W. Va. Code R. § 114-54-7
Current through Register Vol. XLI, No. 50, December 13, 2024
Section 114-54-7 - Prohibition Against Discrimination Based on a Health Status-Related Factor7.1. A health insurer may not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of the group health plan based on a health status-related factor in relation to the individual or a dependent of the individual: a. Rules for eligibility to enroll include rules defining any applicable waiting or affiliation period and rules relating to late and special enrollment; and b. This section does not: 1. Require a health insurer to provide particular benefits other than those provided under the terms of the group health plan or health benefit plan; or2. Prevent a health insurer from establishing limitations or restrictions on the amount, level, extent or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage.7.2. A health insurer may not require an individual, as a condition of enrollment or continued enrollment, to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the group health plan based on a health status-related factor in relation to the individual or a dependent of the individual.a. Subject to the commissioner's approval pursuant to other provisions of W. Va. Code thirty-three this subsection does not:1. Restrict the amount of premium that may be charged by a health insurer; or2. Prevent a health insurer from establishing premium discounts or modifying otherwise applicable copayments or deductibles in return for covered individuals' adherence to a bona fide wellness program of health promotion and disease prevention.W. Va. Code R. § 114-54-7