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.
Email
Webmaster | © 2024 West Virginia Legislature **
