Source: http://www.legis.state.wv.us/WVCODE/code.cfm?chap=33&art=24&section=11
Timestamp: 2016-08-28 01:06:47
Document Index: 233331267

Matched Legal Cases: ['§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33', '§33']

Chapter 33 | Article 33 - 24
33 - 24 - 1 33 - 24 - 2 33 - 24 - 3 33 - 24 - 4 33 - 24 - 4 A 33 - 24 - 4 B 33 - 24 - 5 33 - 24 - 6 33 - 24 - 7 33 - 24 - 7 A 33 - 24 - 7 B 33 - 24 - 7 C 33 - 24 - 7 D 33 - 24 - 7 E 33 - 24 - 7 F 33 - 24 - 7 G 33 - 24 - 7 H 33 - 24 - 7 I 33 - 24 - 7 J 33 - 24 - 7 K 33 - 24 - 7 L 33 - 24 - 7 M 33 - 24 - 8 33 - 24 - 9 33 - 24 - 10 33 - 24 - 11 33 - 24 - 12 33 - 24 - 13 33 - 24 - 14 33 - 24 - 15 33 - 24 - 16 33 - 24 - 17 33 - 24 - 18 33 - 24 - 19 33 - 24 - 21 33 - 24 - 22 33 - 24 - 23 33 - 24 - 24 33 - 24 - 25 33 - 24 - 26 33 - 24 - 27 33 - 24 - 28 33 - 24 - 29 33 - 24 - 30 33 - 24 - 31 33 - 24 - 32 33 - 24 - 33 33 - 24 - 34 33 - 24 - 35 33 - 24 - 36 33 - 24 - 37 33 - 24 - 38 33 - 24 - 39 33 - 24 - 40 33 - 24 - 41 33 - 24 - 42 33 - 24 - 43 33 - 24 - 44 33 - 24 - 7 K 25 - HEALTH CARE CORPORATIONS
WVC 33 - 24 - ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE CORPORATIONS.
WVC 33 - 24 - 1 §33-24-1. Declaration of policy. In view of the desirability of making available to the
people of this state increased hospital, medical, dental services
and other health services, the declared policy of the Legislature
in the enactment of this article is to encourage the
organization, promotion and expansion of hospital service
corporations, medical service corporations, dental service
corporations and health service corporations by exempting them
from the payment of all taxes and from the operation of the
general insurance laws of this state, but at the same time
subjecting them to such regulation as may be necessary for the
adequate protection of those members of the public who subscribe
for the services offered by such corporation.
WVC 33 - 24 - 2 §33-24-2. Definitions. For the purpose of this article:
(a) "Corporation" means either a hospital service
corporation, a medical service corporation, a dental service
corporation or a health service corporation.
(b) "Hospital service corporation" means a nonprofit,
nonstock corporation, organized in accordance with the provisions
of article one, chapter thirty-one of this code, for the sole
purpose of contracting with the public and with hospitals and
other health agencies for hospital or other health services to be
furnished to subscribers under terms of their contract with the
corporation, and controlled by a board of directors, not more
than twenty percent of whom, or whose spouse, parent, child,
brother or sister by blood or marriage, are engaged in the
providing of health care and at least eighty percent of whom
shall be chosen as representatives of the interests of consumers,
elderly persons, organized labor and business subscribers.
(c) "Hospital service" means only such hospital or other
health care, to be provided by hospitals or other health
agencies, or such payment therefor, as may be specified in the
contract made by the subscriber with the corporation.
(d) "Medical service corporation" means a nonprofit,
purpose of contracting with the public and with duly licensed
physicians, duly licensed dentists and duly licensed podiatrists
for medical or surgical services and with duly licensed chiropractors and other health agencies for other health services
to be furnished to subscribers under terms of their contract with
the corporation, and controlled by a board of directors, not more
(e) "Medical service" means only such medical, surgical, or
other health care, to be provided by duly licensed physicians,
duly licensed dentists, duly licensed podiatrists or other health
agencies and only such health care, to be provided by duly
licensed chiropractors, or such payment therefor, as may be
specified in the contract made by the subscribed with the
(f) "Dental service corporation" means a nonprofit, nonstock
corporation, organized in accordance with the provisions of
article one, chapter thirty-one of this code, for the sole
dentists for dental services to be furnished to subscribers under
terms of their contracts with the corporations, and controlled by
a board of directors, not more than twenty percent of whom or
whose spouse, parent, child, brother or sister by blood or
marriage, are engaged in the providing of health care and at
least eighty percent of whom shall be chosen as representatives
of the interests of consumers, elderly persons, organized labor
and business subscribers.
