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The Glenville Democrat
Glenville, West Virginia
December 2, 2004     The Glenville Democrat
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December 2, 2004

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Page 2 -- The Glenville Democrat -- Thursday, Dec. 2, 2004 Thanksgiving By Delegate Brent Boggs I hope everyone enjoyed a great Thanksgiving with family, friends and neighbors. This was a special Thanksgiving for us, as we spent time with the entire family, including Justin and his fiancte, Jennifer, and her family; my parents; and Jessica, Paul and Collin. The holiday was, as the commercial says, "price- less." As of this writing, the first week deer harvest count has yet to be announced, but it appears to be better than last year, despite a couple days of bad weather. This coming weekend, the Legisla- ture will return to Charleston for the final interim meetings of 2004 on De- cember 5 - 7. At Noon on Sunday, House and Senate Democrats and Re- publicans will caucus separately to nominate a candidate for House Speaker and Senate President for their respective political party and legislative chamber. The actual election for each office will be in mid-January. Committee appointments will likely be forthcoming in the next several days for members of the House and Senate. A couple weeks ago, I met with Insurance Commissioner Jane Cline, in order to get an update on implementation of Senate Bill 143 - Small Employer Group Health Plan for Uninsured Groups. This bill passed during the 2004 regular session and is one of the most anticipated bills by small business owners. Here is a basic overview of the components of the plan, as supplied by Commissioner Cline's staff, per my request: The Bill: Senate B ill ! 43 "Uninsured Small Group Heahh Benefit Plans" • Was passed by the WV Legislature on 3/13/04 and became effective on 6/11/04. • Created a new section in Article 16D (Marketing and Rate Practices for Small Employer Accident and Sickness Policies). W. Va. Code Section 33-16D-16. • Was intended to make it easier for small employers to provide insurance for employees. • Should ultimately help alleviate the burden on all citizens of the State caused by uncompensated health care. Which Insurance Carriers Can Offer the Plan? • Any licensed accident and sickness carrier that uses a provider network can offer plan and applicable rates. Other S,B, 143 Provisions Relating to Carrier: • The carrier must file and obtain approval of rates and forms relating to the plan before it can be offered. • Carriers may not underwrite a S.B. 143 plan any more strictly than other small group policies. • Carriers must offer the plan through one of their existing provider networks. • The carrier's payment methodology, copays/ deductibles, and other conditions of coverage are not affected by the bill. • S.B. 143 has no effect on provider rates for other products offered by the carrier. • Carriers are not required to pay premium taxes on S.B. 143 plans. • A carrier may nonrenew an employer's S.B. 143 plan if it determines that it no longer has an adequate network for the employer. • A carrier may nonrenew all S.B. 143 plans upon 30 2004: Priceless... days notice to Commissioner, but it will be prevented from offering a S.B. 143 plan to small employers for two years. • Careers must annually report the number of S.B. 143 plans written and the number of individuals covered to the Commissioner. Which Small Employers Can Purchase the Plan? • After December 11, 2004, only a small employer that has been without employee coverage for 12 consecutive months is eligible. • Employer must employ an average of two to 50 employees. • Employer must be able to pay at least 50% of its employees' premium forindividualemployee coverage. Reimbursement Rates for Health Care Providers: • Participating providers must accept PEIA's managed care/HMO reimbursement rates for services provided. • Providers have option annually of informing PEIA that they will not participate. • The S.B. 143 reimbursement rates may not be lowered during a plan year; however PEIA may adjust reimbursement rates for its own plans. • Director of PEIA has sole discretion to specify the appropriate rate for S.B. 143 plan in event of dispute. • Participating providers must accept PEIA reimbursement rates as payment in full for services or products provided under a S.B. 143 plan. PEIA Must Establish the Network. • PEIA Director must annually provide written notice to all known in-state providers about the provisions of S.B. 143 and give 30 days for providers to "opt out" of network, • Notice must go out by May 1 of each year, to establish network for the following calendar year. • Each provider in the network will have an opportunity to opt out each year. • A refusal to participate will continue in effect until rescinded by the provider. Role of Insurance Commissioner: • Establish a Policy Advisory Committee to provide advice and monitor effectiveness of S.B. 143 offerings. • Committee shall include representation from labor, hospitals, physicians, business, local government, carriers, and the uninsured. • Commissioner must propose emergency and legislative rules relating to small employer eligibility (emergency rule was effective 9/1/04). • Commissioner maintains list of providers who have opted out of S.B. 143 network. To obtain additional details or information, please con- tact the WV Insurance Commissioner's Office 558-3354. If you have any difficulty in obtaining additional details, please let me know and I will be glad to help. Please contact me if I may be of assistance. Until the 2005 legislative session begins, please address your mail to my home office: PO Box 254, Gassaway, WV 26624. By telephone, you may contact me at 364-8411. For those with Internet access, my e-mail address is You can obtain additional legislative information from the Legislature's web site at http:// www. leg is. state, wv. us/ As always, please remember our troops - at home and abroad - and keep them and their families in your thoughts and prayers. Until next week, take care. Glenville y's nod 1 : ~!:i i~i/::: '!~i!CΈ ::: !ii~i?:: ,:.i~ iii:: • i•i::• • v: "