Senate Bill No. 486
(By Senators Kimble and Walker)
____________
[Introduced February 19, 1996; referred to the Committee on
Banking and Insurance; and then to the Committee on Finance.]
____________
A BILL to amend and reenact sections seven and nine, article
sixteen, chapter five of the code of West Virginia, one
thousand nine hundred thirty-one, as amended; to amend
article fifteen, chapter thirty-three of said code by adding
thereto a new section, designated section four-e; to amend
and reenact section fifteen of said article; to amend
article sixteen of said chapter by adding thereto a new
section, designated section three-i; to amend and reenact
section seven, article sixteen-a of said chapter; to amend
and reenact section four, article sixteen-c of said chapter;
to amend article twenty-four of said chapter by adding
thereto a new section, designated section seven-e; to amend article twenty-five of said chapter by adding thereto a new
section, designated section eight-d; to amend article
twenty-five-a of said chapter by adding thereto a new
section, designated section eight-d; and to amend and
reenact section five, article twenty-eight of said chapter,
all relating to health insurance; mandating certain
benefits; and requiring coverage of inpatient care for
mothers and newly born infants during specified time periods
following childbirth.
Be it enacted by the Legislature of West Virginia:
That sections seven and nine, article sixteen, chapter five
of the code of West Virginia, one thousand nine hundred thirty-
one, as amended, be amended and reenacted; that section fifteen,
article fifteen; section seven, article sixteen-a; section four,
article sixteen-c; and section five, article twenty-eight, all of
chapter thirty-three of said code, be amended and reenacted; that
article fifteen be further amended by adding thereto a new
section, designated section four-e; that article sixteen be
amended by adding thereto a new section, designated section
three-i; that article twenty-four be amended by adding thereto a
new section, designated section seven-e; that article twenty-five be amended by adding thereto a new section, designated section
eight-d; and that article twenty-five-a be amended by adding
thereto a new section, designated section eight-d, all of said
chapter thirty-three, all to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,
SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD OF
PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS,
OFFICES, PROGRAMS, ETC.
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7. Authorization to establish group hospital and surgical
insurance plan, group major medical insurance plan,
group prescription drug plan and group life and
accidental death insurance plan; rules for
administration of plans; mandated benefits; what
plans may provide; optional plans; separate rating
for claims experience purposes.
(a) The agency shall establish a group hospital and surgical
insurance plan or plans, a group prescription drug insurance plan
or plans, a group major medical insurance plan or plans, and a
group life and accidental death insurance plan or plans for those
employees herein made eligible, and to establish and promulgate
rules and regulations for the administration of such plans,
subject to the limitations contained in this article. Such Those plans shall include:
(1) Coverages and benefits for X ray and laboratory services
in connection with mammograms and pap smears when performed for
cancer screening or diagnostic services; and
(2) Annual checkups for prostate cancer in men age fifty and
over; and
(3) For plans that include maternity benefits, coverages for
a minimum of forty-eight hours of inpatient care following a
vaginal delivery and a minimum of ninety-six hours of inpatient
care following a caesarean section for a mother and her newly
born child in a duly licensed health care facility: Provided,
That a plan which provides coverages for postdelivery care to a
mother and her newly born child in the home is not required to
provide those minimum hours of inpatient care following
childbirth, unless inpatient care is determined to be medically
necessary by the attending physician or is requested by the
mother.
Such Those plans may also include, among other things,
medicines, medical equipment, prosthetic appliances, and such
other inpatient and outpatient services and expenses deemed
appropriate and desirable by the agency.
(b) The agency shall make available to each employee herein
made eligible, at full cost to the employee, the opportunity to
purchase optional group life and accidental death insurance in an
amount not to exceed fifty thousand dollars for life insurance
and fifty thousand dollars for accidental death insurance as
established under the rules and regulations of the agency. In
addition, each employee shall be entitled to have his spouse and
dependents, as defined by the rules and regulations of the
agency, included in such optional coverage, at full cost to the
employee, in an amount not to exceed five thousand dollars for
life insurance and five thousand dollars for accidental death
insurance for the spouse and not to exceed two thousand dollars
in life insurance and two thousand dollars in accidental death
insurance for each eligible dependent; and with full
authorization hereby to the agency to make the same available and
provide such opportunity of purchase to each employee.
(c) The finance board may cause to be separately rated for
claims experience purposes: (1) All employees of the state of
West Virginia; (2) all teaching and professional employees of the
university of West Virginia board of trustees or the board of
directors of the state college system and county boards of education; (3) all nonteaching employees of the university of
West Virginia board of trustees or the board of directors of the
state college system and county boards of education; or (4) any
other categorization which would ensure the stability of the
overall program.
