Senate Bill No. 603
(By Senator Stollings)
____________
[Introduced February 28, 2010; referred to the Committee on
Health and Human Resources; and then to the Committee on Banking
and Insurance.]
____________
A BILL to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new article, designated §33-25G-1 and §33-
25G-2, all relating to requiring a minimum level of health
insurance plan coverage to out-of-network health care
providers where there is no in-network provider with
substantially similar experience relating to a covered
condition, treatment or procedure.
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new article, designated §33-25G-1 and §33-25G-
2, all to read as follows:
ARTICLE 25G. OUT-OF-NETWORK PROVIDERS.
§33-35G-1. Applicability.
The provisions of this article apply to individual and group health insurance plans issued by accident and sickness insurers;
health maintenance organizations; fraternal benefit societies;
hospital service corporations; the West Virginia Public Employees
Insurance Agency; health-care service corporations; health service
corporations; multiple employee trusts; and multiple employer
welfare arrangements. The provisions of this article do not apply
to persons eligible for coverage under Title IX of the Social
Security Act known as Medicaid (42 U.S.C. §1396A et seq.), or for
any other similar coverage under state or federal governmental
plans.
§33-25G-2. Minimum coverage for out-of network services in
certain situations.
A health insurance plan shall provide at least eighty percent
of the coverage that is applicable to an in-network provider for a
covered condition, treatment or procedure to an out-of-network
provider if there is no in-network provider with substantially
similar training or experience with regard to the particular
condition, treatment or procedure.
NOTE: The purpose of this bill is to require health insurance
plans to provide at least eighty percent of the coverage to out-of-
network providers that would be provided for services provided by
an in-network provider for a given condition, treatment or
procedure where there is no in-network provider with substantially
similar training or experience with regard to the covered
condition, treatment or procedure.
This article is new; therefore, strike-throughs and underscoring have been omitted.
Email
Webmaster | © 2024 West Virginia Legislature **
