West Virginia Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
AccessWV
Insurance Regulation Establishing Risk Pool
West Virginia Legislation
House Bill 4021
AccessWV
AccessWV, created by West Virginia statute in 2004, provides health insurance to West Virginia residents who have been unable to find or who have been denied health insurance in the private market because of a medical condition. The risk pool also provides coverage to people who are eligible under the Federal Portability Act or under the IRS Health Coverage Tax Credit Program.
Funding
The West Virginia Risk Pool is funding from insurance premiums paid by insured members and surcharges on hospital bills.
Plans Offered
AccessWV offers one PPO plans, with a variable of different deductibles, depending upon whether you are seeking individual or family coverage.
Plan Benefits
Plan A is a standard PPO plan offering an individual deductible of $400 or family deductible of $800. For most in-patient covered medical services, the AccessWV member is required to pay a 20% coinsurance. For most out-patient covered medical services, the AccessWV member is required to pay a 40% coinsurance. The annual out-of-pocket maximum for the individual plan is $2,000 with the family plan out-of-pocket maximum is $4,000.
Plan B is a standard PPO plan offering an individual deductible of $800 or family deductible of $1,600.00. For most in-patient covered medical services, the AccessWV member is required to pay a 20% coinsurance. For most out-patient covered medical services, the AccessWV member is required to pay a 40% coinsurance. The annual out-of-pocket maximum for the individual plan is $2,500 with the family plan out-of-pocket maximum is $5,000.
Plan C is a standard PPO plan offering an individual deductible of $2,000 or family deductible of $4,000. For most in-patient covered medical services, the AccessWV member is required to pay a 20% coinsurance. For most out-patient covered medical services, the AccessWV member is required to pay a 40% coinsurance. The annual out-of-pocket maximum for the individual plan is $3,000 with the family plan out-of-pocket maximum is $6,000.
Family coverage is not available with Plan D. Plan D is also a standard PPO plan offering an individual deductible of $4,000. For most in-patient covered medical services, the AccessWV member is required to pay a 20% coinsurance. For most out-patient covered medical services, the AccessWV member is required to pay a 40% coinsurance. The annual out-of-pocket maximum for the individual plan is $5,000.
Maximum Benefit Limits
The maximum benefits provided by AccessWV are $200,000 per calendar year, with a lifetime maximum benefit of $1,000,000.
Eligibility
- Eligible individuals must be a resident of West Virginia for at least 30 days and
- Are not eligible to receive coverage under a group insurance plan
- And, you are not eligible for medical coverage under a federal or state program including Medicare, Medicaid, WVCHIP
- And, You are not residents of a public institution (i.e. federal or state correctional facility or Veteran’s home
And , one of the following must be true
- You have been rejected for health insurance coverage by a carrier selling health insurance in West Virginia within the last six months
- You have received coverage from a carrier selling health insurance in West Virginia that offers less coverage or similar coverage at a greater price than AccessWV
- You became eligible under the Health Care Tax Credit (HCTC) Program (TAA, ATAA, PBGC) or HIPAA
- You have a pre-existing, severe or chronic medical condition
Enrollment Periods
Application submitted and approved before the 15th day of the month will have coverage made effective on the first day of the following month.
Premium Payments
Monthly premiums for AccessWV are based on age, gender, geographic area and single or family coverage. AccessWV members will be given the option of paying by check, money order or automatic withdrawal from their bank account. Premium payments are due on the 1st of each month.
Premium Calculations
Participants in AccessWV will be charged somewhat higher premiums compared to standard insurance, however there is a cap on premiums that can be charged. West Virginia's risk pool rates can be between 125 to 150 percent of standard rates for comparable individual market plans.
Pre-Existing Condition Waiting Periods
In some cases, there is a 6 month waiting period before the plan will provide coverage for services related to a pre-existing condition of a new enrollee. This waiting period does not apply to persons who are HIPAA eligible and to certain persons eligible for the HCTC.
AccessWV Contact Information
AccessWV
P.O. Box 50540
Charleston, WV 25305-0540
Phone: 1-866-445-8491
AccessWV Website
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