§5-16-9. Authorization to execute contracts for group hospital
and surgical insurance, group major medical
insurance, group prescription drug insurance, group
life and accidental death insurance and other
accidental death insurance; mandated benefits;
limitations; awarding of contracts; reinsurance;
certificates for covered employees; discontinuance
of contracts.
(a) The director is hereby given exclusive authorization to
execute such contract or contracts as are necessary to carry out
the provisions of this article and to provide the plan or plans
of group hospital and surgical insurance coverage, group major
medical insurance coverage, group prescription drug insurance
coverage and group life and accidental death insurance coverage
selected in accordance with the provisions of this article, such
contract or contracts to be executed with one or more agencies,
corporations, insurance companies or service organizations licensed to sell group hospital and surgical insurance, group
major medical insurance, group prescription drug insurance and
group life and accidental death insurance in this state.
(b) The group hospital or surgical insurance coverage and
group major medical insurance coverage herein provided for shall
include coverages and benefits for X ray and laboratory services
in connection with mammograms and pap smears when performed for
cancer screening or diagnostic services and annual checkups for
prostate cancer in men age fifty and over. Such benefits shall
include, but not be limited to, the following:
(1) Baseline or other recommended mammograms for women age
thirty-five to thirty-nine, inclusive;
(2) Mammograms recommended or required for women age forty
to forty-nine, inclusive, every two years or as needed;
(3) A mammogram every year for women age fifty and over;
(4) A pap smear annually or more frequently based on the
woman's physician's recommendation for women age eighteen and
over; and
(5) A checkup for prostate cancer annually for men age fifty
or over.
(c) The group life and accidental death insurance herein provided for shall be in the amount of ten thousand dollars for
every employee. The amount of the group life and accidental
death insurance to which an employee would otherwise be entitled
shall be reduced to five thousand dollars upon such employee
attaining age sixty-five.
(d) All of the insurance coverage to be provided for under
this article may be included in one or more similar contracts
issued by the same or different carriers.
(e) The provisions of article three, chapter five-a of this
code, relating to the division of purchases of the department of
finance and administration, shall not apply to any contracts for
any insurance coverage or professional services authorized to be
executed under the provisions of this article. Before entering
into any contract for any insurance coverage, as herein
authorized, said director shall invite competent bids from all
qualified and licensed insurance companies or carriers, who may
wish to offer plans for the insurance coverage desired. The
director shall deal directly with insurers in presenting
specifications and receiving quotations for bid purposes. No
commission or finder's fee, or any combination thereof, shall be
paid to any individual or agent; but this shall not preclude an underwriting insurance company or companies, at their own
expense, from appointing a licensed resident agent, within this
state, to service the companies' contracts awarded under the
provisions of this article. Commissions reasonably related to
actual service rendered for such agent or agents may be paid by
the underwriting company or companies: Provided, That in no
event shall payment be made to any agent or agents when no actual
services are rendered or performed. The director shall award
such contract or contracts on a competitive basis. In awarding
the contract or contracts the director shall take into account
the experience of the offering agency, corporation, insurance
company or service organization in the group hospital and
surgical insurance field, group major medical insurance field,
group prescription drug field and group life and accidental death
insurance field, and its facilities for the handling of claims.
In evaluating these factors, the director may employ the services
of impartial, professional insurance analysts or actuaries or
both. Any contract executed by the director with a selected
carrier shall be a contract to govern all eligible employees
subject to the provisions of this article. Nothing contained in
this article shall prohibit any insurance carrier from soliciting employees covered hereunder to purchase additional hospital and
surgical, major medical or life and accidental death insurance
coverage.
(f) The director may authorize the carrier with whom a
primary contract is executed to reinsure portions of such
contract with other carriers which elect to be a reinsurer and
who are legally qualified to enter into a reinsurance agreement
under the laws of this state.
(g) Each employee who is covered under any such contract or
contracts shall receive a statement of benefits to which such
employee, his or her spouse and his or her dependents are
entitled thereunder, setting forth such information as to whom
such benefits shall be payable, to whom claims shall be
submitted, and a summary of the provisions of any such contract
or contracts as they affect the employee, his or her spouse and
his or her dependents.
(h) The director may at the end of any contract period
discontinue any contract or contracts it has executed with any
carrier and replace the same with a contract or contracts with
any other carrier or carriers meeting the requirements of this
article.
