H. B. 2482
(By Delegates Webster, Staggers, Varner,
Fleischauer, Brown, Guthrie, Hatfield and Doyle)
[Introduced February 14, 2009; referred to the
Committee on Banking and Insurance then Finance.]
A BILL to amend and reenact §5-16-13 of the Code of West Virginia,
1931, as amended, relating the spouse and dependent insurance
coverage under the West Virginia Public Employees' Insurance
Act; requiring coverage of pregnancy related conditions for
covered spouses and dependents, when pregnancy related
benefits are extended to covered employees by a group
insurance plan; and providing that such coverage is excess or
secondary coverage for each spouse and dependent who has
primary coverage from any other source.
Be it enacted by the Legislature of West Virginia:
That §5-16-13 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.
§5-16-13. Payment of costs by employer and employee; spouse and
dependent coverage; involuntary employee termination
coverage; conversion of annual leave and sick leave
authorized for health or retirement benefits;
authorization for retiree participation; continuation of health insurance for surviving dependents of
deceased employees; requirement of new health plan,
limiting employer contribution.
(a)
Cost-sharing. -- The director shall provide under any
contract or contracts entered into under the provisions of this
article that the costs of any group hospital and surgical
insurance, group major medical insurance, group prescription drug
insurance, group life and accidental death insurance benefit plan
or plans shall be paid by the employer and employee.
(b)
Spouse and dependent coverage. -- Each employee is
entitled to have his or her spouse and dependents included in any
group hospital and surgical insurance, group major medical
insurance or group prescription drug insurance coverage to which
the employee is entitled to participate:
Provided, That the spouse
and dependent coverage is limited to excess or secondary coverage
for each spouse and dependent who has primary coverage from any
other source. For purposes of this section, the term "primary
coverage" means individual or group hospital and surgical insurance
coverage or individual or group major medical insurance coverage or
group prescription drug coverage in which the spouse or dependent
is the named insured or certificate holder. For the purposes of
this section, "dependent" means an eligible employee's unmarried
child or stepchild under the age of 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.
The director may require proof regarding spouse and dependent primary coverage and shall adopt rules governing the nature,
discontinuance and resumption of any employee's coverage for his or
her spouse and dependents.
(c) Coverage for pregnancy related conditions of spouse or
dependant. -- If the group hospital and surgical insurance, group
major medical insurance or group prescription drug insurance
coverage to which the employee has elected to participate includes
benefits for prenatal, natal, postnatal or other pregnancy related
conditions for a covered employee, coverage of similar pregnancy
related conditions shall be extended to any spouse or dependent
covered by that same plan: Provided, That any such spouse and
dependent coverage so extended is limited to excess or secondary
coverage for each spouse and dependent who has primary coverage
from any other source.
(c) (d) Continuation after termination. -- If an employee
participating in the plan is terminated from employment
involuntarily or in reduction of work force, the employee's
insurance coverage provided under this article shall continue for
a period of three months at no additional cost to the employee and
the employer shall continue to contribute the employer's share of
plan premiums for the coverage. An employee discharged for
misconduct shall not be eligible for extended benefits under this
section. Coverage may be extended up to the maximum period of
three months, while administrative remedies contesting the charge
of misconduct are pursued. If the discharge for misconduct be
upheld, the full cost of the extended coverage shall be reimbursed by the employee. If the employee is again employed or recalled to
active employment within twelve months of his or her prior
termination, he or she shall not be considered a new enrollee and
may not be required to again contribute his or her share of the
premium cost, if he or she had already fully contributed such share
during the prior period of employment.
(d) (e) Conversion of accrued annual and sick leave for
extended insurance coverage upon retirement for employees who
elected to participate in the plan before July, 1988. -- Except as
otherwise provided in subsection
(g) (h) of this section, when an
employee participating in the plan, who elected to participate in
the plan before July 1, 1988, is compelled or required by law to
retire before reaching the age of sixty-five, or when a
participating employee voluntarily retires as provided by law, that
employee's accrued annual leave and sick leave, if any, shall be
credited toward an extension of the insurance coverage provided by
this article, according to the following formulae: The insurance
coverage for a retired employee shall continue one additional month
for every two days of annual leave or sick leave, or both, which
the employee had accrued as of the effective date of his or her
retirement. For a retired employee, his or her spouse and
dependents, the insurance coverage shall continue one additional
month for every three days of annual leave or sick leave, or both,
which the employee had accrued as of the effective date of his or
her retirement.
