H. B. 4710
(By Delegates Staton, Mahan, Capito and Hines)
[Introduced
February 25, 2000; referred to the
Committee on Banking and Insurance then Finance.]
A BILL to amend and reenact section seven, article sixteen,
chapter five of the code of West Virginia, one thousand nine
hundred thirty-one, as amended; to amend and reenact section
nine of said article; to amend article fifteen, chapter
thirty-three of said code by adding thereto a new section,
designated section four-f; to amend article sixteen of said
chapter by adding thereto a new section, designated section
three-o; to amend article twenty-four of said chapter by
adding thereto a new section, designated section seven-f; to
amend article twenty-five of said chapter by adding thereto
a new section, designated section eight-e; to amend article
twenty-five-a of said chapter by adding thereto a new
section, designated section eight-e, all relating to
requiring the coverage of infant formula under certain
circumstances.
Be it enacted by the Legislature of West Virginia:
That section seven, article sixteen, chapter five of the
code of West Virginia, one thousand nine hundred thirty-one, as
amended, be amended and reenacted; that section nine of said
article be amended and reenacted; that article fifteen, chapter
thirty-three be amended by adding thereto a new section,
designated section four-f; that article sixteen of said chapter
be amended by adding thereto a new section, designated section
three-o; that article twenty-four of said chapter be amended by
adding thereto a new section, designated section seven-f; that
article twenty-five of said chapter be amended by adding thereto
a new section, designated section eight-e; that article twenty-
five-a of said chapter be amended by adding thereto a new
section, designated section eight-e, 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 for the administration of such plans, subject to the
limitations contained in this article. 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;
(2) Annual checkups for prostate cancer in men age fifty and
over;
(3) For plans that include maternity benefits, coverage for
inpatient care in a duly licensed health care facility for a
mother and her newly born infant for the length of time which the
attending physician deems medically necessary for the mother or
her newly born child: Provided, That no such plan may deny
payment for a mother or her new born child prior to forty-eight
hours following a vaginal delivery, or prior to ninety-six hours
following a caesarean section delivery, if the attending
physician deems discharge medically inappropriate; and
(4) For plans which provide coverages for post-delivery care
to a mother and her newly born child in the home, coverage for
inpatient care following childbirth as provided in subdivision (3) of this subsection if such inpatient care is determined to be
medically necessary by the attending physician. 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.; and
(5) Coverage for prescribed infant formula, such as neocate,
regardless of how ingested, designed to provide complete
nutritional support for infants with milk or multiple food
protein intolerance, unless rejected by the insured.
(b) The agency shall make available to each eligible
employee, at full cost to the employee, the opportunity to
purchase optional group life and accidental death insurance as
established under the rules of the agency. In addition, each
employee is entitled to have his or her spouse and dependents, as
defined by the rules of the agency, included in the optional
coverage, at full cost to the employee, for each eligible
dependent; and with full authorization to the agency to make the
optional coverage available and provide an 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 non-teaching 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 mammogram 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 prescription drug insurance coverage herein
provided for shall included coverage and benefits for prescribed
infant formula, such as neocate, regardless of how ingested,
designed to provide complete nutritional support for infants with
milk or multiple food protein intolerance, unless rejected by the
insured.
(c) (d) 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) (e) 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) (f) 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
authorized in this article, the 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: Provided, That the director shall negotiate and
contract directly with health care providers and other entities,
organizations and vendors in order to secure competitive
premiums, prices and other financial advantages. The director
shall deal directly with insurers or health care providers and
other entities, organizations and vendors 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 the agent or agents may be paid by
the underwriting company or companies: Provided, however, 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 the 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) (g) The director may authorize the carrier with whom a primary contract is executed to reinsure portions of the 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) (h) Each employee who is covered under any contract or
contracts shall receive a statement of benefits to which the
employee, his or her spouse and his or her dependents are
entitled under the contract, setting forth the information as to
whom the benefits are payable, to whom claims shall be submitted,
and a summary of the provisions of the contract or contracts as
they affect the employee, his or her spouse and his or her
dependents.
(h) (i) 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) (j) 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-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.
CHAPTER 33. INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4f. Third party reimbursement for neocate.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after the first day
of July, two thousand, provide as benefits to all subscribers and
members coverage for prescribed infant formula, such as neocate,
regardless of how ingested, designed to provide complete
nutritional support for infants with milk or multiple food
protein intolerance, unless rejected by the insured.
(b) A policy, provision, contract, plan or agreement may
apply to prescribed infant formula the same deductibles,
coinsurance and other limitations as apply to other covered
services.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3o. Third party reimbursement for neocate.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after the first day
of July, two thousand, provide as benefits to all subscribers and
members coverage for prescribed infant formula, such as neocate,
regardless of how ingested, designed to provide complete
nutritional support for infants with milk or multiple food
protein intolerance, unless rejected by the insured.
(b) A policy, provision, contract, plan or agreement may
apply to prescribed infant formula the same deductibles,
coinsurance and other limitations as apply to other covered
services.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE
CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE
CORPORATIONS.
§33-24-7f. Third party reimbursement for neocate.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after the first day
of July, two thousand, provide as benefits to all subscribers and
members coverage for prescribed infant formula, such as neocate,
regardless of how ingested, designed to provide complete
nutritional support for infants with milk or multiple food
protein intolerance, unless rejected by the insured.
(b) A policy, provision, contract, plan or agreement may apply to prescribed infant formula the same deductibles,
coinsurance and other limitations as apply to other covered
services.
ARTICLE 25. HEALTH CARE CORPORATIONS.
§33-25-8e. Third party reimbursement for neocate.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after the first day
of July, two thousand, provide as benefits to all subscribers and
members coverage for prescribed infant formula, such as neocate,
regardless of how ingested, designed to provide complete
nutritional support for infants with milk or multiple food
protein intolerance, unless rejected by the insured.
(b) A policy, provision, contract, plan or agreement may
apply to prescribed infant formula the same deductibles,
coinsurance and other limitations as apply to other covered
services.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8e. Third party reimbursement for neocate.
(a) Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after the first day
of July, two thousand, provide as benefits to all subscribers and
members coverage for prescribed infant formula, such as neocate,
regardless of how ingested, designed to provide complete nutritional support for infants with milk or multiple food
protein intolerance, unless rejected by the insured.
(b) A policy, provision, contract, plan or agreement may
apply to prescribed infant formula the same deductibles,
coinsurance and other limitations as apply to other covered
services.
NOTE: The purpose of this bill is to require the coverage of
infant formula regardless of how ingested when prescribed for
milk or multiple food protein intolerance.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.
§§33-15-4f, 33-16-3o, 33-24-7f, 33-25-8e and 33-25A-8e are
new; therefore, strike-throughs and underscoring have been
omitted.