COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 449
(By Senators Helmick, Kessler, Minard, Unger and Plymale)
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[Originating in the Committee on the Judiciary;
reported February 11, 2010.]
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A BILL to amend and reenact §5-16-17 of the Code of West Virginia,
1931, as amended, relating to the West Virginia Public
Employees Insurance Act; and when employees may enroll without
limitations of preexisting conditions.
Be it enacted by the Legislature of West Virginia:
That §5-16-17 of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-17. Preexisting conditions not covered; defined.
A preexisting condition is an injury, or sickness, or any
condition relating to that injury, or sickness, for which a
participant is diagnosed, receives treatment, or incurs expenses
within three months prior to the effective date of coverage.
Provided, That a preexisting condition shall not include a
condition which meets the definition of handicap as provided in section three, article eleven, chapter five of this code. In
determining whether the preexisting condition limitation provision
applies to an eligible employee or dependent, the Public Employees
Insurance Agency shall credit the time such person was covered
under any previous employer-based health benefit plan, any
comparable individual health benefit plan, or any self-insured plan
if the previous coverage was continuous to a date not more than
thirty days prior to the effective date of the new coverage,
exclusive of an applicable waiting period under such plan
For all participants enrolling in the plan after the effective
date of this section,
no
payment shall be made for expenses
incurred for or in connection with a preexisting condition: unless
the expenses are incurred after the expiration of a one-year period
during which the participant is continuously participating in the
plan Provided, That participants may enroll or make plan selections
only at the time of hire, during annual open enrollment or upon the
occurrence of a "qualifying event" under section 125 of the United
States Internal Revenue Code.
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(NOTE: The purpose of this bill is to prohibit the imposition
of preexisting condition limitations on employees under the West
Virginia Public Employees Insurance Act, while limiting the
occasions upon which employees may enroll or make benefit changes.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.)