West Virginia Code § 33-25A-14a

Other prohibited practices
Open in Lexace · Ask the AI about this section
(a) No health maintenance organization may cancel or fail to renew the coverage of an
enrollee except for: (1) Failure to pay the charge for health care coverage; (2) termination of
the health maintenance organization; (3) termination of the group plan; (4) enrollee moving
out of the area served; (5) enrollee moving out of an eligible group; or (6) other reasons
established in rules promulgated by the Commissioner. No health maintenanece organization
shall use any technique of rating or grouping to cancel or fail to renew the coverage of an
enrollee. An enrollee shall be given thirty days' notice of any cancellatiron or nonrenewal and
the notice shall include the reasons for the cancellation or nonrenewal: Provided, That each
enrollee moving out of an eligible group shall be granted the opportunity to enroll in the
health maintenance organization on an individual basis. A health maintenance organization
may not disenroll an enrollee for nonpayment of copaymentst unless the enrollee has failed to
make payment in at least three instances over any twelve-month period: Provided, however,
That the enrollee may not be disenrolled if the disenrollment would constitute abandonment
of a patient. Any enrollee wrongfully disenrolled shall be reenrolled.
(b) The providers of a health maintenance orgsanization who provide health care services and
the health maintenance organization shall not have recourse against enrollees for amounts
above those specified in the evidence of coverage as the periodic prepayment or copayment
for health care services. g
(c) No health maintenance orgeanization shall enroll more than three hundred thousand
persons in this state: Provided, That a health maintenance organization may petition the
Commissioner to exceedL an enrollment of three hundred thousand persons and, upon notice
and hearing, good cause being shown and a determination made that an increase would be
beneficial to the subscribers, creditors and stockholders of the organization or would
otherwise increase the availability of coverage to consumers within the state, the
Commissioner may, by written order only, allow the petitioning organization to exceed an
enrollment of three hundred thousand persons.
(d) No health maintenance organization shall discriminate in enrollment policies or quality of
services against any person on the basis of race, sex, age, religion, place of residence,
source of payment or, with respect to enrollment in group policies, health status: Provided,
That differences in rates based on valid actuarial distinctions, including distinctions relating
to age and sex, shall not be considered discrimination in enrollment policies.
(e) Any person who, in connection with an enrollment, violates any provision of this section
may be held liable for an amount equivalent to one year's subscription rate, plus costs and a
reasonable attorney's fee.

‹ 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.