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.