(e) (f) Conversion of accrued annual and sick leave for extended insurance coverage upon retirement for employees who
elected to participate in the plan after June, 1988. --
Notwithstanding subsection
(d) (e) of this section, and except as
otherwise provided in subsections
(g) (h) and
(l) (m) of this
section when an employee participating in the plan who elected to
participate in the plan on and after July, 1, 1988 is compelled or
required by law to retire before reaching the age of sixty-five, or
when the participating employee voluntarily retires as provided by
law, that employee's annual leave or sick leave, if any, shall be
credited toward one half of the premium cost of the insurance
provided by this article, for periods and scope of coverage
determined according to the following formulae: (1) One additional
month of single retiree coverage for every two days of annual leave
or sick leave, or both, which the employee had accrued as of the
effective date of his or her retirement; or (2) one additional
month of coverage for a retiree, his or her spouse and dependents
for every three days of annual leave or sick leave, or both, which
the employee had accrued as of the effective date of his or her
retirement. The remaining premium cost shall be borne by the
retired employee if he or she elects the coverage. For purposes of
this subsection, an employee who has been a participant under
spouse or dependent coverage and who reenters the plan within
twelve months after termination of his or her prior coverage shall
be considered to have elected to participate in the plan as of the
date of commencement of the prior coverage. For purposes of this
subsection, an employee shall not be considered a new employee after returning from extended authorized leave on or after July 1,
1988.
(f) (g) Increased retirement benefits for retired employees
with accrued annual and sick leave. -- In the alternative to the
extension of insurance coverage through premium payment provided in
subsections
(d) and (e)
and (f) of this section, the accrued annual
leave and sick leave of an employee participating in the plan may
be applied, on the basis of two days retirement service credit for
each one day of accrued annual and sick leave, toward an increase
in the employee's retirement benefits with those days constituting
additional credited service in computation of the benefits under
any state retirement system. However, the additional credited
service shall not be used in meeting initial eligibility for
retirement criteria, but only as additional service credited in
excess thereof.
(g) (h) Conversion of accrued annual and sick leave for
extended insurance coverage upon retirement for certain higher
education employees. -- Except as otherwise provided in subsection
(l) (m) of this section, when an employee, who is a higher
education full-time faculty member employed on an annual contract
basis other than for twelve months, is compelled or required by law
to retire before reaching the age of sixty-five, or when such a
participating employee voluntarily retires as provided by law, that
employee's insurance coverage, as provided by this article, shall
be extended according to the following formulae: The insurance
coverage for a retired higher education full-time faculty member, formerly employed on an annual contract basis other than for twelve
months, shall continue beyond the effective date of his or her
retirement one additional year for each three and one-third years
of teaching service, as determined by uniform guidelines
established by the University of West Virginia Board of Trustees
and the board of directors of the state college system, for
individual coverage, or one additional year for each five years of
teaching service for "family" coverage.
(h) (i) Any employee who retired prior to April 21, 1972, and
who also otherwise meets the conditions of the "retired employee"
definition in section two of this article, shall be eligible for
insurance coverage under the same terms and provisions of this
article. The retired employee's premium contribution for any such
coverage shall be established by the finance board.
(i) (j) Retiree participation. -- All retirees under the
provisions of this article, including those defined in section two
of this article; those retiring prior to April 21, 1972; and those
hereafter retiring are eligible to obtain health insurance
coverage. The retired employee's premium contribution for the
coverage shall be established by the finance board.
(j) (k) Surviving spouse and dependent participation. -- A
surviving spouse and dependents of a deceased employee, who was
either an active or retired employee participating in the plan just
prior to his or her death, are entitled to be included in any group
insurance coverage provided under this article to which the
deceased employee was entitled, and the spouse and dependents shall bear the premium cost of the insurance coverage. The finance board
shall establish the premium cost of the coverage.
(k) (l) Elected officials. -- In construing the provisions of
this section or any other provisions of this code, the Legislature
declares that it is not now nor has it ever been the Legislature's
intent that elected public officials be provided any sick leave,
annual leave or personal leave, and the enactment of this section
is based upon the fact and assumption that no statutory or inherent
authority exists extending sick leave, annual leave or personal
leave to elected public officials and the very nature of those
positions preclude the arising or accumulation of any leave, so as
to be thereafter usable as premium paying credits for which the
officials may claim extended insurance benefits.
(l) (m) Participation of certain former employees. -- An
employee, eligible for coverage under the provisions of this
article who has twenty years of service with any agency or entity
participating in the public employees insurance program or who has
been covered by the public employees insurance program for twenty
years may, upon leaving employment with a participating agency or
entity, continue to be covered by the program if the employee pays
one hundred five percent of the cost of retiree coverage:
Provided, That the employee shall elect to continue coverage under
this subsection within two years of the date the employment with a
participating agency or entity is terminated.
(m) (n) Prohibition on conversion of accrued annual and sick
leave for extended coverage upon retirement for new employees who elect to participate in the plan after June, 2001. -- Any employee
hired on or after July 1, 2001, who elects to participate in the
plan may not apply accrued annual or sick leave toward the cost of
premiums for extended insurance coverage upon his or her
retirement. This prohibition does not apply to the conversion of
accrued annual or sick leave for increased retirement benefits, as
authorized by this section:
Provided, That any person who has
participated in the plan prior to July 1, 2001, is not a new
employee for purposes of this subsection if he or she becomes
reemployed with an employer participating in the plan within two
years following his or her separation from employment and he or she
elects to participate in the plan upon his or her reemployment.
NOTE: The purpose of this bill is to extend PEIA coverage for
pregnancy related conditions to covered dependants.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.