SB 480 — Modifying group accident and sickness insurance requirements
Last action — To House Health and Human Resources
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✓Introduced
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✓In Committee
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3Passed Senate
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4Passed House of Delegates
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5To Executive
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6Enacted
This bill died with 2023 Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
This bill is no longer active — its legislative session has ended, so there are no live odds of enactment. It would have to be reintroduced in the current session to move again.
Bill Text
What changed in the latest version
200 added · 210 removedPlain-language change summary
The updated version of SB 480 introduces several key changes to the regulations governing group accident and sickness insurance. Notably, it now allows bona fide associations—groups that meet specific criteria—to sponsor self-insured multiple employer welfare arrangements, which can provide health benefits for members. This change reduces some previous requirements, making it easier for these associations to offer insurance, potentially expanding access to healthcare coverage for more individuals in similar professions. Additionally, the bill includes provisions for annual reporting and penalties for non-compliance, ensuring ongoing oversight of these arrangements.
WEST VIRGINIA LEGISLATURE REGULAR SESSION IntroducedCommittee Substitute for Senate Bill 480 ByB SenatorsYSENATORS Oliverio,OLIVERI, Azinger,AZINGE, Barrett,BARRETTAND andQ QueenUEEN [Introduced[Originating Januaryin 26,the 2023;Committee on Banking and Insurance;
referredreported to the Committee on BankingFebruary and21, Insurance]2023] IntrCS for SB 480 2023R3136 A BILL to amend and reenact §33-16-1a and §33-16-2 of the Code of West Virginia, 1931, as amended;
and to amend said code by adding thereto a new section, designated §33-16- 2a, all relating to modifymodifying group accident and sickness insurance requirements.requirements and permitting self-insured multiple employer welfare arrangements;
modifying and creating definitions;
reducing requirements for bona fide associations;
authorizing bona fide associations in good standing to sponsor and operate self-insured multiple employer welfare arrangements if certain requirements are met;
setting forth requirements for self- insured multiple employer welfare arrangements;
authorizing Insurance Commissioner to issue certificates of authority;
imposing a non-refundable filing fee;
requiring annual reporting by the arrangements;
requiring rulemaking by Insurance Commissioner;
and authorizing rulemaking on penalties, fines, and suspension and revocation of certificates of authority for violations of requirements for multiple employer welfare arrangements.
has been formed andandmaintained maintained in goodgoodfaith faith for purposes other than obtaining insurance of employers that are in the same trade, industry, line of businessbusiness, or profession:
CS for SB 480 (b) "Commissioner" means the commissioner of insurance.
§1395§ 1395 et seq.;
§1396a§ 1396a et seq.
C., Intr SB 2023R3136 Chapter 55;
C., chapterChapter 89;
(d) "Dependent" means an eligible employee’s spouse or any unmarried child or stepchild under the age of 26 25 if that child or stepchild meets the definition of a "qualifying child" or a "qualifying relative" in section 152 of the Internal Revenue Code.Code 26.
or CS for SB 480 (2) If offered separately, a policy providing benefits for long-term care, nursing home care, home health care, community-based carecare, or any combination thereof, dental or vision benefits or other similar, limited benefits;
(g) "Excess insurance" or "stop-loss insurance" means an insurance policy purchased by a multiple employer welfare arrangement under which it receives reimbursement for benefits it pays Intr SB 2023R3136 in excess of a preset deductible or limit.
(g) h) "Group health plan" means an employee welfare benefit plan, including a church plan or a governmental plan, all as defined in section three of the Employee Retirement Income Security Act of 1974, 29 U.
§1003,§ 1003, to the extent that the plan provides medical care.
"Group(i) "Goup self-insurance program" means a program by which benefits are provided to members, employees of members, or the dependents of such members or employees,employees other than through sickness and accident insurance purchased from an insurance company licensed to do business in this statestate, or health care services purchased from a hospital, medicalmedical, or health service corporationcorporation, or health maintenance organization authorized to do business in this state.
