West Virginia Code 33-16D-8 – Disclosure of rating practices, renewability provisions and availability of health benefit plans
(a) Each small employer carrier shall make reasonable disclosure in solicitation and sales materials provided to small employers of the following:
Terms Used In West Virginia Code 33-16D-8
- carrier: means any health insurer, as defined in section one-a, article sixteen of this chapter, which offers health benefit plans covering the employees of a small employer situate within the State of West Virginia. See West Virginia Code 33-16D-2
- Class of business: means all or any distinct grouping of small employers as shown on the records of the small employer carrier, which shall be subject to the following requirements:
(1) A distinct grouping may only be established by the small employer carrier on the basis that the applicable health benefit plans:
(A) Are marketed and sold through individuals and organizations which are not participating in the marketing or sale of other distinct groupings of small employers for such small employer carrier. See West Virginia Code 33-16D-2
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Small employer: means any person, firm, corporation, partnership or association actively engaged in business in the State of West Virginia who, during the preceding calendar year, employed an average of no more than fifty but not fewer than two eligible employees and employs at least two employees on the first day of its group health plan year. See West Virginia Code 33-16D-2
(1) The extent to which premium rates for a specific small employer are established or adjusted due to the claim experience, health status or duration of coverage of the employees of the small employer;
(2) The provisions concerning the carrier's right to change premium rates and the factors, including case characteristics, which affect changes in premium rates;
(3) A description of the class of business in which the small employer is or will be included, including the applicable grouping of plans and the benefits and premiums available under all health benefit plans for which the small employer is qualified;
(4) The provisions relating to renewability of coverage;
(5) The provisions relating to any preexisting conditions limitations; and
(6) An explanation, if applicable, that the small employer is purchasing a minimum benefits plan issued pursuant to article sixteen-c of this chapter.
(b) All disclosure statements shall be presented in clear and understandable form and format and shall be separate from any policy, certificate or evidence of coverage otherwise provided. No carrier may be required under this section to disclose proprietary or trade secret information to a small employer.