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Introduced Version House Bill 3099 History

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H. B. 3099

 

         (By Delegates Arvon, Border, Householder, Ellington, Gearheart, Miller, Staggers, Longstreth, Moye, Raines and Butler)

 

         [Introduced March 25, 2013; referred to the

         Committee on the Judiciary then Finance.]

 

 

A BILL to amend the Code of West Virginia, 1931, as amended by adding thereto a new section, designated §5-16-7f; and to amend and reenact §33-15-4e of said code; and to amend said code by adding thereto a new section, designated §33-16-3w; and to amend said code by adding thereto a new section, designated §33-24-7i; and to amend said code by adding thereto a new section, designated §33-25A-8k, all relating to insurance; requiring the Public Employees Insurance Agency to provide optional maternity and pediatric benefits to dependent mothers covered under the article; requiring insurers offering accident and sickness insurance to provide the same benefits; requiring insurers offering group accident and sickness insurance to provide the same coverage; requiring hospital, medical, dental and health service corporations offering plans to provide the same coverage; and requiring health maintenance organizations offering plans to provide the same coverage.

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 §5-16-7f; that §33-15-4e of said code be amended and reenacted; that said code be amended by adding thereto a new section, designated §33-16-3w; that said code be amended by adding thereto a new section, designated §33-24-7i; and that said code be amended by adding thereto a new section, designated §33-25A-8k, 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.

§5-16-7f. Benefits for certain mothers and infants.

    (a) On or after July 1, 2013, notwithstanding any other provision of this code to the contrary, the agency shall make optional maternity and pediatric care benefits available at a reasonable rate to any mother under the age of eighteen who is covered by one or another of her subscriber or member parent or legal guardian’s insurance policy provision, contract, plan or agreement. The subscriber or member parent or legal guardian may decline to purchase the benefits or to permit the mother to purchase the benefits. The offered coverage shall include the mother’s prenatal, postnatal and maternity care and the infant child’s pediatric care, and shall continue either until the mother turns eighteen years of age, graduates from high school or until the child turns one year old, whichever event last occurs.

    (b) If the mother’s parents or legal guardians have no insurance coverage through any policy, provision, contract, plan or agreement, or decline to purchase benefits available under this section, then the infant child’s father’s parents or legal guardians may secure coverage for maternal and pediatric care, as defined under this section, for the infant and the infant’s mother through any policy, provision, contract, plan or agreement under which they have coverage. The father’s subscriber or member parent or legal guardian may decline to purchase the benefits or to permit the mother to purchase the benefits.

    (c) In order for the mother to secure coverage for herself and her child, under the provisions of this subsection, either she or the child’s father must be enrolled in secondary school and living with his or her parents or legal guardians.

    (d) To the extent that the provisions of this section require benefits that exceed the essential health benefits specified under section 1302(b) of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended:

    (1) The specific benefits that exceed the specified essential health benefits shall not be required of a health benefit plan when the plan is offered by a health care insurer in this state through the state medical exchange; and

    (2) This section continues to apply to plans offered outside of the state medical exchange.

                 CHAPTER 33. INSURANCE.

ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-4e. Benefits for mothers and newborns.

    (a) Nothing in this section shall be construed to require a mother to give birth in a hospital or to stay in a hospital for a fixed period of time following the birth of her child. However, an insurer offering accident and sickness insurance coverage under this article may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or her newborn child to less than forty-eight hours following a normal vaginal delivery, or to less than ninety-six hours following a cesarean section, or require a provider to obtain authorization for such length hospital stays. The mother and her newborn child may be discharged prior to the expiration of the minimum length of stay required under this section only in those cases in which the decision to discharge is made by an attending provider in consultation with the mother.

    (b) Coverage for maternity and pediatric care shall be provided in accordance with guidelines established by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, or other established professional medical associations.

