WVC 33 - 25 A- 5
§33-25A-5. Powers of health maintenance organizations.
(a) Upon obtaining a certificate of authority as required
under this article, a health maintenance organization may enter
into health maintenance contracts in this state and engage in any
activities, consistent with the purposes and provisions of this
article, which are necessary to the performance of its obligations
under such contracts, subject to the limitations provided in this
article. A health maintenance organization may offer to its
enrollees in conjunction with the benefits provided to them through
their contractual arrangement for health services with the health
maintenance organization a point of service option to be provided
either by the health maintenance organization directly or by an
insurance carrier licensed in this state with which the health
maintenance organization has a contractual arrangement. Benefits
for health care services within the health maintenance
organization's contracted provider panel shall comply with all
other provisions of this article.
(b) The commissioner shall propose rules for legislative
approval in accordance with the provisions of article three,
chapter twenty-nine-a of this code limiting or regulating the
powers of health maintenance organizations which the commissioner
finds to be in the public interest. The commissioner may
promulgate emergency rules pursuant to the provisions of section
fifteen, article three, chapter twenty-nine-a of this code to
implement standards and requirements for a point of service option.
Note: WV Code updated with legislation passed through the 2014 1st Special Session
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