(i) The director shall provide by contract or contracts
entered into under the provisions of this article the cost for
coverage of children's immunization services from birth through
age sixteen years to provide immunization against the following
illnesses: Diphtheria, polio, mumps, measles, rubella, tetanus,
hepatitis-b, haemophilus influenzae influenza-b and whooping
cough. Additional immunizations may be required by the
commissioner of the bureau of public health for public health
purposes. Any contract entered into to cover these services
shall require that all costs associated with immunization,
including the cost of the vaccine, if incurred by the health care
provider, and all costs of vaccine administration, be exempt from
any deductible, per visit charge and/or copayment provisions
which may be in force in these policies or contracts. This
section does not require that other health care services provided
at the time of immunization be exempt from any deductible and/or
copayment provisions.
(j) The director shall provide by contract or contracts
that include maternity benefits and which are entered into under
the provisions of this article the cost of coverage for a minimum
of forty-eight hours of inpatient care following a vaginal delivery and a minimum of ninety-six hours of inpatient care
following a caesarean section for a mother and her newly born
child in a duly licensed health care facility: Provided, That a
contract or contracts which provides coverage for postdelivery
care to a mother and her newly born child in the home is not
required to provide for a minimum of forty-eight hours and
ninety-six hours, respectively, of inpatient care unless in-
patient care is determined to be medically necessary by the
attending physician or is requested by the mother. For purposes
of this subsection, "attending physician" includes an attending
obstetrician, pediatrician or other physician attending the
mother or newly born child.
CHAPTER 33. INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4e. Third-party reimbursement for minimum inpatient care
following childbirth.
Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall provide as benefits to all
subscribers and members coverage for maternity benefits which
include, but are not limited to, the following unless rejected by
the insured: Coverage for a minimum of forty-eight hours of in-patient care following a vaginal delivery and a minimum of
ninety-six hours of inpatient care following a caesarean section
for a mother and her newly born child in a duly licensed health
care facility: Provided, That a contract or contracts which
provides coverage for postdelivery care to a mother and her newly
born child in the home is not required to provide for a minimum
of forty-eight hours and ninety-six hours, respectively, of
inpatient care unless inpatient care is determined to be
medically necessary by the attending physician or is requested by
the mother. For purposes of this subsection, "attending
physician" includes an attending obstetrician, pediatrician or
other physician attending the mother or newly born child.
§33-15-15. Insurance commissioner to establish minimum benefits
and coverages for an individual policy design;
basic policy benefits; exemptions; legislative
rules; premiums; applicability.
(a) The insurance commissioner shall establish minimum
benefits which may be included in any individual accident and
sickness insurance policy issued pursuant to this article. The
commissioner may accept bids on designs for such minimum plans
and shall compile a final basic benefit plan for use by insurers
within six months after the effective date of this article.
(b) The basic policy plan established by the insurance
commissioner may include coverage for the services of medical
physicians or surgeons, podiatrists, physician assistants,
osteopathic physicians or surgeons, chiropractors, midwives,
advanced nurse practitioners or any other professional health
care provider as deemed appropriate by the insurance
commissioner.
(c) The following shall serve as a guide to the commissioner
in the design of a basic policy issued pursuant to this article:
(1) Inpatient hospital care up to twenty days per year;
(2) Outpatient hospital care including, but not limited to,
surgery and anesthesia, preadmission testing, radiation therapy
and chemotherapy;
(3) Accident or emergency care through emergency room care
and emergency admissions to a hospital;
(4) Physician office visits for primary, preventive, well,
acute or sick care, up to four visits per year, and laboratory
fees, surgery and anesthesia, diagnostic X rays, physician care
in a hospital inpatient or outpatient setting;
(5) Prenatal care, including a minimum of one prenatal
office visit per month during the first two trimesters of pregnancy, two office visits per month during the seventh and
eighth months of pregnancy, and one office visit per week during
the ninth month and until term. Coverage for each such visit
shall include necessary appropriate screening, including history,
physical examination, and such laboratory and diagnostic
procedures as may be deemed appropriate by the physician based
upon recognized medical criteria for the risk group of which the
patient is a member. Coverage for each office visit shall also
include such prenatal counseling as the physician deems
appropriate;
(6) Obstetrical care, including physician's services,
delivery room and other medically necessary hospital services:
Provided, That a basic policy is required to include coverage for
a minimum of forty-eight hours of inpatient care following a
vaginal delivery and a minimum of ninety-six hours of inpatient
care following a caesarean section for a mother and her newly
born child in a duly licensed health care facility: Provided,
however, That a basic policy which provides coverage for post-
delivery care to a mother and her newly born child in the home is
not required to provide for a minimum of forty-eight hours and
ninety-six hours, respectively, of inpatient care unless in-patient care is determined to be medically necessary by the
attending physician or is requested by the mother. For purposes
of this subsection, "attending physician" includes an attending
obstetrician, pediatrician or other physician attending the
mother or newly born child.
