H. B. 2495
(By Delegates Boggs and Amores)
[Introduced February 23, 2001
; referred to the
Committee on Banking and Insurance then the Judiciary.]
A BILL to amend and reenact section three, article sixteen, chapter
thirty-three of the code of West Virginia, one thousand nine
hundred thirty-one, as amended, relating to required insurance
policy language.
Be it enacted by the Legislature of West Virginia:
That section three, article sixteen, chapter thirty-three of
the code of West Virginia, one thousand nine hundred thirty-one, as
amended, be amended and reenacted to read as follows:
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3. Required policy provisions.
Each
such policy hereafter delivered or issued for delivery in
this state shall contain in substance the following provisions:
(a) A provision that the policy, the application of the policyholder, a copy of which shall be attached to
such the policy,
and the individual applications, if any, submitted in connection
with
such the policy by the employees or members, shall constitute
the entire contract between the parties, and that all statements
made by any applicant or applicants
shall be deemed are
representations and not warranties, and that no
such statement
shall void the insurance or reduce benefits
thereunder under the
insurance unless contained in a written application.
(b) A provision that the insurer will furnish to the
policyholder, for delivery to each employee or member of the
insured group, an individual certificate setting forth in substance
the essential features of the insurance coverage of
such the
employee or member and to whom benefits
thereunder under the
insurance are payable. If dependents are included in the coverage,
only one certificate
need needs to be issued for each family unit.
(c) A provision that all new employees or members, as the case
may be, in the groups or classes eligible for insurance, shall from
time to time be added to
such the groups or classes eligible to
obtain
such insurance in accordance with the terms of the policy.
(d) No provision relative to notice or proof of loss or the
time for paying benefits or the time within which suit may be brought upon the policy shall be less favorable to the insured than
would be permitted in the case of an individual policy by the
provisions set forth in article fifteen of this chapter.
(e) A provision that all members in groups or classes eligible
for insurance provided through an employee's group plan shall be
permitted to pay the premiums at the same group rate and receive
the same coverages for a period not to exceed eighteen months when
they are involuntarily laid off from work.
(f) A provision requiring full disclosure by the insurer as to
methods, statistics or other means by which the insurer sets
reasonable and customary hospital and medical costs schedules and
physician's fee schedules used by the insurer for the purpose of
determining acceptable hospital costs, medical costs and physicians
fees for the payment of the costs, fees or services rendered within
the scope of the policy.
(f) (g) Such Further provisions establishing group accident
and sickness minimum policy coverage standards as the commissioner
shall promulgate by rule pursuant to chapter twenty-nine-a of this
code.
NOTE: This bill provides that a provision must be in every
insurance policy which requires full disclosure by the insurer as to the methods used to set reasonable and customary hospital and
medical costs and physician's fee schedules used by the insurer for
the purpose of determining acceptable fees for the payment of
benefits rendered within the scope of the policy.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.
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