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

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 20% 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 20% 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 20% 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.

AccessWV Plan Brochure

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

And , one of the following must be true

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 no more than 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.

AccessWV Contact Information

AccessWV
C/O PEIA
State Capitol Complex Bldg. 5, Room 1001
1900 Kanawha Blvd. E
Charleston, WV 25305-0710
Phone: 1-866-445-8491

AccessWV Website

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