(7) X ray and laboratory services in connection with
mammograms or pap smears when performed for cancer screening or
diagnostic purposes, at the direction of a physician, including,
but not limited to, the following:
(A) Baseline or other recommended mammograms for women age
thirty-five to thirty-nine, inclusive;
(B) Mammograms recommended or required for women age forty
to forty-nine, inclusive, every two years or as needed;
(C) A mammogram every year for women age fifty and over; or
(D) A pap smear annually or more frequently based on the
woman's physician's recommendation for women age eighteen or
over. A basic policy issued pursuant to this article may apply
to mammograms or pap smears the same deductibles or copayments as
apply to other covered services;
(8) Medical and laboratory services in connection with
annual checkups for prostate cancer in men age fifty and over; and
(9) Child immunization services as described in section
five, article three, chapter sixteen of this code. This coverage
will cover all costs associated with immunization, including the
cost of the vaccine, if incurred by the health care provider, and
all costs of vaccine administration. These services shall be
exempt from any deductible, per-visit charge and/or copayment
provisions which may be in force in these policies or contracts.
This section does not require that other health care services
provided at the time of immunization be exempt from any
deductible and/or copayment provisions.
(d) Notwithstanding any other provision of this code to the
contrary, any basic policy issued pursuant to this section shall
be exempt from all statutorily and regulatorily mandated benefits
and coverages except for the minimum benefits and coverages as
established by the commissioner pursuant to subsection (a) of
this section.
(e) Nothing in this section shall preclude an insurer from
offering any other benefit or coverage under a basic policy
issued pursuant to this article, for an appropriate additional
premium: Provided, That any additional benefit or coverage must first be approved by the insurance commissioner.
(f) A basic policy issued pursuant to this section may
include deductibles, copayments and maximum benefits: Provided,
That any additional benefit must first be approved by the
insurance commissioner.
(g) The insurance commissioner shall promulgate legislative
rules pursuant to chapter twenty-nine-a of this code to implement
the provisions of this section, including, but not limited to,
rules regarding bids, forms and rates.
(h) The premiums paid for insurance provided pursuant to
this article shall be exempt from the premium tax required to be
paid pursuant to sections fourteen and fourteen-a, article three
of this chapter.
(i) A basic policy provided by this section shall be issued
only to individuals who have been without health insurance
coverage for at least one year prior to application for the same.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3i. Third party reimbursement for minimum inpatient care
following childbirth.
Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any entity regulated by this article shall provide as benefits to all
subscribers and members coverage for maternity benefits which
include, but are not limited to, the following unless rejected by
the insured: Coverage for a minimum of forty-eight hours of in-
patient care following a vaginal delivery and a minimum of
ninety-six hours of inpatient care following a caesarean section
for a mother and her newly born child in a duly licensed health
care facility: Provided, That a contract or contract which
provides coverage for postdelivery care to a mother and her newly
born child in the home is not required to provide for a minimum
of forty-eight hours and ninety-six hours, respectively, of
inpatient care unless inpatient care is determined to be
medically necessary by the attending physician or is requested by
the mother. For purposes of this subsection, "attending
physician" includes an attending obstetrician, pediatrician or
other physician attending the mother or newly born child.
ARTICLE 16A. GROUP HEALTH INSURANCE CONVERSION.
§33-16A-7. Limits of coverage.
An insurer shall may not be required to issue a converted
policy which provides benefits in excess of those provided under
the group policy from which conversion is made: Provided, That a converted policy issued which provides maternity benefits is
required to include coverage for a minimum of forty-eight hours
of inpatient care following a vaginal delivery and a minimum of
ninety-six hours of inpatient care following a caesarean section
for a mother and her newly born child in a duly licensed health
care facility: Provided, however, That a converted policy which
provides coverage for postdelivery care to a mother and her newly
born child in the home is not required to provide for a minimum
of forty-eight hours and ninety-six hours, respectively, of
inpatient care unless inpatient care is determined to be
medically necessary by the attending physician or is requested by
the mother. For purposes of this subsection, "attending
physician" includes an attending obstetrician, pediatrician or
other physician attending the mother or newly born child..
