H. B. 3008
(By Delegates Perry, Schoen, Hartman, Shook,
Reynolds, Walters and Moore)
[Introduced
March 10, 2009
; referred to the
Committee on Banking and Insurance then Finance.]
A BILL to repeal §33-48-11 of the Code of West Virginia, 1931, as
amended; to amend and reenact §33-48-4 of said code; and to
amend said code by adding thereto a new section, designated
§33-48-7b, all relating to the model health plan for
uninsurable individuals; removing obsolete sunset provision;
permitting the Insurance Commissioner to waive the waiting
period under certain circumstances; and authorizing the use
of surpluses to subsidize premiums.
Be it enacted by the Legislature of West Virginia:
That §33-48-11 of the Code of West Virginia, 1931, as
amended, be repealed; that §33-48-4 of said code be amended and
reenacted; and that said code be amended by adding thereto a new
section, designated §33-48-7b, all to read as follows:
ARTICLE 48. MODEL HEALTH PLAN FOR UNINSURABLE INDIVIDUALS ACT.
§33-48-4. Eligibility.
(a) The following persons are eligible for plan coverage:
(1) Any individual who is and continues to be a resident of
this state if evidence is provided of a notice of rejection or
refusal to issue substantially similar insurance for health
reasons by one insurer or of a refusal by an insurer to issue
insurance except at a rate exceeding the plan rate, except that a
rejection or refusal by an insurer offering only stop loss,
excess of loss or reinsurance coverage
shall not be is not
sufficient evidence under this subdivision;
(2) Any individual who is legally domiciled in this state
and is eligible for the credit for health insurance costs under
Section 35 of the Internal Revenue Code of 1986; and
(3) Any federally defined eligible individual who has not
experienced a significant break in coverage and who is and
continues to be a resident of this state.
(b) The board shall promulgate a list of medical or health
conditions for which a person is eligible for plan coverage
without applying for health insurance coverage pursuant to
subdivision (1), subsection (a) of this section. Persons who can
demonstrate the existence or history of any medical or health
conditions on the list promulgated by the board are not required
to prove the evidence specified in said subdivision. The list
shall be effective on the first day of the operation of the plan
and may be amended, from time to time, as may be appropriate.
(c) Each dependent of a person who is eligible for plan
coverage is also eligible for plan coverage.
(d) A person is not eligible for coverage under the plan if:
(1) The person has or obtains health insurance coverage
substantially similar to or more comprehensive than a plan policy
or would be eligible to have coverage if the person elected to
obtain it, except that:
(A) A person may maintain other coverage for the period of
time the person is satisfying any preexisting condition waiting
period under a plan policy; and
(B) A person may maintain plan coverage for the period of
time the person is satisfying a preexisting condition waiting
period under another health insurance policy intended to replace
the plan policy;
(2) The person is determined to be eligible for health care
benefits under the state Medicaid law or the West Virginia
Children's Health Insurance Program;
(3) The person has previously terminated plan coverage
unless twelve months have lapsed since
such the terminations,
except that this subdivision does not apply with respect to an
applicant who is a federally defined eligible individual or with
respect to an applicant who has exhausted annual benefits under
the West Virginia Children's Health Insurance Program:
Provided,
That the commissioner may waive the twelve-month waiting period for good cause;
(4) The plan has paid out $1 million in benefits on behalf
of the person;
(5) The person is an inmate or resident of a public
institution, except that this subdivision does not apply with
respect to an applicant who is a federally defined eligible
individual; or
(6) The person's premiums are paid for or reimbursed under
any government sponsored program or by any government agency or
health care provider, except as an otherwise qualifying full-time
employee, or dependent thereof, of a government agency or health
care provider.
(e) Coverage shall cease:
(1) On the date a person is no longer a resident of this
state;
(2) On the date a person requests coverage to end;
(3) Upon the death of the covered person;
(4) On the date state law requires cancellation of the
policy; or
(5) At the option of the plan, thirty days after the plan
makes any inquiry concerning the person's eligibility or place of
residence to which the person does not reply.
(f) Except under the circumstance described in subsection
(d) of this section, a person who ceases to meet the eligibility requirements of this section may be terminated at the end of the
policy period for which the necessary premiums have been paid.
§33-48-7b. Surplus available to subsidize premiums.
Whenever the account created pursuant to section seven-a of
this article contains a surplus above those amounts necessary to
provide fully for the expected costs of claims and other expenses
listed in subsection (a), section seven of this article, the
board may use the surpluses to subsidize the premium of low
income enrollees.
NOTE: The purpose of this bill is to permit the Insurance
Commissioner to waive the waiting period for eligibility for
coverage under the state's high risk health insurance plan and to
use surpluses in the program to subsidize premiums of certain low
income persons.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.
§33-48-7b is new; therefore, underscoring and
strike-throughs have been omitted.