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SB490 SUB1 Senate Bill 490 History

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Key: Green = existing Code. Red = new code to be enacted

COMMITTEE SUBSTITUTE

FOR

Senate Bill No. 490

(By Senators Tucker, D. Hall, Green and Barnes)

____________

[Originating in the Committee on Banking and Insurance;

reported February 25, 2014.]

____________

 

A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §33-6-38, relating to dental and vision insurance; defining terms; specifying an effective date; prohibiting insurers from requiring optometrists, ophthalmologists and dentists to provide discounts on noncovered services; prohibiting optometrists, ophthalmologists and dentists from charging more to covered persons on noncovered services than their customary or usual rate charged to noninsured individuals for such services; and providing that insurers may not provide for a nominal reimbursement for a service in order to claim that a service or material is covered.

Be it enacted by the Legislature of West Virginia:

    That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated §33-6-38, to read as follows:

ARTICLE 6. THE INSURANCE POLICY.

§33-6-38. Noncovered discounts.

    (a) For the purposes of this section:

    (1) “Covered services” means services and materials for which reimbursement from vision insurance or dental insurance is provided by an enrollee’s plan contract, or for which a reimbursement would be available but for the application of the enrollee’s contractual limitations of deductibles, copayments, and coinsurance.

    (2) “Contractual discount” means a percentage reduction from a provider’s usual and customary rate for covered services and materials required under a participating provider agreement.

    (3) “Materials” includes, but is not limited to, any material or device utilized within the scope of practice of a health care professional.

    (b) No agreement renewed or entered into on or after July 1, 2014, between an insurer or an entity that writes vision insurance or dental insurance and an optometrist, ophthalmologist or dentist for the provision of any services on a preferred or in-network basis to plan members or insurance subscribers in connection with any vision insurance or dental insurance may require that such professional provide services or materials at a fee limited or set by the plan or insurer unless the services or materials are reimbursed as covered services under the contract.

    (c) An optometrist, ophthalmologist or dentist may not charge more for services and materials that are noncovered services under any vision insurance or dental insurance than his or her usual and customary rate charged to non-insured individuals for those services and materials.

    (d) Reimbursement for covered services and materials paid pursuant to a vision insurance or dental insurance agreement that is renewed or entered into on or after July 1, 2014, shall be reasonable and may not provide nominal reimbursement in order to claim that services and materials are covered services.


    NOTE: The purpose of this bill is to provide that insurers may not contractually require optometrists, ophthalmologists and dentists to provide a discount on services such insurers do not cover under their insurance; to prohibit optometrists, ophthalmologists or dentists from charging more for services and materials that are noncovered services under any vision insurance or dental insurance than their usual and customary rate charged to non-insured individuals for those services and materials; and prohibiting vision and dental insurers from paying nominal reimbursements in order to claim that services or materials are covered services.


    This section is new; therefore, strike-throughs and underscoring have been omitted.

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