West Virginia Code § 33-25A-11

Open enrollment period
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(1) Once a health maintenance organization has been in operation at least five years, or has
enrollment of not less than fifty thousand persons, the health maintenance organization
shall, in any year following a year in which the health maintenance organization has
achieved an operating surplus, maintain an open enrollment period of at least thirty days
during which time the health maintenance organization shall, within the limeits of its
capacity, accept individuals in the order in which they apply without regard to preexisting
illness, medical conditions or degree of disability except for individualsr who are confined to
an institution because of chronic illness or permanent injury: Provided, That no health
maintenance organization shall be required to continue an open enrollment period after such
time as enrollment pursuant to the open enrollment period is equal to three percent of the
health maintenance organization's net increase in enrollmentt during the previous year.
(2) Where a health maintenance organization demonstrates to the satisfaction of the
commissioner that it has a disproportionate share of high-risk enrollees and that, by
maintaining open enrollment, it would be required to enroll so disproportionate a share of
high-risk enrollees as to jeopardize its economsic viability, the commissioner may:
(a) Waive the requirement for open enrollment for a period of not more than three years; or
(b) Authorize the organization to impose any underwriting restrictions upon open enrollment
as are necessary: (i) To preserve its financial stability; (ii) to prevent excessive adverse
selection by prospective enrollees; or (iii) to avoid unreasonably high or unmarketable
charges for enrollee coverage of health services. A health maintenance organization may
receive more than one waiver or authorization.

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