West Virginia Health Study Guide

West Virginia letters what most states number, tiers what most states state flatly, and keeps two of its most-tested health rules in articles you would not think to open. The accident and sickness provisions themselves are close to the national model — the exam points are in the designations, the triggers, and the one provision that flips the burden onto the insurer.

The uniform provisions are LETTERED

§33-15-4 sets out West Virginia’s required accident and sickness policy provisions, and it designates them (a) through (l) — letters, not numbers. A pinpoint of the form “§33-15-4(3)” is structurally impossible here. Learn the letters that carry the numbers:

The grace period at (c) is the one that moves: 7 days for weekly premium policies, 10 days for monthly premium policies, and 31 days for all others. That is a direct contrast with ordinary life, where §33-13-3 fixes a flat 31 days regardless of mode — and the exam likes putting the two side by side.

Notice of claim (e) is 20 days after the occurrence or commencement of loss, or as soon thereafter as is reasonably possible. Proof of loss (g) is 90 days — and note the trigger: it runs from the date of loss, or from termination of the period for which the insurer is liable on a periodic-payment claim. Legal actions (k) bars suit before 60 days after proof of loss and after three years from the date proof was required.

The 15-day rule that decides who loses

Subsection (f) is the provision that changes answers. The insurer, on receiving a notice of claim, must furnish the claimant the forms it usually supplies for filing proofs of loss — and “if such forms are not furnished within fifteen days after the giving of such notice the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss.”

So the ninety days in (g) is not the whole story. If the insurer sits on the forms past day fifteen, the proof-of-loss requirement is satisfied by operation of law. Exam questions put (e), (f) and (g) together and ask what happens when the carrier goes quiet.

Free looks — and the article they are not in

Article 15 contains no free look. The accident and sickness free look is §33-6-11b, the same sentence that covers life: 10 days from receipt. A candidate who searches the health article concludes West Virginia has none, which is the trap.

Medicare supplement is different again — 30 days from delivery — and it needs two instruments to find. §33-6-11a names thirty days only for direct-response policies and gives no number for the general case; §33-28-5b(f) and the Commissioner’s rule at §114-24-15.1.5 supply it for everything else. Long-term care is 30 days and sits in the statute at §33-15A-6(f)(1), with the LTC rule carrying none.

Long-term care contestability comes in three tiers

§33-15A-8 does not give a single incontestability date. It gives a ladder:

• In force less than six months — rescind or deny on a showing of misrepresentation material to the acceptance for coverage.
• Six months to two years — the misrepresentation must be both material to acceptance and pertain to the condition for which benefits are sought. Both limbs.
• Two years or more — not contestable on misrepresentation alone, and contestable only on a showing that the insured knowingly and intentionally misrepresented facts relating to health.

That last tier is not flat incontestability. Knowing and intentional health misrepresentation stays contestable indefinitely.

Continuation, and the number that is not a floor

West Virginia’s group continuation right is §33-16-3(e): members involuntarily laid off may pay premiums at the same group rate and keep the same coverages for a period not to exceed eighteen months. Read what the statute does not contain — there is no employer-size number in it at all.

The “fewer than 20 employees” figure that circulates belongs to the Commissioner’s rule, 114CSR93, and it is the definition of small employer — it decides which plans the rule reaches, being the population not subject to federal COBRA. It is not an eligibility floor and not a price. The price is a percentage: 100% of the applicable premium under §114-93-3, against federal COBRA’s 102%.