ARTICLE 16C. EMPLOYER GROUP ACCIDENT AND SICKNESS INSURANCE
POLICIES.
§33-16C-4. Insurance commissioner to establish minimum benefits
and coverages; basic policy benefits.
(a) The insurance commissioner shall establish minimum
benefits which shall be included in every insurance policy issued
pursuant to this article. The commissioner may accept bids on
designs for such minimum plans and shall compile a final basic benefit plan for use by insurers within six months after the
effective date of this article.
(b) The basic policy plan established by the insurance
commissioner may include coverage for the services of medical
physicians or surgeons, podiatrists, physician assistants,
osteopathic physicians or surgeons, chiropractors, midwives,
advanced nurse practitioners, or any other professional health
care provider as deemed appropriate by the insurance
commissioner.
(c) The following shall serve as a guide to the commissioner
in the design of a basic policy issued pursuant to this article:
(1) Inpatient hospital care up to twenty days per year;
(2) Outpatient hospital care including, but not limited to,
surgery and anesthesia, preadmission testing, radiation therapy
and chemotherapy;
(3) Accident or emergency care through emergency room care
and emergency admissions to a hospital;
(4) Physician office visits for primary, preventive, well,
acute or sick care, up to four visits per year, and laboratory
fees, surgery and anesthesia, diagnostic X rays, physician care
in a hospital inpatient or outpatient setting;
(5) Prenatal care, including a minimum of one prenatal
office visit per month during the first two trimesters of
pregnancy, two office visits per month during the seventh and
eighth months of pregnancy, and one office visit per week during
the ninth month and until term. Coverage for each such visit
shall include necessary appropriate screening, including history,
physical examination, and such laboratory and diagnostic
procedures as may be deemed appropriate by the physician based
upon recognized medical criteria for the risk group of which the
patient is a member. Coverage for each office visit shall also
include such prenatal counseling as the physician deems
appropriate;
(6) Obstetrical care, including physician's services,
delivery room and other medically necessary hospital services:
Provided, That a basic policy is required to include coverage for
a minimum of forty-eight hours of inpatient care following a
vaginal delivery and a minimum of ninety-six hours of inpatient
care following a caesarean section for a mother and her newly
born child in a duly licensed health care facility: Provided,
however, That a basic policy which provides coverage for post-
delivery care to a mother and her newly born child in the home is not required to provide for a minimum of forty-eight hours and
ninety-six hours, respectively, of inpatient care unless in-
patient care is determined to be medically necessary by the
attending physician or is requested by the mother. For purposes
of this subsection, "attending physician" includes an attending
obstetrician, pediatrician or other physician attending the
mother or newly born child;
(7) X ray and laboratory services in connection with
mammograms or pap smears when performed for cancer screening or
diagnostic purposes, at the direction of a physician, including,
but not limited to, the following:
(A) Baseline or other recommended mammograms for women age
thirty-five to thirty-nine, inclusive;
(B) Mammograms recommended or required for women age forty
to forty-nine, inclusive, every two years or as needed;
(C) A mammogram every year for women age fifty and over; or
(D) A pap smear annually or more frequently based on the
woman's physician's recommendation for women age eighteen or
over. A basic policy issued pursuant to this article may apply
to mammograms or pap smears the same deductibles or copayments as
apply to other covered services;
(8) Medical and laboratory services in connection with
annual checkups for prostate cancer in men age fifty and over;
and
(9) Child immunization services as described in section
five, article three, chapter sixteen of this code. This coverage
will cover all costs associated with immunization, including the
cost of the vaccine, if incurred by the health care provider, and
all costs of vaccine administration. These services shall be
exempt from any deductible, per-visit charge and/or copayment
provisions which may be in force in these policies or contracts.
This section does not require that other health care services
provided at the time of immunization be exempt from any
deductible and/or copayment provisions.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE
CORPORATIONS, DENTAL SERVICE CORPORATIONS AND
HEALTH SERVICE CORPORATIONS.
§33-24-7e. Third party reimbursement for minimum inpatient care
following childbirth.
Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall provide as benefits to all
subscribers and members coverage for maternity benefits which include, but are not limited to, the following unless rejected by
the insured: Coverage for a minimum of forty-eight hours of
inpatient care following a vaginal delivery and a minimum of
ninety-six hours of inpatient care following a caesarean section
for a mother and her newly born child in a duly licensed health
care facility: Provided, That a contract or contracts which
provides coverage for postdelivery care to a mother and her newly
born child in the home is not required to provide for a minimum
of forty-eight hours and ninety-six hours, respectively, of
inpatient care unless inpatient care is determined to be
medically necessary by the attending physician or is requested by
the mother. For purposes of this subsection, "attending
physician" includes an attending obstetrician, pediatrician or
other physician attending the mother or newly born child.
