H. B. 4728
(By Delegate Sparks)
[Introduced February 25, 2000; Referred to
the Committee on Banking and Insurance then Finance.]
A BILL to amend and reenact section four-a, article fifteen,
chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, relating to
requiring group insurers to cover the cost of necessary
treatment of their insureds for social anxiety disorder.
Be it enacted by the Legislature of West Virginia:
That section four-a, article fifteen, chapter thirty-three of
the code of West Virginia, one thousand nine hundred thirty-one, as
amended, be amended and reenacted to read as follows:
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4a. Required policy provisions -- Mental illness.
Any policy of insurance described in this article which
provides hospital expense and surgical expense insurance and which
is issued or subsequently renewed by agreement between the insurer
and the policyholder, within this state, or any policy of accident and sickness insurance which provides hospital expense and surgical
expense insurance and which is delivered or issued for delivery or
subsequently renewed by agreement between the insurer and the
policyholder in this state, shall provide, unless specifically
refused by the policyholder, benefits for expense of residents of
the state covered under any such policy or plan, arising from
mental or nervous conditions as described in the standard
nomenclature of the American psychiatric association which are at
least equal to the following minimum requirements:
(a) In the case of benefits based upon confinement as an
inpatient in a mental hospital under the direction and supervision
of the department of mental health, or in a private hospital or
private mental hospital licensed by the department of mental health
or any other duly authorized state agency, the period of
confinement for which benefits shall be payable shall be at least
forty-five consecutive days in any calendar year.
(b) In the case of benefits based upon confinement as an
inpatient in a licensed or accredited general hospital, such
benefits shall be no different than for any other illness.
(c) In the case of outpatient benefits, these shall cover
fifty percent of eligible expenses up to five hundred dollars over
a twelve-month period, services furnished: (1) By a comprehensive
health service organization; (2) by a licensed or accredited
hospital; or (3) subject to the approval of the department of mental health, services furnished by a community mental health
center or other mental health clinic or day care center which
furnishes mental health services; or (4) consultations or
diagnostic or treatment sessions, provided that such services are
rendered by a psychotherapist or by a psychologist and do not
exceed fifty such sessions over a twelve-month period. For
purposes of this article "psychotherapist" means any person
employed by the mental health center to provide direct services to
clients, such person to serve under the authority and direction of
a licensed psychologist, physician, psychiatrist or director of a
duly licensed mental health facility.
(d) (1) The Legislature finds and declares the following:
(A) Social anxiety disorder (social phobia) is the most common
anxiety disorder affecting approximately seven and nine-tenths
percent of Americans annually with a lifetime prevalence of
twenty-three and three-tenths percent;
(B) Patients with social anxiety disorder are at a four-fold
increased risk of developing depression, three times more likely to
develop panic and two times as likely to suffer from alcoholism;
(C) Patients with social anxiety disorder are twice as likely
to attempt suicide than those without the disorder;
(D) Annual direct medical costs are twenty-five percent higher
on average for patients suffering with social anxiety disorder
versus those with no psychiatric disorder; and
(E) Social anxiety disorder has been scientifically linked to
reduced quality of life, lower educational attainment and
impairment of professional advancement and wage earning ability.
(2) Any policy of insurance described in this section that
provides mental health benefits and that is issued, amended,
delivered or renewed in this state on or after the first day of
January, two thousand one, shall include coverage for medically
necessary treatment of social anxiety disorder.
(A) Any provision of any contract issued, amended, delivered
or renewed in this state on or after the first day of January, two
thousand one, that is in conflict with this section shall be of no
force or effect.
(B) As used in this section, "social anxiety disorder" means
a condition that meets the criteria for generalized social phobia
set forth in the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, of the American Psychiatric Association.
NOTE: The purpose of this bill is to recognize social anxiety
disorder and to require group insurance policies to provide
coverage for medically necessary treatment of social anxiety
disorder.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.