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
Universal Citation: 114 WV Code of State Rules 114-73-3
Current through Register Vol. XLI, No. 38, September 20, 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.
Disclaimer: These regulations may not be the most recent version. West Virginia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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