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Introduced Version Senate Bill 51 History

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Senate Bill No. 51

(By Senator Bailey)

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[Introduced February 9, 2005; referred to the Committee

on Banking and Insurance; and then to the Committee on Finance.]

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A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new article, designated §33-16E-1, §33-16E-2, §33-16E-3, §33-16E-4, §33-l6E-5 and §33-16E-6, all relating to requiring health insurance plans to cover the cost of smoking cessation services for its covered people.

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 article, designated §33-16E-1, §33-16E-2, §33-16E-3, §33-16E-4, §33-l6E-5 and §33-16E-6, all to read as follows:
ARTICLE 16E. SMOKING CESSATION COVERAGE.
§33-16E-1. Short title.
The Legislature hereby finds and declares that:
(a) Smoking cessation services enhance the health of residents of our state by helping them quit smoking. Since tobacco use is one of the leading causes of bad health, this saves the State financial resources.
(b) Smoking cessation techniques also helps citizens to take responsibility for their own care by allowing them to quit an addictive and harmful habit; and
(c) Under current standards, not all insurance companies pay for smoking cessation, even though smoking cessation helps to reduce the cost of health care.
Therefore, the Legislature finds that smoking cessation services are vital for West Virginia's citizens and further, that health insurance plans should be required to cover smoking cessation techniques.
§33-16E-2. Definitions.
For the purposes of this artic1e, the words and phrases defined in this section have the meanings ascribed to them. These
definitions are applicable unless a different meaning clearly appears from the context.
(a) "Covered person" means the policyholder, subscriber, certificate holder, enrollee or other individual who is participating in, or receiving coverage under, a health insurance plan.
(b) "Health insurance plan" means any individual or group plan, policy, certificate, subscriber contract or contract of insurance provided by a managed care plan, preferred provider agreement, or health maintenance organization that is delivered, issued, renewed, modified, amended or extended by a health insurer
in this State that pays for or purchases health care services for covered persons.
(c) "Health insurer" means a disability insurer, health care insurer, health maintenance organization, accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, health service corporation, health care service plan, preferred provider organization or arrangement or multiple employer welfare arrangement.
(d) "Smoking cessation services" means consultations, examinations, procedures and medical services, provided on an outpatient basis and related to the use of smoking cessation techniques.
(e) "Smoking cessation techniques" means drugs or devices or counseling or a combination thereof scientifically proven to aid individuals in quitting a dependency on tobacco.
§33-16E-3. Parity for smoking cessation services, drugs, devices and outpatient services.

(a) Health insurance plans that provide benefits for prescription drugs or devices may not exclude or restrict benefits to covered persons for any prescription smoking cessation drug or device approved by the federal food and drug administration.
(b) Health insurance plans that provide benefits for outpatient services provided by a health care professional may not exclude or restrict outpatient smoking cessation services for covered persons.
§33-16E-4. Extraordinary surcharges prohibited.
A health insurance plan is prohibited from:
(a) Imposing deductibles, copayments, other cost-sharing mechanisms, or waiting periods for prescription smoking cessation drugs or devices greater than deductibles, copayments, other cost-sharing mechanisms or waiting periods for other covered prescription drugs or devices.
(b) Imposing deductibles, copayments, other cost-sharing mechanisms or waiting periods for outpatient smoking cessation services greater than such deductibles, copayments, other cost-sharing mechanisms or waiting periods for other covered outpatient services.
§33-16E-5. Additional prohibitions.
A health insurance plan is prohibited from:
(a) Denying eligibility, enrollment or renewal of coverage to any individual because of their use or smoking cessation services.
(b) Providing monetary payments or rebates to covered persons to encourage them to accept less than the minimum protections available under this section.
(c) Penalizing, or otherwise reducing or limiting the reimbursement of a health care professional because such professional prescribed smoking cessations drugs or devices or cessation services.
(d) Providing incentives, monetary or otherwise, to a health care professional to induce such professional to withhold smoking cessation services from covered persons.
§33-16E-6. Enforcement.
In addition to any remedies at common law, the insurance commissioner shall receive and review written complaints regarding compliance with this section. The insurance commissioner may use all investigatory tools available to verify compliance with this section. If the insurance commissioner determines that a health insurance plan is not in compliance with any section in this article, the commissioner shall:
(a) Impose a fine of ten thousand dollars for each violation of this section. An additional ten thousand dollars shall be imposed for every thirty days that a health insurance plan is not in compliance; or
(b) Suspend or revoke the certificate of authority or deny the health insurer's application for a certificate of authority.

NOTE: The purpose of this bill is to require insurers to cover the cost of smoking cessation services acquired by covered persons, just as it would for any other medication.

This article is new; therefore, strike-throughs and underscoring have been omitted.
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