181002. Coverage Under Health Benefit Plan for Co lorectal Cancer Examinations and Laboratory Tests. § 181003. Breast Cancer Screening Benefit in Every Health Insurance Policy. § 181004. Diabetes Screening Coverage in Health Ins urance Policies. § 181001. Coverage for Prostate and Cervical Cancer Detection. (a) Except for a fraternal benefit society, a healt h care insurer that offers, issues for delivery, delivers, or renews in Guam, a health care insurance plan, shall provide c overage for the costs of prostate cancer screening tests as req uired under the schedule described in Subsection (b) of this Sectio n, and shall provide coverage for the costs of cervical cancer s creening tests as required under the schedule described in Subsect ion (c) of this Section. The coverage required by this Section is s ubject to standard policy provisions applicable to other bene fits, including deductible or copayment provisions.

cribed in Subsect ion (c) of this Section. The coverage required by this Section is s ubject to standard policy provisions applicable to other bene fits, including deductible or copayment provisions. (b) The minimum coverage required under Subsection (a) of this Section for prostate cancer screening inclu des an annual prostate cancer screening test, by digital rectal e xamination, for a person who is forty (40) or more years of age. (c) The minimum coverage required under Subsection (a) of this Section for cervical cancer screening is an annual pap COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 27 smear cancer screening test for a person who is twe nty-one (21) or more years of age. (d) The coverage described by this Section shall be effective in the event that the United States Preve ntive Services Task Force, its recommendations, or the provisions of the Affordable Care Act or its successor acts, should c ease to require such coverage. SOURCE: Added by P.L. 34-002:2 (May 10, 2017). § 181002. Coverage Under Health Benefit Plan for Colorectal Cancer Examinations and Laboratory Tests .

sor acts, should c ease to require such coverage. SOURCE: Added by P.L. 34-002:2 (May 10, 2017). § 181002. Coverage Under Health Benefit Plan for Colorectal Cancer Examinations and Laboratory Tests . (a) Except for a fraternal benefit society, a heal th benefit plan issued or renewed on or after January 1, 2018, shall provide coverage for all colorectal cancer examinations and laboratory tests specified in current American Cancer Society guidelines for complete colorectal cancer screening of asymptomati c individuals as follows: (1) Coverage or benefits shall be provided for all colorectal screening examinations and tests that ar e administered at a frequency identified in the most recent version of the American Cancer Society guidelines f or complete colorectal cancer screening; and (2) The covered individual shall be: (A) fifty (50) years of age or older; or (B) less than fifty (50) years of age and at high risk for colorectal cancer according to the current colorectal cancer screening guidelines of the Ameri can Cancer Society. (b) Coverage under this Section shall not be subjec t to a deductible or coinsurance for services received fro m participating providers under the

creening guidelines of the Ameri can Cancer Society. (b) Coverage under this Section shall not be subjec t to a deductible or coinsurance for services received fro m participating providers under the health benefit pl an in the event that the United States Preventive Services Task For ce recommendations or the provisions of the Affordable Care Act or its successor acts should cease to require such coverage. SOURCE: Added by P.L. 34-003:2 (May 10, 2017). COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 28 § 181003. Breast Cancer Screening Benefit in Every Health Insurance Policy. (a) (1) Every policy of health insurance issued or renewed to a resident of Guam on or after January 1, 2019, except a policy that provides coverage only for specified an d limited benefits, shall provide coverage for screening by low-dose mammography for occult breast cancer as follows: (A) for women thirty-five (35) to thirty-nine (39) years of age, one (1) baseline mammogram; (B) for women forty (40) years of age and older, an annual mammogram; and (C) for a woman of any age, and for men beginning at age forty (40) who have a first-degree consanguineous relative that was

