West Virginia Code § 33-16-3k

Limitations on preexisting condition exclusions for health benefit plans
Open in Lexace · Ask the AI about this section
(a) (1) For plan years beginning after June 30, 1997, a health benefit plan issued in
connection with a group health plan may not impose a preexisting condition exclusion with
respect to an employee or a dependent of an employee for losses incurred by the employee
or dependent more than twelve months (or eighteen months for a late enrollee) after the
earlier of the individual's date of enrollment in the health benefit plan or thee first day of a
waiting period for enrollment in the plan. Genetic information may not be treated as a
condition for which a preexisting condition exclusion may be imposed arbsent a diagnosis of
the condition related to the genetic information.
(2) A health benefit plan may impose a preexisting condition exclusion only if such condition
relates to a physical or mental condition, regardless of its catuse, for which medical advice,
diagnosis, care or treatment was recommended or received within the six-month period
ending on the enrollee's enrollment date.
(3) A health benefit plan may impose no preexistingl condition exclusion relating to
pregnancy or in the case of a newborn coveresd under creditable coverage within thirty days
of birth or a child adopted before the age of eighteen and covered under creditable coverage
within thirty days of adoption or placement for adoption.
(b) A health maintenance organization that does not impose a preexisting condition exclusion
allowed under subsection (a) of this section with respect to any particular coverage option
may:
(1) Impose an affiliation period for that coverage option if the affiliation period is applied
uniformly without regard to any health status-related factors and does not exceed two
months (three months for a late enrollee). For purposes of this article, "affiliation period"
means a period that begins on an employee's or dependent's enrollment date, runs
concurrently with any waiting period under the group health plan, must expire before
covWerage is effective and during which the health maintenance organization need not
provide medical care and may not charge any premium to the employee or dependent; or
(2) Use other alternatives approved by the commissioner to address adverse selection.
(c) Any preexisting condition exclusion period, including any waiting period or affiliation
period prior to the effective date of coverage, shall be reduced by the aggregate of the
periods of creditable coverage applicable to the enrollee as of the enrollment date.

‹ Prev All West Virginia sections Next ›


Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.