COBRA Law Summaries

COBRA Law Summaries

West Virginia, COBRA Law Summaries

West Virginia's health care continuation law is codified in the West Virginia Code at Chapter 33, Article 16, Section 33-16-3 and Article 16A, Sections 33-16A-1 through 33-16A-14.

DEFINITIONS

The term “employees” includes officers, managers, and employees of the employer, the partners, if the employer is a partnership, the officers, managers, and employees of subsidiary or affiliated corporations of a corporate employer, and the individual proprietors, partners and employees of individuals or firms, the business of which is controlled by the insured employer through stock ownership, contract, or otherwise (Sec. 33-16-2).

The term “employer” may include any municipal or governmental corporation, unit, agency or department and the officers of any unincorporated municipality or department, as well as private individuals, partnerships and corporations (Sec. 33-16-2).

COVERAGE

West Virginia's health care continuation law covers all employers maintaining group accident and sickness insurance issued for delivery in West Virginia (Sec. 33-16-3).

PROCEDURES

An employer must offer continuation coverage to all persons eligible for group coverage when they are involuntarily laid off (Sec. 33-16-3). Continuation coverage must last for a period not to exceed 18 months and the premium charged must be the same rate charged for the group coverage (Sec. 33-16-3).

WHAT THE EMPLOYER MUST DO

West Virginia's health care continuation law requires an employer to offer continuation coverage to all persons eligible for group coverage when they are involuntarily laid off (Sec. 33-16-3).

Eligibility requirements.- All persons who are eligible for group coverage are eligible for continuation coverage when they are involuntarily laid off (Sec. 33-16-3).

Extended election period for subsidy-eligible individuals. Individuals without a state mini-COBRA election in effect as of February 17 (the date of American Recovery and Reinvestment Act of 2009’s enactment) and eligible as “assistance eligible individuals” have an extended period in which to elect coverage. The West Virginia extended election period is available to those whose coverage was lost due to the involuntary termination of an employee of a “small employer” (an employer that had fewer than 20 employees during 50 percent or more of its typical business days in the previous calendar year). The election must be made no later than 60 days after notice is provided by the administrator of the group health plan (or other involved entity). Notice of the state extended election period must be provided prior to April 18, 2009 (60 days after ARRA’s date of enactment) (Sec. 33-16-3t, as added by S. 552, enacted and effective April 16, 2009).

Conversion to individual policy.- Generally, any employee who has been continuously insured under the group policy for at least three months immediately prior to termination is eligible for conversion coverage. Conversion coverage is also available to surviving spouses and dependents, and to spouses whose group coverage stopped when they ceased to be a qualified family member. Persons eligible for similar group coverage or for Medicare are not eligible for a converted policy if overinsurance would result (Sec. 33-16A-1, 33-16A-5 and 33-16A-13).

Notice.- Insurers, prior to terminating a group policy for any reason, must notify the employee spouse or dependent in writing of the conversion privilege at least 45 days prior to termination. A notification of the conversion privilege must also be in each certificate of coverage (Sec. 33-16A-14).

Deadlines.- To elect conversion coverage, a written application and the first premium must be sent to the insurer not later than 31 days after termination of the group policy (Sec. 33-16A-2).

Premiums.- The amount of premium must be determined in accordance with the applicable premium rates, the age and class of risk of each person to be covered under the converted policy, and the type and amount of insurance provided (Sec. 33-16A-2).

Duration of coverage.- Continuation coverage must last for a period not to exceed 18 months (Sec. 33-16-3).

Premiums: Continuation coverage.- The premium charged for continuation coverage must be the same rate charged for the group coverage (Sec. 33-16-3).

Premiums: Conversion coverage.- The amount of premium for conversion coverage must be determined in accordance with the applicable premium rates, the age and class of risk of each person to be covered under the converted policy, and the type and amount of insurance provided (Sec. 33-16A-2).

NOTICE

West Virginia law is silent as to an employer's duty to provide notice of the right to continuation coverage. However, with regard to conversion coverage, insurers, prior to terminating a group policy for any reason, must notify the employee spouse or dependent in writing of the conversion privilege, at least 45 days prior to termination. A notification of the conversion privilege must also be in each certificate of coverage (Sec. 33-16A-14).

DEADLINES

West Virginia law is silent as to a deadline for an employee to elect continuation coverage. However, with regard to conversion coverage, a written application and the first premium must be sent to the insurer not later than 31 days after termination of the group policy (Sec. 33-16A-2).