West Virginia maintains a high risk pool, called AccessWV.  AcesssWV provides insurance coverage for residents of West Virginia who, because of health conditions, are unable to obtain private health insurance and for people who are HIPAA eligible. 

When can I get coverage from AccessWV?

• If you are HIPAA eligible, you can buy health insurance from AccessWV. You will not have a pre-existing condition exclusion period.
• If you are not HIPAA eligible, you can buy insurance from AccessWV if you are West Virginia resident for at least 30 days, not eligible for group coverage, Medicare, Medicaid, or WVChip, and are medically eligible. To be medically eligible you must meet one of the following:

You have, in the last 6 months, been turned down for coverage from one insurance company;

You are only able to obtain insurance coverage at a rate that is higher than the coverage offered by AccessWV;

You have a recognized chronic or serve illness, including AIDS, Cancer, Diabetes, and Parkinson’s disease; or

You are eligible for the Health Coverage Tax Credit (HCTC) (see page 33).

• AccessWV does offer family coverage for dependents.

What will AccessWV cover?

• AccessWV offers three plans. All three plans offer the same benefits, the primary difference between the plans is the cost sharing.
• Plan A has an annual in-network deductible of $400 for individuals and $800 for families. The annual out-or-pocket limit is $2,000 for individual and $4,000 for families. Plan B has an annual deductible of $800 for individuals and $1,600 for families for in-network services. The annual out-or-pocket limit is $2,500 for individual and $5,000 for families. Plan C has an annual deductible of $2,000 for individuals and $4,000 for families for in-network services. The annual out-or-pocket limit is $3,000 for individual and $6,000 for families. For all three plans, after the deductible is met, AccessWV pays 70% of the claims until your out-of-pocket limit for the plan is met. Prescription drugs are subject to an additional annual deductible.
• AccessWV covers hospital and physician care, prescription drugs, mental health services, and other services. Total coverage is subject to a lifetime maximum of $1,000,000 and an annual maximum of $200,000.

What about coverage for my pre-existing condition?

• If you are HIPAA eligible, you will not be subject to a pre-existing condition exclusion when you enroll in AccessWV.
• If you are not HIPAA eligible, you will have a 6-month pre-existing condition exclusion period when you first enroll in AccessWV. When you enroll, AccessWV will look back 6 months to see if you had a condition for which you actually received a diagnosis or for which medical advice or treatment was recommended or received. Genetic information can be considered a pre-existing condition, but pregnancy cannot.

What can I be charged for AccessWV coverage?

• Premiums will vary based on the plan you choose. In addition, AccessWV charges enrollees different rates based on their age, gender, and where they live.
• The monthly AccessWV premium for a 24-year old man ranges from $179 to $248 depending on which plan option is selected; and the monthly premium for a 64-year old man ranges from $862- $1190.

How long does AccessWV coverage last?

• AccessWV polices are renewable as long as you pay your premiums, continue to be a resident of West Virginia, and meet other eligibility requirements.