West Virginia Offices of the Insurance Commissioner 2009 Annual ...

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