WEST VIRGINIA CODE
WVC 33 - 25 A- 10
§33-25A-10. Information to enrollees.
Every health maintenance organization or its representative
shall annually, before the first day of April, provide to its
enrollees a summary of: Its most recent annual financial
statement, including a balance sheet and statement of receipts and
disbursements; a description of the health maintenance
organization, its basic health care services, its facilities and
personnel, any material changes therein since the last report, the
current evidence of coverage, and a clear and understandable
description of the health maintenance organization's method for
resolving enrollee complaints:
Provided, That with respect to
enrollees who have been enrolled through contracts between a health
maintenance organization and an employer, the health maintenance
organization shall be deemed to have satisfied the requirement of
this section by providing the requisite summary to each enrolled
employee:
Provided, however, That with respect to medicaid
recipients enrolled under a group contract between a health
maintenance organization and the governmental agency responsible
for administering the medicaid program, the health maintenance
organization shall be deemed to have satisfied the requirement of
this section by providing the requisite summary to each local
office of the governmental agency responsible for administering the
medicaid program for inspection by enrollees of the health
maintenance organization.
Note: WV Code updated with legislation passed through the 2012 1st Special Session