H. B. 2678
(By Delegates Douglas, Collins, Tucker, Prunty, Claypole,
Stalnaker and Capito)
(Originating in the Committee on Government Organization)
[March 21, 1997]
A BILL to repeal section six, article sixteen, chapter five of
the code of West Virginia, one thousand nine hundred thirty- one, as amended; and to amend and reenact sections two,
three and eight of said article, repealing provisions of
the code creating a public insurance agency advisory board
and terminating said board on the first day of July, one
thousand nine hundred ninety-seven.
Be it enacted by the Legislature of West Virginia:
That section six, article sixteen, chapter five of the code
of West Virginia, one thousand nine hundred thirty-one, as
amended, be repealed; and that sections two, three and eight of
said article be amended and reenacted to read as follows:
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-2. Definitions.
The following words and phrases as used in this article,
unless a different meaning is clearly indicated by the context, have the following meanings:
(1) "Advisory board" means the public employees insurance
agency advisory board created by this article.
(2)(1) "Agency" means the public employees insurance
agency created by this article.
(3)(2) "Director" means the director of the public
employees insurance agency, created by this article.
(4)(3) "Employee" means any person, including elected
officers, who works regularly full time in the service of the
state of West Virginia and, for the purpose of this article only,
the term "employee" also means any person, including elected
officers, who works regularly full time in the service of a
county board of education; a county, city or town in the state;
any separate corporation or instrumentality established by one or
more counties, cities or towns, as permitted by law; any
corporation or instrumentality supported in most part by
counties, cities or towns; any public corporation charged by law
with the performance of a governmental function and whose
jurisdiction is coextensive with one or more counties, cities or
towns; any comprehensive community mental health center or
comprehensive mental retardation facility established, operated
or licensed by the secretary of health and human resources
pursuant to section one, article two-a, chapter twenty-seven of
this code, and which is supported in part by state, county or
municipal funds; any person who works regularly full time in the service of the university of West Virginia board of trustees or
the board of directors of the state college system; and any
person who works regularly full time in the service of a combined
city-county health department created pursuant to article two,
chapter sixteen of this code. On and after the first day of
January, one thousand nine hundred ninety-four, and upon election
by a county board of education to allow elected board members to
participate in the public employees insurance program pursuant to
this article, any person elected to a county board of education
shall be deemed to be an "employee" during the term of office of
the elected member:
Provided, That the elected member shall pay
the entire cost of the premium if he or she elects to be covered
under this act. Any matters of doubt as to who is an employee
within the meaning of this article shall be decided by the
director.
(5)(4) "Employer" means the state of West Virginia, its
boards, agencies, commissions, departments, institutions or
spending units; a county board of education; a county, city or
town in the state; any separate corporation or instrumentality
established by one or more counties, cities or towns, as
permitted by law; any corporation or instrumentality supported in
most part by counties, cities or towns; any public corporation
charged by law with the performance of a governmental function
and whose jurisdiction is coextensive with one or more counties, cities or towns; any comprehensive community mental health center
or comprehensive mental retardation facility established,
operated or licensed by the secretary of health and human
resources pursuant to section one, article two-a, chapter
twenty-seven of this code, and which is supported in part by
state, county or municipal funds; and a combined city-county
health department created pursuant to article two, chapter
sixteen of this code. Any matters of doubt as to who is an
"employer" within the meaning of this article shall be decided by
the director. The term "employer" does not include within its
meaning the national guard.
(6)(5) "Finance board" means the public employees
insurance agency finance board created by this article.
(7)(6) "Plan" means the medical indemnity plan or a
managed care plan option offered by the agency.
(8)(7) "Retired employee" means an employee of the state
who retired after the twenty-ninth day of April, one thousand
nine hundred seventy-one, and an employee of the university of
West Virginia board of trustees or the board of directors of the
state college system or a county board of education who retires
on or after the twenty-first day of April, one thousand nine
hundred seventy-two, and all additional eligible employees who
retire on or after the effective date of this article and meet
the minimum eligibility requirements for their respective state
retirement system:
Provided, That for the purposes of this article, the employees who are not covered by a state retirement
system shall, in the case of education employees, meet the
minimum eligibility requirements of the state teachers retirement
system, and in all other cases, meet the minimum eligibility
requirements of the public employees retirement system.
§5-16-3. Public employees insurance agency continued;
appointment, qualification, compensation and duties
of director of agency; employees; civil service
coverage; director vested after specified date with
powers of public employees insurance board;
expiration of agency.
(a) The public employees insurance agency is continued, and
consists of the director, the finance board
the advisory board
and any employees who may be authorized by law. The director
shall be appointed by the governor, with the advice and consent
of the Senate. He or she shall serve at the will and pleasure of
the governor, unless earlier removed from office for cause as
provided by law. The director shall have at least three years
experience in health insurance administration prior to
appointment as director. The director shall receive an annual
salary established by the governor not to exceed sixty-five
thousand dollars and actual expenses incurred in the performance
of official business. The director shall employ such
administrative, technical and clerical employees as are required for the proper administration of the insurance programs provided
for in this article. The director shall perform such duties as
are required of him or her under the provisions of this article
and is the chief administrative officer of the public employees
insurance agency.
(b) All positions in the agency, except for the director,
his or her personal secretary and the chief financial officer
shall be included in the classified service of the civil service
system pursuant to article six, chapter twenty-nine of this code.
