H. B. 2730
(By Delegates Brown, Hrutkay, Poling,
Martin, Yeager, Foster and Staton)
[Introduced January 28, 2003; referred to the
Committee on Banking and Insurance then the Judiciary.]
A BILL to amend chapter thirty-three of the code of West Virginia,
one thousand nine hundred thirty-one, as amended, by adding
thereto a new article, designated article sixteen-e, all
relating to requiring health insurance plans to cover the cost
of contraceptives for its covered people.
Be it enacted by the Legislature of West Virginia:
That chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, be amended by adding
thereto a new article, designated article sixteen-e, all to read as
follows:
ARTICLE 16E. CONTRACEPTIVE COVERAGE.
§33-16E-1. Definitions.
For the purposes of this article, the words and phrases
defined in this section have the meanings ascribed to them. These
definitions are applicable unless a different meaning clearly
appears from the context.
(1) "Covered person" means the policy holder, subscriber,
certificate holder, enrollee, or other individual who is
participating in, or receiving coverage under, a health insurance
plan.
(2) "Health insurance plan" means any individual or group
plan, policy, certificate, subscriber contract, or contract of
insurance provided by a managed care plan, preferred provider
agreement, or health maintenance organization that is delivered,
issued, renewed, modified, amended or extended by a health insurer
in this state that pays for or purchases health care services for
covered persons.
(3)"Health insurer" means a disability insurer, health care
insurer, health maintenance organization, accident and sickness
insurer, fraternal benefit society, nonprofit hospital service
corporation, health service corporation, health care service plan,
preferred provider organization or arrangement, or multiple
employer welfare arrangement.
(4) "Outpatient contraceptive services" means consultations,
examinations, procedures and medical services, provided on an
outpatient basis and related to the use of contraceptive drugs and
devices to prevent pregnancy.
§33-16E-2. Parity for contraceptive drugs, devices and outpatient
services.
(1) Health insurance plans that provide benefits for prescription drugs or devices shall not exclude or restrict
benefits to covered persons for any prescription contraceptive drug
or device approved by the federal food and drug administration.
(2) Health insurance plans that provide benefits for
outpatient services provided by a health care professional shall
not exclude or restrict outpatient contraceptive services for
covered persons.
§33-16E-3. Extraordinary surcharges prohibited.
A health insurance plan is prohibited from:
(1) Imposing deductibles, copayments, other cost-sharing
mechanisms, or waiting periods or prescription contraceptive drugs
or devices greater than deductibles, copayments, other cost-sharing
mechanisms, or waiting periods for other covered prescription drugs
or devices.
(2) Imposing deductibles, copayments, other cost-sharing
mechanisms, or waiting periods for outpatient contraceptive
services greater than such deductibles, copayments, other
cost-sharing mechanisms, or waiting periods for other covered
outpatient services.
§33-16E-4. Additional prohibitions.
A health insurance plan is prohibited from:
(1) Denying eligibility, enrollment, or renewal of coverage to
any individual because of their use or potential use of
contraceptives.
(2) Providing monetary payments or rebates to covered persons
to encourage them to accept less than the minimum protections
available under this section.
(3) Penalizing, or otherwise reducing or limiting the
reimbursement of a health care professional because such
professional prescribed contraceptive drugs or devices, or provided
contraceptive services.
(4) Providing incentives, monetary or otherwise, to a health
care professional to induce such professional to withhold
contraceptive drugs, devices or services from covered persons.
§33-16E-5. Enforcement.
In addition to any remedies at common law, the insurance
commissioner shall receive and review written complaints regarding
compliance with this section. The insurance commissioner may use
all investigatory tools available to verify compliance with this
section. If the insurance commissioner determines that a health
insurance plan is not in compliance with any section in this
article, the commissioner shall:
(1) Impose a fine of $10,000 per violation of this section.
An additional $10,000 shall be imposed for every thirty days that
a health insurance plan is not in compliance; and/or
(2) Suspend or revoke the certificate of authority or deny the
health insurer's application for a certificate of authority.
NOTE: The purpose of this bill is to require insurers to
cover the cost of contraceptives acquired by covered persons, just
as it would for any other medication.
This article is new; therefore, strike-throughs and
underscoring have been omitted.