(B) for women forty (40) years of age and older, an annual mammogram; and (C) for a woman of any age, and for men beginning at age forty (40) who have a first-degree consanguineous relative that was diagnosed to have developed breast cancer at forty (40) years of age or younger, mammogram screening may be performed as recommended by the patient’s physician, but not mor e than once annually. (2) The services provided in this Section are not subject to any coinsurance or deductible provisions which may be in force in such policies, contracts, plans or agreements for routine x-ray examinations. (b) The term, 'low-dose mammography' means the x-ra y examination of the breast using equipment dedicated specifically for mammography, including, but not limited to, the x-ray tube, filter, compression device, screens, films, and cas settes, with an average radiation exposure delivery of less than on e (1) rad mid- breast, with two (2) views for each breast, or digi tal breast tomosynthesis (DBT), or full-field digital mammogra phy (FFDM). (1) Digital breast tomosynthesis (DBT) is a form of breast imaging, or mammography, that uses a low-dos e x- ray system and computer reconstructions to

BT), or full-field digital mammogra phy (FFDM). (1) Digital breast tomosynthesis (DBT) is a form of breast imaging, or mammography, that uses a low-dos e x- ray system and computer reconstructions to create t hree- dimensional images of the breasts. (2) Full-field digital mammography (FFDM) is a mammography system in which the x-ray film is repla ced COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 29 by electronics that convert x-rays into mammographi c pictures of the breast. (c) To the extent permitted by federal law, rules, and regulations, the provisions of this Section, supra, shall apply to persons covered by Medicaid without the requirement for precertification. The provisions of this Section, supra, shall also apply to persons covered by the Medically Indigent Program (MIP) without the requirement for precertification. SOURCE: Added by P.L. 34-109:2 (May 14, 2018). 2018 NOTE: Subsection/subitem designations added/altered pur suant to 1 GCA § 1606. § 181004. Diabetes Screening Coverage in Health Ins urance Policies. (a) This screening recommendation applies to adults aged forty (40) to seventy (70) years who are obese or o verweight.

CA § 1606. § 181004. Diabetes Screening Coverage in Health Ins urance Policies. (a) This screening recommendation applies to adults aged forty (40) to seventy (70) years who are obese or o verweight. Persons who have a family history of diabetes, have a history of gestational diabetes or polycystic ovarian syndrome , or are members of certain racial/ethnic groups (that is, A frican Americans, American Indians or Alaskan Natives, Asi an Americans, Hispanics or Latinos, or Native Hawaiian s or Pacific Islanders) may be at an increased risk for diabetes at a younger age or at a lower body mass index, and clinicians s hould consider screening earlier in persons with one (1) or more of these characteristics. (b) The Director of the Department of Public Health and Social Services may adjust the screening recommenda tions in Subsection (a) of this Section in the event that th e U.S. Preventive Services Task Force adopts new recommendations. (c) Every policy of health insurance issued or rene wed to a resident of Guam on or after January 1, 2021 and th e Medically Indigent Program shall cover diabetes screening as defined in Subsection (a) of this Section.

health insurance issued or rene wed to a resident of Guam on or after January 1, 2021 and th e Medically Indigent Program shall cover diabetes screening as defined in Subsection (a) of this Section. Coverage under this Section shall not be subject to a deductible or coinsurance for s ervices. SOURCE: Added by P.L. 35-104:2 (Oct. 29, 2020). --------- COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 30 ARTICLE 11 HEALTH INSURANCE COVERAGE FOR AUTISM SPECTRUM DISORDER SOURCE: Added by P.L. 34-006:3 (May 10, 2017 as 22 GCA, Chapter 29A (§§ 29A101-29A103). Codified to this ch apter and article by Compiler pursuant to 1 GCA § 1606. 2017 NOTE: Pursuant to P.L. 34-006:7 (May 10, 2017), insuran ce coverage requirements shall be in effect regardless of any repeal or change in provisions of the Affordable Care Act. § 181101. Definitions. § 181102. Mandate. § 181103. Subscription Contracts for Healthcare Ins urance: Autism Spectrum Disorder; Coverage; Exceptions. § 181101. Definitions. For the purposes of this Chapter: (a) Autism spectrum disorder (ASD) means one (1) of the three (3) following disorders as defined in the most recent edition of the diagnostic and

