Introduced Version House Bill 3138 History

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H. B. 3138

(By Delegates Amores, Trump, Caputo, Brown, Webster,

Palumbo, Schadler, Campbell, Browning, Marshall and Mahan)

[Introduced March 22, 2005; referred to the

Committee on Banking and Insurance then the Judiciary.]

A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new article, designated §33-16E-1, §33-16E-2, §33-16E-3, §33-16E-4, §33-16E-5, §33-16E-6 and §33-16E-7, all relating to requiring health insurance plans to cover the cost of contraceptives.

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 §33-16E-1, §33-16E-2, §33-16E-3, §33-16E-4, §33-16E-5, §33-16E-6 and §33-16E-7, all to read as follows:


§33-16E-1. Short title.

This article shall be known and may be cited as "The Prescription Fairness Act."

§33-16E-2. Legislative findings.

(a) The Legislature hereby finds and declares that:

(1) Contraceptives enhance the health of women, including the prevention of certain cancers, endometriosis and anemia;

(2) Contraceptives prevent unintended pregnancy;

(3) Planned pregnancies lead to healthier pregnancies, children and families;

(4) Contraceptive coverage provides West Virginians with critical access to birth control; and

(5) Under current standards, women of childbearing age must pay more for basic health care than men in the same age group because they must pay for birth control out-of-pocket.

(b) Therefore, the Legislature finds that contraceptives are basic health care for West Virginia's women and families, health insurance plans as provided by this article will be required to cover contraceptives.

§33-16E-3. Definitions.

Unless the context in which used clearly requires a different meaning, as used in this article:

(a) "Covered person" means the policyholder, subscriber, certificate holder, enrollee or other individual who is participating in, or receiving coverage under, a health insurance plan;

(b) "Health insurance plan" means any individual or group plan, policy, certificate, subscriber contract, or contract of
insurance provided by a managed care plan, preferred provider agreement, or health maintenance organization that is delivered, issued, renewed, modified, amended or extended by a health insurer in this state that pays for or purchases health care services for covered persons;
(c) "Health insurer" means a disability insurer, health care insurer, health maintenance organization, accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, health service corporation, health care service plan, preferred provider organization or arrangement or multiple employer welfare arrangement: Provided, That the term health insurer does not apply to the Public Employees Insurance Agency ;

(d) "Outpatient contraceptive services" means consultations, examinations, procedures and medical services, provided on an outpatient basis and related to the use of contraceptive drugs and devices to prevent pregnancy; and

(e) "Contraceptives" means drugs or devices approved by the food and drug administration to prevent pregnancy.

§33-16E-4. Parity for contraceptive drugs, devices and outpatient services.

(a) Health insurance plans that provide benefits for prescription drugs or devices may not exclude or restrict benefits to covered persons for any prescription contraceptive drug or device approved by the federal food and drug administration.
(b) Health insurance plans that provide benefits for outpatient services provided by a health care professional may not exclude or restrict outpatient contraceptive services for covered persons.
§33-16E-5. Extraordinary surcharges prohibited.
A health insurance plan is prohibited from:
(1) Imposing deductibles, copayments, other cost-sharing mechanisms, or waiting periods for prescription contraceptive drugs or devices greater than deductibles, copayments, other cost-sharing mechanisms or waiting periods for other covered prescription drugs or devices; and
(2) Imposing deductibles, copayments, other cost-sharing mechanisms or waiting periods for outpatient contraceptive services greater than such deductibles, copayments, other cost-sharing mechanisms or waiting periods for other covered outpatient services.
§33-16E-6. Additional prohibitions.
A health insurance plan is prohibited from:
(1) Denying eligibility, enrollment or renewal of coverage to any individual because of their use or potential use of contraceptives;
(2) Providing monetary payments or rebates to covered persons to encourage them to accept less than the minimum protections available under this section;
(3) Penalizing, or otherwise reducing or limiting the reimbursement of a health care professional because such professional prescribed contraceptive drugs or devices, or provided contraceptive services; and
(4) Providing incentives, monetary or otherwise, to a health care professional to induce such professional to withhold contraceptive drugs, devices or services from covered persons.
§33-16E-7. Enforcement.
In addition to any remedies at common law, the Insurance Commissioner shall receive and review written complaints regarding compliance with this section. The Insurance Commissioner may use all investigatory tools available to verify compliance with this section. If the Insurance Commissioner determines that a health insurance plan is not in compliance with any section in this article, the Commissioner shall:
(1) Impose a fine of ten thousand dollars for each violation of this section. An additional ten thousand dollars shall be imposed for every thirty days that a health insurance plan is not in compliance; or
(2) Suspend or revoke the certificate of authority or deny the health insurer's application for a certificate of authority.

NOTE: The purpose of this bill is to require insurers to cover the cost of contraceptives acquired by covered persons, just as it would for any other medication.
This article is new; therefore, strike-throughs and underscoring have been omitted.
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