H. B. 4796
(By Delegates Beane, Laird and Hatfield)
(Originating in the House Committee on Banking and Insurance)
[March 1, 2000]
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, relating to coverage by the public
employees insurance agency
of transport for dialysis patients.
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, to read as follows:
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.
(5) For plans which provide coverage for dialysis, coverage
for transportation to and from the place where dialysis is
administered.
(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.