H. B. 3307
(By Delegates H.K. White and R.M. Thompson)
[Introduced March 25, 2005; referred to the
Committee on Banking and Insurance then the Judiciary.]
A BILL to amend and reenact §33-16-2 of the Code of West Virginia,
1931, as amended, relating to groups eligible to purchase
accident and sickness policies; permitting the issuance of
group health insurance policies to certain associations and
trusts established by associations; setting eligibility
standards for associations to purchase these policies;
providing allowable sources for funding these policies;
establishing requirements for coverage of these policies; and
granting Commissioner of Insurance authority to permit similar
groups to purchase these policies.
Be it enacted by the Legislature of West Virginia:
That §33-16-2 of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
ARTICLE 16. GROUP ACCIDENT AND SICKNESS.
§33-16-2. Eligible groups.
Any insurer licensed to transact accident and sickness
insurance in this state may issue group accident and sickness
policies coming within any of the following classifications:
(a) A policy issued to an employer, who shall be considered
the policyholder, insuring at least ten employees of
such
the employer, for the benefit of persons other than the employer,
and conforming to the following requirements:
(1) If the premium is paid by the employer the group shall
comprise all employees or all of any class or classes thereof
determined by conditions pertaining to the employment; or
(2) If the premium is paid by the employer and employees
jointly, or by the employees, the group shall comprise not less
than seventy percent of all employees of the employer or not less
than seventy-five percent of all employees of any class or classes
thereof determined by conditions pertaining to the employment;
(3) The term "employee" as used herein shall be considered to
include the officers, managers and employees of the employer, the
partners, if the employer is a partnership, the officers, managers
and employees of subsidiary or affiliated corporations of a
corporation employer, and the individual proprietors, partners and
employees of individuals and firms, the business of which is
controlled by the insured employer through stock ownership,
contract or otherwise. The term "employer" as used herein may be
considered to include any municipal or governmental corporation, unit, agency or department thereof and the proper officers, as
such, of any unincorporated municipality or department thereof, as
well as private individuals, partnerships and corporations.
(b) A policy issued to an association which has been in
existence for at least one year, which has a constitution and
bylaws and which has been organized and is maintained in good faith
for purposes other than that of obtaining insurance, insuring at
least ten members of the association for the benefit of persons
other than the association or its officers or trustees, as such;
(b) A policy issued to an association or to a trust or to the
trustees of a fund established, created or maintained for the
benefit of members of one or more associations. The association or
associations shall have at the issuance of the policy a minimum of
one hundred persons and have been organized and maintained in good
faith for purposes other than that of obtaining insurance; shall
have been in active existence for at least one year; and shall have
a constitution and bylaws that provide that: (i) The association
or associations hold regular meetings not less than annually to
further the purposes of the members; (ii) except for credit unions,
the association or associations collect dues or solicit
contributions from members; and (iii) the members have voting
privileges and representation on the governing board and
committees. The policy is subject to the following requirements:
(1) The policy may insure members of the association or associations, employees thereof or employees of members, or one or
more of the preceding or all of any class or classes thereof for
the benefit of persons other than the employee's employer.
(2) The premium for the policy shall be paid from:
(A) Funds contributed by the association or associations;
(B) Funds contributed by covered employer members;
(C) Funds contributed by both covered employer members and the
association or associations;
(D) Funds contributed by the covered persons; or
(E) Funds contributed by both the covered persons and the
association, associations or employer members.
(3) Except as provided in paragraph (4) of this subdivision,
a policy on which no part of the premium is to be derived from
funds contributed by the covered persons specifically for their
insurance must insure all eligible persons, except those who reject
coverage in writing.
(4) An insurer may exclude or limit the coverage on any person
as to whom evidence of individual insurability is not satisfactory
to the insurer.
(5) A small employer, as defined in subdivision (r),section
two, article sixteen-d of this chapter, insured under an eligible
group policy provided in this subdivision shall also be subject to
the marketing and rate practices provisions in article sixteen-d of
this chapter.
(c) A policy issued to a bona fide association;
(d) A policy issued to a college, school or other institution
of learning or to the head or principal thereof, insuring at least
ten students, or students and employees, of the institution;
(e) A policy issued to or in the name of any volunteer fire
department, insuring all of the members of the department or all of
any class or classes thereof against any one or more of the hazards
to which they are exposed by reason of the membership but in each
case not less than ten members;
(f) A policy issued to any person or organization to which a
policy of group life insurance may be issued or delivered in this
state, to insure any class or classes of individuals that could be
insured under the group life policy;
(g) Under a policy issued to cover any other substantially
similar group which in the discretion of the Commissioner may be
subject to the issuance of a group accident and sickness policy or
contract.
NOTE: The purpose of this bill is to expand eligible groups
for group health insurance to include trusts established by
eligible associations and discretionary groups with approval of the
Insurance Commissioner.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.
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