Senate Bill No. 312
(By Senators Macnaughtan, Bowman, Blatnik, Grubb, Ross,
Anderson, Scott, Wagner, Plymale, Sharpe and Manchin)
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[Introduced February 6, 1996; referred to the Committee on
Banking and Insurance.]
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A BILL to amend and reenact chapter thirty-three of the code of
West Virginia, one thousand nine hundred thirty-one, as
amended, by adding thereto a new article, designated article
fifteen-c, relating to requiring insurance companies to
cover the complete treatment and management of diabetes for
their insureds to the same extent that they provide coverage
for the complete treatment of other diseases.
Be it enacted by the Legislature of West Virginia:
That chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, be amended by
adding thereto a new article, designated article fifteen-c, to
read as follows:
ARTICLE 15C. DIABETES INSURANCE.
§33-15C-1. Legislative findings.
The Legislature finds the following:
1. That persons with diabetes will suffer serious costly
long-term health complications such as kidney failure, blindness
and coronary disease if they do not maintain their blood sugar
concentrations within normal limits;
2. That as a result of diabetes the cost of these long-term
health complications currently represents one in every seven
health care dollars spent;
3. That with appropriate resources, treatment and training
persons with diabetes can effectively manage their diabetes and
control their blood sugar concentrations within normal limits;
4. That scientific medical studies have conclusively shown
that control of blood sugar concentrations within normal levels
results in the elimination or postponement of these long-term
disastrous illnesses for persons with diabetes;
5. That studies have consistently shown that the expense
incurred for persons with diabetes to control their blood sugar
concentrations within normal levels results in health care cost
savings greatly in excess of that expense; and
6. That the expense to support persons with diabetes in the
management of their condition results not only in health care
cost savings but also in substantial improvement in their future
health and welfare.
§33-15C-2. Insurance for diabetics.
Except as provided in section six of article fifteen of this
chapter, any policy which provides medical coverage that includes
coverage for physician services in a physician's office, any
policy which provides major medical or similar comprehensive-type
coverage and any health insurance policy, including health
maintenance organizations, hospitalization insurance and health
care insurance shall include coverage for the following equipment
and supplies for the treatment and/or management of diabetes for
both insulin dependent and non-insulin dependent persons with
diabetes and those with gestational diabetes, if recommended or
prescribed by a licensed physician or other licensed health care
provider: Blood glucose monitors, monitor supplies, insulin,
injection aids, syringes, insulin infusion devices,
pharmacological agents for controlling blood sugar, orthodics and
any additional items as promulgated by rule, pursuant to the
provisions of chapter twenty-nine-a of this code, by the insurance commissioner with input from the commissioner of the
bureau of public health. All policies affected by the provisions
of this section shall also include coverage for diabetes
self-management education to ensure that persons with diabetes
are educated as to the proper self-management and treatment of
their diabetes, including information on proper diets. Coverage
for self-management education and education relating to diet
shall be limited to visits medically necessary upon the diagnosis
of diabetes, where a physician or other licensed or registered
health care provider identifies or diagnoses a significant change
in the patient's symptoms or conditions that necessitate changes
in a patient's self-management, or where reeducation or refresher
education is necessary. The education may be provided by the
physician or other licensed health care provider as part of an
office visit for diabetes diagnosis or treatment, or by a
certified diabetes educator certified by a National Diabetes
Educator Certification program, or registered dietitian
registered by a nationally recognized professional association of
dietitians upon the referral of a physician or other licensed
health care provider. Coverage for self-management education and education relating to diet shall also include home visits when
determined medically necessary by a licensed physician. Any
deductible or coinsurance billed for any service as provided in
this section shall apply on an equal basis with all other
coverages provided by the insurer but not included in this
section.
NOTE: The purpose of this bill is to require insurance
companies to cover the treatment of diabetes for their insureds
on an equal basis with their coverage of other diseases.
This article is new; therefore, strike-throughs and
underscoring have been omitted.