Credible West Virginia Health Insurance Coverage & Major Risk Insurance

Creditable Coverage

Creditable coverage is any previous period of health insurance coverage that was not interrupted by a break in coverage of more than 63 days. HIPAA reduces any PECEP by the length of time that you previously had creditable coverage. Example: If you previously had coverage for four months, have not had a break in coverage of more than 63 days, and your new insurance plan has a PECEP of 12 months, then you get a credit for your 4 previous months of coverage, leaving you with only 8 months left on your PECEP. So, if you have 12 months or more of previous health insurance coverage, and you never have a break in coverage of more than 63 days, you will never face a PECEP.

Almost all types of health insurance can qualify as creditable coverage. (Medicare, Medicaid, group, individual, COBRA, and HIPAA plans can all qualify.) One exception is student health insurance plans because they are not typically a full policy with catastrophic coverage. If a particular condition was not covered by the policy that you are claiming as creditable coverage, then your new health plan may still subject that condition to a PECEP.

To show that you have creditable coverage, call your insurance company to request a "certificate of creditable coverage," which lists the dates that you have been insured by that company. If you have been insured by multiple companies, you need certificates of creditable coverage from each one.

AccessWV Major Risk Insurance Plan

West Virginia's major risk insurance plan (AccessWV) is available to people who are not able to obtain private health insurance due to a medical condition, and people who are eligible for a HIPAA plan. If you are eligible for a HIPAA guarantee issue plan, then you can buy health insurance from AccessWV without being subject to a pre-existing condition exclusion period.

If you are not eligible for a HIPAA guarantee issue plan, you can still purchase insurance through AccessWV if you are a West Virginia resident and you are not able to obtain coverage due to a pre-existing condition, or you have been diagnosed with a "Presumptive Health Condition" such as cancer. However, you will be subject to a 6-month pre-existing condition exclusion period. If you had previous health coverage, you can use that creditable coverage to reduce the length of the exclusion period as long as you did not have a break in coverage over 63 days. If one person in a family qualifies for AccessWV coverage, then his or her dependents are eligible as long as they are also West Virginia residents.

Three plans are offered through AccessWV. All three plans cover the same range of services, but they vary in their premiums, deductibles and out-of-pocket maximums. The premiums for the coverage depend on where you live, your age, gender, and which plan you choose.