Senate Bill No. 516
(By Senators Tomblin (Mr. President), Helmick,
Walker, Hunter, Sprouse, Wooton, Mitchell,
Prezioso, McCabe, Craigo, Snyder, Minard, Kessler, Ross,
Anderson, Sharpe, Plymale, Edgell, Ball, Love, Dawson, Unger,
Redd, Bowman and Jackson)
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[Introduced February 16, 2000; referred to the Committee
on Banking and Insurance.]
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A BILL to amend and reenact section seven, article sixteen, chapter
five of the code of West Virginia, one thousand nine hundred
thirty-one, as amended; to amend article fifteen, chapter
thirty-three of said code by adding thereto a new section,
designated section four-f; to amend article sixteen of said
chapter by adding thereto a new section, designated section
three-o; to amend article twenty-four of said chapter by
adding thereto a new section, designated section seven-f; to
amend article twenty-five of said chapter by adding thereto a
new section, designated section eight-e; and to amend article
twenty-five-a of said chapter by adding thereto a new section, designated section eight-e, all relating to requiring
insurance companies that provide health care coverage to
provide for colorectal cancer examinations and laboratory
tests for colorectal cancer.
Be it enacted by the Legislature of West Virginia:
That section seven, article sixteen, chapter five of the code
of West Virginia, one thousand nine hundred thirty-one, as amended,
be amended and reenacted; that article fifteen, chapter
thirty-three of said code be amended by adding thereto a new
section, designated section four-f; that article sixteen of said
chapter be amended by adding thereto a new section, designated
section three-o; that article twenty-four of said chapter be
amended by adding thereto a new section, designated section
seven-f; that article twenty-five of said chapter be amended by
adding thereto a new section, designated section eight-e; and that
article twenty-five-a of said chapter be amended by adding thereto
a new section, designated section eight-e, all to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,
SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD
OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS,
OFFICES, PROGRAMS, ETC.
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7. Authorization to establish group hospital and surgical
insurance plan, group major medical insurance plan,
group prescription drug plan and group life and
accidental death insurance plan; rules for
administration of plans; mandated benefits; what
plans may provide; optional plans; separate rating
for claims experience purposes.
(a) The agency shall establish a group hospital and surgical
insurance plan or plans, a group prescription drug insurance plan
or plans, a group major medical insurance plan or plans and a group
life and accidental death insurance plan or plans for those
employees herein made eligible, and to establish and promulgate
rules for the administration of such plans, subject to the
limitations contained in this article. Those plans shall include:
(1) Coverages and benefits for X ray and laboratory services
in connection with mammograms and pap smears when performed for
cancer screening or diagnostic services;
(2) Annual checkups for prostate cancer in men age fifty and
over;
(3) Colorectal cancer examination and laboratory tests for
colorectal cancer for any nonsymptomatic person in accordance with
the current American cancer society guidelines, when performed for colorectal cancer screening or diagnostic purposes, at the
direction of a person licensed to practice medicine and surgery by
the board of medicine.
(3) (4) For plans that include maternity benefits, coverage
for inpatient care in a duly licensed health care facility for a
mother and her newly born infant for the length of time which the
attending physician deems considers medically necessary for the
mother or her newly born child: Provided, That no such plan may
deny payment for a mother or her new born child prior to
forty-eight hours following a vaginal delivery, or prior to
ninety-six hours following a caesarean section delivery, if the
attending physician deems considers discharge medically
inappropriate; and
(4) (5) For plans which provide coverages for post-delivery
care to a mother and her newly born child in the home, coverage for
inpatient care following childbirth as provided in subdivision (3)
(4) of this subsection if such inpatient care is determined to be
medically necessary by the attending physician. Those plans may
also include, among other things, medicines, medical equipment,
prosthetic appliances, and such other inpatient and outpatient
services and expenses deemed considered appropriate and desirable
by the agency.
(b) The agency shall make available to each eligible employee,
at full cost to the employee, the opportunity to purchase optional
group life and accidental death insurance as established under the
rules of the agency. In addition, each employee is entitled to
have his or her spouse and dependents, as defined by the rules of
the agency, included in the optional coverage, at full cost to the
employee, for each eligible dependent; and with full authorization
to the agency to make the optional coverage available and provide
an opportunity of purchase to each employee.