(g) "Dental service" means only such dental care, to be
provided by duly licensed dentists, duly licensed physicians, or
such payment therefor, as may be specified in the contract made
by the subscriber with the corporation.
(h) "Health service corporation" means a nonprofit, nonstock
article one, chapter thirty-one of this code, for the purpose of
contracting with the public and with hospitals and other health
agencies for hospital or other health services to be furnished to
subscribers or for the purpose of contracting with the public and
with duly licensed physicians, duly licensed dentists and duly
licensed chiropodists-podiatrists for medical or surgical
services and with duly licensed chiropractors and other health
agencies for other health services or for the purpose ofcontracting with the public and with duly licensed dentists for
dental services to be furnished to subscribers, all under terms
of their contract or contracts with the corporation, and
controlled by a board of directors, not more than twenty percent
of whom, or whose spouse, parent, child, brother or sister by
blood or marriage, are engaged in the providing of health care
and at least eighty percent of whom shall be chosen as
representatives of the interests of consumers, elderly persons,
organized labor and business subscribers. A hospital service
corporation, or hospital service corporations, a medical service
corporation, or medical service corporations, or a dental service
corporation, or dental service corporations, licensed in
accordance with the provisions of this article shall be authorized and permitted to merge into or consolidate with other
such corporations in accordance with the merger or consolidation
provisions of sections one hundred fifty and one hundred fifty-one, article one, chapter thirty-one of the code, to form a
health service corporation: Provided, That no such merger or
consolidation shall be effectuated unless in advance thereof the
plan, agreement and other supporting documents have been filed
with and approved in writing by the commissioner. The
commissioner shall give such approval within a reasonable time
after such filing unless he finds such plan or agreement:
(2) Hazardous to the interests of the subscribers of any
corporations involved; or
(3) Would substantially reduce the security of and service
to be rendered to the subscribers of any corporation involved.
If the commissioner does not approve any such plan or
agreement he shall so notify the corporation or corporations in
writing specifying his reasons therefor.
(i) "Health service" means such hospital, medical, surgical,
dental care or other health care to be provided by hospitals or
other health agencies, duly licensed physicians, duly licensed
dentists, duly licensed podiatrists or other health care, to be
provided by duly licensed chiropractors, as the case may be, or
(j) "Service" means such hospital, medical, dental and other
health service as shall be provided under the terms of the contracts issued by the corporation to subscribers.
(k) "Commissioner" means the insurance commissioner of West
WVC 33 - 24 - 3 §33-24-3. Corporations affected by article; eligibility of hospitals, physicians, dentists, chiropodists-podiatrists and chiropractors. (a) Every such corporation operating within this state shall
(b) Every hospital or other health agency in this state
meeting the standards prescribed by the board of directors of
each such corporation shall be eligible for participation in any
hospital service plan, or health service plan, operating in this
state. Every duly licensed physician, duly licensed dentist,
duly licensed chiropodist-podiatrist, duly licensed chiropractor
or other health agency in this state meeting the standards
prescribed by the board of directors of each such corporation
shall be eligible for participation in any medical service plan,
or health service plan, operating in this state. Every duly
licensed dentist or duly licensed physician in this state meeting
the standards prescribed by the board of directors of each such
corporation shall be eligible for participation in any dental
service plan, or health service plan, operating in this state. The board of directors of every such corporation may also
prescribe standards for hospitals, physicians, dentists, chiropodists- podiatrists, chiropractors and other health agencies located in
states adjoining this state, and all such hospitals, physicians,
dentists, chiropodists-podiatrists, chiropractors and other
health agencies meeting such standards shall be eligible for
participation in such plans.
