Your Rights under West Virginia Health Insurance Law
(Copyright 2005 All Rights Reserved)
Individual Health Insurance:
In West Virginia, your ability to buy individual health coverage may depend on your health status. There are certain circumstances, however, when you must be allowed to buy individual health coverage.
If you are federally eligible you are guaranteed the right to buy an individual health plan and are exempted from pre-existing condition exclusion periods. To be federally eligible, you must meet all of the following:
You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan.
You also must have used up any COBRA or state continuation coverage for which you were eligible.
You must not be eligible for Medicare, Medicaid or a group health plan.
You must apply for health insurance for which you are federally eligible within 63 days of losing your prior coverage.
West Virginia Children’s Health Insurance Program is a state-designed program that provides health coverage to low-income children under the age of 19 who have health insurance.
A child whose family has a household income below 150% of the federal poverty level is eligible of West Virginia Children’s Health Insurance Program.
Eligibility is guaranteed for one year unless the child moves from the state, enrolls in Medicaid, is found to have other insurance coverage, or becomes financially ineligible.
For more information, please visit the West Virginia Insurance Commission at http://www.state.wv.us/insurance
Group Health Insurance:
You cannot be turned away or charged more because of your health status.
Under West Virginia law, newborns, adopted children and children placed for adoption are automatically covered under the parents’ fully insured health plan for the first 31 days.
When you begin a new job with health insurance through an HMO, the HMO may require an affiliation period before coverage begins.
Under group health plans, coverage for pre-existing conditions can be excluded only for a limited time.
No pre-existing condition exclusion period can be applied without appropriate notice.
Your protections may differ if you move to a group health plan that offers more
benefits then your old one did.
If you leave your job, you may be able to remain in your old group health plan for a limited time.
If you are leaving a fully insured group health plan, you can buy an individual health plan under a group conversion policy.
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