81101. Definitions. For the purposes of this Chapter: (a) Autism spectrum disorder (ASD) means one (1) of the three (3) following disorders as defined in the most recent edition of the diagnostic and statistical ma nual of mental disorders of the American Psychiatric Associ ation: (1) Autistic disorder; (2) Asperger’s syndrome; or (3) Pervasive developmental disorder—not otherwise specified. (b) Behavioral therapy means interactive therapies derived from evidence-based research, including app lied behavior analysis, which includes discrete trial tr aining, pivotal response training, intensive intervention p rograms, and early intensive behavioral intervention. (c) Behavioral health treatment means professional services and treatment programs, including applied behavior analysis and evidence-based behavior intervention programs, that develop or restore, to the maximum e xtent practicable, the functioning of an individual with autism COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 31 spectrum disorder, and that meet all of the followi ng criteria: (1) The treatment is prescribed by a physician or surgeon duly licensed to practice on Guam, or is developed by

NTRACT OF INSURANCE 31 spectrum disorder, and that meet all of the followi ng criteria: (1) The treatment is prescribed by a physician or surgeon duly licensed to practice on Guam, or is developed by a psychiatrist or psychologist, any of which shall be duly licensed to practice on Guam. (2) The treatment is provided under a treatment plan prescribed by a qualified ASD service provider and is administered by one (1) of the following: (A) a qualified ASD service provider; (B) a qualified ASD service professional supervised and employed by the qualified autism spectrum disorder service provider; or (C) an ASD service paraprofessional supervised and employed by a qualified ASD service provider. (3) The treatment plan has measurable goals over a specific timeline that is developed and approved by the qualified ASD service provider for the specific patient being treated. The treatment plan shall be reviewed no less than once every six (6) months by the qualified autism spectrum disorder service provider and modified whenever appropriate, and shall be consistent with all of the following items performe d by the qualified autism spectrum disorder service provider, who: (A) describes the

rvice provider and modified whenever appropriate, and shall be consistent with all of the following items performe d by the qualified autism spectrum disorder service provider, who: (A) describes the patient’s behavioral health impairments to be treated; (B) designs an intervention plan that includes the service type, number of hours, and parent participation needed to achieve the plan’s goal and objectives, and the frequency at which the patient’s progress is evaluated and reported; (C) provides intervention plans that utilize evidence-based practices, with demonstrated COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 32 clinical efficacy in treating autism spectrum disorder; and (D) discontinues intensive behavioral intervention services when the treatment goals and objectives are achieved or no longer appropriate. (4) The treatment plan is not used for purposes of providing or for the reimbursement of respite, d ay care, or educational services, and is not used to reimburse a parent for participating in the treatme nt program. The treatment plan shall be made available to the health care insurance service plan upon request .

tional services, and is not used to reimburse a parent for participating in the treatme nt program. The treatment plan shall be made available to the health care insurance service plan upon request . (d) Qualified autism spectrum disorder service provider means either of the following: (1) a person, entity, or group that is certified by a national entity, such as the Behavior Analyst Certification Board, that is accredited by the Nati onal Commission for Certifying Agencies, and who designs , supervises, or provides treatment for autism spectr um disorder, provided the services are within the experience and competence of the person, entity, or group that is nationally certified; or (2) a person licensed pursuant to Part 1 or Part 2 of Chapter 12, 10 GCA as a physician or surgeon, physical therapist, occupational therapist, psychol ogist, marriage and family therapist, educational psychologist, clinical social worker, professional clinical counselor, speech-language pathologist, or audiologist who designs, supervises, or provides treatment or services for autism spectrum disorder, provided the services are within the experience and competence of the licensee.

