§5-16-13. Payment of costs by employer and employee; spouse and dependent coverage; involuntary employee termination coverage; conversion of annual leave and sick leave authorized for health or retirement benefits; authorization for retiree participa...


Published: 2015

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WEST VIRGINIA CODE











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WVC 5 - 16 - 13

§5-16-13. Payment of costs by employer and employee; spouse and

dependent coverage; involuntary employee termination

coverage; conversion of annual leave and sick leave

authorized for health or retirement benefits;

authorization for retiree participation; continuation

of health insurance for surviving dependents of

deceased employees; requirement of new health plan,

limiting employer contribution.

     (a) Cost-sharing. -- The director shall provide under any

contract or contracts entered into under the provisions of this

article that the costs of any group hospital and surgical

insurance, group major medical insurance, group prescription drug

insurance, group life and accidental death insurance benefit plan

or plans shall be paid by the employer and employee.

     (b) Spouse and dependent coverage. -- Each employee is

entitled to have his or her spouse and dependents included in any

group hospital and surgical insurance, group major medical

insurance or group prescription drug insurance coverage to which

the employee is entitled to participate: Provided, That the spouse

and dependent coverage is limited to excess or secondary coverage

for each spouse and dependent who has primary coverage from any

other source. For purposes of this section, the term "primary

coverage" means individual or group hospital and surgical insurance

coverage or individual or group major medical insurance coverage or

group prescription drug coverage in which the spouse or dependent is the named insured or certificate holder. For the purposes of

this section, "dependent" includes an eligible employee's unmarried

child or stepchild under the age of twenty-five if that child or

stepchild meets the definition of a "qualifying child" or a

"qualifying relative" in Section 152 of the Internal Revenue Code.

The director may require proof regarding spouse and dependent

primary coverage and shall adopt rules governing the nature,

discontinuance and resumption of any employee's coverage for his or

her spouse and dependents.

     (c) Continuation after termination. -- If an employee

participating in the plan is terminated from employment

involuntarily or in reduction of work force, the employee's

insurance coverage provided under this article shall continue for

a period of three months at no additional cost to the employee and

the employer shall continue to contribute the employer's share of

plan premiums for the coverage. An employee discharged for

misconduct shall not be eligible for extended benefits under this

section. Coverage may be extended up to the maximum period of

three months, while administrative remedies contesting the charge

of misconduct are pursued. If the discharge for misconduct be

upheld, the full cost of the extended coverage shall be reimbursed

by the employee. If the employee is again employed or recalled to

active employment within twelve months of his or her prior

termination, he or she shall not be considered a new enrollee and

may not be required to again contribute his or her share of the premium cost, if he or she had already fully contributed such share

during the prior period of employment.

     (d) Conversion of accrued annual and sick leave for extended

insurance coverage upon retirement for employees who elected to

participate in the plan before July, 1988. -- Except as otherwise

provided in subsection (g) of this section, when an employee

participating in the plan, who elected to participate in the plan

before July 1, 1988, is compelled or required by law to retire

before reaching the age of sixty-five, or when a participating

employee voluntarily retires as provided by law, that employee's

accrued annual leave and sick leave, if any, shall be credited

toward an extension of the insurance coverage provided by this

article, according to the following formulae: The insurance

coverage for a retired employee shall continue one additional month

for every two days of annual leave or sick leave, or both, which

the employee had accrued as of the effective date of his or her

retirement. For a retired employee, his or her spouse and

dependents, the insurance coverage shall continue one additional

month for every three days of annual leave or sick leave, or both,

which the employee had accrued as of the effective date of his or

her retirement.

     (e) Conversion of accrued annual and sick leave for extended

insurance coverage upon retirement for employees who elected to

participate in the plan after June, 1988. -- Notwithstanding

subsection (d) of this section, and except as otherwise provided in subsections (g) and (l) of this section, when an employee

participating in the plan who elected to participate in the plan on

and after July 1, 1988, is compelled or required by law to retire

before reaching the age of sixty-five, or when the participating

employee voluntarily retires as provided by law, that employee's

annual leave or sick leave, if any, shall be credited toward one

half of the premium cost of the insurance provided by this article,

for periods and scope of coverage determined according to the

following formulae: (1) One additional month of single retiree

coverage for every two days of annual leave or sick leave, or both,

which the employee had accrued as of the effective date of his or

her retirement; or (2) one additional month of coverage for a

retiree, his or her spouse and dependents for every three days of

annual leave or sick leave, or both, which the employee had accrued

as of the effective date of his or her retirement. The remaining

premium cost shall be borne by the retired employee if he or she

elects the coverage. For purposes of this subsection, an employee

who has been a participant under spouse or dependent coverage and

who reenters the plan within twelve months after termination of his

or her prior coverage shall be considered to have elected to

participate in the plan as of the date of commencement of the prior

coverage. For purposes of this subsection, an employee shall not

be considered a new employee after returning from extended

authorized leave on or after July 1, 1988.

