West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-73 - Small Employer Eligibility Requirements › Section 114-73-3 - Eligibility of Small Employers

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. A small
				employer is eligible to purchase a health benefit plan subject to the following
				conditions:
a. On or before December 11, 2004, a
				small employer is eligible to purchase a health benefit plan if the small employer
				has not provided health care coverage for its employees at any time during a period
				beginning December 11, 2003 through the date on which the health benefit plan is
				purchased.
b. After December 11, 2004, a
				small employer is eligible to purchase a health benefit plan if the small employer
				has not provided health care coverage for its employees for twelve consecutive
				months prior to obtaining the health benefit plan.
c. The small employer will pay at least fifty
				percent (50%) of individual employee coverage for its eligible employees.
d. Every small employer seeking to obtain a health
				benefit plan must furnish to the carrier an Affidavit, in a form acceptable to the
				Commissioner, from which the carrier may verify the eligibility of the small
				employer. A copy of the affidavit must be filed with the Commissioner. The
				provisions contained in the Affidavit shall include but not be limited to the
				following:
1. As applicable, a representation that
				the small employer has never provided health care coverage for its employees or the
				date on which the small employer last provided health care coverage for its
				employees.
2. For an employer that was
				in existence for all of the preceding calendar year, the average number of employees
				that were employed during the preceding calendar year and the number of employees
				employed on the first day of the small employer's group health plan year.
3. A representation that the majority of eligible
				employees are employed in West Virginia or, if no state contains a majority of
				eligible employees, that the primary business location of the small employer is in
				West Virginia.
4. A representation that
				the small employer is actively engaged in business in the state of West
				Virginia.
5. A representation that the
				small employer was not formed for the purpose of securing health benefits coverage
				under W. Va. Code §
											33-16D-16.
6. A disclosure of the true and accurate name(s)
				of the business entity, including but not limited to DBAs and trade names.
7. As applicable, a disclosure of the following
				changes to the small employer if the changes occurred after January 1, 2004:
A. Any business name changes;
B. Amendments to or restatement of the articles of
				incorporation;
C.
				Reincorporations;
D. Mergers with other
				businesses;
E. Dissolutions;
F. Withdrawals;
G. Reinstatements;
H. Conversions; and
I. Any other changes relating to the structure,
				ownership or governance of the small employer.
Copies of documents associated with the disclosures listed in
				  subparagraphs A through I of this paragraph must be provided to the carrier by
				  attachment to the Affidavit.