West Virginia (WV)
Individual Health Insurance Regulations

Learn more about West Virginia Individual Health Insurance

While there are some individual HMO plans offered throughout the state on a guarantee issue basis, West Virginia insurance regulations allow for the use of medical underwriting for the issuance of individual health plan policies. The use of medical underwriting is a widespread process which allows the health insurance carrier an opportunity to review the applicants past and present medical history. Once a review of the history has been made, the health insurance carrier may then opt to (1) provide coverage under the terms of the health plan (2) offer modified coverage, with specific limitations and/or exclusions or (3) deny coverage based upon the applicant's medical history. West Virginia does not require that insurers offer credit for prior coverage thereby subjecting all applicants to a 12 month look back, 24 month exclusionary period on pre-existing conditions. Persons with qualified creditable coverage under federal HIPAA regulations are exempt from exclusionary periods and elimination riders. Under current insurance regulations, health insurance carriers are permitted to use elimination riders to modify the applied for coverage by eliminating, whether it is temporarily or permanently, the coverage of specified pre-existing medical conditions. Individual health insurance rates are banded and may vary plus or minus 30 percent of the individual indexed rate.

Request West Virginia Individual Health Insurance Quotes from any of our multiple providers.

West Virginia (WV)
Small Group Health Insurance Regulations

West Virginia insurance regulations defines a small group employer as any employer with 2 -50 employees. Pursuant to the federal Health Insurance Portability and Accountability Act of 1996, groups of this size must be offered health insurance coverage on a guarantee issue basis, which provides that no group may be declined medical insurance coverage based upon past or current health history of the group or individual employee. Although credit for qualifying prior creditable coverage is required under state law, those applicants lacking prior coverage are subject to a 6 month look back, 12 month exclusionary period limit on pre-existing conditions as determined by the health insurance carrier. Medical underwriting is permitted for purposes of determining group premium rates. Accordingly, rates may vary by plus or minus 30 percent of the indexed group rate based upon the overall health of the group as a whole.

Small business owners can request quotes for West Virginia group health insurance from any of our listed providers.

West Virginia COBRA and Continuation Coverage

Although groups of 20 or more employees are regulated by federal COBRA regulations, West Virginia has implemented its own state mini-COBRA laws. Under the state program, groups of less than 20 employees who, as a result of a qualifying event, have had their group benefits terminated may be eligible for continuation of coverage for an additional 18 month period. Coverage and benefits would continue under the employer sponsored plan, cost of which would be at the sole expense of the individual covered under COBRA. Conversion plans are available in place of COBRA coverage, or after the COBRA coverage has been exhausted. AccessWV is the state's high-risk health pool that can provide medical insurance to those that are uninsurable due to pre-existing medical conditions.