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West Virginia - Compensation & Benefit Legislation

WEST VIRGINIA - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverages within the State.

 

WEST VIRGINIA - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of birth of adopted children is included in state's newborn health care mandate.

 

Preventive care for children: yes, for immunizations without per visit charge or co-pay.

 

(West Virginia Code Sections 33-6-32, 33-16-12)

 

WEST VIRGINIA - ALCOHOLISM & DRUG ABUSE

Employer option (alcoholism treatment only).

 

Minimum annual inpatient coverage: 30 days.

 

Minimum annual outpatient coverage: $750. Outpatient coinsurance factor may not exceed 50% of coinsurance factor for physical illness generally.

 

Minimum lifetime coverage: $10,000 or 25% of the lifetime policy limit, whichever is less.

 

(West Virginia Code Section 33-16-3c)

 

WEST VIRGINIA - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: For state Unemployment Insurance purposes, employees' elective contributions are not counted as wages, and employer contributions are excluded.

 

WEST VIRGINIA - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

WEST VIRGINIA - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits. Based on 1986 National Association of Insurance Commissioner Rules model. (West Virginia Code Ann. Section 33-15-5)

 

WEST VIRGINIA - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

WEST VIRGINIA - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

The West Virginia Supreme Court has held it is contrary to state's public policy for a private employer to require employees to submit to drug testing sine such testing portends an invasion of the individual's right to privacy.

 

(West Virginia Twigg v. Hercules Corp., 185 WV 155, 406 S.E. 2d52 [1990].)

 

WEST VIRGINIA - GROUP HEALTH CODE ADDITIONS (MANDATED)

AIDS: Accident and sickness policies may not cancel or not renew coverage solely because the insured is diagnosed with AIDS. (West Virginia Code Ann. Sections 33-15-13, 33-16-9.)

 

Alcoholism Treatment: Insurers must make available group coverage for at least 30 days of inpatient treatment and outpatient costs of $750 with a maximum lifetime limit equal to the lesser of $10,000 or 25 percent of the policy lifetime limit, whichever is less. (West Virginia Code Ann. Section 33-16-3c.)

 

Basic Policies: A group accident and sickness insurance contract for medical, surgical, or hospital care that is a "basic policy" must cover certain minimum benefits, but may cover additional benefits. Employees eligible to participate under basic policy plans are those employed for an average of at least 20 hours per week, including sole proprietors, general and limited partners, and individuals who work or reside in the state. The basic policy generally is exempt from mandatory benefits and coverages required of other group insurance policies, but does cover certain minimum benefits include inpatient hospital care up to 20 days per year; outpatient hospital care including surgery, anesthesia, pre-admission testing, radiation therapy and chemotherapy; accident or emergency room care and emergency admissions to a hospital; physician office visits for primary, preventive, well, acute or sick care, up to four visits per year, and laboratory fees, surgery and anesthesia, diagnostic x-rays, physician care in a hospital inpatient or outpatient setting; prenatal care; obstetrical care, including physicians' services, delivery room, and other medically necessary care; x-ray and laboratory services relating to mammograms or pap smears; medical and lab services for men over age 50 in connection with checkups for prostate cancer; and child immunization services. (West Virginia Code Ann. Sections 33-16C-2, 33-16C-4.)

 

Continuum of Care Services: Insurers must make available coverage of such services. (West Virginia Code Ann. Sections 33-15-12, 33-16-8.)

 

Coverage Continuation and Conversion: Policies must provide continuation rights of up to 18 months to employees subject to involuntary layoff. (West Virginia Code Ann. Section 33-16-3(e).) Group hospital, surgical, and major medical policies must provide conversion rights to employees whose coverage terminates for any reason, including termination of policy, for themselves and their dependents, and to spouses and dependents ineligible due to age, death of the insured, or dissolution of marriage. (West Virginia Code Ann. Sections 33-16A-1, 33-16A-4, 33-16A-13.)

 

Diabetes: Group health policies must cover medically necessary equipment and supplies prescribed by licensed physicians for persons for the treatment of insulin dependent, non-insulin dependent, and gestational diabetes. Equipment and supplies covered include blood glucose monitors, monitor supplies insulin, injection aids, syringes, insulin infusion devices, pharmacological agents for controlling blood sugar, and orthodontics. Covered self-management education must be provided by a physician; a certified diabetes educator; or a registered dietitian. Such education must be limited to medically necessary visits upon a diagnosis of a condition, a significant change in symptoms, or a change in medications or therapeutic treatments. Annual coverage for reeducation is limited to $100.00 (S312, 1996) (West Virginia Code Ann. Sections 33-15c-1, 33-16-16, 33-24-4, 33-25-6, 33-25A-24.)