WVC 33 - 24 - 4 §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 herein below indicated, of
the following articles of this chapter: Article two (Insurance
Commissioner); article four (general provisions), except that
section sixteen of said article may not be applicable thereto;
section twenty, article five (borrowing by insurers); section
thirty-four, article six (fee for form, rate and rule filing);
article six-c (guaranteed loss ratios as applied to individual
sickness and accident insurance policies); article seven (assets
and liabilities); article eight-a (use of clearing corporations and
federal reserve book-entry system); article eleven (unfair trade
practices); article twelve (insurance producers and solicitors),
except that the agent's license fee shall be twenty-five dollars;
section two-a, article fifteen (definitions); section two-b,
article fifteen (guaranteed issue; limitation of coverage;
election; denial of coverage; network plans); section two-d,
article fifteen (exceptions to guaranteed renewability); section
two-e, article fifteen (discontinuation of particular type of
coverage; uniform termination of all coverage; uniform modification of coverage); section two-f, article fifteen (certification of
creditable coverage); section two-g, article fifteen
(applicability); section four-e, article fifteen (benefits for
mothers and newborns); section fourteen, article fifteen (policies
discriminating among health care providers); section sixteen,
article fifteen (policies not to exclude insured's children from
coverage; required services; coordination with other insurance);
section eighteen, article fifteen (equal treatment of state
agency); section nineteen, article fifteen (coordination of
benefits with medicaid); article fifteen-a (West Virginia Long-Term
Care Insurance Act); article fifteen-c (diabetes insurance);
section three, article sixteen (required policy provisions);
section three-a, article sixteen (same - mental health); section
three-d, article sixteen (medicare supplement insurance); section
three-f, article sixteen (required policy provisions - treatment of
temporomandibular joint disorder and craniomandibular disorder);
section three-j, article sixteen (hospital benefits for mothers and
newborns); section three-k, article sixteen (limitations on
preexisting condition exclusions for health benefit plans); section
three-l, article sixteen (renewability and modification of health
benefit plans); section three-m, article sixteen (creditable
coverage); section three-n, article sixteen (eligibility for
enrollment); section eleven, article sixteen (group policies not to
exclude insured's children from coverage; required services;
coordination with other insurance); section thirteen, article sixteen (equal treatment of state agency); section fourteen,
article sixteen (coordination of benefits with medicaid); section
sixteen, article sixteen (insurance for diabetics); article
sixteen-a (group health insurance conversion); article sixteen-c
(employer group accident and sickness insurance policies); article
sixteen-d (marketing and rate practices for small employer accident
and sickness insurance policies); 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); article
thirty-seven (managing general agents); and article forty-one
(Insurance Fraud Prevention Act) 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.
WVC 33 - 24 - 4 A
article twenty-five-f of this chapter shall apply to the insurance
regulated by this article.
WVC 33 - 24 - 4 B
Notwithstanding any provision of this code to the contrary,
article forty-one of this chapter is applicable to hospital service
WVC 33 - 24 - 5 §33-24-5. Licenses; name of corporation.
(a) No such corporation shall enter into any contract with a
subscriber until it has obtained from the commissioner a license as
provided in this section. Application for a license shall be made
on forms to be prescribed and furnished by the commissioner.
(b) The application shall be accompanied by a copy of the
following documents: (1) Certificate of incorporation; (2) bylaws;
(3) contracts between the corporation and participating hospitals,
physicians, dentists or other health agencies; (4) proposed
contracts to be issued to subscribers, setting forth the hospital,
medical or dental service to which subscribers are entitled, and
the table of rates to be charged for such service; and (5)
financial statement showing the amount of contributions paid, or
agreed to be paid, to the corporation for working capital, the name
or names of each contributor and the terms of each contribution.
(c) The commissioner shall, upon payment to him of a license
fee of two hundred dollars, issue a license authorizing the
corporation to transact business in this state in the area to be
served by it, if he is satisfied (1) that the applicant is
incorporated in this state under the provisions of article one,
chapter thirty-one of this code, as a bona fide nonprofit
corporation, (2) that the contracts between the corporation and
participating hospitals, physicians, dentists and other health
agencies contain all the terms required by section seven of this
article, (3) that the working capital available to the corporation
will be sufficient to pay all operating expenses, other than
payment for hospital, medical or dental services, for a reasonable period after the issuance of the license, and (4) that the proposed
plan will serve the best interests of all of the people of the area
in which the corporation intends to operate, regardless of their
race, color or economic status. Any license so issued may be
renewed annually upon payment to the commissioner of a renewal fee
of two hundred dollars.
(d) The term of such license, renewal, refusal to license,
revocation, suspension or penalty in lieu thereof shall be governed
by the provisions of sections eight, nine, ten and eleven, article
three of this chapter, in the same manner that these sections are
applicable to insurers generally.
(e) No such corporation shall include in its name the words
"insurance," "casualty," "surety," "health and accident," "accident
and sickness," "mutual," or any other words descriptive of the
insurance business; nor shall its name be so similar to that of any
insurer which was licensed to transact insurance in this state when
such corporation was formed, as to tend, in the opinion of the
commissioner, to confuse the public.
WVC 33 - 24 - 6 §33-24-6. Commissioner to enforce article; approval of contracts,
forms, rates and fees.
provisions of this article. If the commissioner finds that a
corporation is impaired, he may issue such orders and otherwise
require that the corporation take all actions that in his judgment
are necessary for the corporation to cure the impairment. Failure
of the corporation to follow such orders and directions is evidence
that the management is incompetent and grounds for an order of
rehabilitation or liquidation, as the commissioner deems
(b) No such corporation shall deliver or issue for delivery
any subscriber's contract, changes in the terms of such contract,
application, rider or endorsement, until a copy thereof and the
rates pertaining thereto have been filed with and approved by the
commissioner. All such forms filed with the commissioner shall be
deemed approved after the expiration of sixty days from the date of
such filing unless the commissioner shall have disapproved the
same, stating his reasons for such disapproval in writing. Such
forms may be used prior to the expiration of such periods if
written approval thereof has been received from the commissioner.