(h) "Health(j) "Hlth benefit plan" means benefits consisting of medical care provided directly, through insurance or reimbursement, or indirectly, including items and services paid for as medical care, under any hospital or medical expense incurred policy or certificate;
or plan provided by a multiple-employermultiple employer trust or a multiple-employermultiple employer welfare arrangement.
CS for SB 480 (i) (k) "Health insurer" means an entity licensed by the commissioner to transact accident and sickness in this state and subject to this chapter.
(j) () "Health status-related factor" means an individual’s health status, medical condition (including both physical and mental illnesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence) or disability.
(k) (m ) "Medical care" means amounts paid for, or paid for insurance covering, the diagnosis, cure, mitigation, treatment or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body, including amounts paid for transportation primarily for and essential to such care.
Intr SB 2023R3136 (l) n) "Mental health benefits" means benefits with respect to mental health services, as defined under the terms of a group health plan or a health benefit plan offered in connection with the group health plan.
"Multiple(o) "M ultiple employer welfare arrangement" means an employee welfare benefit plan, trust, or any other arrangement, whether such plan, trust, or arrangement is subject to the "EmployeeEmployee Retirement Income Security Act of 1974,"1974, as amended, that is established or maintained for the purpose of offering or providing, through group insurance or group self-insurance programs, medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, or death, to theemployees employees, and their dependents, of two or more employers,employers or(including toone two or more self-employed individualsindividuals) and their dependents.
(m)As "Networkit plan"relates meansto amultiple healthemployer benefitwelfare planarrangements, underthe whichterm the“self-employed financingindividuals” andincludes deliveryany ofworking medicalowners careand arepersons provided,to inthe wholeextent orthey inare part,allowed throughunder afederal definedlaw setto ofbe providersa underpart contractof witha thebona healthfide insurer.association.
"Self-employed(m) individual(p) with"Network noplan" employees" means ana individualhealth that:benefit plan under which the financing and delivery of medical care are provided, in whole or in part, through a defined set of providers under contract with the health insurer.
(1)CS Hasfor anSB ownership480 right(n) in(q) "Preexisting condition exclusion" means, with respect to a "tradehealth orbenefit business,"plan, regardlessa limitation or exclusion of whetherbenefits relating to a condition based on the "tradefact that the condition was present before the enrollment date for such coverage, whether or business"not isany incorporatedmedical advice, diagnosis, care, or unincorporated;treatment was recommended or received before the enrollment date.
(2)§33-16-2. Earns wages or self-employment income from the "trade or business";
and (3) Works at least 20 hours a week (or 80 hours per month) providing personal services to the "trade or business" or earns income from the "trade or business" that at least equals the self- employed individual’s cost of any health coverage in which the individual enrolls.
For purpose of this article, a self-employed individual with no employees shall be considered an employer and an employee.
(n) "Preexisting condition exclusion" means, with respect to a health benefit plan, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the enrollment date for such coverage, whether or not any medical advice, diagnosis, care or treatment was recommended or received before the enrollment date.
Intr SB 2023R3136 §33-16-2.
The term "employee" as used herein is considered to include the officers, managers and employees of the employer, the partners, if the employer is a partnership, the officers, managersmanagers, and employees of subsidiary or affiliated corporations of a corporate employer, and the individual proprietors, partners and employees of individuals and firms, the business of which is controlled by the insured employer through stock ownership, contract or otherwise.
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The term "employer" as used herein may include any municipal or governmental corporation, unit, agency or department and the proper officers of any unincorporated municipality or department, as well as private individuals, partnershipspartnerships, and corporations.
(2) A policy issued to an association or to a trust or to the trustees of a fund established, createdcreated, or maintained for the benefit of members of one or more associations.
The association or associations shall have at the issuance of the policy a minimum of one hundred fifty50 persons and have been organized and maintained in good faith for purposes other than that of obtaining CS for SB 480 insurance;
and the members have voting Intr SB 2023R3136 privileges and representation on the governing board and committees.
or (v) Funds contributed by both the covered persons and the association, associationsassociations, or employer members.
