West Virginia health insurance tips


West Virginia insurance law and regulation

The West Virginia Office of the Insurance Commissioner’s Web site contains links to the complete text of the state’s insurance laws and regulations.  The Web site has not yet developed resources to help individuals find commercial low cost health plans like mini-med or core coverage, specific illness policies, Supplemental Accident Insurance and basic health insurance.

The state insurance department can be reached by telephone at (888) 879-9842 or by mail at PO Box 50540, Charleston WV 25305. The state children’s health insurance plan (CHIP) Web site is West Virginia CHIP.

News that affects your health insurance and planning

July 25, 2020 – This week the West Virginia Department of Health and Human Resources announced the launch of the first resource of its kind to help residents seeking high-quality and appropriate care addiction treatment . The ATLAS (Addiction Treatment Locator, Assessment, and Standards Platform) website at TreatmentATLAS.org, provides transparent data on the use of evidence-based medical practices and patient experiences at addiction treatment facilities. Users can compare treatment facilities side-by-side, or filter by selected criteria, such as facility location, program needs, or insurance carrier. Patients and their families will also be able to leave feedback on treatment facilities by responding to validated survey questions similar to those used in other areas of healthcare.

June 3, 2019 – Status of alternative non-ACA health plans: West Virginia does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market and does not limit the sale of short-term coverage more strictly than the federal government.

May 23, 2019 – New income guidelines are announced for WIC. West Virginia WIC serves 75 percent of all babies born in West Virginia. Families enrolled in the program receive nutrition education, breastfeeding education, nutritious foods, support and access to maternal, prenatal and pediatric health-care services that may otherwise be unavailable. This program is believed to be a foundation of the state’s healthcare by providing essential fundamental support for healthy living.

March 19, 2019 – As poverty and related stress increase, health worsens. In West Virginia, 24% of children are living in poverty. Children in poverty among West Virginia counties range from 12% to 46%. Child poverty rates among racial/ethnic groups in West Virginia range from 25% to 52%.

November 30, 2018 – Enrollment in subsidized health insurance in West Virginia is down 27% for 2019 compared to last year. The Health Insurance Marketplace and WVNavigator say that some people may be confused by the president’s statements that “Obamacare is dead”.  Jeremy Smith, program director for WV Navigator, adds “We are trying our best to get the word out that if you want a 2019 health insurance plan through the Marketplace then you have to sign up by Dec. 15. We don’t work on commission. Our job is to make sure you get the best insurance for you and your family and guide you through the whole enrollment process.” After December 15 enrollment in the state insurance plans will be closed but alternative plans through Freedom Benefits will continue to be available at any time.

The history of health care planning in West Virginia (Information is outdated and links may be expired)

1/23/2016  Freedom Benefits expanded OnlineAdviser service service to West Virgina mining workers laid off who made need independent advice on benefits continuation or conversion. Seneca Coal Resources, Patriot, Arch, Blackhawk Mining, Murray Energy and CSX are among the employers who have laid off workers.

1/4/2016 West Virginia hospitals are enjoying the positive impact of health care reform with more than two dozen health care corporations reporting reductions of 30% to 50% in uncompensated charity are and bad debt. The West Virginia Hospital Association points out that most of the profits realized from Obamacare implementation have been offset by reductions in the government’s Medicare payments.

10/20/2015 Kentucky Health Cooperative that provided coverage for 51,000 members (including some in West Virginia) will not offer coverage for 2016. Seven other commercial companies offer coverge alternatives. Some members are concerned that the options may be unaffordable.

9/3/2015 Highmark Health will offer fewer health insurance product choices in 2016 to the residents of Pennsylvania, Delaware and West Virginia.

1/1/2015 Of the 12,000 West Virginia residents who signed up for individiual health insurance at Healthcare.gov, 85% qualified for financial assistance in the cost of insurance premiums. The national avrage is 87%.

12/15/2014 – West Virginia is the only state offering only one issuer on its insurance exchange, Highmark Blue Cross Blue Shield West Virginia. This limits the health plan options for residents as compared with those offered in other states. An accountant in Logan West Virginiadrew national attention with his involvement and criticism of Obamacare’s small business provisions.

2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.

7/26/2013 Affordable Smart Term Life Insurance is now available to most West Virginia residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.

3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.

2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Highmark Blue Cross Blue Shield West Virginia is the state’s largest health insurance provider and as such, earns the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.

1/12/2012 Value Access Guarantee is now available in West Virginia. This is a guaranteed issue limited benefit plan that is available to all applicants under age 70. Premiums are the same for everyone regardless of age, sex or health.

2/12/2011 With dozens of health plans choices available online offering a wide range of pricing and benefits, how do you find the best combination of price and benefits? Celtic Insurance realizes that the choices can be overwhelming; the company offers more than 40 possible health plan designs in many parts of the United States. A new feature called “Help Me Choose” lets users easily and quickly select the benefits they value most and narrows the list down to a few of the best choices. No personal information is required other than zip code and date of birth.

2/7/2011 The state’s pre-existing condition insurance plan (PCIP) monthly premium rates (per person). PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods. PCIP applicants who are approved to participate in PCIP can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses. Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the amount the plan pays for your care. If you apply for PCIP coverage on the government Web site, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed. Note that your premium may increase if you age into a higher rate tier, or if PCIP adjusts its premiums to any changes in the commercial market.

12/16/2010 West Virginia Offices of the Insurance Commissioner officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.

In its initial federal grant request for the insurance exchange project, West Virginia said that it would: 1) Assess State’s health insurance consumer and business markets using previous demographic surveys, 2) Develop an economic assessment of West Virginia health insurance market and determine who will participate in Exchange, 3) Develop education and outreach strategy for Exchange project, which will result in education and outreach plan. The plan will help promote the Exchange by providing easily accessible information, and 4) Assess efficiency and effectiveness of technical capacity of current West Virginia systems to perform technical tasks for the Exchange.

The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.

5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in West Virginia is now available at Freedom Benefits.