West Virginia Code
Article 16. West Virginia Public Employees Insurance Act
§5-16-24. Rules for Administration of Article; Eligibility of Certain Retired Employees and Dependents of Deceased Members for Coverage; Employees on Medical Leave of Absence Entitled to Coverage; Life Insurance

The director shall promulgate any necessary rules for the effective administration of the provisions of this article. Except as specifically provided in subsection (e), section four of this article, all rules of the Public Employees Insurance Agency and all hearings held by the Public Employees Insurance Agency are exempt from the provisions of chapter twenty-nine-a of this code. Any rules promulgated by the public employees insurance board or director shall remain in full force and effect until they are amended or replaced by the director.
The rules shall provide that any employee of the state who has been compelled or required by law to retire before reaching the age of sixty-five years is eligible to participate in the public employees' health insurance program at the premium contribution established by the finance board after any extended coverage to which he or she, his or her spouse and dependents may be entitled by virtue of his or her accrued annual leave or sick leave, pursuant to the provisions of section thirteen of this article, has expired. Any employee who voluntarily retires, as provided by law, is eligible to participate in the public employees' health insurance program at the premium contribution established by the finance board after any extended coverage to which he or she, his or her spouse and dependents may be entitled by virtue of his or her accrued annual leave or sick leave, pursuant to the provisions of section thirteen of this article, has expired: Provided, That the employee's last employer is a participating employer. The dependents of any deceased retired employee are entitled to continue their participation and coverage upon payment of the premium contribution established by the finance board. In establishing the cost of health insurance coverage for retired employees and their spouses and dependents, the finance board, in its discretion, may cause the claims experience of the retired employees and their spouses and dependents to be rated separately from that of active employees and their spouses and dependents, or may cause the claims experience of retired and active employees, and their spouses and dependents, to be rated together.
Any employee who is on a medical leave of absence, approved by his or her employer, is subject to the following provisions of this paragraph, is entitled to continue his or her coverage until he or she returns to his or her employment, and the employee and employer shall continue to pay their proportionate share of premium costs as provided by this article: Provided, That the employer is obligated to pay its proportionate share of the premium cost only for a period of one year: Provided, however, That during the period of the leave of absence, the employee shall, at least once each month, submit to the employer the statement of a qualified physician certifying that the employee is unable to return to work.
Any retiree is eligible to participate in the public employees' life insurance program, including the optional life insurance coverage as already available to active employees under this article, at his or her own expense for the cost of coverage, based upon actuarial experience; and the director shall prepare, by rule, for that participation and coverages under declining term insurance and optional additional coverage for the retirees.

Structure West Virginia Code

West Virginia Code

Chapter 5. General Powers and Authority of the Governor, Secretary of State and Attorney General; Board of Public Works; Miscellaneous Agencies, Commissions, Offices, Programs, etc.

Article 16. West Virginia Public Employees Insurance Act

§5-16-1. Short Title; Legislative Intent

§5-16-2. Definitions

§5-16-3. Composition of Public Employees Insurance Agency; Appointment, Qualification, Compensation and Duties of Director of Agency; Employees; Civil Service Coverage

§5-16-4. Public Employees Insurance Agency Finance Board Continued; Qualifications, Terms, and Removal of Members; Quorum; Compensation and Expenses; Termination Date

§5-16-5. Purpose, Powers and Duties of the Finance Board; Initial Financial Plan; Financial Plan for Following Year; and Annual Financial Plans

§5-16-5a. Retiree Premium Subsidy From Retiree Health Benefit Trust for Hires Prior to July 1, 2010

§5-16-5b. Creation of Trust for Retirees Hired on or After July 1, 2010

§5-16-7. Authorization to Establish Group Hospital and Surgical Insurance Plan, Group Major Medical Insurance Plan, Group Prescription Drug Plan, and Group Life and Accidental Death Insurance Plan; Rules for Administration of Plans; Mandated Benefits...

§5-16-7a. Additional Mandated Benefits; Third Party Reimbursement for Colorectal Cancer Examination and Laboratory Testing

§5-16-7b. Coverage for Telehealth Services

§5-16-7c. Required Coverage for Reconstruction Surgery Following Mastectomies

§5-16-7d. Coverage for Patient Cost of Clinical Trials

§5-16-7e. Definitions

§5-16-7f. Prior Authorization

§5-16-7g. Coverage for Prescription Insulin Drugs

§5-16-8. Conditions of Insurance Program

§5-16-8a. Air-Ambulance Fees

§5-16-9. Authorization to Execute Contracts for Group Hospital and Surgical Insurance, Group Major Medical Insurance, Group Prescription Drug Insurance, Group Life and Accidental Death Insurance, and Other Accidental Death Insurance; Mandated Benefit...

§5-16-10. Contract Provisions for Group Hospital and Surgical, Group Major Medical, Group Prescription Drug and Group Life and Accidental Death Insurance for Retired Employees, Their Spouses and Dependents

§5-16-11. To Whom Benefits Paid

§5-16-12. Misrepresentation by Employer, Employee or Provider; Penalty

§5-16-12a. Inspections; Violations and Penalties

§5-16-12b. Privileges and Immunity

§5-16-13. Payment of Costs by Employer and Employee; Spouse and Dependent Coverage; Involuntary Employee Termination Coverage; Conversion of Annual Leave and Sick Leave Authorized for Health or Retirement Benefits; Authorization for Retiree Participa...

§5-16-14. Program Qualifying for Favorable Federal Income Tax Treatment

§5-16-15. Optional Dental, Optical, Disability and Prepaid Retirement Plan and Audiology and Hearing-Aid Service Plan

§5-16-16. Preferred Provider Plan

§5-16-17. Preexisting Conditions Not Covered; Defined

§5-16-18. Payment of Costs by Employer; Schedule of Insurance; Special Funds Created; Duties of Treasurer With Respect Thereto

§5-16-19. Authorization to Take Advantage of Acts of Congress, Accept Gifts, Grants and Matching Funds

§5-16-20. Expense Fund

§5-16-21. No Member or Employee of Public Employees Insurance Agency Shall Gain Directly or Indirectly From Any Contract or Contracts Provided for Hereunder; Criminal Penalties

§5-16-22. Permissive Participation; Exemptions

§5-16-23. Members of Legislature May Be Covered, if Cost of the Entire Coverage Is Paid by Such Members

§5-16-24. Rules for Administration of Article; Eligibility of Certain Retired Employees and Dependents of Deceased Members for Coverage; Employees on Medical Leave of Absence Entitled to Coverage; Life Insurance

§5-16-24a. Paper Transactions

§5-16-25. Reserve Fund

§5-16-26. Quarterly Report

§5-16-28. Incorporation of the Coverage for 12-Month Refill for Contraceptive Drugs

§5-16-29. Limitation on Peia Participation