 

Genetic Information: This information must not be treated as a condition for which a pre-existing condition exclusion applies in the absence of a diagnosis of an illness related to such genetic information. (H2667, 1997) (West Virginia Code Ann. Section 33-16-3k.)

 

Home Health Care: Insurers must make available group coverage for at least 100 visits per year. (West Virginia Code Ann. Section 33-16-3b.)

 

Maternity: Effective January 1, 1998, health insurers must provide benefits for hospitalization in connection with childbirth for a mother and her newborn child for not less than 48 hours following a normal vaginal delivery and not less than 96 hours following a Caesarean section. Earlier hospitalization discharges are permissible if such decision is made by an attending provider in consultation with a mother. (H2667, 1997) (West Virginia Code Ann. Section 33-16-3j.)

 

Mental Health: Insurers must offer coverage for mental and nervous conditions of up to 45 days of inpatient treatment and 50 percent of outpatient expenses up to $500 over a 12 month period, and up to 50 outpatient sessions over a 12 months period. Mental health benefits do not cover treatments for substance abuse or chemical dependency. (H2667, 1997) (West Virginia Code Ann. Sections 33-15-4a, 33-16-3a, 33-15-3c.)

 

Newborns: Policies providing family coverage must provide benefits for newborns from the moment of birth for injury or sickness including treatment of medically diagnosed congenital defects and birth abnormalities. (West Virginia Code Ann. Section 33-6-32.)

 

Policies for Small Employers: Small employers are those organizations engaged in business in this state which, during the preceding calendar year, employed an average of no more than 50 but not fewer than 2 eligible employees and which employs at least 2 employees on the first day of the group health year. (H2667, 1997) (West Virginia Code Ann. Section 33-16D-2.)

 

Pre-existing Conditions: Pre-existing conditions are those conditions which have caused an ordinarily prudent person to seek medical advice, diagnosis, recommendations, or treatments during the 12 months preceding the effective date of coverage under a plan. Group health plans must not impose pre-existing condition exclusions upon employees or their dependents for conditions incurred more than 12 months (18 months for late enrollees) after the earlier of an employee's date of enrollment or the first day of a plan enrollment waiting period. (H2667, 1997) (West Virginia Code Ann. Section 33-16-3k.)

 

Providers: Insurers must make available coverage for nursing services. (West Virginia Code Ann. Sections 33-15-4b, 33-16-3e.) Rehabilitative Services: Insurers must make available coverage rehabilitative services for such conditions as stroke, deformity, injury. (West Virginia Code Ann. Sections 33-15-4d, 33-16-3h.)

 

Temporomandibular Joint and Craniomandibular Disorder: Insurers must make available coverage for such disorders. (West Virginia Code Ann. Section 33-16-3f.)

 

WEST VIRGINIA - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

 

WEST VIRGINIA - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: Yes, unless amount of insurance is less than $1,000 per life of any employee.

 

Percent of employees who must elect coverage (if employees pay part of premium): 75%.

 

Percent of employees who must be covered if employer pays all of premium: 100%.

 

Minimum number of employees in group plan: 10.

 

Employer prohibited as beneficiary: Yes.

 

Grace period (days): 31.

 

Mandatory conversion: Yes.

 

Other provisions: None.

 

(West Virginia Code Sections 33-14-2, 33-14-9, 33-14-16)

 

WEST VIRGINIA - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Lincoln's Birthday, Columbus Day (or 2nd Monday in October), Thanksgiving. Other: All days appointed or recommended by Governor or President. If any holiday falls on Sunday, following Monday is a holiday. (West Virginia Code 2-2-1)

 

WEST VIRGINIA - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

WEST VIRGINIA - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: Violator is guilty of a misdemeanor, punishable by a fine of $100 - $1,000, or imprisonment for not more than 60 days, or both.

 

Other Requirements: Employer is not required to pay employee for time spent in jury service. (West Virginia Code Section 61-5-25a.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: State reports no statutory requirements.

 

Remedies and Penalties: State reports no statutory requirements.

 

Other Requirements: State reports no statutory requirements.

 

WEST VIRGINIA - LEAVES OF ABSENCE

Employers Subject to Leave Laws: State agencies; county boards, divisions, and any units of state and county boards of education.

 

Criteria for Eligibility: Must have permanent working status for pay at least 12 consecutive weeks.

 

Maximum length of leave: 12 weeks in any 12 month period.

 

Paid Leave: State does not require paid leave.

 

Acceptable Reasons for Leave: Birth/adoption of a child; illness of a spouse, child, parent, or other dependent.

 

Employment Guarantees After Leave: Entitled to reinstatement of same position held prior to leave; employer may hire a temporary replacement during leave.

 

Use of Vacation or other Time-off Benefits: Employer may require employee to first use all other accrued annual and personal benefits prior to receiving leave benefits. Employee may also chose to use other accrued leaves first.