(c) No rates to be charged subscribers shall be used or
established by any such corporation unless and until the same have
been filed with the commissioner and approved by him. The
procedure for such filing and approval shall be the same as that
prescribed in subsection (b) of this section for the approval of
forms. The commissioner shall approve all such rates which are not excessive, inadequate or unfairly discriminatory.
(d) The commissioner shall pass upon the actuarial soundness
of the schedule of fees to be paid hospitals, physicians, dentists
and other health agencies.
WVC 33 - 24 - 7 §33-24-7. Required provisions in contracts made by corporations with hospitals, physicians, dentists
and other health agencies. Each contract made by the corporation with participating
hospitals, physicians, dentists and other health agencies shall
contain the following provisions:
(a) That the hospital, physician, dentist or other health
agency will render to any subscriber such service as he may be
entitled to under the terms and conditions of the contract issued
to the subscriber by the corporation.
(b) That in submitting bills to the corporation for services
rendered to subscribers under the terms of their contracts, the
hospitals, physicians, dentists and other health agencies will
make only such charges as are set forth in an agreed schedule of
fees to be paid by the corporation.
WVC 33 - 24 - 7 A
(a) Any contract made under the provisions of this article
shall, on or after the first day of January, one thousand nine
hundred eighty-four, contain a provision that the corporation shall
make available as covered benefits to all subscribers and members
coverage for primary health care nursing services as defined in
section four-b, article fifteen of this chapter, if such services
are currently being reimbursed when rendered by any other duly
licensed health care practitioner. No corporation may be required
to pay for duplicative health care services actually provided by
both a registered professional nurse or licensed midwife and other
perform professional services beyond such individual's scope of
WVC 33 - 24 - 7 B
§33-24-7b. Third party reimbursement for mammography, pap smear
(2)A pap smear, either conventional or liquid-based
cytology, whichever is medically appropriate and consistent with
Gynecologists, for women age eighteen or over; or
(3) A test for the human papilloma virus (HPV), when medically
appropriate and consistent with the current guidelines from either
the United States Preventive Services Task Force or The American
College of Obstetricians and Gynecologists, for women age eighteen
WVC 33 - 24 - 7 C
WVC 33 - 24 - 7 D
§33-24-7d. Required provisions in contracts which include child
immunization services in the terms of the contract.
Each contract made by the corporation with participating
hospitals, physicians, and other health agencies which provide
immunizations to children shall require that bills submitted to the
corporation for child immunization services rendered under the
terms of their contracts will set forth separately those charges
for said services. Charges for other health care services provided
during the same visit shall not be included in the charge for
WVC 33 - 24 - 7 E
WVC 33 - 24 - 7 F
§33-24-7f. Third party reimbursement for colorectal cancer
WVC 33 - 24 - 7 G
§33-24-7g. Required coverage for reconstruction surgery following
WVC 33 - 24 - 7 H
(a) A corporation defined in section two of this article may
not require any person covered under a contract which provides
coverage for prescription drugs to obtain the prescription drugs
from a mail-order pharmacy in order to obtain benefits for the
(b) A corporation may not violate the provisions of subsection
WVC 33 - 24 - 7 I §33-24-7i. Third-party reimbursement for kidney disease screening.
WVC 33 - 24 - 7 J
WVC 33 - 24 - 7 K
§33-24-7k. Coverage for diagnosis and treatment of autism spectrum
entity regulated by this article, for policies issued or renewed on or after January 1, 2012, which delivers, renews or issues a
the provisions of this article shall include coverage for diagnosis
and treatment of autism spectrum disorder in individuals ages
eighteen months to eighteen years. To be eligible for coverage and
benefits under this section, the individual must be diagnosed with
autism spectrum disorder at age eight or younger. The policy shall
reevaluation of the individual. This section shall not be construed
as limiting, replacing or affecting any obligation to provide
services to an individual under the Individuals with Disabilities
Education Act, 20 U.S.C. 1400 et seq., as amended from time to time
or other publicly funded programs. Nothing in this section shall
be construed as requiring reimbursement for services provided by
of actual total costs of coverage for the plan year the corporation
may apply additional cost containment measures.
