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West Virginia Health Insurance
To ensure a safe and secure financial future of your family, your top priority remains in owning a health insurance policy, protecting your family’s healthcare needs. However, buying suitable health insurance coverage for your family can be costly and needs a good consideration of all future risks and its impact on your finances. More than 47 million Americans are uninsured, majority of whom are the working families. These families, especially children, often end up in a financial rut when it comes to paying huge medical expenses due to the absence of proper health coverage. However, for those families who are not covered under their employers’ group plan, there are low-cost state sponsored health insurance programs.
According to United Health Foundation’s 2008 Health Rankings, West Virginia is ranked at 38th position in the healthiest states list. The state climbed five spots from its 44th position in 2007; it was on the 43rd place in 2006. Predominantly, high prevalence of smoking, high percentage of children under 18 in poverty and high levels of air pollution are the main challenges faced by the state’s health system. West Virginia, having the population of more than one million citizens, boasts of both private-market and public health insurance alternatives. The private-market health insurance comprises of numerous types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced health coverage to the uninsurable residents of West Virginia who meet specific eligibility requirements.
The West Virginia Office of the Insurance Commissioner is in charge of regulating all types of insurance sold in the state of West Virginia including health insurance policies offered by private-market health insurers or public health coverage programs. However, despite strong public health funding, approximately 13.8% of the state population remains uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, approximately 35.1% uninsured West Virginia residents come under the above 200% FPL category.
Health insurance is an inevitable alternative and choosing a health plan can be quite tedious and confusing. Before buying a particular health policy, get in touch with a licensed health insurance agent/broker to avail the benefits of various health insurance alternatives.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of West Virginia. These regulations apply to all insurance companies offering individual or family health insurance in West Virginia:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 12 months |
Look Back Period | 24 months |
Look Back Standard | Prudent person |
Mandatory Benefits | Cancer screening for women including screening of breast cancer and cervical cancer, reconstructive surgery after mastectomy, direct access to OB/GYNs, OB/GYNs as Primary Care Providers, eating disorder parity, infertility treatment |
Market Rate Restrictions | None |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of West Virginia. These regulations apply to all insurance companies offering small group health insurance in West Virginia:
| Small Group Size | 2-50 |
Employee Qualifications | Two employees must work for at least 6 months out of the year, and work 20 hours per week |
Guaranteed Issue | Yes |
Premium Rating Factors | Rate Bands |
Rate Adjustment Factors | 30% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as Individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of West Virginia. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
| Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 18 months |
Extension of Benefits Period - Disabled | 18 months |
Maximum Premium Increase | 100% |
State Legislation Reference | Article 16 of Chapter 33 of the West Virginia Insurance Codes |
Additional Notes |
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State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of West Virginia to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of West Virginia is summarized in the chart below:
| Plan Name | AccessWV |
Website | |
Phone Number | 866-445-8491 |
HIPPA Eligibility Required? | Yes |
Available Carriers | Wells Fargo Third Party Administrators, Express Scripts, Inc. ™ |
Pre-Existing Condition Waiting Period | 6 months |
Enrollment Periods | Currently Open to New Enrollment |
Premium Limits | No more than 150% of standard rate |
Lifetime Maximum Benefit | $1 million |
Special Notes | To be eligible, you must have been rejected, within the last six months, for health insurance by a carrier selling health insurance in West Virginia; you should not be eligible to receive coverage under a group insurance plan or federal or state program including Medicare, Medicaid, or WVCHIP. |
Children’s Health Insurance Program
Through shared funding from the federal government, the State of West Virginia provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | West Virginia Children’s Health Insurance Program (WVCHIP) |
Website | |
Phone Number | 877-WVA-CHIP |
Apply Online | Yes |
Age Limits | Under 18 |
Insurance Carrier | Wells Fargo Third Party Administrators, Express Scripts, Inc. ™ |
Length of Coverage | 12 months |
Residency Requirements | West Virginia residents, U.S. citizen, legal immigrants |
Other Eligibility Requirements | To qualify, the children should not have health insurance in the past six months (for the Basic CHIP Plans) or the past twelve months for the CHIP Premium Plan (some exceptions apply); should not be eligible for the West Virginia State Employee Health Insurance – PEIA ; and should not be eligible for West Virginia Medicaid |
Pre-Existing Condition Exclusions | None |
Cost | $0-$35 co-pays for drugs and services with a maximum of $0-$600 annually depending on family size and income |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of West Virginia.
| Governing Agency | West Virginia Department of Health & Human Resources |
Website | |
Phone Number | 888-483-0797 |
Residency Requirements | West Virginia resident, U.S. citizen |
Federal Poverty Line Income Limits | Pregnant Women and infants (ages 0-1): 150% FPL |
Additional Resources
West Virginia Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines West Virginia’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
West Virginia: At-A-Glance
Provides all-inclusive health data of West Virginia. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
