ENGROSSED
COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 312
(By Senators Macnaughtan, Bowman, Blatnik, Grubb, Ross, Anderson,
Scott, Wagner, Plymale, Sharpe and Manchin)
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[Originating in the Committee on Banking and Insurance;
reported February 28, 1996.]
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A BILL to amend and reenact chapter thirty-three of the code of
West Virginia, one thousand nine hundred thirty-one, as
amended, by adding thereto a new article, designated article
fifteen-c; to amend and reenact section four, article
twenty-four of said chapter; to amend and reenact section six,
article twenty-five of said chapter; and to amend and reenact
section twenty-four, article twenty-five-a of said chapter,
all relating to requiring insurance companies to cover the
complete treatment and management of diabetes for their
insureds to the same extent that they provide coverage for the
complete treatment of other diseases.
Be it enacted by the Legislature of West Virginia:
That chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, be amended by adding
thereto a new article, designated article fifteen-c; that section twenty-four, article four of said chapter be amended and reenacted;
that section six, article twenty-five of said chapter be amended
and reenacted; and that section twenty-four, article twenty-five-a
of said chapter be amended and reenacted, all to read as follows:
ARTICLE 15C. DIABETES INSURANCE.
§33-15C-1. Insurance for diabetics.
(a) Except as provided in section six, article fifteen of this
chapter, any policy which provides major medical or similar
comprehensive-type medical coverage shall include coverage for the
following equipment and supplies for the treatment and/or
management of diabetes for both insulin dependent and noninsulin
dependent persons with diabetes and those with gestational
diabetes, if medically necessary and prescribed by a licensed
physician: Blood glucose monitors, monitor supplies, insulin,
injection aids, syringes, insulin infusion devices, pharmacological
agents for controlling blood sugar, orthodics and any additional
items as promulgated by rule, pursuant to the provisions of chapter
twenty-nine-a of this code, by the insurance commissioner, with the
advice of the commissioner of the bureau of public health.
(b) All policies affected by the provisions of this section
shall also include coverage for diabetes self-management education
to ensure that persons with diabetes are educated as to the proper
self-management and treatment of their diabetes, including
information on proper diets. Coverage for self-management
education and education relating to diet and prescribed by a
licensed physician shall be limited to: (1) visits, including home visits, medically necessary upon the diagnosis of diabetes; (2)
visits, including home visits, under circumstances whereby a
physician identifies or diagnoses a significant change in the
patient's symptoms or conditions that necessitates changes in a
patient's self-management; and (3) where a new medication or
therapeutic process relating to the person's treatment and/or
management of diabetes has been identified as medically necessary
by a licensed physician:
Provided, That coverage for reeducation or
refresher education shall be limited to one hundred dollars
annually.
(c) The education may be provided by the physician as part of
an office visit for diabetes diagnosis or treatment, or by a
certified diabetes educator certified by a national diabetes
educator certification program, or registered dietitian registered
by a nationally recognized professional association of dietitians
upon the referral of a physician:
Provided, That such national
diabetes education certification program or nationally recognized
professional association of dieticians has been certified to the
commissioner of insurance by the commissioner of the bureau of
public health.
(d) Any deductible or coinsurance billed for any service as
provided in this section shall apply on an equal basis with all
other coverages provided by the insurer but not included in this
section.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE
CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE CORPORATIONS.
§33-24-4. Exemptions; applicability of insurance laws.
Every corporation defined in section two of this article is
hereby declared to be a scientific, nonprofit institution and
exempt from the payment of all property and other taxes. Every
corporation, to the same extent the provisions are applicable to
insurers transacting similar kinds of insurance and not
inconsistent with the provisions of this article, shall be governed
by and be subject to the provisions as hereinbelow indicated, of
the following articles of this chapter: Article two (insurance
commissioner), except that, under section nine of said article,
examinations shall be conducted at least once every four years;
article four (general provisions), except that section sixteen of
said article shall not be applicable thereto; section thirty-four,
article six (fee for form and rate filing); article six-c
(guaranteed loss ratio); article seven (assets and liabilities);
article eleven (unfair trade practices); article twelve (agents,
brokers and solicitors), except that the agent's license fee shall
be five dollars; section fourteen, article fifteen (individual
accident and sickness insurance); section sixteen, article fifteen
(coverage of children); section eighteen, article fifteen (equal
treatment of state agency); section nineteen, article fifteen
(coordination of benefits with medicaid); article fifteen-a (long-
term care insurance);
article fifteen-c (diabetes insurance);
section three, article sixteen (required policy provisions);
section three-a, article sixteen (mental illness); section three-c, article sixteen (group accident and sickness insurance); section
three-d, article sixteen (medicare supplement insurance); section
three-f, article sixteen (treatment of temporomandibular joint
disorder and craniomandibular disorder); section eleven, article
sixteen (coverage of children); section thirteen, article sixteen
(equal treatment of state agency); section fourteen, article
sixteen (coordination of benefits with medicaid); article sixteen-a
(group health insurance conversion); article sixteen-c (small
employer group policies); article sixteen-d (marketing and rate
practices for small employers); article twenty-six-a (West Virginia
life and health insurance guaranty association act), after the
first day of October, one thousand nine hundred ninety-one; article
twenty-seven (insurance holding company systems); article twenty-
eight (individual accident and sickness insurance minimum
standards); article thirty-three (annual audited financial report);
article thirty-four (administrative supervision); article thirty-
four-a (standards and commissioner's authority for companies deemed
to be in hazardous financial condition); article thirty-five
(criminal sanctions for failure to report impairment); and article
thirty-seven (managing general agents); and no other provision of
this chapter may apply to these corporations unless specifically
made applicable by the provisions of this article. If, however,
the corporation is converted into a corporation organized for a
pecuniary profit or if it transacts business without having
obtained a license as required by section five of this article, it
shall thereupon forfeit its right to these exemptions.
