HB 3014 Text

H. B. 3014

(By Delegates H. White, Hrutkay, G. White,
R. M. Thompson, Webster, Cann and Hamilton)
[Introduced March 14, 2005; referred to the
Committee on Banking and Insurance then the Judiciary.]

A BILL to amend and reenact §33-15-2g of the Code of West Virginia, 1931, as amended; and to amend the code by adding thereto a new section, designated §33-16-1b, all relating to required coverage for specific conditions or treatments in individual and group accident and sickness policies of insurance; and providing limitations on applicability of these requirements.

Be it enacted by the Legislature of West Virginia:
That §33-15-2g of the Code of West Virginia, 1931, as amended, be amended and reenacted; and that said code be amended by adding thereto a new section, designated §33-16-1b, all to read as follows:

ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-2g. Applicability.
(a) The requirements of sections two-b, two-d, two-e and two-f of this article and the provisions of this article which generally require policies of accident and sickness insurance to cover specific conditions or treatments, but which are not expressly made applicable to the following types of policies, do not apply to:
(1) Coverage only for accident, or disability income insurance or any combination thereof;
(2) Coverage issued as a supplement to liability insurance;
(3) Liability insurance, including general liability insurance and automobile liability insurance;
(4) Workers' Compensation or similar insurance;
(5) Automobile medical payment insurance;
(6) Credit-only insurance;
(7) Coverage for on-site medical clinics; and
(8) Other similar insurance coverage, which may be specified by rule, under which benefits for medical care are secondary or incidental to other insurance benefits.
(b) The requirements of sections two-b, two-d, two-e and two-f of this article and the provisions of this article which generally require policies of accident and sickness insurance to cover specific conditions or treatments, but which are not expressly made applicable to the following types of policies, do not apply to the following if provided under a separate policy, certificate, or contract of insurance:
(1) Limited scope dental or vision benefits;
(2) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof;
(3) Coverage for only a specified disease or illness;
(4) Hospital indemnity or other fixed indemnity insurance;
(5) Medicare supplement insurance (as defined under section 1882(g)(1) of the Social Security Act), coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code, and similar supplemental coverage provided to coverage under group accident and sickness insurance; and
(6) Any other benefits as may be specified by rule.

ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-1b. Applicability.
(a) The provisions of this article which generally require policies of group accident and sickness insurance to cover specific conditions or treatments, but which are not expressly made applicable to the following types of policies, do not apply to:
(1) Coverage only for accident, or disability income insurance or any combination thereof;
(2) Coverage issued as a supplement to liability insurance;
(3) Liability insurance, including general liability insurance and automobile liability insurance;
(4) Workers' Compensation or similar insurance;
(5) Automobile medical payment insurance;
(6) Credit-only insurance;
(7) Coverage for on-site medical clinics; and
(8) Other similar insurance coverage, which may be specified by rule, under which benefits for medical care are secondary or incidental to other insurance benefits.
(b) The requirements of sections two-b, two-d, two-e and two-f of this article and the provisions of this article which generally require policies of group accident and sickness insurance to cover specific conditions or treatments, but which are not expressly made applicable to the following types of policies, do not apply to the following if provided under a separate policy, certificate, or contract of insurance:
(1) Limited scope dental or vision benefits;
(2) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof;
(3) Coverage for only a specified disease or illness;
(4) Hospital indemnity or other fixed indemnity insurance;
(5) Medicare supplement insurance (as defined under section 1882(g)(1) of the Social Security Act), coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code, and similar supplemental coverage provided to coverage under group accident and sickness insurance; and
(6) Any other benefits as may be specified by rule.

NOTE: The purpose of this bill is to clarify that mandated accident and sickness insurance benefits do not apply to limited coverage policies, unless expressly made applicable to such policies.

Strike-throughs indicate language that would be stricken from the present law, and underscoring indicates new language that would be added.

§33-16-1b is new; therefore, strike-throughs and underscoring have been omitted.

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