H. B. 3222
(By Delegates Border and Perdue)
[Introduced March 30, 2001; referred to the
Committee on Banking and Insurance then Government
Organization.]
A BILL to amend article four, chapter thirty-three of the code of
West Virginia, one thousand nine hundred thirty-one, as
amended, by adding thereto a new section, designated section
twenty-one, relating to requiring health benefit plans to
issue uniform prescription drug information cards or
technology.
Be it enacted by the Legislature of West Virginia:
That article four, chapter thirty-three of the code of West
Virginia, one thousand nine hundred thirty-one, as amended, be
amended by adding thereto a new section, designated section
twenty-one, to read as follows:
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, or administers a plan,
including, but not limited to, third party administrators for
self-insured plans and state administered plans, excluding the
medicaid program, shall issue to its insureds a card or other
technology containing prescription drug information. The uniform
prescription drug information card or technology shall be in the
format approved by the national council for prescription drug
programs and shall 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 or conform to a national format
acceptable to the insurance commissioner. If a health care plan
includes a conditional or situational field, it shall conform to
the most recent pharmacy information card or technology
implementation guide by the national council for prescription drug
programs or conform to a national format acceptable to the
insurance commissioner.
(b) A new uniform prescription drug information card or
technology, as required under subsection (a) 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 or upon any change in the national council for
prescription drug programs implementation guide or successor
document, provided that the change affects data elements contained on the card. Newly issued cards or technology shall be updated
with the latest coverage information and shall conform to the
national council for prescription drug programs standards in effect
and to the implementation guide then in use.
(c) For purposes of this section, a "health benefit plan" is
a health insurance policy, including a self-insured health plan,
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. 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; or automobile medical-payment insurance. For
the purposes of this section, a health benefit plan located or
domiciled outside of West Virginia 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 or
who receive health care services in West Virginia.
(d) 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. A health benefit plan may
not conduct business in this state if the plan violates this
section.
(e) 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.
NOTE: The purpose of this bill is to
require health benefit
plans to issue uniform prescription drug information cards or
technology.
This section is new; therefore, strike-throughs and
underscoring have been omitted.
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