Continuation of Benefits (COBRA) in West Virginia (WV)

Federal COBRA

The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) generally requires group health plans sponsored by employers with 20 or more employees in the prior year to offer employees and their families the option to continue benefits for limited periods of time when coverage under the plan would otherwise end due to certain qualifying events. These events include voluntary or involuntary job loss, reduction in hours worked, death, divorce, and other life events.  

COBRA sets rules for how and when continuation coverage must be offered, how employees and their families may elect COBRA, and what circumstances justify terminating coverage. The length of time for which continuation coverage must be made available depends on the type of qualifying event. For termination of employment or a reduction in hours, the maximum period of COBRA is generally 18 months. Up to 36 months of coverage may be available due to other qualifying events, or if a second qualifying event occurs during the initial period of COBRA coverage.

Please review our COBRA Steps to Success to understand the key areas involved in implementing COBRA for your company. Most states also have laws (commonly referred to as "mini-COBRA" laws) which require that group health plans provide COBRA-like continuation of benefits for certain employees and their families.

West Virginia Continuation of Coverage

West Virginia requires private employers with fewer than 20 employees to provide employees and their covered spouses and dependents who would otherwise lose group health insurance coverage due to certain qualifying events the right to elect continuation coverage for up to 18 months.

Qualifying Events

Continuation coverage must be provided for up to 18 months due to the following events, which would otherwise result in a loss of coverage:

• Involuntary layoff of the covered employee
• Termination of the covered employee's employment for reasons other than misconduct that would disqualify such employee for unemployment benefits

How Coverage May Be Terminated

Continuation of benefits may be terminated before the end of 18 months for the following reasons:

• Failure to make timely payment of required premiums
• The qualified beneficiary becomes covered under any other group health plan, if the qualified beneficiary will not be subject to any preexisting condition exclusion or limitation
• The qualified beneficiary becomes entitled to Medicare benefits
• The employer terminates coverage under the group health policy for all employees and does not replace it with similar coverage

Notice Requirements and Premium Payments

Any qualified beneficiary may give written notice to the carrier within 20 days after a qualifying event of his or her intent to apply for continuation coverage, identifying the covered employee, the employer and, to the extent such information is known, the names and addresses of all other qualified beneficiaries and the health benefit plan number.

Within 15 days after receipt of written notice from a qualified beneficiary, the carrier must send each adult qualified beneficiary an election and premium notice which provides for each beneficiary's election or nonelection of continuation coverage and, if elected, the applicable premium amount due.

A covered employee or other qualified beneficiary who wants to elect continuation coverage must do so in writing to the carrier within 30 days after receiving notice from the carrier and must include payment of the initial premium set forth in such notice. The premium charged for continuation of coverage may not exceed 100% of the applicable premium. After an election and initial premium payment, the carrier must bill the beneficiary for premiums no more often than monthly and with an allowance for a 30-day grace period for payment.

Every plan booklet or other explanation of rights under a health benefit plan must include all information necessary for a qualified beneficiary to comply with these election requirements and either a form for notice of such election to the carrier or directions on how to find such a form on the West Virginia Insurance Commissioner's website.

For More Information

• West Virginia Code (§33-16-3(e))
• West Virginia Legislative Rules (§§ 114-93-1 through 114-93-3)

Dependent Status and Health Insurance

Under the federal Patient Protection and Affordable Care Act (Health Care Reform), beginning with plan years starting on or after September 23, 2010, group health plans that offer dependent coverage must make the coverage available until a child reaches the age of 26. There is a temporary exception for grandfathered group health plans, which may exclude adult children who are eligible to enroll in an employer-sponsored health plan other than the group health plan of the parent. This exception will no longer be available for plan years beginning on or after January 1, 2014.

Individual states may have requirements that are more favorable to plan participants. For information about your state, please click here and contact your state insurance department for guidance.