Senate Bill No. 25
(By Senators Boley, Hunter, Minear, Deem, White and Scott)
[Introduced January 14, 1998;
referred to the Committee on Banking and Insurance; and then to
the Committee on Finance.]
A BILL to amend 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 forty- two, relating to women's access to health care; defining
terms; legislative findings and purpose; requiring providers
of health benefits policies to provide coverage for direct
access to women's health care providers and specified
services without referral or additional deductibles or
copayments; disclosure of female enrollees' rights to direct
access to certain health care services; disclosure of
certain exclusions from coverage; disclosure of right to
limit coverage to medically necessary and appropriate
services; prohibiting certain cost-sharing; permitting
limitations on the number of women's health care providers in a network under certain conditions; and short title.
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 forty-two, to
read as follows:
ARTICLE 42. WOMEN'S ACCESS TO HEALTH CARE ACT.
§33-42-1. Short title.
This article shall be known and may be cited as the "Women's
Access To Health Care Act".
§33-42-2. General provisions.
For purposes of this article:
(1) "Women's health care provider" means an obstetrician/
gynecologist or certified nurse-midwife practicing within the
lawful scope of a health care practice that is devoted to
providing health care services to women throughout their lives.
(2) "Health benefit policy" means any individual or group
plan, policy or contract for health care services issued,
delivered, issued for delivery or renewed in this state by a
health care corporation, health maintenance organization,
accident and sickness insurer, fraternal benefit society,
nonprofit hospital service corporation, nonprofit medical service
corporation or similar entity.
§33-42-3. Legislative findings and purpose.
The Legislature of West Virginia hereby finds and declares
that delivery of health care services for women has been proven
to be variable from that of men and enacts this article for the
purpose of providing for the improved delivery and accessibility
of health care services to women in this state.
§33-42-4. Required coverage.
No health benefits policy that covers hospital, medical or
surgical expenses may require as a condition to the coverage of
the services of a women's health care provider that an enrollee,
subscriber or insured first obtain a referral from another
physician. Services covered by this section are limited to those
services specified in the published recommendation of the
accreditation council for graduate medical education for training
as an obstetrician/gynecologist for physicians or the American
college of nurse-midwives' core competencies for nurse-midwives.
These services include diagnosis, treatment and referral.
§33-42-5. Required disclosure.
Every health benefits policy that is issued, delivered,
issued for delivery or renewed in this state on or after the
first day of July, one thousand nine hundred ninety-eight, shall
disclose in writing to enrollees, subscribers and insureds, in
clear and accurate language, the female enrollee's right of direct access to a women's health care provider of her choice.
The information required to be disclosed shall include, at a
minimum, any specific women's health care services that are
excluded from coverage and the health benefits policy's right to
limit coverage to medically necessary and appropriate women's
health care services.
§33-42-6. Certain cost-sharing prohibited.
No health benefits policy may impose additional copayments
or deductibles for female enrollees' direct access to in-network,
participating women's health care providers unless the same
additional cost-sharing is imposed for other types of health care
services not delineated in this article.
§33-42-7. Limitation on number of women's health care providers.
A health benefits policy may limit the number of women's
health care providers in a network: Provided, That a sufficient
number of providers are available to serve a defined population
or geographic service area so that female enrollees will have
direct and timely access to women's health care providers.
NOTE: The purpose of this bill is to create the Women's
Access To Health Care Act.
This article is new; therefore, strike-throughs and
underscoring have been omitted.