 

Certification Required: Employer may require certification of illness if leave is taken to care for ill family member or dependent.

 

Effect of Leave on Other Benefits: Health benefits continue during leave, but employee must pay premiums.

 

Effect of Seniority Accrual During Leave: Seniority does not accrue during leave.

 

Minimum Requirements for Notification to Employer: 2 weeks written notice, if possible, is required.

 

Conditions for Denial of a Request For Leave: State reports no statutory requirements.

 

(West Virginia Code Ann. Sections 21-5D-1 et seq.)

 

See U.S. Federal Family and Medical Leave Act

 

WEST VIRGINIA - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

WEST VIRGINIA - MANDATED PROVIDERS

Chiropractors, podiatrists, nurse practitioners and midwives. Mandatory coverage for nursing services and osteopaths. (West Virginia Code Sections 33-16-3e, 33-16-10)

 

WEST VIRGINIA - MENTAL HEALTH CARE

Employer option.

 

Minimum yearly inpatient coverage: 45 days in mental hospital; same as for any other illness in general hospital.

 

Minimum yearly outpatient coverage: Not to exceed 50 visits (50% coverage, up to $500).

 

Minimum lifetime coverage: No statutory requirements. (West Virginia Code Section 33-16-3a)

 

WEST VIRGINIA - MINIMUM WAGE

Refer to the Federal minimum wage: $5.15 per hour (effective September 1, 1997).

 

Exemptions: Certain agriculture workers, outside sales, students, apprentices, and handicapped workers in special environments.

 

(West Virginia Code Sections 21-5C1,21-5C-2)

 

See U.S. Minimum Wage

 

WEST VIRGINIA - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: All employees and rehires.

 

Exempt from reporting: No exemptions.

 

Form(s) to file: W-4 or other mutually agreeable method.

 

Filing deadline: Within 14 days of hire.

 

Employer information to be included: Name, address, address of payroll office, and federal tax identification number.

 

Employee information to be included: Name, address, SSN, and date of birth.

 

Penalty for failure to report: $25 for each failure to report, $500 if the failure is a result of conspiracy.

 

(West Virginia Code Section 48A-2-34)

 

WEST VIRGINIA - NEWBORN CARE MANDATE

Mandated coverage.

 

Preventive care for children: Yes, for immunizations without per visit charge or co-pay. (West Virginia Code Sections 33-6-32, 33-16-12)

 

WEST VIRGINIA - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

WEST VIRGINIA - PRE-EXISTING CONDITIONS

For insurance plans offered to small employers, pre-existing conditions must be covered within 12 months. (West Virginia Code Ann. Sections 33-160-1 et seq.)

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

WEST VIRGINIA - PROTECTED CLASSIFICATIONS

Age:  Yes, older than 40.

Race:  Yes.

Color:  Yes.

National Origin: Yes.

Ancestry:  Yes.

Religion:  Yes.

Sex: Yes.

Pregnancy:  Yes.

Sexual Harassment: Yes.

 

(W. Va. Code Sections 5-11-3, 5-11-9; Frank's Shoe Store v. W. Va. Human Rights Comm'n, 178 W. Va. 53, 365 S.E.2d 251 (1986).)

 

WEST VIRGINIA - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

WEST VIRGINIA - SHORT TERM DISABILITY CODE ADDITIONS

State does not require employer or employee participation in short term disability plans.

 

WEST VIRGINIA - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Within 72 hours.

 

Date due if employee resigns: Payday.

 

Wages: Yes.

 

Vacation Pay: Yes.

 

Holiday: Yes.

 

Sick leave: Yes.

 

Severance: No.

 

(West Virginia Code Sections 21-5-1, 21-5-4)

 

WEST VIRGINIA - UNEMPLOYMENT TAX

Employer Contributions:

 

 

Voluntary Contribution Provision: Yes. Within 30 days of mailing of rate notice.

 

(West Virginia Code Sections 21A-10-4, 21A-5-10, 21A-5-10b, 21A-5-11, 21A-5-17a.)

 

WEST VIRGINIA - VACATION PAY

See TERMINATION & SEVERANCE PAY (above)

 

WEST VIRGINIA - VOTING TIME OFF

3 hours, if employee does not already have 3 consecutive hours while the polls are open. (West Virginia Code Sections 3-1-42, 3-9-15.)

 

WEST VIRGINIA - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employments. Elective as to partners, sole proprietors, and officers of associations and corporations.

 

Public Employers: Mandatory as to all public employments, including elected officials. Elective for churches.

 

Exceptions: Domestic workers, farm labor of 5 or fewer employees, casual employers and employees working out of state (except temporarily).

 

Special Coverage Provisions: Elective as to employers in organized professional sports, including thoroughbred house racing.

 

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)