    (c) Benefits provided under this section may be subject to deductibles, coinsurance, or other cost-sharing in relation to benefits for hospital stays in connection with childbirth for a mother or newborn child if the coinsurance or other cost-sharing for any portion of the hospital stay required under subsection (a) of this section is no greater than the coinsurance or cost-sharing for any preceding portion of the stay.

    (d) Nothing in this section may be construed to prevent an insurer from negotiating the level and type of reimbursement with a provider for the care provided a mother or newborn child in connection with childbirth.

    (e) This section shall not apply with respect to any accident and sickness insurance coverage which does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn child.

    (f) This section shall apply to accident and sickness insurance coverage offered, sold, issued, renewed, or in effect in the individual market on or after January 1, 1998.

    (g) On or after July 1, 2013, notwithstanding any other provision of this code to the contrary, the agency shall make optional maternity and pediatric care benefits available at a reasonable rate to any mother under the age of eighteen who is covered by one or another of her subscriber or member parent or legal guardian’s insurance policy provision, contract, plan or agreement. The subscriber or member parent or legal guardian may decline to purchase the benefits or to permit the mother to purchase the benefits. The offered coverage shall include the mother’s prenatal, postnatal and maternity care and the infant child’s pediatric care, and shall continue either until the mother turns eighteen years of age, graduates from high school or until the child turns one year old, whichever event last occurs.

    (h) If the mother’s parents or legal guardians have no insurance coverage through any policy, provision, contract, plan or agreement, or decline to purchase benefits available under this section, then the infant child’s father’s parents or legal guardians may secure coverage for maternal and pediatric care, as defined under this section, for the infant and the infant’s mother through any policy, provision, contract, plan or agreement under which they have coverage. The father’s subscriber or member parent or legal guardian may decline to purchase the benefits or to permit the mother to purchase the benefits.

    (i) In order for the mother to secure coverage for herself and her child, under the provisions of this subsection, either she or the child’s father must be enrolled in secondary school and living with his or her parents or legal guardians.

    (j) To the extent that the provisions of this section require benefits that exceed the essential health benefits specified under section 1302(b) of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended:

    (1) The specific benefits that exceed the specified essential health benefits shall not be required of a health benefit plan when the plan is offered by a health care insurer in this state through the state medical exchange; and

    (2) This section continues to apply to plans offered outside of the state medical exchange.

ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-3w. Other benefits for mothers and newborns.

    (a) Any insurer who, on or after January 1, 2014, delivers, renews or issues a policy of group accident and sickness insurance in this state under the provisions of this article shall, notwithstanding any other provision of this code to the contrary, make optional maternity and pediatric care benefits available at a reasonable rate to any mother under the age of eighteen who is covered by her subscriber or member parent or legal guardian’s policy of group accident and sickness insurance. The subscriber or member parent or legal guardian may decline to purchase the benefits or to permit the mother to purchase the benefits. The offered coverage shall include the mother’s prenatal, postnatal and maternity care and the infant child’s pediatric care, and shall continue either until the mother turns eighteen years of age, graduates from high school or until the child turns one year old, whichever event last occurs.

    (b) If the mother’s parents or legal guardians have no insurance coverage through the policy of group accident and sickness insurance, or decline to purchase benefits available under this section, then the infant child’s father’s parents or legal guardians may secure coverage for maternal and pediatric care, as defined under this section, for the infant and the infant’s mother through a policy of group accident and sickness insurance under which they have coverage. The father’s subscriber or member parent or legal guardian may decline to purchase the benefits or to permit the mother to purchase the benefits.

    (c) In order for the mother to secure coverage for herself and her child, under the provisions of this subsection, either she or the child’s father must be enrolled in secondary school and living with his or her parents or legal guardians.

    (d) To the extent that the provisions of this section require benefits that exceed the essential health benefits specified under section 1302(b) of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended, the specific benefits that exceed the specified essential health benefits shall not be required of a health benefit plan when the plan is offered by a health care insurer in this state and this section continues to apply to plans offered outside of the state medical exchange.

ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE CORPORATIONS.

§33-24-7i. Benefits for certain mothers and infants.

    (a) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article, for policies issued or renewed on or after January 1, 2014, which delivers, renews or issues a policy of group accident and sickness insurance in this state under the provisions of this article shall make optional maternity and pediatric care benefits available at a reasonable rate to any mother under the age of eighteen who is covered by one or another of her subscriber or member parent or legal guardian’s insurance policy provision, contract, plan or agreement. The subscriber or member parent or legal guardian may decline to purchase the benefits or to permit the mother to purchase the benefits. The offered coverage shall include the mother’s prenatal, postnatal and maternity care and the infant child’s pediatric care, and shall continue either until the mother turns eighteen years of age, graduates from high school or until the child turns one year old, whichever event last occurs.

    (b) If the mother’s parents or legal guardians have no insurance coverage through any policy, provision, contract, plan or agreement, or decline to purchase benefits available under this section, then the infant child’s father’s parents or legal guardians may secure coverage for maternal and pediatric care, as defined under this section, for the infant and the infant’s mother through any policy, provision, contract, plan or agreement under which they have coverage. The father’s subscriber or member parent or legal guardian may decline to purchase the benefits or to permit the mother to purchase the benefits.

    (c) In order for the mother to secure coverage for herself and her child, under the provisions of this subsection, either she or the child’s father must be enrolled in secondary school and living with his or her parents or legal guardians.

    (d) To the extent that the provisions of this section require benefits that exceed the essential health benefits specified under section 1302(b) of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended, the specific benefits that exceed the specified essential health benefits shall not be required of a health benefit plan when the plan is offered by a corporation in this state.

ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.

§33-25A-8k. Benefits for certain mothers and infants

    (a) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article for policies issued or renewed on or after July 1, 2013, which delivers, renews or issues a policy of group accident and sickness insurance in this state under the provisions of this article shall make optional maternity and pediatric care benefits available at a reasonable rate to any mother under the age of eighteen who is covered by one or another of her subscriber or member parent or legal guardian’s insurance policy provision, contract, plan or agreement. The subscriber or member parent or legal guardian may decline to purchase the benefits or to permit the mother to purchase the benefits. The offered coverage shall include the mother’s prenatal, postnatal and maternity care and the infant child’s pediatric care, and shall continue either until the mother turns eighteen years of age, graduates from high school or until the child turns one year old, whichever event last occurs.

    (b) If the mother’s parents or legal guardians have no insurance coverage through any policy, provision, contract, plan or agreement, or decline to purchase benefits available under this section, then the infant child’s father’s parents or legal guardians may secure coverage for maternal and pediatric care, as defined under this section, for the infant and the infant’s mother through any policy, provision, contract, plan or agreement under which they have coverage. The father’s subscriber or member parent or legal guardian may decline to purchase the benefits or to permit the mother to purchase the benefits.

    (c) In order for the mother to secure coverage for herself and her child, under the provisions of this subsection, either she or the child’s father must be enrolled in secondary school and living with his or her parents or legal guardians.

    (d) To the extent that the provisions of this section require benefits that exceed the essential health benefits specified under section 1302(b) of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended, the specific benefits that exceed the specified essential health benefits shall not be required of a health benefit plan when the plan is offered by a health maintenance organization in this state. 

 

    NOTE: The purpose of this bill is to require the Public Employees Insurance Agency, insurers offering accident and sickness insurance, insurers offering group accident and sickness insurance, hospital, medical, dental and health service corporations and requiring health maintenance organizations offering plans to provide optional maternity and pediatric benefits to dependent mothers covered under the article, and their children, either through a parent or legal guardian or the parent or legal guardian of an infant’s father.

 

     

    Strike-throughs indicate language that would be stricken from the present law, and underscoring indicates new language that would be added.

 

 

   §5-16-7f, §33-16-3w, §33-24-7i and §33-25A-8k are new; therefore, they have been completely underscored.

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