CS for SB 480 (4) A policy issued to a college, school or other institution of learning or to the head or principal thereof, insuring at least ten10 students, or students and employees, of the institution;
(5) A policy issued to or in the name of any volunteer fire department, insuring all of the members of the department or all of any class or classes thereof against any one or more of the Intr SB 2023R3136 hazards to which they are exposed by reason of the membership but in each case not less than 10 members;
(a) Effective July 1, 2023,2024, to the extent allowed by federal lawlaw, and in good standing, a bona fide association shallin begood allowedstanding is authorized to sponsor and operate a self-insured multiple employer welfare arrangement in this state,state: if it meets the following requirements:
(1)Provided, NoThat bonathe fidefollowing associationrequirements shallare bemet: permitted to sponsor a group self-insurance program or self-insured multiple employer welfare arrangement unless it has been issued a certificate of authority by the commissioner.
(2)(1) WhenThe applyingassociation forhas been issued a certificate of authority toby sponsorthe acommissioner proposedto groupsponsor self-insuranceand programoperate ora self-insured multiple employer welfare arrangement,arrangement. the bona fide association shall file with the commissioner a nonrefundable filing fee of one thousand dollars and an application setting forth all of the following:
(A)When Theapplying namefor a certificate of eachauthority arrangement;to sponsor a self-insured multiple employer welfare arrangement, the bona fide association shall submit to the commissioner a nonrefundable filing fee of $1,000 and an application setting forth all of the following:
(B)(A) The addressname of eachhe arrangement’sarrangement; principal place of business;
(C)(B) The name and address of ahe residentarrangement’s ofprincipal thisplace state designated and appointed as the registered agent of eachbusiness; proposed arrangement for service of process in this state.
(C) The name and address of a resident of this state designated and appoined as the registered agent of the proposed arrangement for service of process in this state.
IntrCS for SB 2023R3136480 (D) The names and addresses of the officers, directors, and trustees of eachthe proposed arrangement and a statement of whether any of such officers, directors, and trustees have been convicted of any felony or misdemeanor within 10 years prior to the date of the application;
(G) AAn briefout outlineline of the method by which the administrative obligations of eachthe arrangement will be met;
(H) A business plan describing the arrangement’s anticipated method of operationsoperations; for two years from its commencement of activities;
(I) A copy ofofthe the articles and bylaws of eachthe arrangement;
(L) A copy of eachthe agreement between eachthe arrangement and all third-party administrators;
(M) A statement certified by an independent certified public accountantaccountant,hich includes an actuarial certification, regarding the financial condition of eachthe arrangement and listing, on a form as may be prescribed by the commissioner, all of its assets and liabilities for the last month ending 45 days prior to the application date;
(N) A copy of each contract, certificate, endorsement, and application form eachhe proposed arrangement intends to issue or use;
(O) The names of any co-sponsors,co-s ponsors, promoters, trustees, or other facilitators involved with the establishment of eachthe arrangement;
and (P) OtherA dditional information, documents, or statements asthat the commissioner requires.may require;
(3)(2) The arrangement shall at all times be in compliance with applicable federal lawlaws and regulation,regulations, including, but not limited to, the Employee Retirement Income Security Act of 1974, as amended, and the regulations thereunder;
IntrCS for SB 2023R3136480 (4)(3) The arrangement’s governing documents shall require the arrangement to be operated in accordance with sound actuarial principlesprinciples, and the arrangement shall be operated in accordance with those principles;
(5)(4)The The arrangement shall be subject to §33-11-1 et seq.
of this code,code and shall not;
(A) Refuse,Refuse without just cause, to pay proper claims arising under coverage provided by the arrangement;arrangement without just cause;
(B) Enroll a member into the groupsensured self-insurance program or self-insured multiple employer welfare arrangement until the arrangement has provided to the member written notification stating that the member may be required to make additional payments in the event the programarrangement has insufficient funds to cover its liabilities.
