H. B. 2771
(By Delegates Walters and Petersen)
[Introduced February 24, 1995; referred to the
Committee on Banking and Insurance then Finance.]
A BILL to amend article four, chapter thirty-three of the code
of West Virginia, one thousand nine hundred thirty-one, as
amended, by adding thereto a new section, designated section
twenty, relating to insurance; general provisions; creating
a reinsurance pool for persons who are unable to qualify for
health insurance because of illnesses or physical
conditions; insurance commissioner to manage and promulgate
rules; how pool funded; insurers prohibited from tightening
underwriting standards; and processing claims.
Be it enacted by the Legislature of West Virginia:
That article four, chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be
amended by adding thereto a new section, designated section
twenty, to read as follows:
ARTICLE 4. GENERAL PROVISIONS.
§33-4-20. Reinsurance pool for health insurance created;
commissioner to manage and promulgate rules; who is
eligible; responsibility of insurers; etc.
(a) There is hereby created a reinsurance pool, managed by
the insurance commissioner and funded by the insurers, authorized
to issue policies of insurance under the provisions of articles
fifteen, fifteen-a, sixteen, sixteen-a and sixteen-c of this
chapter, in order to provide coverage for individuals who have
existing conditions which prevent them from qualifying for an
insurance policy or coverage from a private insurance company.
Any reinsurance pool, plan or agreement shall be governed by the
provisions of sections fifteen, fifteen-a and fifteen-b, article
four of this chapter.
(b) The commissioner shall promulgate rules pursuant to
chapter twenty-nine-a of this code for the implementation and
administration of the provisions of this section, but which shall provide that these individuals shall pay a premium to the state
equal to the highest rate, plus twenty-five percent, charged by
any insurance company in the state for insurance of that type.
(c) Employers who have employees in their group plans with
illnesses or physical conditions that prohibit the group from
obtaining lower cost insurance bids from other insurers may move
that individual risk to the state pool. The individual employee
is required to have a specific amount in claims, to be determined
by the commissioner, paid by the new insurance carrier before the
existing insurance carrier can move that individual to the state
risk pool. Only the employee(s) identified at current enrollment
as high risk are eligible for the reinsurance pool. The
contribution shall be reviewed quarterly to ensure fairness.
(d) The current insurer of the group shall continue to
process claims for the individual moved to the reinsurance pool
and pay the claims but shall send the explanation of benefits to
the reinsurance pool for payment back to the insurance company.
All insurance companies issuing health insurance policies in West
Virginia shall, on a monthly basis, pay for all cost overruns in the reinsurance pool on a basis equal to their market share.
Self-insured persons and third-party administrators shall make a
monthly contribution of three dollars per person per month to
help fund the reinsurance pool.
(e) No insurance company may change its underwriting
standards just for West Virginia unless it changes them
nationally. If a company tightens its standards, it shall go to
the risk pool in greater numbers.
(f) Insurance carriers shall reevaluate the insurability of
each employee who is assigned to the reinsurance pool on an
annual basis, in order to return the employee to the group
insurance plan.
(g) Any insurer subject to this section is also subject to
the provisions of article thirty-eight of this chapter.
NOTE: The purpose of this bill is to create a reinsurance
pool, supervised by the Insurance Commissioner, to provide health
insurance for persons who are not eligible therefor because of
illnesses or physical conditions, or who cannot otherwise qualify
for insurance because of these conditions.
Section 20 is new; therefore, strike-throughs and underscoring have been omitted.
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