West Virginia HB 2876: Modify the five-year waiting period and 100-person minimum for an association health plan, and to allow new flexibility granted under federal rules

Bill Text

HB 2876 Text

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Introduced Version

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WEST virginia 
legislature

2021 regular session

Introduced

House Bill 2876

By Delegates Westfall, Summers 
and Bates

[Introduced March 03, 2021; 
Referred to the Committee on Health and Human Resources]

A BILL to amend and 
reenact §33-16-1a and §33-16-2 of the Code of West Virginia, 1931, as amended; 
and to further amend said code by adding thereto a new section, designated 
§33-16-2a, all relating to modify group accident and sickness insurance requirements

Be it enacted by the 
Legislature of West Virginia:

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 established by 
one of the following: 

(1) An association of 
employers that are in the same trade, industry, line of business or profession; 

(2) An association of employers that do not share the same industry, 
lines of business or profession with a principal office within this state; or

(3) An association of employers that do not share the 
same, industry, line of business or profession with a principal office within a 
metropolitan area that has boundaries in this state: Provided, That the 
association 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 June 30, 1996, 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 25 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