West Virginia Offices of the Insurance Commissioner 2009 Annual ...
West Virginia Offices of the Insurance Commissioner 2009 Annual ...
West Virginia Offices of the Insurance Commissioner 2009 Annual ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
AccessWV<br />
<strong>West</strong> <strong>Virginia</strong> Health <strong>Insurance</strong> Plan<br />
Introduction<br />
AccessWV, <strong>the</strong> state's high risk insurance pool, guarantees that all <strong>West</strong> <strong>Virginia</strong>ns who qualify can<br />
purchase health insurance through <strong>the</strong> Plan, regardless <strong>of</strong> <strong>the</strong>ir current and past health circumstances.<br />
Coverage through AccessWV is also available to persons with portability rights through <strong>the</strong> federal<br />
Health <strong>Insurance</strong> Portability and Accountability Act (HIPAA) and to persons eligible for <strong>the</strong> Health<br />
Coverage Tax Credit (HCTC). The program is authorized by <strong>the</strong> "Model Health Plan for Uninsurable<br />
Individuals Act", which is Article 48 <strong>of</strong> Chapter 33 <strong>of</strong> <strong>the</strong> State Code. The program operates through<br />
<strong>the</strong> <strong>Offices</strong> <strong>of</strong> <strong>the</strong> <strong>Insurance</strong> <strong>Commissioner</strong>.<br />
AccessWV is governed by a seven-member Board <strong>of</strong> Directors. Six members are appointed by <strong>the</strong><br />
Governor. The <strong>Insurance</strong> <strong>Commissioner</strong> is an ex <strong>of</strong>ficio member and <strong>the</strong> Chair. An Executive Director<br />
oversees <strong>the</strong> day-to-day operations <strong>of</strong> <strong>the</strong> Plan, provides policy direction and ongoing program<br />
development, and works closely with <strong>the</strong> Plan Administrator, <strong>the</strong> Public Employees <strong>Insurance</strong> Agency<br />
(PEIA), and its subcontractors. PEIA coordinates <strong>the</strong> various administrative services needed by <strong>the</strong><br />
Plan, including eligibility determination, premium billing, customer service and medical and<br />
pharmaceutical claims processing.<br />
AccessWV was launched in July 2005 and had completed its fourth full-year <strong>of</strong> operation by December<br />
<strong>2009</strong>.<br />
Program Fundamentals<br />
Eligibility for Coverage<br />
To qualify for AccessWV coverage, an applicant must document eligibility under one or more <strong>of</strong> <strong>the</strong><br />
following criteria:<br />
Applicant has portability rights through <strong>the</strong> federal Health <strong>Insurance</strong> Portability and<br />
Accountability Act (HIPAA); or<br />
Applicant is eligible for <strong>the</strong> Health Coverage Tax Credit (HCTC) Program; or<br />
Applicant was rejected for health insurance during <strong>the</strong> last six months by a carrier selling health<br />
insurance in <strong>West</strong> <strong>Virginia</strong>; or<br />
Applicant was <strong>of</strong>fered coverage during <strong>the</strong> last six months by a carrier doing business in <strong>West</strong><br />
<strong>Virginia</strong> but <strong>the</strong> quoted rate was higher than AccessWV for substantially similar coverage or <strong>the</strong>re<br />
was a restrictive waiver that excluded coverage for a medical condition; or<br />
Applicant has one or more <strong>of</strong> <strong>the</strong> presumptive health conditions identified by <strong>the</strong> Board <strong>of</strong><br />
Directors as qualifying a person for coverage in <strong>the</strong> high risk plan, regardless <strong>of</strong> whe<strong>the</strong>r an<br />
application was made to ano<strong>the</strong>r carrier. Forty-seven conditions qualify as presumptive health<br />
conditions.<br />
18