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Introduced Version House Bill 2392 History

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hb2392 intr
H. B. 2392


(By Delegates Border and Perdue)

[Introduced February 14, 2005; referred to the

Committee on Health and Human Resources then Finance.]





A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §5-16-28; to amend said code by adding thereto a new section, designated §33-4-21; to amend said code by adding thereto a new section, designated §33-24-45; to amend said code by adding thereto a new section, designated §33-25-22; and to amend said code by adding thereto a new section, designated §33-25A-36, all relating to requiring health benefit plans to issue uniform prescription drug cards or technology; providing exemptions for the medicaid program; establishing format guidelines and coordination with federal laws; defining terms; providing enforcement authority to the Insurance Commissioner; requiring the Insurance Commissioner to propose rules for legislative approval and establishing an effective date.

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 §5-16-28; that said code be amended by adding thereto a new section, designated §33-4- 21; that said code be amended by adding thereto a new section, designated §33-24-45; that said code be amended by adding thereto a new section, designated §33-25-22; and that said code be amended by adding thereto a new section, designated §33-25A-36, all to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR, SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS, OFFICES, PROGRAMS, ETC.

ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-28. Uniform prescription drug information card or technology.

Notwithstanding any other provision of this code to the contrary, the provisions of section twenty-one, article four, chapter thirty-three of this code shall apply to this article, and the director shall issue to all public employee members, spouses and dependents insured under this article a card or other technology containing prescription drug information as required by said section.
CHAPTER 33. INSURANCE.

ARTICLE 4. GENERAL PROVISIONS.
§33-4-21. Uniform prescription drug information card or technology.

(a) Every health benefit plan that provides coverage for prescription drugs or devices, excluding the medicaid program, shall issue to its insureds a card or other technology containing standardized prescription drug information. The card shall contain at a minimum the following information:
(1) The card issuer's name or logo on the front of the card;
(2) The cardholder's name and identification number, which shall be displayed on the front side of the card;
(3) The insured's group number when required for proper claims administration;
(4) If applicable, the name and address of the benefits administrator or other entity responsible for prescription claims submission;
(5) All electronic transaction routing information and other numbers required by the entity to process a prescription claim electronically; and
(6) A help desk telephone number that pharmacy provider may call for pharmacy benefit claims administration.
(b) In the alternative, the uniform prescription drug information card or technology may be in a format approved by the national council for prescription drug programs and may include all of the required fields and conform to the most recent pharmacy identification card or technology implementation guide produced by the national council for prescription drug programs and shall conform to a national format as approved by the Insurance Commissioner. If a health care plan uses the format approved by the national council for prescription drug programs and includes a conditional or situational field, it shall conform to a pharmacy information card or technology implementation guide form which has been recommended by the national council for prescription drug programs and approved by the Insurance Commissioner.
(c) A new uniform prescription drug information card or technology, as required under subsection (a) or (b) of this section, shall be issued by an insurer upon enrollment and revised upon any change in the certificate holder's coverage that impacts data contained on the card, provided however, that a card or technology shall only be required to be changed annually on renewal of the insurance coverage.
(d) This section does not require a health benefit plan to issue an identification card separate from any identification card issued to an enrollee to evidence coverage under the health benefit plan if the identification card contains the elements required by either subsection (a) or (b) of this section.
(e) For purposes of this section, a "health benefit plan" is a health insurance policy, that covers hospital, medical or surgical expenses, health maintenance organizations, preferred provider organizations, medical service organizations, physician-hospital organizations or any other person, firm, corporation, joint venture or other similar business entity that pays for, purchases or furnishes health care services to patients, insureds or beneficiaries in this State including the Public Employee Insurance Program and the Children's Health Insurance Program. The term does not include accident-only, specified disease, individual hospital indemnity, credit, dental-only, medicare-supplement, long-term care or disability income insurance; coverage issued as a supplement to liability insurance, workers' compensation or similar insurance; self-insured plans or automobile medical-payment insurance. For the purposes of this section, a health benefit plan located or domiciled outside of West Virginia under the jurisdiction of the Insurance Commissioner is subject to the provisions of this section if it receives, processes, adjudicates, pays or denies claims for health care services submitted by or on behalf of patients, insureds or beneficiaries who reside in West Virginia. The Insurance Commissioner shall propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code that are necessary to effectuate this section. A health benefit plan may not conduct business in this State if the plan violates this section.
(f) For purposes of this section, renewal of a health benefit policy, contract or plan is presumed to occur on each anniversary of the date on which coverage was first effective on the person or persons covered by the health benefit plan.
(g) Enforcement of this section is the responsibility of the Insurance Commissioner. The Insurance Commissioner shall propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code that are necessary to effectuate this section.
(h) The provisions of this section shall apply to any policy, contract or plan delivered after the first day of July, two thousand five.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE CORPORATIONS.

§33-24-45. Uniform prescription drug information card or technology.

Notwithstanding any other provision of this code to the contrary, the provisions of section twenty-one, article four, chapter thirty-three of this code shall apply to this article, and all corporations authorized by this article shall issue to all of its members and subscribers a card or other technology containing prescription drug information as required by said section.
ARTICLE 25. HEALTH CARE CORPORATIONS.

§33-25-22. Uniform prescription drug information card or technology.

Notwithstanding any other provision of this code to the contrary, the provisions of section twenty-one, article four, chapter thirty-three of this code shall apply to this article, and all corporations authorized by this article shall issue to all of its members and subscribers a card or other technology containing prescription drug information as required by said section.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.

§33-25A-36. Uniform prescription drug information card or technology.

Notwithstanding any other provision of this code to the contrary, the provisions of section twenty-one, article four, chapter thirty-three of this code shall apply to this article, and all health maintenance organizations authorized by this article shall issue to all of its enrollees a card or other technology containing prescription drug information as required by said section.


NOTE: The purpose of this bill is to require health benefit plans to issue uniform prescription drug information cards or technology.

These sections are new; therefore, strike-throughs and underscoring have been omitted.
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