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Introduced Version House Bill 4197 History

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Key: Green = existing Code. Red = new code to be enacted
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.
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