H. B. 2096
(By Delegate McKinley)
[Introduced February 10, 1993; referred to the
Committee on Banking and Insurance then the Judiciary.]
A BILL to amend and reenact section eight, article sixteen,
chapter five of the code of West Virginia, one thousand nine
hundred thirty-one, as amended, relating to allowing a
credit against the deductible share of medical costs of one
hundred dollars for persons covered under the provisions of
the public employees insurance system who, while wearing a
seat belt, are injured in a motor vehicle accident.
Be it enacted by the Legislature of West Virginia:
That section eight, article sixteen, chapter five of the
code of West Virginia, one thousand nine hundred thirty-one, as
amended, be amended and reenacted to read as follows:
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-8. Conditions of insurance program.
The insurance plans herein provided for shall be designed by
the public employees insurance agency:
(1) To provide a reasonable relationship between the
hospital, surgical, medical, and prescription drug benefits tobe included and the expected reasonable and customary hospital,
surgical, medical and prescription drug expenses as established
by the director to be incurred by the affected employee, his or
her spouse and his or her dependents. The establishment of
reasonable and customary expenses by the public employees
insurance agency pursuant to the preceding sentence is not
subject to the state administrative procedures act in chapter
twenty-nine-a of this code.
(2) To include reasonable controls which may include
deductible and coinsurance provisions applicable to some or all
of the benefits, and shall include other provisions, including,
but not limited to, copayments, preadmission certification, case
management programs, and preferred provider arrangements:
Provided, That any person covered by the provisions of this
article, who is injured in a motor vehicle accident and at the
time of the accident is wearing a proper seat restraint, shall
be given a credit of one hundred dollars against any deductible
provision in any medical insurance plan provided in this article
for medical costs incurred as a result of the motor vehicle
accident.
(3) To prevent unnecessary utilization of the various
hospital, surgical, medical and prescription drug services
available.
(4) To provide reasonable assurance of stability in future
years for the plans.
(5) To provide major medical insurance for said employees.
(6) To provide certain group life and accidental death
insurance for the employees covered under this article.
(7) To include provisions for the coordination of benefits
payable by the terms of such plans with the benefits to which
such employee, or his or her spouse or his or her dependents may
be entitled by the provisions of any other group hospital,
surgical, medical, major medical, or prescription drug insurance
or any combination thereof.
(8) To provide a cash incentive plan for employees, spouses,
and dependents by the thirty-first day of December, one thousand
nine hundred eighty-eight, to increase utilization of, and to
encourage the use of, lower cost alternative health care
facilities, health care providers and generic drugs. Such plan
shall be reviewed annually by the director and the advisory
board.
(9) To provide "wellness" programs and activities which will
include, but not be limited to, benefit plan incentives to
discourage tobacco, alcohol and chemical abuse and an educational
program to encourage proper diet and exercise. In establishing
"wellness" programs, the division of vocational rehabilitation
shall cooperate with the public employees insurance agency in
establishing statewide wellness programs and with such division
of vocational rehabilitation to contact county boards of
education for the use of facilities, equipment or any service
related to such purpose, at the request of the director, under
the authority hereby granted to contract therefor. Boards ofeducation shall be limited to charging only the cost of
janitorial service and increased utilities for the use of the
gymnasium and related equipment. The cost of the exercise
program shall be paid by county boards of education, the public
employees insurance agency, or participating employees, their
spouses or dependents. All exercise programs shall be made
available to all employees, their spouses or dependents and shall
not be limited to employees of county boards of education.
(10) To provide a program, to be administered by the
director, for a patient audit plan with reimbursement up to a
maximum of one thousand dollars annually, to employees for
discovery of health care provider or hospital overcharges when
the affected employee brings such overcharge to the attention of
the plan. The hospital or health care provider shall certify to
the director that it has provided, prior to or simultaneously
with the submission of the statement of charges for payments, an
itemized statement of the charges to the employee participant for
which payment is requested of the plan.
(11) To require that all employers give written notice to
each covered employee prior to institution of any changes in
benefits to employees, and to include appropriate penalty for any
employer not providing the required information to any employee.
NOTE: The purpose of this bill is to allow a credit against
the deductible share of medical costs of one hundred dollars for
persons covered under the provisions of the public employees
insurance system who, while wearing a seat belt, are injured in
a motor vehicle accident.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.