West Virginia Code § 33-16D-12

Equality of terms; preexisting conditions; continuous coverage
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restrictions, eligibility for enrollment.
Health benefit plans and, to the extent permitted by the federal Employee Retirement
Income Security Act (ERISA), other benefit arrangements covering small employers shall be
subject to the following provisions:
(a) Preexisting conditions provisions may not exclude coverage for a period beyond twelve
months following an individual's effective date of coverage and may only relate to conditions
which had, during the twelve months immediately preceding the effective date of coverage,
manifested themselves in such a manner as would cause an ordinuarily prudent person to
seek medical advice, diagnosis, care or treatment or for which medical advice, diagnosis,
care or treatment was recommended or received, or as to a tpregnancy existing on the
effective day of coverage. For plan years beginning after June 30, 1997, in which the plan
has, on the first day of the plan year, at least two enrollees who are current employees, a
health benefit plan shall meet all requirements set forth in section three-k, article sixteen of
this chapter (preexisting condition exclusions).
(b) In determining whether a preexisting condition limitation provision applies to an eligible
employee or dependent, all health benefit plans shall credit the time such person was
covered under a previous employer-gbased health benefit plan, a comparable individual
health benefit plan, or a self-insured plan if the previous coverage was continuous to a date
not more than thirty days prioer to the effective date of the new coverage, exclusive of any
applicable waiting period under such plan. For plan years beginning after June 30, 1997, in
which the plan has, on tLhe first day of the plan year, at least two enrollees who are current
employees, a health benefit plan shall meet all requirements set forth in section three-m,
article sixteen of this chapter (creditable coverage).
(c) Subject to subsections (a) and (b) of this section, when a small group employer converts
its health benefit plan from one health benefit plan to another health benefit plan or from
oneW carrier to another carrier, all eligible employees who at the time of conversion are
covered by the health benefit plan shall be offered health benefits coverage under the
subsequent plan, and no employee who at the time of conversion is covered by a health
benefit plan offered by said employer may be treated any differently relative to other
covered employees under the new health benefit plan than he or she is treated under the
current health benefit plan.
(d) For plan years beginning after June 30, 1997, in which the plan has, on the first day of
the plan year, at least two enrollees who are current employees, no carrier may condition
eligibility or continued eligibility of any employee or dependent on a health status-related
factor, and a health benefit plan shall meet all requirements set forth in section three-n,
article sixteen of this chapter (eligibility for enrollment).

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