H. B. 4292
(By Delegate H. White)
[Introduced January 31, 2006; 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 the modification of group
accident and sickness insurance requirements.
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:
(1) A policy issued to an employer, who shall be considered
the policyholder, insuring at least ten employees of the employer,
for the benefit of persons other than the employer, and conforming
to the following requirements:
(A) 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
(B) 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
determined by conditions pertaining to the employment;
(C) The term "employee" as used herein is 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
corporate 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
include any municipal or governmental corporation, unit, agency or
department and the proper officers of any unincorporated
municipality or department, as well as private individuals,
partnerships and corporations.
(1) A policy issued to an employer insuring at least two
employees of the employer, which employer shall be deemed the
policyholder, to insure employees of the employer for the benefit
of persons other than the employer, subject to the following requirements:
(A) The employees eligible for insurance under the policy
shall be all of the employees of the employer, or all of any class
or classes thereof. The policy shall provide that the term
"employees" may include the employees of one or more subsidiary
corporations, and the employees, including proprietors and partners
of one or more affiliated corporations, proprietorships or
partnerships if the business of the employer and of the affiliated
corporations, proprietorships or partnerships is under common
control. The policy may provide that the term, "employees" shall
include retired employees, former employees and directors of a
corporate employer. A policy issued to insure the employees of a
public body may provide that the term "employees" shall include
elected or appointed officials.
(B) The premium for the policy shall be paid either from the
employer's fund, from funds contributed by the insured employees or
from both. Except as provided in subdivision (C), a policy in
which no part of the premium is to be derived from funds
contributed from the funds employees must insure all eligible
employees except those that reject coverage in writing.
(C) An insurer may exclude or limit the coverage on any person
as to whom evidence of individual insurability is not satisfactory
to the insurer.
(2) 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: The association or
associations hold regular meetings not less than annually to
further the purposes of the members; except for credit unions, the
association or associations collect dues or solicit contributions
from members; and the members have voting privileges and
representation on the governing board and committees. The policy
is subject to the following requirements:
(A) 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 for the
benefit of persons other than the employee's employer.
(B) The premium for the policy shall be paid from:
(i) Funds contributed by the association or associations;
(ii) Funds contributed by covered employer members;
(iii) Funds contributed by both covered employer members and
the association or associations;
(iv) Funds contributed by the covered persons; or
(v) Funds contributed by both the covered persons and the association, associations or employer members.
(C) Except as provided in
paragraph subdivision (D), 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.
(D) An insurer may exclude or limit the coverage on any person
as to whom evidence of individual insurability is not satisfactory
to the insurer.
(E) 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.
(3) A policy issued to a bona fide association;
(4) 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;
(5) 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;
(6) 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; and
(7) 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 amend the group
requirements for accident and sickness insurance by adopting, in
part, language consistent with the National Association of
Insurance Commissioners' model language.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.