ENGROSSED
COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 70
(By Senators Hunter, Minard, Mitchell, Walker, Kessler and
Snyder)
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[Originating in the Committee on Health and Human Resources;
reported February 29, 2000.]
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A BILL to amend and reenact section three, article twenty-five-c,
chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, relating to the
patients' bill of rights; and providing for notice of certain
enrollees' rights.
Be it enacted by the Legislature of West Virginia:
That section three, article twenty-five-c, chapter
thirty-three of the code of West Virginia, one thousand nine
hundred thirty-one, as amended, be amended and reenacted to read as
follows:
ARTICLE 25C. HEALTH MAINTENANCE ORGANIZATION PATIENT BILL OF RIGHTS.
§33-25C-3. Notice of certain enrollee rights.
All managed care plans must provide on a yearly basis to
subscribers enrollees, on a form prescribed by the commissioner
which he or she shall provide to all health maintenance
organizations by the first day of January each year, a notice of
certain subscriber enrollee rights. The notice shall address the
following areas:
(1) A description of an enrollee's rights and
responsibilities, plan benefits, benefit limitations, premiums and
individual cost-sharing requirements;
(1) (2) The ability of the subscriber enrollee to pursue
grievance and hearing procedures without reprisal from the managed
care plan, along with an explanation of the plan's enrollee
complaint procedure, including the appeals procedure for care
denied, terminated or reduced;
(2) (3) A description of how the enrollee can obtain a listing
of the plan's provider network, including the names and credentials
of all participating physicians in the network which further
details how the subscriber enrollee may choose providers within the
plan;
(4) The enrollee's right to a consumer's guide, as published by the insurance commissioner, and procedures for obtaining a copy
of the guide;
(3) (5) The subscriber's enrollee's right to privacy and
confidentiality;
(4) (6) The subscriber's enrollee's ability to examine and
offer corrections to their his or her own medical records;
(5) (7) The subscriber's enrollee's right to be informed of
plan policies and any charges for which the subscriber enrollee
will be responsible;
(6) (8) The subscriber's enrollee's ability to obtain evidence
of the medical credentials of a plan provider such as diploma and
board certifications;
(7) (9) The right of subscriber's enrollees to have coverage
denials reviewed by appropriate medical professionals with
equivalent professional licensure and specialty and that such
review be completed within three business days after the request of
the enrollee;
(10) A description of procedures to obtain emergency services,
experimental treatment, if covered, and out-of-area services;
(11) The right of the enrollee to services as provided under
sections two through seven, article forty-two of this chapter;
(12) The right of the enrollee to full disclosure from his or her health care provider of any information relating to his or her
medical condition or treatment plan;
(13) A description of the procedures for obtaining access to
a summary of the accreditation report as set forth in section
seventeen-a, article twenty-five-a of this chapter;
(14) The right of the enrollee to emergency services without
prior authorization in accordance with section eight-d, article
twenty-five-a of this chapter, if a prudent person acting
reasonably would have believed that an emergency medical condition
existed; and
(8) (15) Any other areas the commissioner may by rule require.