Senate Bill No. 518

(By Senator Jones)

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[Introduced March 22, 1993; referred to the Committee
on Banking and Insurance.]

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A BILL to amend article fifteen, chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto three new sections, designated sections seventeen, eighteen and nineteen; and to amend article sixteen of said chapter by adding thereto a new section, designated section twelve, all relating to insurance coverage provided for services of psychologists and social workers.

Be it enacted by the Legislature of West Virginia:
That article fifteen, chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by adding thereto three new sections, designated sections seventeen, eighteen and nineteen; and that article sixteen of said chapter be amended by adding thereto a new section, designated section twelve, all to read as follows:
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-17. Coverage on expenses incurred basis for services of
psychologist or social worker; payment to insured or provider.
Every individual health insurance policy issued, delivered or renewed in this state which provides coverage on an expense incurred basis for any services which can be performed within the lawful scope of practice of a psychologist as the practice of psychology is defined by section two, article twenty-one, chapter thirty of the code of West Virginia, or a social worker as defined by section two, article thirty, chapter thirty of the code of West Virginia, shall be deemed to entitle the policyholder, or other person entitled to these benefits under the policy, to payment of or reimbursement for the cost of any such service, not in excess of the coverage limits, regardless of provider progression. If the policy, contract or plan provides, payment may be made directly to the provider of the services, but if it does not so provide, the person entitled to these benefits shall be entitled to reimbursement for the costs of services received. Nothing in this section shall require an individual health insurance policy which places the insured within a preferred or exclusive provider arrangement to cover services by a provider with whom the insurer does not have a contract, or to make payment of or reimbursement for the cost of any service which exceeds the limits of the policy.
§33-15-18. Services provided by nonprofit medical providers under policy providing coverages for psychologist and social worker.

Every policy, contract or plan issued, delivered or renewed in this state by a nonprofit hospital, medical-surgical, dental or health service corporation which provides services which can be performed within the lawful scope of practice of a psychologist as the practice of psychology is defined by section two, article twenty-one, chapter thirty of the code of West Virginia, or a social worker as defined by section two, article thirty, chapter thirty of the code of West Virginia, shall be deemed to provide benefits for those services regardless of provider profession. If the policy, contract or plan provides, payment may be made directly to the provider of the services, but if it does not so provide, the person entitled to these benefits shall be entitled to reimbursement for the cost of services received. Nothing in this section shall require a policy issued by a nonprofit hospital, medical-surgical, dental or health service corporation which places the insured within a preferred or exclusive provider arrangement to cover services by a provider with whom the insurer does not have a contract, or to make payment of or reimbursement for the cost of any service which exceeds the limits of the policy.
§33-15-19. Services provided by health maintenance organizations under policy providing coverage for psychologists and social workers.

Every policy, contract, agreement or certificate entered into, issued or delivered by a health maintenance organization which provides coverage for services which can be performedwithin the lawful scope of practice of a psychologist as the practice of psychology is defined by section two, article twenty- one, chapter two of the code of West Virginia, or a social worker as defined by section two, article thirty, chapter thirty of the code of West Virginia, shall be deemed to provide benefits for those services regardless of provider professional. If the policy, contract or agreement so provides, payment may be made directly to the provider of the services, but if it does not so provide, the person entitled to these benefits shall be entitled to reimbursement for the cost of services received. Nothing in this section shall require a policy issued by a health maintenance organization which places the insured within a preferred or exclusive provider arrangement to cover services by a provider with whom the insurer does not have a contract, or to make payment of or reimbursement for the cost of any service which exceeds the limits of the policy.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-12. Group policies providing coverage for psychologist or social worker; payment to insured or provider depending on policy language.

Every policy of group or blanket health insurance issued, delivered or renewed in this state which provides coverage on an expense incurred basis for any services which can be performed within the lawful scope of practice of a psychologist, as the term of psychology is defined by section two, article twenty-one, chapter thirty of the code of West Virginia, or a social workeras defined by section two, article thirty, chapter thirty of the code of West Virginia, shall be deemed to entitle the policyholder, or other person entitled to these benefits under the policy, to payment of, or reimbursement for, the cost of any such service, not in excess of the coverage limits, regardless of provider profession. If the policy, contract or plan provides, payment may be made directly to the provider of the services, but if it does not so provide, the person entitled to these benefits shall be entitled to reimbursement for the cost of services received. Nothing in this section shall require a group or blanket health insurance policy which places the insured within a preferred or exclusive provider arrangement to cover services by a provider with whom the insurer does not have a contract, or to make payment of or reimbursement for the cost of any service which exceeds the limits of the policy.



NOTE: The purpose of this bill is to expand the type of mental health professional who can be reimbursed by insurance providers beyond psychiatrists to include psychologists and social workers.

§§33-15-17, 33-15-18, 33-15-19 and §33-16-12 are new; therefore, strike-throughs and underscoring have been omitted.