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How It WorksDoctor treating patient

The West Virginia Small Business Plan is working to achieve the goal of more affordable health insurance because it is a partnership among;

  • private sector insurance companies,
  • state government through the West Virginia Public Employees Insurance Agency (PEIA), and
  • physicians and other health care providers.

Without the participation of each partner group, the Small Business Plan could not work. Because of this partnership, health insurance premium rates for qualified small companies are significantly lower.

Each partner plays a significant role in making the West Virginia Small Business Plan work.

Private Insurance Carriers

Businessmen Talking

Insurance companies offering coverage under the Small Business Plan must provide choices that are substantially similar to standard commercially available insurance. This makes it easy to compare rates with, versus without, buying under the Small Business Plan. Each participating carrier designs and manages its own coverage options. These may not be identical across carriers even though all options are under the Small Business Plan.

The insurance companies are assuming all administrative functions and risk underwriting for Small Business Plan policies. To help keep rates low, carriers are accepting lower administrative fees for Plan contracts.

Participating insurance carriers will use PEIA payment rates for doctors and other health care providers. This is the key to making Small Business Plan premium rates lower than standard rates.

WV Public Employees Insurance Agency (PEIA)

PEIA provides insurance coverage for large numbers of West Virginians (approximately 1 in 8 workers are under PEIA.) By state law, PEIA sets the rates it pays to physicians and health care providers.

For policies under the West Virginia Small Business Plan, PEIA allows the insurance companies to use its lower payment rates for the services of doctors and other providers, such as hospitals, that choose to be part of the Plan’s service network. Each year, PEIA surveys all providers who are eligible to provide services under the Small Business Plan. Those who choose to see patients covered under the Plan, make up the Provider Network.

Physician and Health Care Provider Network

The doctors, hospitals, primary care centers and other care providers who choose to be part of the Small Business Plan Provider Network have agreed to accept PEIA reimbursement rates as payment in full for care provided to Plan patients.

Although the PEIA rates are usually lower than the payment rates under standard commercial policies, the Small Business Plan Provider Network members are accepting these rates as their part in keeping premiums lower.

This means that more West Virginians can enjoy the security of having quality health insurance.