Senate Bill No. 362
(By Senators Ross, Anderson, Minard,
Snyder, Boley and Minear)
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[Introduced January 25, 2002; referred to the
Committee on Banking and Insurance; and then to the Committee
on the Judiciary.]
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A BILL to amend and reenact section two, article seven, chapter
sixty-four of the code of West Virginia, one thousand nine
hundred thirty-one, as amended, relating to authorizing the
insurance commissioner to promulgate a legislative rule
relating to the external review of coverage denials.
Be it enacted by the Legislature of West Virginia:
That section two, article seven, chapter sixty-four of the
code of West Virginia, one thousand nine hundred thirty-one, as
amended, be amended and reenacted to read as follows:
ARTICLE 7. AUTHORIZATION FOR DEPARTMENT OF TAX AND REVENUE TO
PROMULGATE LEGISLATIVE RULES.
§64-7-2. Insurance commissioner.
(a) The legislative rule filed in the state register on the
first day of October, two thousand, authorized by section three,
article fifteen-b, chapter thirty-three of this code, relating
to the insurance commissioner (standards for uniform health care
administration, 114 CSR 16), is authorized.
(b) The legislative rule filed in the state register on the
first day of September, two thousand, authorized under the
authority of section ten, article two, chapter thirty-three of
this code, modified by the insurance commissioner to meet the
objections of the legislative rule-making review committee and
refiled in the state register on the seventeenth day of
November, two thousand, relating to the insurance commissioner
(examiners' compensation, qualifications and classification, 114
CSR 15), is authorized.
(c) The legislative rule filed in the state register on the first day of September, two thousand, authorized by section ten,
article two, chapter thirty-three of this code, modified by the
insurance commissioner to meet the objections of the legislative
rule-making review committee and refiled in the state register
on the seventeenth day of November, two thousand, relating to
the insurance commissioner (Medicare supplement insurance, 114
CSR 24), is authorized.
(d) The legislative rule filed in the state register on the
first day of September, two thousand, authorized under the
authority of section ten, article two, chapter thirty-three of
this code, modified by the insurance commissioner to meet the
objections of the legislative rule-making review committee and
refiled in the state register on the seventeenth day of
November, two thousand, relating to the insurance commissioner
(AIDS, 114 CSR 27), is authorized with the following amendment:
"On page six of the rule, subsection 5.9, by striking
subdivision 5.9 in its entirety and inserting in lieu thereof,
the following:
'5.9. The testing is required to be administered on a
nondiscriminatory basis for all individuals in the same
underwriting class. No proposed insured may be denied coverage
or rated a substandard risk on the basis of HIV testing unless acceptable testing protocol is followed. The insurer may at its
option use a urine HIV test as an initial screening device;
provided that if the urine test yields a negative result for the
purpose of HIV antibodies then HIV blood or OMT testing may be
required by the insurer. The proposed insured may not be denied
insurance coverage or rated a substandard risk on the basis of
a positive urine HIV test alone, including the use of FDA-
licensed tests. An applicant may not be denied coverage on the
basis of AIDS related testing unless:
a. An initial enzyme linked immunosorbent assay (ELISA) test
is administered to the proposed insured, and it indicates the
presence of HIV antibodies,
b. The initially reactive specimen is retested by ELISA in
duplicate and at least one of the repeat tests is reactive. The
specimen considered repeatedly reactive, is examined in a
Western blot test to confirm the ELISA test results; and
c. A Western blot test is positive.'"
If an initial ELISA test is negative, or both repeat-
duplicate tests are negative, the testing ceases and the
proposed insured cannot be denied coverage based on AIDS-related
testing. If the initial and at least one of the repeat-
duplicate LISA tests is positive but the Western blot test is negative, for purposes of insurability, the results are
negative.
(e) The legislative rule filed in the state register on the
first day of September, two thousand, authorized by section ten,
article two, chapter thirty-three of this code, modified by the
insurance commissioner to meet the objections of the legislative
rule-making review committee and refiled in the state register
on the seventeenth day of November, two thousand, relating to
the insurance commissioner (continuing education for insurance
agents, 114 CSR 42), is authorized.
(f) The legislative rule filed in the state register on the
twenty-fifth day of July, two thousand one, authorized under the
authority of section six, article twenty-five-c, chapter thirty-
three, of this code, modified by the insurance commissioner to
meet the objections of the legislative rule-making review
committee and refiled in the state register on the twenty-first
day of December, two thousand one, relating to the insurance
commissioner (external review of coverage denials, 114 CSR 58),
is authorized.
NOTE: The purpose of this bill is to authorize the Insurance
Commissioner to promulgate a legislative rule relating to the
External Review of Coverage Denials.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.