Senate Bill No. 49
(By Senator Blatnik)
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[Introduced February 10, 1993; referred to the Committee
on Banking amd Insurance.]
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A BILL to amend 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 sixteen-
e, relating to insurance; requiring certain insurance
policies to contain provisions relating to child
immunizations; defining certain terms; requiring coverage
for child immunizations; cost sharing; authorizing the
promulgation of rules; and exempting certain policies.
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 sixteen-e, to
read as follows:
ARTICLE 16E. CHILDHOOD IMMUNIZATION INSURANCE.
§33-16E-1. Short title.
This article is known and may be cited as the "Childhood
Immunization Insurance Act".
§33-16E-2. Definitions.
The following words and phrases when used in this article
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Child immunizations" means immunizations, including the
immunizing agent, reimbursement for which shall not exceed one
hundred fifty percent of the average wholesale price, which, as
determined by the bureau of public health, conform with the
standards of the advisory committee on immunization practices of
the center for disease control, the United States department of
health and human services.
"Health insurance policy" means, except for specified
disease policies, any group health insurance policy, contract or
plan or any individual policy, contract or plan with dependent
coverage for children, which provides medical coverage on an
expense incurred, service or prepaid basis. The term includes
the following:
(a) A health insurance policy or contract issued by a
nonprofit corporation.
(b) A health service plan operating under a health
maintenance organization.
§33-16E-3. Child immunizations.
Except as provided in section six of this article, any
health insurance policy which is delivered, issued for delivery,
renewed, extended or modified in this state by any health care
insurer shall provide that the health insurance benefitsapplicable under the policy include coverage for child
immunizations. A health insurance policy shall provide for
coverage for medically necessary booster doses of all immunizing
agents used in child immunizations.
§33-16E-4. Delivery of policy.
Except as provided in section six, if a health insurance
policy provides coverage or benefits to a resident of this state,
it is delivered in this state within the meaning of this article
regardless of whether the health care insurer issuing or
delivering the policy is located within the state.
§33-16E-5. Cost sharing provisions.
(a)
Applicability. -- Benefits for child immunization
services are subject to copayment and coinsurance provisions of
a health insurance policy to the extent that other medical
services covered by the policy are subject to those provisions.
(b)
Exemption. -- Benefits for child immunization services
are exempt from deductible or dollar limit provisions in a health
insurance policy. This exemption must be explicitly provided for
in the policy.
§33-16E-6. Exemption.
Notwithstanding sections three and four, this article is not
to be construed to require a health insurance policy to include
coverage for child immunizations for an individual who is a
resident of this state if all of the following apply:
(a) The individual is employed outside this state.
(b) The individual's employer maintains a health insurancepolicy for the individual as an employment benefit.
§33-16E-7. Rules.
The commissioner of insurance may promulgate rules to
implement the provisions of this article.
§33-16E-8. Application of article.
This article applies to all insurance policies, subscriber
contracts and group insurance certificates issued under any group
master policy, delivered or issued for delivery on or after the
effective date of this article. This article also applies to all
renewals of contracts on any renewal date which is on or after
the effective date of this article.
NOTE: The purpose of this bill is to require health
insurance policies to provide coverage for childhood
immunizations. The bill also exempts the immunization costs from
deductible or dollar limit provisions in a health insurance
policy.
This article is new; therefore, strike-throughs and
underscoring have been omitted.
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