Senate Bill No. 309

(By Senators Foster, Wells and McCabe)

____________

[Introduced January 27, 2011; referred to the Committee on Banking and Insurance; then to the Committee on Health and Human Resources; and then to the Committee on Finance.]

____________

A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §5-16-27; to amend said code by adding thereto a new section, designated §33-15-22; and to amend said code by adding thereto a new section, designated §33-16-18, all relating to requiring individual and group health insurance providers and the West Virginia Public Employees Insurance Agency to offer wellness programs with incentives for participation.

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 §5-16-27; that said code be amended by adding thereto a new section, designated §33-15-22; and that said code be amended by adding thereto a new section, designated §33-16-18, 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.

§5-16-27. Wellness coverage.

    (a) Notwithstanding any provision in this article to the contrary, a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this act that provides coverage for hospital or medical treatment on an expense incurred basis shall offer a reasonably designed program for wellness coverage that allows for a reward, a contribution, a reduction in premiums or reduced medical, prescription drug, or equipment copayments, coinsurance, or deductibles, or a combination of these incentives, for participation in any health behavior wellness, maintenance, or improvement program approved or offered by the insurer or managed care plan. The insured or enrollee may be required to provide evidence of participation in a program. Individuals unable to participate in these incentives due to an adverse health factor may not be penalized based upon an adverse health status.

    (b) For purposes of this section, "wellness coverage" means health care coverage with the primary purpose to engage and motivate the insured or enrollee through: incentives; provision of health education, counseling, and self-management skills; identification of modifiable health risks; and other activities to influence health behavior changes. For purposes of this section, "reasonably designed program" means a program of wellness coverage that has a reasonable chance of improving health or preventing disease; is not overly burdensome; does not discriminate based upon factors of health; and is not otherwise contrary to law.

    (c) Incentives as outlined in this section are specific and unique to the offering of wellness coverage and have no application to any other required or optional health care benefit.

    (d) Such wellness coverage must satisfy the requirements for an exception from the general prohibition against discrimination based on a health factor under the federal Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191; 110 Stat. 1936), including any federal regulations that are adopted pursuant to that Act.

    (e) A plan offering wellness coverage must do the following:     (1) Give participants the opportunity to qualify for offered incentives at least once a year;

    (2) Allow a reasonable alternative to any individual for whom it is unreasonably difficult, due to a medical condition, to satisfy otherwise applicable wellness program standards. Plans may seek physician verification that health factors make it unreasonably difficult or medically inadvisable for the participant to satisfy the standards; and

    (3) Not provide a total incentive that exceeds twenty percent of the cost of employee-only coverage. The cost of employee-only coverage includes both employer and employee contributions. For plans offering family coverage, the twenty percent limitation applies to cost of family coverage and applies to the entire family.

CHAPTER 33. INSURANCE.

ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-22. Wellness coverage.

    (a) Notwithstanding any provision in this chapter to the contrary, a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this act that provides coverage for hospital or medical treatment on an expense incurred basis shall offer a reasonably designed program for wellness coverage that allows for a reward, a contribution, a reduction in premiums or reduced medical, prescription drug, or equipment copayments, coinsurance, or deductibles, or a combination of these incentives, for participation in any health behavior wellness, maintenance, or improvement program approved or offered by the insurer or managed care plan. The insured or enrollee may be required to provide evidence of participation in a program. Individuals unable to participate in these incentives due to an adverse health factor shall not be penalized based upon an adverse health status.

    (b) For purposes of this section, "wellness coverage" means health care coverage with the primary purpose to engage and motivate the insured or enrollee through: incentives; provision of health education, counseling, and self-management skills; identification of modifiable health risks; and other activities to influence health behavior changes. For purposes of this section, "reasonably designed program" means a program of wellness coverage that has a reasonable chance of improving health or preventing disease; is not overly burdensome; does not discriminate based upon factors of health; and is not otherwise contrary to law.

    (c) Incentives as outlined in this section are specific and unique to the offering of wellness coverage and have no application to any other required or optional health care benefit.

    (d) Such wellness coverage must satisfy the requirements for an exception from the general prohibition against discrimination based on a health factor under the federal Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191; 110 Stat. 1936), including any federal regulations that are adopted pursuant to that Act.

    (e) A plan offering wellness coverage must do the following:     (1) Give participants the opportunity to qualify for offered incentives at least once a year;

    (2) Allow a reasonable alternative to any individual for whom it is unreasonably difficult, due to a medical condition, to satisfy otherwise applicable wellness program standards. Plans may seek physician verification that health factors make it unreasonably difficult or medically inadvisable for the participant to satisfy the standards; and

    (3) Not provide a total incentive that exceeds twenty percent of the cost of employee-only coverage. The cost of employee-only coverage includes both employer and employee contributions. For plans offering family coverage, the twenty percent limitation applies to cost of family coverage and applies to the entire family.

ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-18. Wellness coverage.

    (a) Notwithstanding any provision in this chapter to the contrary, a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this act that provides coverage for hospital or medical treatment on an expense incurred basis shall offer a reasonably designed program for wellness coverage that allows for a reward, a contribution, a reduction in premiums or reduced medical, prescription drug, or equipment copayments, coinsurance, or deductibles, or a combination of these incentives, for participation in any health behavior wellness, maintenance, or improvement program approved or offered by the insurer or managed care plan. The insured or enrollee may be required to provide evidence of participation in a program. Individuals unable to participate in these incentives due to an adverse health factor shall not be penalized based upon an adverse health status.

    (b) For purposes of this section, "wellness coverage" means health care coverage with the primary purpose to engage and motivate the insured or enrollee through: incentives; provision of health education, counseling, and self-management skills; identification of modifiable health risks; and other activities to influence health behavior changes. For purposes of this section, "reasonably designed program" means a program of wellness coverage that has a reasonable chance of improving health or preventing disease; is not overly burdensome; does not discriminate based upon factors of health; and is not otherwise contrary to law.

    (c) Incentives as outlined in this section are specific and unique to the offering of wellness coverage and have no application to any other required or optional health care benefit.

    (d) Such wellness coverage must satisfy the requirements for an exception from the general prohibition against discrimination based on a health factor under the federal Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191; 110 Stat. 1936), including any federal regulations that are adopted pursuant to that Act.

    (e) A plan offering wellness coverage must do the following:

    (1) Give participants the opportunity to qualify for offered incentives at least once a year;

    (2) Allow a reasonable alternative to any individual for whom it is unreasonably difficult, due to a medical condition, to satisfy otherwise applicable wellness program standards. Plans may seek physician verification that health factors make it unreasonably difficult or medically inadvisable for the participant to satisfy the standards; and

    (3) Not provide a total incentive that exceeds twenty percent of the cost of employee-only coverage. The cost of employee-only coverage includes both employer and employee contributions. For plans offering family coverage, the twenty percent limitation applies to cost of family coverage and applies to the entire family.

    NOTE: The purpose of this bill is to require individual and group health insurance providers and the West Virginia Public Employees Insurance Agency to offer wellness programs with incentives for participation.

    §5-16-27, §33-15-22 and §33-16-18 are new; therefore, strike-throughs and underscoring have been omitted.