ARTICLE 25. HEALTH CARE CORPORATIONS.
§33-25-6. Supervision and regulation by insurance commissioner;
exemption from insurance laws.
Corporations organized under this article are subject to
supervision and regulation of the insurance commissioner. The
corporations organized under this article, to the same extent these
provisions are applicable to insurers transacting similar kinds of
insurance and not inconsistent with the provisions of this article,
shall be governed by and be subject to the provisions as
hereinbelow indicated of the following articles of this chapter:
Article four (general provisions), except that section sixteen of
said article shall not be applicable thereto; article six-c
(guaranteed loss ratio); article seven (assets and liabilities);
article eight (investments); article ten (rehabilitation and
liquidation); section fourteen, article fifteen (individual
accident and sickness insurance); section sixteen, article fifteen
(coverage of children); section eighteen, article fifteen (equal
treatment of state agency); section nineteen, article fifteen
(coordination of benefits with medicaid);
article fifteen-c,
(diabetes insurance); section three, article sixteen (required
policy provisions); section eleven, article sixteen (coverage of
children); section thirteen, article sixteen (equal treatment of
state agency); section fourteen, article sixteen (coordination of
benefits with medicaid); article sixteen-a (group health insurance
conversion); article sixteen-c (small employer group policies);
article sixteen-d (marketing and rate practices for small employers); article twenty-six-a (West Virginia life and health
insurance guaranty association act); article twenty-seven
(insurance holding company systems); article thirty-three (annual
audited financial report); article thirty-four-a (standards and
commissioner's authority for companies deemed to be in hazardous
financial condition); article thirty-five (criminal sanctions for
failure to report impairment); and article thirty-seven (managing
general agents); and no other provision of this chapter may apply
to these corporations unless specifically made applicable by the
provisions of this article.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-24. Statutory construction and relationship to other laws.
(a) Except as otherwise provided in this article, provisions
of the insurance laws and provisions of hospital or medical service
corporation laws are not applicable to any health maintenance
organization granted a certificate of authority under this article.
The provisions of this article shall not apply to an insurer or
hospital or medical service corporation licensed and regulated
pursuant to the insurance laws or the hospital or medical service
corporation laws of this state except with respect to its health
maintenance corporation activities authorized and regulated
pursuant to this article.
(b) Factually accurate advertising or solicitation regarding
the range of services provided, the premiums and copayments
charged, the sites of services and hours of operation, and any
other quantifiable, nonprofessional aspects of its operation by a health maintenance organization granted a certificate of authority,
or its representative shall not be construed to violate any
provision of law relating to solicitation or advertising by health
professions:
Provided, That nothing contained in this subsection
shall be construed as authorizing any solicitation or advertising
which identifies or refers to any individual provider or makes any
qualitative judgment concerning any provider.
(c) Any health maintenance organization authorized under this
article shall not be considered to be practicing medicine and is
exempt from the provision of chapter thirty of this code, relating
to the practice of medicine.
(d) The provisions of section fifteen, article four (general
provisions); article six-c (guaranteed loss ratio); article seven
(assets and liabilities); article eight (investments); article nine
(administration of deposits); article twelve (agents, brokers,
solicitors and excess line); section fourteen, article fifteen
(individual accident and sickness insurance); section sixteen,
article fifteen (coverage of children); section eighteen, article
fifteen (equal treatment of state agency); section nineteen,
article fifteen (coordination of benefits with medicaid); article
fifteen-b (uniform health care administration act);
article
fifteen-c, (diabetes insurance); section three, article sixteen
(required policy provisions); section three-f, article sixteen
(treatment of temporomandibular disorder and craniomandibular
disorder); section eleven, article sixteen (coverage of children);
section thirteen, article sixteen (equal treatment of state agency); section fourteen, article sixteen (coordination of
benefits with medicaid); article sixteen-a (group health insurance
conversion); article sixteen-c (small employer group policies);
article sixteen-d (marketing and rate practices for small
employers); article twenty-seven (insurance holding company
systems); article thirty-four-a (standards and commissioner's
authority for companies deemed to be in hazardous financial
condition); article thirty-five (criminal sanctions for failure to
report impairment); article thirty-seven (managing general
agents); and article thirty-nine (disclosure of material
transactions) shall be applicable to any health maintenance
organization granted a certificate of authority under this article.
In circumstances where the code provisions made applicable to
health maintenance organizations by this section refer to the
"insurer", the "corporation" or words of similar import, the
language shall be construed to include health maintenance
organizations.
(e) Any long-term care insurance policy delivered or issued
for delivery in this state by a health maintenance organization
shall comply with the provisions of article fifteen-a of this
chapter.