H. B. 4197
(By Delegates Perry, Ashley, Reynolds, Hartman,
Walters, Schoen and Moore)
[Introduced January 27, 2010; referred to the
Committee on Banking and Insurance then Judiciary.]
A BILL to amend and reenact §33-25A-5 of the Code of West Virginia,
1931, as amended, relating to health maintenance
organizations; the authority to provide a point of service
option; and the authority to develop standards for a point of
service option by emergency rule.
Be it enacted by the Legislature of West Virginia:
That §33-25A-5 of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§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
for 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.
The commissioner may promulgate rules and regulations limiting or
regulating the powers of health maintenance organizations which he
finds to be in the public interest.
(b) For purposes of this article, "point of service option"
means a delivery system that permits an enrollee to receive
services, outside the panel of providers with which the health
maintenance organization has a contractual arrangement, under the
terms and conditions of the enrollee's contract with the health
maintenance organization or the insurance carrier that provides
the point of service option.
(c) The commissioner may propose rules for promulgation
limiting or regulating the powers of health maintenance
organizations which the commissioner finds to be in the public
interest. The commissioner may by emergency rule implement
standards and requirements for a point of service option in
accordance with the provisions of article three, chapter twenty-
nine of this code.
NOTE: The purpose of this bill is to authorize HMO's to offer
a point of service option.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.