ARTICLE 25. HEALTH CARE CORPORATIONS.
§33-25-8d. Third party reimbursement for minimum in
patient care
following childbirth.
Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall provide as benefits to all
subscribers and members coverage for maternity benefits which include, but are not limited to, the following unless rejected by
the insured: Coverage for a minimum of forty-eight hours of
inpatient care following a vaginal delivery and a minimum of
ninety-six hours of inpatient care following a caesarean section
for a mother and her newly born child in a duly licensed health
care facility: Provided, That a contract or contracts that
provides coverage for postdelivery care to a mother and her newly
born child in the home is not required to provide for a minimum
of forty-eight hours and ninety-six hours, respectively, of
inpatient care unless inpatient care is determined to be
medically necessary by the attending physician or is requested by
the mother. For purposes of this subsection, "attending
physician" includes an attending obstetrician, pediatrician or
other physician attending the mother or newly born child.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8d. Third party reimbursement for minimum in
patient care
following childbirth.
Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall provide as benefits to all
subscribers and members coverage for maternity benefits which include, but are not limited to, the following unless rejected by
the insured: Coverage for a minimum of forty-eight hours of
inpatient care following a vaginal delivery and a minimum of
ninety-six hours of inpatient care following a caesarean section
for a mother and her newly born child in a duly licensed health
care facility: Provided, That a contract or contracts which
provides coverage for postdelivery care to a mother and her newly
born child in the home is not required to provide for a minimum
of forty-eight hours and ninety-six hours, respectively, of
inpatient care unless inpatient care is determined to be
medically necessary by the attending physician or is requested by
the mother. For purposes of this subsection, "attending
physician" includes an attending obstetrician, pediatrician or
other physician attending the mother or newly born child.
ARTICLE 28. INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM
STANDARDS.
§33-28-5. Minimum standards for benefits.
(a) The commissioner shall promulgate rules and regulations,
in accordance with chapter twenty-nine-a of the code, to
establish minimum standards for benefits under each of the
following categories of coverage in individual policies of accident and sickness insurance and subscriber contracts of
hospital, medical, dental and service corporations:
(1) Basic hospital expense coverage;
(2) Basic medical-surgical expense coverage;
(3) Hospital confinement indemnity coverage, including
maternity benefits which include, but are not limited to, the
following unless rejected by the insured: Coverage for a minimum
of forty-eight hours of inpatient care following a vaginal
delivery and a minimum of ninety-six hours of inpatient care
following a caesarean section for a mother and her newly born
child in a duly licensed health care facility: Provided, That a
contract or contracts which provides coverage for postdelivery
care to a mother and her newly born child in the home is not
required to provide for a minimum of forty-eight hours and
ninety-six hours, respectively, of inpatient care unless
inpatient care is determined to be medically necessary by the
attending physician or is requested by the mother. For purposes
of this subsection, "attending physician" includes an attending
obstetrician, pediatrician or other physician attending the
mother or newly born child;
(4) Major medical expense coverage;
(5) Disability income protection coverage;
(6) Accident only coverage; and
(7) Specified disease or specified accident coverage.
(b) Nothing in this section shall preclude the issuance of
any policy or subscriber contract which combines two or more of
the categories of coverage enumerated in subdivisions (1) through
(6) of subsection (a) of this section.
(c) No policy or subscriber contract shall be delivered or
issued for delivery in this state which does not meet the
prescribed minimum standards for the categories of coverage
listed in subdivisions (1) through (7) of subsection (a) of this
section unless the commissioner finds that such policy or
subscriber contract will be in the public interest and that such
policy or subscriber contract contains benefits which are
reasonable in relation to the premium charged.
(d) The commissioner shall prescribe the method of
identification of policies and subscriber contracts based upon
coverages provided.
NOTE: The purpose of this bill is to require all entities
providing health insurance to cover inpatient treatment of a
mother and newly born child for these minimum time periods following childbirth: 48 hours after a vaginal delivery and 96
hours after a caesarean section.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.
§§33-15-4e, 33-16-3i, 33-24-7e, 33-25-8d and 33-25A-8d are
new; therefore, strike-throughs and underscoring have been
omitted.