ge pathologist, or audiologist who designs, supervises, or provides treatment or services for autism spectrum disorder, provided the services are within the experience and competence of the licensee. (e) Small employer shall mean a business with less than ten (10) employees. (f) Bundling means combining various limited benefit insurance policies, and advertising or indi cating in any manner that these policies are major medical ex pense COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 33 coverage policies or could be substituted for major medical expense coverage. (g) Limited benefit coverage means an insurance policy that is designed, advertised, and marketed t o supplement major medical insurance; and that includ es accident only, dental only, vision only, disability income only, fixed or hospital indemnity, specified diseas e insurance, credit insurance, or Taft-Hartley trusts . SOURCE: Added by P.L. 34-006:3 (May 10, 2017 as 22 GCA § 29A101-29A103). Codified to this section by the Com piler pursuant to 1 GCA § 1606. § 181102. Mandate. (a) Except for those offered by a fraternal benefit society, every health care insurance service or health maint enance

d to this section by the Com piler pursuant to 1 GCA § 1606. § 181102. Mandate. (a) Except for those offered by a fraternal benefit society, every health care insurance service or health maint enance organization plan contract that provides hospital, medical, or surgical coverage shall also provide coverage for b ehavioral health treatment for autism spectrum disorder no la ter than October 1, 2017. The coverage shall be provided in the same manner and shall be subject to the same requirement s as provided in 22 GCA Chapter 29. (b) Except for a fraternal benefit society, every i nsurer, which shall include all insurance companies, health care service plans, health maintenance organizations, and any ot her entity delivering or issuing for delivery in Guam Medicare supplement policies or certificates licensed to do business on Guam, shall be subject to the provisions of this Chapter. SOURCE: Added by P.L. 34-006:3 (May 10, 2017 as 22 GCA § 29A102. Codified to this section by the Compiler pu rsuant to 1 GCA § 1606. § 181103. Subscription Contracts for Healthcare In surance; Autism Spectrum Disorder; Coverage; Exceptions.

017 as 22 GCA § 29A102. Codified to this section by the Compiler pu rsuant to 1 GCA § 1606. § 181103. Subscription Contracts for Healthcare In surance; Autism Spectrum Disorder; Coverage; Exceptions. (a) Except for those offered by a fraternal benefit society, health care insurance service plans issued by a hea lth insurance carrier, hospital service corporation, medical serv ice corporation, insurance company, health maintenance organization, and any other entity delivering or issuing for delivery in Guam Medicare COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 34 supplement policies or certificates issued pursuant to 22 GCA Chapter 29 shall not: (1) exclude or deny coverage for a treatment or impose dollar limits, deductibles and coinsurance p rovisions based solely on the diagnosis of autism spectrum di sorder. For the purposes of this Subsection, 'treatment' in cludes diagnosis, assessment, and services; or (2) exclude or deny coverage for medically necessar y behavioral therapy services. To be eligible for co verage, behavioral therapy services shall be provided or su pervised by a licensed or certified autism spectrum disorder provider.

ically necessar y behavioral therapy services. To be eligible for co verage, behavioral therapy services shall be provided or su pervised by a licensed or certified autism spectrum disorder provider. (b) This Chapter does not: (1) apply to a health insurance subscription contra ct that is issued to an individual or through a small employer; or (2) apply to bundled or limited benefit coverage as defined in § 181101(f) of this Chapter. (c) The coverage required by this Chapter is subjec t to all the terms and conditions of the subscription contra ct. Nothing in this Chapter prevents a corporation from imposing d eductibles, coinsurance or other cost sharing in relation to th e coverage required by this Chapter. (d) Coverage for diagnosis, treatment and behaviora l therapy is subject to: (1) a Seventy-five Thousand Dollars ($75,000) maximum benefit per year for an eligible person up to the age of fifteen (15); or (2) a Twenty-five Thousand Dollars ($25,000) maximum benefit per year for an eligible person who is between the ages of sixteen (16) and twenty-one (21 ). COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 35 SOURCE: Added by P.L.

benefit per year for an eligible person who is between the ages of sixteen (16) and twenty-one (21 ). COL6/24/202122 GCA BUSINESS REGULATIONS CH. 18 THE CONTRACT OF INSURANCE 35 SOURCE: Added by P.L. 34-006:3 (May 10, 2017 as 22 GCA § 29A103. Subsection (d) amended by P.L. 35-019:3 (Ma y 9, 2019). NOTE: Codified to this section by the Compiler pursuant to 1 GCA § 1606. Internal reference altered to reflect change. ---------- COL6/24/2021 COL6/24/2021