West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-54 - Group Accident And Sickness Insurance Issuance, Portability And marketing Requirements › Section 114-54-6 - Renewability and Modification of Coverage

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1.
				Except as provided in subsection 6.2, a health insurer shall renew or continue in
				force a health benefit plan at the policyholder's option. In the case of a health
				benefit plan offered only through one or more associations, a reference to
				"policyholder" is deemed, with respect to coverage provided to an employer member of
				the association, to include a reference to the employer.
6.2. A health insurer may non renew or discontinue
				a health benefit plan only at the policyholder's option or for one of the following
				reasons:
a. The policyholder has failed to pay
				premiums or contributions in accordance with the terms of the health benefit plan,
				including any timeliness requirements;
b. The policyholder has performed an act or
				practice that constitutes fraud or made an intentional misrepresentation of material
				fact in connection with the coverage;
c.
				The policyholder has failed to comply with a material plan provision relating to
				employer contribution or group participation rules permitted under W. Va. Code
				chapter thirty-three;
d. The health
				insurer elects to discontinue offering health benefit plans:
1. Of a particular type offered to large employers
				or to small employers, respectively, if:
A. The
				health insurer gives written notice to each policyholder of that product and all
				covered individuals at least ninety days before the date the coverage will be
				discontinued;
B. On a guaranteed issue
				basis, the health insurer offers each large employer policyholder the option to
				purchase any other health benefit plan currently being offered by the health insurer
				to large employers, or offers each small employer policyholder the option to
				purchase all other health benefit plans currently being offered by the health
				insurer to small employers; and
C. In
				electing to discontinue health benefit plans of a particular type and in offering
				coverage under the subparagraph B of paragraph 1 of subdivision d of subsection 6.2,
				the health insurer acts uniformly without regard to policyholders' claims experience
				or any health status-related factor relating to any covered employee, member or
				dependent or new employees, members or dependents who may become eligible for
				coverage; or
2. Of all types
				offered to large employers or to small employers, respectively, if:
A. The health insurer gives written notice to the
				commissioner and to each policyholder and all covered individuals at least one
				hundred eighty days before the date plans are discontinued; and
B. The health insurer discontinues all, and does
				not renew any, health benefit plans issued to large employers or to small employers,
				respectively;
e.
				For network plans, there is no longer any enrollee under the group health plan who
				lives, resides or works in the health insurer's service area, and, in the case of a
				small employer policyholder, the health insurer applies the same criteria it would
				apply in denying enrollment in the health benefit plan under section seven of this
				rule; or
f. For a health benefit plan
				made available to employers only through one or more bona fide associations, the
				employer's membership in the association ceases, but only if the coverage is
				terminated uniformly without regard to any health status-related factor relating to
				any covered individual.