The arrangement shall maintain a copy of the notification in its program files to evidence compliance with this requirement;
or (C) Allow an officer, director, trustee, third-partythrty administrator, member of any board or committee, or employee of the arrangement who is charged with the duty of investing or handling the arrangement’s assets to deposit or invest the assets except in the name of the arrangement, borrow the assets of the arrangement, have a pecuniary interest in any loan, pledge of deposit, security, investment, sale, purchase, exchange, reinsurance, or other similar transaction or property of the arrangement, take or receive for personal use any fee, brokerage, commission, gift, or other consideration for, or use any fee, brokerage, commission, gift, or other consideration for, or on account of any transaction made by or on behalf of the arrangement, or guarantee any financial obligation of any of its officers, directors, trustees, board or committee members, or third- party administrators:
Provided, That this paragraph does not prohibit a trustee, officer, director, member of a board or committee, or employee from being covered by the arrangement as a member or an employee of a member.member;
(6)(5)The The commissioner may examine, as often as necessary,reasonably required, the affairs of the arrangement and its members as permitted by §33-2-9 of this code.
The arrangementcost mayof beany requiredsuch toexamination payshall Intrbe SB 2023R3136 the commissionerresponsibility forof the expensesarrangement; incurred by the agency in making an examination authorized under this section.
(7)CS for SB 480 (6) The commissioner may examine and determine the financial capacitysoundness of the arrangementbona fide association operating a group self-insurance program or self-insured multiple welfare arrangement to ensure the association’s ability to pay employee welfare benefit obligations promptly and to otherwise meet its obligations.
(A) Maintenance of minimum reserves that are necessary in the exercise of sound and prudent actuarial judgmentjudgment, either/andor that are certified by a member of the American academyAcademy of actuariesActuaries as having been computed in accordance with accepted loss reserving standards and as being fairly stated in accordance with sound loss reserving principles, or that are determined to be sufficient through such other documentation acceptable to the commissioner;
and (C) Any other measure of financial capacity as the commissioner considersdeems appropriate.appropriate;
(8)(7)Each Each arrangement shall,shall annually, no later than the thirty-first31st day of March, make and file with the commissioner an annual report of its affairs and operations during the last preceding calendar year.
A bona fide association that fails to file an annual report is subject to suspension or revocation of its certificate of authority.authority;
(9)(8)Each Each arrangement shall file with the commissioner its excess loss funding program.
A bona fide association sponsoring a group self-insurance program or self-insured multiple employer welfare arrangement shall purchase individual stop-loss insurance from insurers authorized to transact business in this state with a deductible retention of no more than five percent of the arrangement’s annual aggregate premium up to one$1 million dollars and no more than two and one-half percent of the arrangement’s annual aggregate premium above that amount.
The arrangement also shall purchase, as a condition to the issuance and maintenance of Intr SB 2023R3136 a certificate of authority, aggregate stop-loss insurance from insurers authorized to transact business in this state with a deductible retention of no more than 125 percent of its projected claims for the succeeding fiscal year.year:
TheProvided, commissionerThat the arrangement CS for SB 480 shall benotify notifiedthe commissioner immediately of the cancellation of the policyinsurance for any reason, including the failure to pay any applicable premium, withinno later than 15 days thereof.thereof;
(10)(9)Each Each arrangement shall maintain a minimum surplus as established by rule of the commissioner for the protection of theits members and their employees.
The assets of athe group self- insurance program or self-insured multiple employer welfare arrangement shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets of domestic insurance companies other than life.life;
(11)and Each(10)Each arrangement shall contract only with a third-party administrator that has and maintains a fidelity bond as required by the "EmployeeEmployee Retirement Income Security Act of 1974,"1974, as amended, and that has and maintains errors and omissions insurance coverage or other appropriate liability insurance in an amount set forth inby rulesrule promulgatedof by the commissioner.commissioner in.
(12)(b)The The Insurance Commissioner mayshall propose rules for legislative approval in accordance with the provisions of §29A-3-1 et seq.
of this code regulating groupself-insured self-insurancemultiple programsemployer orwelfare self-arrangements, insuredincluding multiplegroup employerself-insurance welfareprograms, arrangements in a manner consistent with this section.
