H. B. 2627
(By Delegate Swartzmiller)
[Introduced February 24, 2005; referred to the
Committee on Banking and Insurance then Finance.]
A BILL to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new article, designated §5-16D-1, §5-16D-2,
§5-16D-3, §5-16D-4, §5-16D-5, §5-16D-6, §5-16D-7, §5-16D-8 and
§5-16D-9, all relating to development of a health coverage
plan through the public employees insurance agency for persons
who lose their jobs and health coverage because of the effects
of international trade.
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new article, designated §5-16D-1, §5-16D-2,
§5-16D-3, §5-16D-4, §5-16D-5, §5-16D-6, §5-16D-7, §5-16D-8 and
§5-16D-9, all to read as follows:
ARTICLE 16D. INSURANCE FOR EMPLOYEES WHO LOST THEIR JOBS TO
INTERNATIONAL TRADE.
§5-16D-1. Legislative findings.
(a) The Legislature finds that many persons employed in the
private sector in the state lose their jobs because of the effects
of international trade such as in the steel industry;
(b) That as a result of their loss of employment these
individuals may lose access to health care coverage;
(c) That in an effort to address these employees' loss of
health care coverage, the federal government has, through the Trade
Act of 2002, developed a program to help provide health care
coverage to these individuals and to permit health coverage tax
credits against the individuals' federal income taxes;
(d) That despite the federal program, certain deserving
individuals who have lost their jobs because of the effects of
international trade are still unable to obtain health care coverage
for themselves or their dependents because of circumstances beyond
their control; and
(e) That there is a need for studying the feasibility of the
development of a program to enable these individuals to obtain
needed health care coverage.
§5-16D-2. Health care coverage plan; purpose; planning;
development and implementation.
A health care coverage plan in the state may be designed and
approved by the public employees insurance agency finance board for
individuals who have lost their jobs because of the effects of
international trade, who would otherwise qualify for health coverage tax credits under the federal program, but who have not
been able to obtain or maintain health care coverage under the
federal health coverage tax credit program. The public employees
insurance agency shall be responsible for implementation and
administration of the plan which may occur on or after the first
day of December, two thousand five, and at such time as the
Legislature appropriates two million dollars to fund the plan. The
purpose of the plan shall be to make available health insurance by
pooling in a group for health insurance purposes the individuals
who have lost their employment and their health coverage. The
public employees insurance agency finance board shall be
responsible for the development and approval of the plan. The
plan, once developed and approved by the finance board, shall not
be implemented by the public employees insurance agency until the
public employees insurance agency provides at least thirty days'
written notice to the Legislature's Joint Committee on Government
and Finance and the Legislature passes a joint resolution
authorizing the public employees insurance agency to proceed with
implementation of the plan. The written notice shall provide the
details of the plan the public employees insurance agency finance
board has developed and approved and proposes to implement.
§5-16D-3. Plan; contents.
(a) The public employees insurance agency finance board may
develop and approve and shall implement when developed and approved the plan authorized by this article. Upon request, in the
planning, development and implementation of the plan, the Insurance
Commissioner and the Commissioner of Health and Human Resources
shall cooperate with advice and assistance.
(b) The plan shall provide for the establishment of an
insurance pool for the provision of health care coverage with
measurable cost containment provisions to these individuals and
their dependents, as determined proper under the plan, who have
lost their job and health coverage because of the effects of
international trade, but who have not been able to obtain health
coverage pursuant to the federal health coverage tax credit program
or otherwise. Once established, the pool shall be actuarially
sound and the premiums adequate to completely self-support the
pool. The plan shall develop criteria for eligibility and may
permit bids from qualified and licensed insurance companies or
carriers, who may wish to offer plans or reinsurance for the
coverage desired. The plan may contain a variety of effective cost
controls and shall provide for an appropriate application form for
participation and the procedures for application. The plan also
shall ensure accurate and appropriate marketing of the health
coverage to eligible individuals throughout the state, which shall
include the utilization of licensed insurance agents and may
include the payment of agent commissions, agent field underwriting
and profit incentives. The plan may include the ability to assess agent performance and shall establish criteria for monitoring the
effectiveness of the insurance pool.
(c) The plan shall provide that the plan will be available to
eligible individuals who can demonstrate that they have lost their
jobs and health coverage because of the effects of international
trade, who are not eligible for the COBRA provisions for the
unemployed and who can demonstrate that their lack of health
insurance is because of an inability to obtain health coverage
under the federal health care tax credit program.
(d) A formulary prescription drug program may also be
included.
(e) The plan shall provide that benefit design and premium
structures be developed with input from the Insurance Commission
and Commissioner of Health and Human Resources.
(f) The plan shall begin with a three-year pilot program. The
plan authorized pursuant to this section is a pilot plan only, and
may be discontinued or terminated at the end thereof without
further liability on behalf of the State of West Virginia or any
that are participating.
(g) The plan may provide that age, and experience underwriting
of groups will take place.
§5-16D-4. Initial funding.
The plan authorized by this article may not be implemented
until the Legislature appropriates two million dollars to initially fund the plan.
§5-16D-5. Legislative report.
The public employees insurance agency, with the advice and
assistance of the finance board, shall cooperate to prepare and
submit reports to the Legislature before it convenes in each year
with studies, findings, conclusions and recommendations, including
any recommendations for legislation, all relating to the purpose
and effect of the health care plan created herein.
§5-16D-6. Exemption from state antitrust laws and insurance laws.
The health care plan and those responsible for developing and
implementing it under the provisions of this article are exempted
from the provisions of section five, article eighteen, chapter
forty-seven of this code and any otherwise applicable provisions of
chapter thirty-three of this code.
§5-16D-7. Termination of health care insurance plan.
The health care plan shall be terminated pursuant to the
provisions of article ten, chapter four of this code on the first
day of December, two thousand seven, unless continued or
reestablished pursuant to the provisions of that article.
§5-16D-8. Misrepresentation by employee or provider; penalty.
Any person who knowingly secures or attempts to secure
benefits payable under this article to which the person is not
entitled, or willfully misrepresents any material fact relating to
any other information requested by the public employees insurance agency, or who willfully overcharges for services provided, or who
willfully misrepresents the diagnosis or nature of the service
provided, may be found to be overpaid and shall be civilly liable
for any overpayment. In addition to the civil remedy provided
herein, the public employees insurance agency shall withhold
payment of any benefits due to that person until any overpayment
has been recovered or may directly set off, after holding internal
administrative proceedings to assure due process, any overcharges
or improperly derived payment against benefits due a person
hereunder. Nothing in this section shall be construed to limit any
other remedy or civil or criminal penalty provided by law.
§5-16D-9. State program.
The insurance program developed pursuant to this article is a
state plan subject to article twenty-nine-d, chapter sixteen of
this code.
NOTE: The purpose of this bill is to authorize the development
by the public employees finance board of a health benefit plan to
provide health insurance benefits to certain former employees of
businesses in this state who have lost their jobs and health
coverage because of the effects of international trade.
This article is new; therefore, strike-throughs and
underscoring have been omitted.
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