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Introduced Version House Bill 4728 History

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Key: Green = existing Code. Red = new code to be enacted
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H. B. 4728

(By Delegate Sparks)

[Introduced February 25, 2000; Referred to

the Committee on Banking and Insurance then Finance.]






A BILL to amend and reenact section four-a, article fifteen, chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, relating to requiring group insurers to cover the cost of necessary treatment of their insureds for social anxiety disorder.

Be it enacted by the Legislature of West Virginia:
That section four-a, article fifteen, 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 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-4a. Required policy provisions -- Mental illness.

Any policy of insurance described in this article which provides hospital expense and surgical expense insurance and which is issued or subsequently renewed by agreement between the insurer and the policyholder, within this state, or any policy of accident and sickness insurance which provides hospital expense and surgical expense insurance and which is delivered or issued for delivery or subsequently renewed by agreement between the insurer and the policyholder in this state, shall provide, unless specifically refused by the policyholder, benefits for expense of residents of the state covered under any such policy or plan, arising from mental or nervous conditions as described in the standard nomenclature of the American psychiatric association which are at least equal to the following minimum requirements:
(a) In the case of benefits based upon confinement as an inpatient in a mental hospital under the direction and supervision of the department of mental health, or in a private hospital or private mental hospital licensed by the department of mental health or any other duly authorized state agency, the period of confinement for which benefits shall be payable shall be at least forty-five consecutive days in any calendar year.
(b) In the case of benefits based upon confinement as an inpatient in a licensed or accredited general hospital, such benefits shall be no different than for any other illness.
(c) In the case of outpatient benefits, these shall cover fifty percent of eligible expenses up to five hundred dollars over a twelve-month period, services furnished: (1) By a comprehensive health service organization; (2) by a licensed or accredited hospital; or (3) subject to the approval of the department of mental health, services furnished by a community mental health center or other mental health clinic or day care center which furnishes mental health services; or (4) consultations or diagnostic or treatment sessions, provided that such services are rendered by a psychotherapist or by a psychologist and do not exceed fifty such sessions over a twelve-month period. For purposes of this article "psychotherapist" means any person employed by the mental health center to provide direct services to clients, such person to serve under the authority and direction of a licensed psychologist, physician, psychiatrist or director of a duly licensed mental health facility.
(d) (1) The Legislature finds and declares the following:
(A) Social anxiety disorder (social phobia) is the most common anxiety disorder affecting approximately seven and nine-tenths percent of Americans annually with a lifetime prevalence of twenty-three and three-tenths percent;
(B) Patients with social anxiety disorder are at a four-fold increased risk of developing depression, three times more likely to develop panic and two times as likely to suffer from alcoholism;
(C) Patients with social anxiety disorder are twice as likely to attempt suicide than those without the disorder;
(D) Annual direct medical costs are twenty-five percent higher on average for patients suffering with social anxiety disorder versus those with no psychiatric disorder; and
(E) Social anxiety disorder has been scientifically linked to reduced quality of life, lower educational attainment and impairment of professional advancement and wage earning ability.
(2) Any policy of insurance described in this section that provides mental health benefits and that is issued, amended, delivered or renewed in this state on or after the first day of January, two thousand one, shall include coverage for medically necessary treatment of social anxiety disorder.
(A) Any provision of any contract issued, amended, delivered or renewed in this state on or after the first day of January, two thousand one, that is in conflict with this section shall be of no force or effect.
(B) As used in this section, "social anxiety disorder" means a condition that meets the criteria for generalized social phobia set forth in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association.




NOTE: The purpose of this bill is to recognize social anxiety disorder and to require group insurance policies to provide coverage for medically necessary treatment of social anxiety disorder.

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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