H. B. 2605
(By Delegates Ennis, Swartzmiller, Pethtel,
Perdue, Hatfield, Ashley and Border)
[Introduced February 18, 2009; referred to the
Committee on Banking and Insurance then the Judiciary.]
A BILL to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new section, designated §33-15-4j; to amend
said code by adding thereto a new section, designated
§33-16-3t; and to amend said code by adding thereto a new
section, designated §33-25A-8i, all relating to requiring
accident and sickness insurance providers and health
maintenance organizations to cover the treatment for Lyme
Disease.
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 §33-15-4j; that said
code be amended by adding thereto a new section, designated
§33-16-3t; and that said code be amended by adding thereto a new
section, designated §33-25A-8i, all to read as follows:
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4j. Policies to cover certain Lyme Disease treatments.
Any insurer who, on or after January 1, 2009, delivers or
issues a policy of accident and sickness insurance in this state
under the provisions of this article shall make available as
benefits to all subscribers and members coverage for diagnostic
testing and long-term antibiotic treatment of chronic Lyme Disease
when determined to be medically necessary and ordered by a
physician after making a thorough evaluation of the patient's
symptoms, diagnostic test results and response to treatment.
Treatment otherwise eligible for benefits pursuant to this section
may not be denied solely because such treatment may be
characterized as unproven, experimental or investigational in
nature: Provided, That this section does not apply to insurance
coverage providing benefits for:
(1) Hospital confinement indemnity;
(2) Disability income;
(3) Accident only;
(4) Long-term care;
(5) Medicare supplement;
(6) Limited benefit health;
(7) Specified disease indemnity;
(8) Sickness or bodily injury or death by accident or both;
and
(9) Other limited benefit policies.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3t. Policies to cover certain Lyme Disease treatments.
Any insurer who, on or after January 1, 2009, delivers or
issues a policy of group accident and sickness insurance in this
state under the provisions of this article shall make available as
benefits to all subscribers and members coverage for
diagnostic
testing and long-term antibiotic treatment of chronic Lyme Disease
when determined to be medically necessary and ordered by a
physician after making a thorough evaluation of the patient's
symptoms, diagnostic test results and response to treatment.
Treatment otherwise eligible for benefits pursuant to this section
may not be denied solely because such treatment may be
characterized as unproven, experimental or investigational in
nature: Provided, That this section does not apply to insurance
coverage providing benefits for:
(1) Hospital confinement indemnity;
(2) Disability income;
(3) Accident only;
(4) Long-term care;
(5) Medicare supplement;
(6) Limited benefit health;
(7) Specified disease indemnity;
(8) Sickness or bodily injury or death by accident or both;
and
(9) Other limited benefit policies.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8i.
Required coverage for certain Lyme Disease treatments.
A health maintenance organization issuing coverage in this
state pursuant to the provisions of this article shall make
available as benefits to all subscribers and members coverage for
diagnostic testing and long-term antibiotic treatment of chronic
Lyme Disease when determined to be medically necessary and ordered
by a physician after making a thorough evaluation of the patient's
symptoms, diagnostic test results and response to treatment.
Treatment otherwise eligible for benefits pursuant to this section
may not be denied solely because such treatment may be
characterized as unproven, experimental or investigational in
nature: Provided, That this section does not apply to insurance
coverage providing benefits for:
(1) Hospital confinement indemnity;
(2) Disability income;
(3) Accident only;
(4) Long-term care;
(5) Medicare supplement;
(6) Limited benefit health;
(7) Specified disease indemnity;
(8) Sickness or bodily injury or death by accident or both;
and
(9) Other limited benefit policies.
NOTE: The purpose of this bill is to require accident and
sickness insurance providers and health maintenance organizations
to cover certain Lyme Disease treatments.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.