33-16D-1 Purpose of article
33-16D-2 Definitions
33-16D-3 Health insurance plans subject to this article
33-16D-4 Discrimination prohibited; guaranteed issue; filing with commissioner; violations and penalties
33-16D-5 Premium rates for small employers; classes; maximum rates; eligibility for rate increases
33-16D-6 Insurance commissioner to promulgate rules
33-16D-7 Renewability of coverage; exceptions
33-16D-8 Disclosure of rating practices, renewability provisions and availability of health benefit plans
33-16D-9 Maintenance of records
33-16D-10 Suspension of requirements
33-16D-11 Effective date
33-16D-12 Equality of terms; preexisting conditions; continuous coverage restrictions, eligibility for enrollment
33-16D-13 Obligations of employer; discrimination as to benefits paid
33-16D-14 Child immunization services coverage
33-16D-15 Continuation of coverage under small plans
33-16D-16 Authorization of uninsured small group health benefit plans

Terms Used In West Virginia Code > Chapter 33 > Article 16D - Marketing and Rate Practices for Small Employer Accident and Sickness Insurance Policies

  • Actuarial certification: means a written statement by an actuary, or other individual acceptable to the commissioner, that a small employer carrier is in compliance with the provisions of section five of this article, based upon that person'. See West Virginia Code 33-16D-2
  • Base premium rate: means , for each class of business as to a rating period, the lowest premium rate charged or which could have been charged under a rating system for that class of business by the small employer carrier to small employers with similar case characteristics for health benefit plans with the same or similar coverage. See West Virginia Code 33-16D-2
  • Bona fide association: has the meaning set forth in section one-a, article sixteen of this chapter. See West Virginia Code 33-16D-2
  • 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

  • Commissioner: means the Insurance Commissioner of West Virginia. See West Virginia Code 33-16D-2
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Dependent: has the meaning set forth in section one-a, article sixteen of this chapter. See West Virginia Code 33-16D-2
  • Dependent: A person dependent for support upon another.
  • 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.
  • Fraud: Intentional deception resulting in injury to another.
  • Group health plan: has the meaning set forth in section one-a, article sixteen of this chapter. See West Virginia Code 33-16D-2
  • Health benefit plan: has the meaning set forth in section one-a, article sixteen of this chapter. See West Virginia Code 33-16D-2
  • Health status-related factor: has the meaning set forth in section one-a, article sixteen of this chapter. See West Virginia Code 33-16D-2
  • Index rate: means for each class of business for small employers with similar case characteristics the arithmetic average of the applicable base premium rate and the corresponding highest premium rate. See West Virginia Code 33-16D-2
  • Network plan: has the meaning set forth in section one-a, article sixteen of this chapter. See West Virginia Code 33-16D-2
  • New business premium rate: means , for each class of business as to a rating period, the premium rate charged or offered by the small employer carrier to small employers with similar case characteristics for newly issued health benefit plans with the same or similar coverage. See West Virginia Code 33-16D-2
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • Rating period: means the calendar period of at least twelve months for which premium rates established by a small employer carrier are assumed to be in effect, as determined by the small employer carrier. See West Virginia Code 33-16D-2
  • 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
  • State: when applied to a part of the United States and not restricted by the context, includes the District of Columbia and the several territories, and the words "United States" also include the said district and territories. See West Virginia Code 2-2-10