(a) The following persons are eligible for plan coverage:

1. (1) Any individual who is and continues to be a resident of this state if evidence is provided; of a notice of rejection or refusal to issue substantially similar insurance for health reasons by one insurer or of a refusal by an insurer to issue insurance except at a rate exceeding the plan rate, except that a rejection or refusal by an insurer offering only stop loss, excess of loss or reinsurance coverage shall not be sufficient evidence under this subdivision;
2. (2) Any individual who is legally domiciled in this state and is eligible for the credit for health insurance costs under Section 35 of the Internal Revenue Code of 1986; and
3. (3) Any federally defined eligible individual who has not experienced a significant break in coverage and who is and continues to be a resident of this state.

(d) A person is not eligible for coverage under the plan if:

1. (1) The person has or obtains health insurance coverage substantially similar to or more comprehensive than a plan policy or would be eligible to have coverage if the person elected to obtain it, except that:

   1. (A) A person may maintain other coverage for the period of time the person is satisfying any preexisting condition waiting period under a plan policy; and
   2. (B) A person may maintain plan coverage for the period of time the person is satisfying a preexisting condition waiting period under another health insurance policy intended to replace the plan policy;
2. (2) The person is determined to be eligible for health care benefits under the state Medicaid law or the West Virginia Children's Health Insurance Program;
3. (3) The person has previously terminated plan coverage unless twelve months have lapsed since such terminations, except that this subdivision does not apply with respect to an applicant who is a federally defined eligible individual or with respect to an applicant who has exhausted annual benefits under the West Virginia Children's Health Insurance Program;
4. (4) The plan has paid out $1 million in benefits on behalf of the person;
5. (5) The person is an inmate or resident of a public institution, except that this subdivision does not apply with respect to an applicant who is a federally defined eligible individual; or
6. (6) The person's premiums are paid for or reimbursed under any government sponsored program or by any government agency or health care provider, except as an otherwise qualifying full-time employee, or dependent thereof, of a government agency or health care provider.

(e) Coverage shall cease:

1. (1) On the date a person is no longer a resident of this state;
2. (2) On the date a person requests coverage to end;
3. (3) Upon the death of the covered person;
4. (4) On the date state law requires cancellation of the policy; or
5. (5) At the option of the plan, thirty days after the plan makes any inquiry concerning the person's eligibility or place of residence to which the person does not reply.