Any person required to be included in the classified service by
the provisions of this subsection who was employed in any of the
positions included in this subsection on or after the effective
date of this article shall not be required to take and pass
qualifying or competitive examinations upon or as a condition to
being added to the classified service:
Provided, That no person
required to be included in the classified service by the
provisions of this subsection who was employed in any of the
positions included in this subsection as of the effective date of
this section shall be thereafter severed, removed or terminated
in his or her employment prior to his or her entry into the
classified service except for cause as if the person had been in
the classified service when severed, removed or terminated.
(c) The director is responsible for the administration and
management of the public employees insurance agency as provided for in this article and in connection with his or her
responsibility shall have the power and authority to make all
rules necessary to effectuate the provisions of this article.
Nothing in section four or five of this article shall limit the
director's ability to manage on a day-to-day basis the group
insurance plans required or authorized by this article,
including, but not limited to, administrative contracting,
studies, analyses and audits, eligibility determinations,
utilization management provisions and incentives, provider
negotiations, provider contracting and payment, designation of
covered and noncovered services, offering of additional coverage
options or cost containment incentives, pursuit of coordination
of benefits and subrogation, or any other actions which would
serve to implement the plan or plans designed by the finance
board.
(d) The public employees insurance agency shall terminate in
the manner provided in article ten, chapter four of this code, on
the first day of July, two thousand one, unless extended by
legislation enacted before the termination date:
Provided, That
the public employees insurance agency advisory board, created in
previous enactment of section six of this article, shall
terminate
in the manner provided in article ten, chapter four of
this code on the first day of July, one thousand nine hundred
ninety-six ninety-seven.
§5-16-8. Conditions of insurance program.
The insurance plans herein provided for shall be designed
by the public employees insurance agency:
(1) To provide a reasonable relationship between the
hospital, surgical, medical and prescription drug benefits to be
included and the expected reasonable and customary hospital,
surgical, medical and prescription drug expenses as established
by the director to be incurred by the affected employee, his or
her spouse and his or her dependents. The establishment of
reasonable and customary expenses by the public employees
insurance agency pursuant to the preceding sentence is not
subject to the state administrative procedures act in chapter
twenty-nine-a of this code.
(2) To include reasonable controls which may include
deductible and coinsurance provisions applicable to some or all
of the benefits, and shall include other provisions, including,
but not limited to, copayments, preadmission certification, case
management programs and preferred provider arrangements.
(3) To prevent unnecessary utilization of the various
hospital, surgical, medical and prescription drug services
available.
(4) To provide reasonable assurance of stability in future
years for the plans.
(5) To provide major medical insurance for said employees.
(6) To provide certain group life and accidental death
insurance for the employees covered under this article.
(7) To include provisions for the coordination of benefits
payable by the terms of such plans with the benefits to which
such employee, or his or her spouse or his or her dependents may
be entitled by the provisions of any other group hospital,
surgical, medical, major medical, or prescription drug insurance
or any combination thereof.
(8) To provide a cash incentive plan for employees,
spouses and dependents by the thirty-first day of December, one
thousand nine hundred eighty-eight, to increase utilization of,
and to encourage the use of, lower cost alternative health care
facilities, health care providers and generic drugs. Such plan
shall be reviewed annually by the director
and the advisory
board.
(9) To provide "wellness" programs and activities which
will include, but not be limited to, benefit plan incentives to
discourage tobacco, alcohol and chemical abuse and an educational
program to encourage proper diet and exercise. In establishing
"wellness" programs, the division of vocational rehabilitation
shall cooperate with the public employees insurance agency in
establishing statewide wellness programs and with such division
of vocational rehabilitation to contact county boards of
education for the use of facilities, equipment or any service
related to such purpose, at the request of the director, under the authority hereby granted to contract therefor. Boards of
education shall be limited to charging only the cost of
janitorial service and increased utilities for the use of the
gymnasium and related equipment. The cost of the exercise
program shall be paid by county boards of education, the public
employees insurance agency, or participating employees, their
spouses or dependents. All exercise programs shall be made
available to all employees, their spouses or dependents and shall
not be limited to employees of county boards of education.
(10) To provide a program, to be administered by the
director, for a patient audit plan with reimbursement up to a
maximum of one thousand dollars annually, to employees for
discovery of health care provider or hospital overcharges when
the affected employee brings such overcharge to the attention of
the plan. The hospital or health care provider shall certify to
the director that it has provided, prior to or simultaneously
with the submission of the statement of charges for payments, an
itemized statement of the charges to the employee participant for
which payment is requested of the plan.
(11) To require that all employers give written notice to
each covered employee prior to institution of any changes in
benefits to employees, and to include appropriate penalty for any
employer not providing the required information to any employee.
(12) To provide coverage for emergency services under
offered plans. For the purposes of this subsection, "emergency services" means services provided in or by a hospital emergency
facility or the private office of a dentist to evaluate and treat
a medical condition manifesting itself by the sudden, and at the
time, unexpected onset of symptoms that require immediate medical
attention and that failure to provide medical attention would
result in serious impairment to bodily function, serious
dysfunction to any bodily organ or part, or would place the
person's health in jeopardy.
NOTE: The purpose of this bill is terminate the public
employees advisory board effective July 1, 1997.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.
This bill is recommended for passage during the 1997
regular Legislative session by the Joint Standing Committee on
Government Operations.