Accident and sickness insurance on a franchise plan is hereby declared to be that form of accident and sickness insurance issued to:
(a) Five or more employees of any corporation, copartnership or individual employer or any governmental corporation, agency or department thereof, or
(b) Five or more members of any trade or professional association or of a labor union or of any other association having had an active existence for at least two years where such association or union has a Constitution or bylaws and is formed in good faith for purposes other than that of obtaining insurance; where such persons, with or without their dependents, are issued the same form of an individual policy varying only as to amounts and kinds of coverage applied for by such persons, under an arrangement whereby the premiums on such policies may be paid to the insurer periodically by the employer, with or without payroll deductions, or by the association or union for its members, or by some designated person acting on behalf of such employer or association or union. The term "employees" as used in this section shall be deemed to include the officers, managers, employees and retired employees of the employer and the individual proprietor or partners if the employer is an individual proprietor or partnership.
Structure West Virginia Code
Article 15. Accident and Sickness Insurance
§33-15-1a. Premium Rate Increase Requests; Loss Ratio Requirement
§33-15-1b. Rates, Individual Major Medical Policies
§33-15-2. Scope and Format of Policy
§33-15-2b. Guaranteed Issue; Limitation of Coverage; Election; Denial of Coverage; Network Plans
§33-15-2c. Feasibility Study for Alternatives to Guaranteed Issue
§33-15-2d. Exceptions to Guaranteed Renewability
§33-15-2f. Certification of Creditable Coverage
§33-15-4. Required Policy Provisions
§33-15-4a. Required Policy Provisions-Mental Illness
§33-15-4b. Policies to Cover Nursing Services; Definition
§33-15-4c. Third Party Reimbursement for Mammography, Pap Smear or Human Papilloma Virus Testing
§33-15-4d. Third Party Reimbursement for Rehabilitation Services
§33-15-4e. Benefits for Mothers and Newborns
§33-15-4f. Third Party Reimbursement for Colorectal Cancer Examination and Laboratory Testing
§33-15-4g. Required Coverage for Reconstruction Surgery Following Mastectomies
§33-15-4h. Coverage for Patient Cost of Clinical Trials
§33-15-4i. Third-Party Reimbursement for Kidney Disease Screening
§33-15-4j. Required Coverage for Dental Anesthesia Services
§33-15-4l. Deductibles, Copayments and Coinsurance for Anti-Cancer Medications
§33-15-4m. Eye Drop Prescription Refills
§33-15-4n. Deductibles, Copayments and Coinsurance for Abuse-Deterrent Opioid Analgesic Drugs
§33-15-4p. Lyme Disease to Be Covered by All Health Insurance Policies
§33-15-4q. Coverage for Amino Acid-Based Formulas
§33-15-4r. Substance Use Disorder
§33-15-4s. Prior Authorization
§33-15-4t. Fairness in Cost-Sharing Calculation
§33-15-4u. Mental Health Parity
§33-15-4v. Incorporation of the Health Benefit Plan Network Access and Adequacy Act
§33-15-4w. Incorporation of the Coverage for 12-Month Refill for Contraceptive Drugs
§33-15-5. Optional Policy Provisions
§33-15-6. Inapplicable or Inconsistent Provisions
§33-15-7. Order of Certain Provisions
§33-15-8. Third Party Ownership of Policy Covering Insured
§33-15-9. Requirements of Other Jurisdictions
§33-15-10. Franchise Insurance
§33-15-12. Continuum of Care Services
§33-15-14. Policies Discriminating Among Health Care Providers
§33-15-17. Child Immunization Services Coverage
§33-15-18. Equal Treatment of State Agency
§33-15-19. Coordination of Benefits With Medicaid
§33-15-20. Individual Medical Savings Accounts; Definitions; Ownership; Trustees; Regulations
§33-15-21. Coverage of Emergency Services
§33-15-22. Assignment of Certain Benefits in Dental Care Insurance Coverage