H. B. 2241
(By Delegates Staton and Mahan)
[Introduced
February 15, 2001
; referred to the
Committee on Banking and Insurance then 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-g; to amend article
sixteen of said chapter by adding thereto a new section,
designated section three-p; to amend article twenty-four of
said chapter by adding thereto a new section, designated
section seven-g; to amend article twenty-five of said chapter
by adding thereto a new section, designated section eight-f;
and to amend article twenty-five-a of said chapter by adding
thereto a new section, designated section eight-f, all relating to requiring the coverage of infant formula under
certain circumstances.
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 article fifteen, chapter
thirty-three be amended by adding thereto a new section, designated
section four-g; that article sixteen of said chapter be amended by
adding thereto a new section, designated section three-p; that
article twenty-four of said chapter be amended by adding thereto a
new section, designated section seven-g; that article twenty-five
of said chapter be amended by adding thereto a new section,
designated section eight-f; and that article twenty-five-a of said
chapter be amended by adding thereto a new section, designated
section eight-f, 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 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 a 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 a
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 The 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.
§33-15-4g. 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 one, 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.
§33-16-3p. 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 one, 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.
§33-24-7g. 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 one, 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.
§33-25-8f. 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 one, 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-8f. 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 one, 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.
§33-15-4g, §33-16-3p, §33-24-7g, §33-25-8f and §33-25A-8f are
new; therefore, strike-throughs and underscoring have been omitted.