RulesThe adoptedrules pursuantmay toinclude, thisbut sectionare maynot setlimited forthto, anthe application process, minimum financial solvency includingand capital and surplus requirements, prohibited acts, participation limitations, annual filing requirements, financial capacity requirements, and penalties orand reasonable fines, including,and withoutsuspension limitation,and monetaryrevocation fines, suspension of licensure,a andcertificate revocation of licensureauthority, for violations of this section andor the rules adopted pursuant to this section.
NOTE:11
The purpose of this bill is to modify the five-year waiting period and 100-person minimum for an association health plan, and to allow new flexibility granted under federal rules.
Intr SB 2023R3136 Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.
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View plain text versions (2)
- Committee Substitute View text pdf
- Introduced Introduced Version Current pdf
Action History
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To House Health and Human Resources
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To Health and Human Resources then Government Organization
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Introduced in House
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Ordered to House
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Passed Senate (Roll No. 246)
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Read 3rd time
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On 3rd reading
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Read 2nd time
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On 2nd reading
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Read 1st time
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Immediate consideration
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Committee substitute reported
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To Banking and Insurance
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Introduced in Senate
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To Banking and Insurance
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Filed for introduction
Sponsors
- Mike Oliverio · Primary
- Mike Azinger · Cosponsor
- Jason Barrett · Cosponsor
- Ben Queen · Cosponsor
Sponsorship breakdown
Export CSV (upgrade) →1 sponsors · 3 co-sponsors · 148 not signed on
Sponsors (1)
- Mike Oliverio Republican
Co-sponsors (3)
- Mike Azinger Republican
- Jason Barrett Republican
- Ben Queen Republican
Not signed on (148)
148 members have not signed on to this bill.
Show all 148 →"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.
Votes
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Republican | 16 | 0 | 0 | 0 |
| Unaffiliated | 17 | 0 | 0 | 0 |
| Democrat | 1 | 0 | 0 | 0 |
| Total | 34 | 0 | 0 | 0 |
| % of votes cast | 100% | 0% | 0% | 0% |
How each member voted (34)
| Member | Party | Vote |
|---|---|---|
| MARONEY | — | Yea |
| STOVER | — | Yea |
| MARTIN | — | Yea |
| STUART | — | Yea |
| BOLEY | — | Yea |
| SWOPE | — | Yea |
| CAPUTO | — | Yea |
| NELSON | — | Yea |
| PHILLIPS | — | Yea |
| PLYMALE | — | Yea |
| TRUMP | — | Yea |
| HAMILTON | — | Yea |
| HUNT | — | Yea |
| JEFFRIES | — | Yea |
| SMITH | — | Yea |
| MR PRESIDENT | — | Yea |
| KARNES | — | Yea |
| Mike Woelfel | Democrat | Yea |
| Amy Grady | Republican | Yea |
| Ben Queen | Republican | Yea |
| Charles H. Clements | Republican | Yea |
| Eric Tarr | Republican | Yea |
| Jack Woodrum | Republican | Yea |
| Jason Barrett | Republican | Yea |
| Jay Taylor | Republican | Yea |
| Laura Wakim Chapman | Republican | Yea |
| Mark R. Maynard | Republican | Yea |
| Mike Azinger | Republican | Yea |
| Mike Oliverio | Republican | Yea |
| Patricia Rucker | Republican | Yea |
| Rollan A. Roberts | Republican | Yea |
| Ryan Weld | Republican | Yea |
| Tom Takubo | Republican | Yea |
| Vince Deeds | Republican | Yea |
Subjects
Frequently asked questions
- Who sponsors SB 480?
- SB 480 is sponsored by Mike Oliverio (Republican), Mike Azinger (Republican), Jason Barrett (Republican), and Ben Queen (Republican).
- What is the current status of SB 480?
- This bill died with 2023 Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
- Where can I track SB 480?
- Track SB 480 free on One Click Politics — get push/email alerts when it moves.
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