W. Va. Code R. § 114-93-2

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-93-2 - Definitions

2.1. "Applicable premium" means, with respect to any period of continuation of coverage for qualified beneficiaries, the premium charged by the health benefit plan for such period of coverage for beneficiaries with respect to whom a qualifying event has not occurred, regardless of whether such premium or portions thereof are paid by the employer or employee.

2.2. "Carrier" means an insurer licensed in this state to transact accident and sickness insurance that has issued a health benefit plan.

2.3. "Commissioner" means the West Virginia Insurance Commissioner.

2.4. "Continuation coverage" means coverage under the health benefit plan that meets the requirements of section 3 of this rule.

2.5. "Covered employee" means an employee of a small employer who is covered under a health benefit plan by virtue of the employee's employment.

2.6. "Health benefit plan" means any group accident and sickness policy issued to a small employer that provides coverage for the employer's employees (including continuation coverage provided in accordance with this rule) and their dependents.

2.7. "Qualified beneficiary" means any individual who, on the day of the qualifying event for the covered employee, was covered under the health benefit plan by virtue of the individual being the covered employee, his or her spouse, or a dependent of the covered employee.

2.8. "Qualifying event" means the involuntary layoff or termination of an employee from employment for reasons other than misconduct that would disqualify such employee for unemployment benefits.

2.9. "Small employer" means any employer that is not subject to COBRA because it employs fewer than 20 employees.

W. Va. Code R. § 114-93-2