     (f) Increased retirement benefits for retired employees with accrued annual and sick leave. -- In the alternative to the

extension of insurance coverage through premium payment provided in

subsections (d) and (e) of this section, the accrued annual leave

and sick leave of an employee participating in the plan may be

applied, on the basis of two days' retirement service credit for

each one day of accrued annual and sick leave, toward an increase

in the employee's retirement benefits with those days constituting

additional credited service in computation of the benefits under

any state retirement system: Provided, That for a person who first

becomes a member of the Teachers Retirement System as provided in

article seven-a, chapter eighteen of this code on or after July 1,

2015, accrued annual and sick leave of an employee participating in

the plan may not be applied for retirement service credit.

However, the additional credited service shall not be used in

meeting initial eligibility for retirement criteria, but only as

additional service credited in excess thereof.

     (g) Conversion of accrued annual and sick leave for extended

insurance coverage upon retirement for certain higher education

employees. - Except as otherwise provided in subsection (l) of this

section, when an employee, who is a higher education full-time

faculty member employed on an annual contract basis other than for

twelve months, is compelled or required by law to retire before

reaching the age of sixty-five, or when such a participating

employee voluntarily retires as provided by law, that employee's

insurance coverage, as provided by this article, shall be extended according to the following formulae: The insurance coverage for a

retired higher education full-time faculty member, formerly

employed on an annual contract basis other than for twelve months,

shall continue beyond the effective date of his or her retirement

one additional year for each three and one-third years of teaching

service, as determined by uniform guidelines established by the

University of West Virginia Board of Trustees and the board of

directors of the state college system, for individual coverage, or

one additional year for each five years of teaching service for

family coverage.

     (h) Any employee who retired prior to April 21, 1972, and who

also otherwise meets the conditions of the "retired employee"

definition in section two of this article, shall be eligible for

insurance coverage under the same terms and provisions of this

article. The retired employee's premium contribution for any such

coverage shall be established by the finance board.

     (i) Retiree participation. -- All retirees under the

provisions of this article, including those defined in section two

of this article; those retiring prior to April 21, 1972; and those

hereafter retiring are eligible to obtain health insurance

coverage. The retired employee's premium contribution for the

coverage shall be established by the finance board.

     (j) Surviving spouse and dependent participation. -- A

surviving spouse and dependents of a deceased employee, who was

either an active or retired employee participating in the plan just prior to his or her death, are entitled to be included in any

comprehensive group health insurance coverage provided under this

article to which the deceased employee was entitled, and the spouse

and dependents shall bear the premium cost of the insurance

coverage. The finance board shall establish the premium cost of

the coverage.

     (k) Elected officials. -- In construing the provisions of this

section or any other provisions of this code, the Legislature

declares that it is not now nor has it ever been the Legislature's

intent that elected public officials be provided any sick leave,

annual leave or personal leave, and the enactment of this section

is based upon the fact and assumption that no statutory or inherent

authority exists extending sick leave, annual leave or personal

leave to elected public officials and the very nature of those

positions preclude the arising or accumulation of any leave, so as

to be thereafter usable as premium paying credits for which the

officials may claim extended insurance benefits.

     (l) Participation of certain former employees. -- An employee,

eligible for coverage under the provisions of this article who has

twenty years of service with any agency or entity participating in

the public employees insurance program or who has been covered by

the public employees insurance program for twenty years may, upon

leaving employment with a participating agency or entity, continue

to be covered by the program if the employee pays one hundred five

percent of the cost of retiree coverage: Provided, That the employee shall elect to continue coverage under this subsection

within two years of the date the employment with a participating

agency or entity is terminated.

     (m) Prohibition on conversion of accrued annual and sick leave

for extended coverage upon retirement for new employees who elect

to participate in the plan after June, 2001. -- Any employee hired

on or after July 1, 2001, who elects to participate in the plan may

not apply accrued annual or sick leave toward the cost of premiums

for extended insurance coverage upon his or her retirement. This

prohibition does not apply to the conversion of accrued annual or

sick leave for increased retirement benefits, as authorized by this

section: Provided, That any person who has participated in the

plan prior to July 1, 2001, is not a new employee for purposes of

this subsection if he or she becomes reemployed with an employer

participating in the plan within two years following his or her

separation from employment and he or she elects to participate in

the plan upon his or her reemployment.

     (n) Prohibition on conversion of accrued years of teaching

service for extended coverage upon retirement for new employees who

elect to participate in the plan July, 2009. -- Any employee hired

on or after July 1, 2009, who elects to participate in the plan may

not apply accrued years of teaching service toward the cost of

premiums for extended insurance coverage upon his or her

retirement.





Note: WV Code updated with legislation passed through the 2015 Regular Session

The WV Code Online is an unofficial copy of the annotated WV Code, provided as a convenience. It has NOT been edited for publication, and is not in any way official or authoritative.