(c) The finance board may cause to be separately rated for
claims experience purposes: (1) All employees of the state of West
Virginia; (2) all teaching and professional employees of the
university of West Virginia board of trustees or the board of
directors of the state college system and county boards of
education; (3) all nonteaching employees of the university of West
Virginia board of trustees or the board of directors of the state
college system and county boards of education; or (4) any other
categorization which would ensure the stability of the overall
program.
CHAPTER 33. INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4f. Third party reimbursement for colorectal cancer examination and laboratory testing.
Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, whenever
reimbursement or indemnity for laboratory or X ray services are
covered, reimbursement or indemnification may not be denied for a
colorectal cancer examination and laboratory tests for colorectal
cancer for any nonsymptomatic person covered under the policy or
contract, in accordance with the current American cancer society
guidelines, when performed for colorectal cancer screening or
diagnostic purposes, at the direction of a person licensed to
practice medicine and surgery by the board of medicine. A policy,
provision, contract, plan or agreement may apply to colorectal
cancer examinations and laboratory tests for colorectal cancer, the
same deductibles, coinsurance and other limitations as apply to
other covered services.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3o. Third party reimbursement for colorectal cancer
examination and laboratory testing.
Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, whenever
reimbursement or indemnity for laboratory or X ray services are
covered, reimbursement or indemnification may not be denied for a colorectal cancer examination and laboratory tests for colorectal
cancer for any nonsymptomatic person covered under the policy or
contract, in accordance with the current American cancer society
guidelines, when performed for colorectal cancer screening or
diagnostic purposes, at the direction of a person licensed to
practice medicine and surgery by the board of medicine. A policy,
provision, contract, plan or agreement may apply to colorectal
cancer examinations and laboratory tests for colorectal cancer, the
same deductibles, coinsurance and other limitations as apply to
other covered services.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE
CORPORATIONS, DENTAL SERVICE CORPORATIONS AND
HEALTH SERVICE CORPORATIONS.
§33-24-7f. Third party reimbursement for colorectal cancer
examination and laboratory testing.
Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, whenever
reimbursement or indemnity for laboratory or X ray services are
covered, reimbursement or indemnification may not be denied for a
colorectal cancer examination and laboratory tests for colorectal
cancer for any nonsymptomatic person covered under the policy or
contract, in accordance with the current American cancer society guidelines, when performed for colorectal cancer screening or
diagnostic purposes, at the direction of a person licensed to
practice medicine and surgery by the board of medicine. A policy,
provision, contract, plan or agreement may apply to colorectal
cancer examinations and laboratory tests for colorectal cancer, the
same deductibles, coinsurance and other limitations as apply to
other covered services.
ARTICLE 25. HEALTH CARE CORPORATIONS.
§33-25-8e. Third party reimbursement for colorectal cancer
examination and laboratory testing.
Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, whenever
reimbursement or indemnity for laboratory or X ray services are
covered, reimbursement or indemnification may not be denied for a
colorectal cancer examination and laboratory tests for colorectal
cancer for any nonsymptomatic person covered under the policy or
contract, in accordance with the current American cancer society
guidelines, when performed for colorectal cancer screening or
diagnostic purposes, at the direction of a person licensed to
practice medicine and surgery by the board of medicine. A policy,
provision, contract, plan or agreement may apply to colorectal
cancer examinations and laboratory tests for colorectal cancer, the same deductibles, coinsurance and other limitations as apply to
other covered services.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8e. Third party reimbursement for colorectal cancer
examination and laboratory testing.
Notwithstanding any provision of any policy, provision,
contract, plan or agreement to which this article applies, whenever
reimbursement or indemnity for laboratory or X ray services are
covered, reimbursement or indemnification may not be denied for a
colorectal cancer examination and laboratory tests for colorectal
cancer for any nonsymptomatic person covered under the policy or
contract, in accordance with the current American cancer society
guidelines, when performed for colorectal cancer screening or
diagnostic purposes, at the direction of a person licensed to
practice medicine and surgery by the board of medicine. A policy,
provision, contract, plan or agreement may apply to colorectal
cancer examinations and laboratory tests for colorectal cancer, the
same deductibles, coinsurance and other limitations as apply to
other covered services.
NOTE: The purpose of this bill is to require insurance
companies that provide health care coverage to provide for
colorectal cancer examinations and laboratory tests for colorectal
cancer.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.
§§33-15-4f, 33-16-3o, 33-24-7f, 33-25-8e and 33-25A-8e are
new; therefore, strike-throughs and underscoring have been omitted.
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