W. Va. Code R. § 113-1-4

Current through Register Vol. XLI, No. 50, December 13, 2024
Section 113-1-4 - Eligibility for Premium Subsidy
4.1. In the event the Board determines that a surplus exists, the Board shall create a schedule of premium subsidies that varies with income to assist low income eligible individuals in paying the premium costs of the Plan. The Board may adopt as many income categories within the premium subsidy schedule as it finds necessary and practical.
4.2. For the purposes of determining the eligibility of a person for a premium subsidy, the Board may consider information obtained from any state or federal agency. The eligibility of low income eligible individuals who receive a premium subsidy shall be reassessed annually by the Board.
4.3. No person shall be eligible for a premium subsidy if that person's premium is paid by a third party who is not a family member of the person.
4.4. Whenever the Board finds that there is a significant possibility that premium subsidies may result in an over-expenditure of the surplus, the Board may discontinue the use of the surplus to subsidize premiums until the Board determines that the possibility for over-expenditure no longer exists. The Board shall give low income eligible individuals who are receiving a premium subsidy thirty days' notice prior to such a discontinuance.

W. Va. Code R. § 113-1-4