Committee Substitute
House Bill 2940 History
OTHER VERSIONS -
Introduced Version
|
HB2940 EnrSUB |
| Email
Key: Green = existing Code. Red = new code to be enacted
COMMITTEE SUBSTITUTE
FOR
H. B. 2940
(By
Cann, Kominar, White, Beach,
Barker, Perry, Perdue and Evans
)
(Originating in the Committee on Finance)
[February 23, 2007]
A BILL to
amend and reenact §33-16-1a
of the Code of West Virginia,
1931, as amended, relating increasing the age of dependents
for health insurance coverage.
Be it enacted by the Legislature of West Virginia:
That §33-16-1a
of the Code of West Virginia, 1931, as amended,
be amended and reenacted, to read as follows:
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-1a. Definitions.
As used in this article:
(a) "Bona fide association" means an association which has
been actively in existence for at least five years; has been formed
and maintained in good faith for purposes other than obtaining
insurance; does not condition membership in the association on any
health status-related factor relating to an individual; makes
accident and sickness insurance offered through the association
available to all members regardless of any health status-related
factor relating to members or individuals eligible for coverage through a member; does not make accident and sickness insurance
coverage offered through the association available other than in
connection with a member of the association; and meets any
additional requirements as may be set forth in this chapter or by
rule.
(b) "Commissioner" means the commissioner of insurance.
(c) "Creditable coverage" means, with respect to an
individual, coverage of the individual after the thirtieth day of
June, one thousand nine hundred ninety-six, under any of the
following, other than coverage consisting solely of excepted
benefits:
(1) A group health plan;
(2) A health benefit plan;
(3) Medicare Part A or Part B, 42 U.S.C. §1395 et seq.;
Medicaid, 42 U.S.C. §1396a et seq. (other than coverage consisting
solely of benefits under Section 1928 of the Social Security Act);
Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS), 10 U.S.C., Chapter 55; and a medical care program of
the Indian Health Service or of a tribal organization;
(4) A health benefits risk pool sponsored by any state of the
United States or by the District of Columbia; a health plan offered
under 5 U.S.C., chapter 89; a public health plan as defined in
regulations promulgated by the federal secretary of health and
human services; or a health benefit plan as defined in the Peace
Corps Act, 22 U.S.C. §2504(e).
(d) "Dependent" means an eligible employee's spouse or any unmarried child or stepchild under the age of eighteen or
unmarried, dependent child or stepchild under age twenty-three if
a full-time student at an accredited school. twenty-five if that
child or stepchild meets the definition of a "qualifying child" or
a "qualifying relative" in section 152 of the Internal Revenue
Code.
(e) "Eligible employee" means an employee, including an
individual who either works or resides in this state, who meets all
requirements for enrollment in a health benefit plan.
(f) "Excepted benefits" means:
(1) Any policy of liability insurance or contract supplemental
thereto; coverage only for accident or disability income insurance
or any combination thereof; automobile medical payment insurance;
credit-only insurance; coverage for on-site medical clinics;
workers' compensation insurance; or other similar insurance under
which benefits for medical care are secondary or incidental to
other insurance benefits; or
(2) If offered separately, a policy providing benefits
for long-term care, nursing home care, home health care,
community-based care or any combination thereof, dental or vision
benefits or other similar, limited benefits; or
(3) If offered as independent, noncoordinated benefits under
separate policies or certificates, specified disease or illness
coverage, hospital indemnity or other fixed indemnity insurance, or
coverage, such as medicare supplement insurance, supplemental to a
group health plan; or
(4) A policy of accident and sickness insurance covering a
period of less than one year.
(g) "Group health plan" means an employee welfare benefit
plan, including a church plan or a governmental plan, all as
defined in section three of the Employee Retirement Income Security
Act of 1974, 29 U.S.C. §1003, to the extent that the plan provides
medical care.
(h) "Health benefit plan" means benefits consisting of
medical care provided directly, through insurance or reimbursement,
or indirectly, including items and services paid for as medical
care, under any hospital or medical expense incurred policy or
certificate; hospital, medical or health service corporation
contract; health maintenance organization contract; or plan
provided by a multiple-employer trust or a multiple-employer
welfare arrangement. "Health benefit plan" does not include
excepted benefits.
(i) "Health insurer" means an entity licensed by the
commissioner to transact accident and sickness in this state and
subject to this chapter. "Health insurer" does not include a group
health plan.
(j) "Health status-related factor" means an individual's
health status, medical condition (including both physical and
mental illnesses), claims experience, receipt of health care,
medical history, genetic information, evidence of insurability
(including conditions arising out of acts of domestic violence) or
disability.
(k) "Medical care" means amounts paid for, or paid for
insurance covering, the diagnosis, cure, mitigation, treatment or
prevention of disease, or amounts paid for the purpose of affecting
any structure or function of the body, including amounts paid for
transportation primarily for and essential to such care.
(l) "Mental health benefits" means benefits with respect to
mental health services, as defined under the terms of a group
health plan or a health benefit plan offered in connection with the
group health plan.
(m) "Network plan" means a health benefit plan under which the
financing and delivery of medical care are provided, in whole or in
part, through a defined set of providers under contract with the
health insurer.
(n) "Preexisting condition exclusion" means, with respect to
a health benefit plan, a limitation or exclusion of benefits
relating to a condition based on the fact that the condition was
present before the enrollment date for such coverage, whether or
not any medical advice, diagnosis, care or treatment was
recommended or received before the enrollment date.