H. B. 2940
(By Delegates Cann, Kominar, White, Beach,
Barker, Perry, Perdue and Evans )
[Introduced February 8, 2007; 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; and to amend and reenact §33-16-1a of said
code, all relating to the public employees insurance program
generally; and increasing the age of dependents for health
insurance coverage.
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; and that §33-16-1a of said code be
amended and reenacted, all to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,
SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD
OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS,
OFFICES, PROGRAMS, ETC.
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
as defined by the
rules of the public employees insurance agency, 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)
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)
Conversion of accrued annual and sick leave for extended
insurance coverage upon retirement for employees who elected to participate in the plan before July, one thousand nine hundred
eighty-eight. -- Except as otherwise provided in subsection (g) of
this section, when an employee participating in the plan, who
elected to participate in the plan before the first day of July,
one thousand nine hundred eighty-eight, 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)
Conversion of accrued annual and sick leave for extended
insurance coverage upon retirement for employees who elected to
participate in the plan after June, one thousand nine hundred
eighty-eight. -- Notwithstanding subsection (d) of this section,
and except as otherwise provided in subsections (g) and (l) of this
section when an employee participating in the plan who elected to
participate in the plan on and after the first day of July, one
thousand nine hundred eighty-eight, 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 the
first day of July, one thousand nine hundred eighty-eight.
(f)
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) 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)
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) 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) Any employee who retired prior to the twenty-first day of
April, one thousand nine hundred seventy-two, 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)
Retiree participation. -- All retirees under the
provisions of this article, including those defined in section two
of this article; those retiring prior to the twenty-first day of
April, one thousand nine hundred seventy-two; 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)
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)
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)
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 and
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)
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, two thousand one. -- Any
employee hired on or after the first day of July, two thousand one
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
the first day of July, two thousand one, 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.
CHAPTER 33. INSURANCE.
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; 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 the thirtieth day of
June, one thousand nine hundred ninety-six, 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
eighteen or
unmarried, dependent child or stepchild under age twenty-three if
a full-time student at an accredited school. 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.
(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 insurance under
which benefits for medical care are secondary or incidental to
other insurance benefits; or
(2) If offered separately, a policy providing benefits
for long-term care, nursing home care, home health care,
community-based care or any combination thereof, dental or vision
benefits or other similar, limited benefits; or
(3) If offered as independent, noncoordinated benefits under
separate policies or certificates, specified disease or illness
coverage, hospital indemnity or other fixed indemnity insurance, or
coverage, such as medicare supplement insurance, supplemental to a
group health plan; or
(4) A policy of accident and sickness insurance covering a
period of less than one year.
(g) "Group health plan" means an employee welfare benefit
plan, including a church plan or a governmental plan, all as
defined in section three of the Employee Retirement Income Security Act of 1974, 29 U.S.C. §1003, to the extent that the plan provides
medical care.
(h) "Health benefit plan" means benefits consisting of
medical care provided directly, through insurance or reimbursement,
or indirectly, including items and services paid for as medical
care, under any hospital or medical expense incurred policy or
certificate; hospital, medical or health service corporation
contract; health maintenance organization contract; or plan
provided by a multiple-employer trust or a multiple-employer
welfare arrangement. "Health benefit plan" does not include
excepted benefits.
(i) "Health insurer" means an entity licensed by the
commissioner to transact accident and sickness in this state and
subject to this chapter. "Health insurer" does not include a group
health plan.
(j) "Health status-related factor" means an individual's
health status, medical condition (including both physical and
mental illnesses), claims experience, receipt of health care,
medical history, genetic information, evidence of insurability
(including conditions arising out of acts of domestic violence) or
disability.
(k) "Medical care" means amounts paid for, or paid for
insurance covering, the diagnosis, cure, mitigation, treatment or
prevention of disease, or amounts paid for the purpose of affecting
any structure or function of the body, including amounts paid for
transportation primarily for and essential to such care.
(l) "Mental health benefits" means benefits with respect to
mental health services, as defined under the terms of a group
health plan or a health benefit plan offered in connection with the
group health plan.
(m) "Network plan" means a health benefit plan under which the
financing and delivery of medical care are provided, in whole or in
part, through a defined set of providers under contract with the
health insurer.
(n) "Preexisting condition exclusion" means, with respect to
a health benefit plan, a limitation or exclusion of benefits
relating to a condition based on the fact that the condition was
present before the enrollment date for such coverage, whether or
not any medical advice, diagnosis, care or treatment was
recommended or received before the enrollment date.
NOTE: The purpose of this bill is to increase the age of a
dependant child or stepchild for coverage under the provisions of
the West Virginia Public Employees Insurance program to twenty-five
years of age.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.
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