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Introduced Version House Bill 2627 History

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hb2627 intr
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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