Senate Bill No. 518
(By Senator Jones)
____________
[Introduced March 22, 1993; referred to the Committee
on Banking and Insurance.]
____________
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.