Introduced Version
Senate Bill 51 History
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Key: Green = existing Code. Red = new code to be enacted
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.