benefits that exceed the essential health benefits specified under section 1302(b) of the Patient Protection and Affordable Care Act,
health benefit plan when the plan is offered by a corporation in
WVC 33 - 24 - 7 L
WVC 33 - 24 - 7 M
§33-24-7m. Deductibles, copayments and coinsurance for
group accident and sickness insurance policy, plan, contract or
agreement issued by an entity regulated by this article that covers
anti-cancer medications that are injected or intravenously
administered by a health care provider and patient administered
anti-cancer medications, including, but not limited to, those
medications orally administered or self-injected, may not require
a less favorable basis for a copayment, deductible or coinsurance
amount for patient administered anti-cancer medications than it
requires for injected or intravenously administered anti-cancer
medications, regardless of the formulation or benefit category
determination by the policy or plan.
(b) An accident or sickness insurance policy, plan, contract
or agreement may not comply with subsection (a) of this section by:
determines that the medication is medically necessary to kill or slow the growth of cancerous cells in a manner consistent with
contrary, in the event that an entity subject to this article can
demonstrate actuarially to the Insurance Commissioner that its
total anticipated costs for any policy, plan, contract or agreement
to comply with this section will exceed or have exceeded two
percent of the total costs for such policy, plan, contract or
agreement in any experience period, then the entity may apply
whatever cost containment measures may be necessary to maintain
costs below two percent of the total costs for the policy, plan,
contract or agreement: Provided, That such cost containment
measures implemented are applicable only for the plan year or
experience period following approval of the request to implement
cost containment measures.
Health Plan as defined in section 223(c)(2)(A) of the Internal Revenue Code of 1986, and that, in connection with every
WVC 33 - 24 - 8 §33-24-8. Contract or certificate to be furnished to
policyholders and subscribers; payment for health
care rendered needy persons. (a) Every such corporation shall deliver to each contract
holder a copy of the contract and to each holder of a master
group contract for delivery to each subscriber to such group
contract a certificate setting forth the essential terms of the
contract to be performed.
(b) A corporation may accept from governmental agencies
payment of all or part of the cost of subscriptions for hospital,
medical or other health care rendered needy persons, and may
accept from private agencies, corporations, associations, groups
or individuals, similar payment for such service to be rendered
needy or other persons.
WVC 33 - 24 - 9 §33-24-9. Payroll deduction for governmental employees. The officer charged with the duty of preparing the payroll
of any subscriber, who is an employee of the state government or
of any of its political subdivisions, including state-operated
educational institutions, may upon request of the subscriber
deduct from his payroll the amount of the fee owed by the
subscriber to any hospital service corporation or medical service
corporation, provided enrollment regulations of the particular
corporation are satisfied, in which case the officer shall pay
over such amount to the corporation.
WVC 33 - 24 - 10 §33-24-10. Investments; bonds of corporate officers and employees,
minimum statutory surplus.
(a) The funds of any corporation shall be invested only as
(1) The first two million dollars of the funds shall be in
cash or government securities of the type described in paragraph
(A) or (B), subdivision (1), subsection (a), section eleven,
article eight of this chapter or paragraph (A), (B) or (C),
subdivision (3) of said subsection.
(2) The balance of the funds may be in cash, invested in the
classes of investments described in subdivision (1), subsection
(a), section eleven, article eight of this chapter or invested in
the classes of investments described in the following sections of
article eight of this chapter: Subdivision (4), subsection (a) and
section eleven (preferred stock), section twelve (investment
pools), section thirteen (equity interests), section fourteen
(tangible personal property under lease), section fifteen (mortgage
loans and real estate), section sixteen (securities lending,
repurchase, reverse repurchase and dollar roll transactions),
section seventeen (foreign investments) and section eighteen
(derivative transactions). All investments are subject to all the
restrictions and conditions contained in said article eight as
applying to similar investments of insurers generally.
(b) Every officer or employee of any corporation, who is
entrusted with the handling of its funds, shall furnish, in an amount fixed by the board of directors of the corporation, with the
approval of the commissioner, a bond with corporate surety,
conditioned upon the faithful performance of all his or her duties.
(c) A corporation shall have and maintain statutory surplus
funds of at least two million dollars: Provided, That any
corporation duly licensed under this article in West Virginia prior
to the effective date of this section whose surplus requirements
are increased by virtue of this section shall maintain statutory
surplus funds of at least five hundred thousand dollars after the
effective date of this section, and any corporation is then subject
to the full two million dollar statutory surplus requirement.
WVC 33 - 24 - 11 §33-24-11. Reciprocity with other service plans; payment authorized. Hospital, medical, dental and health service corporations
licensed and operating under provisions of this article are
hereby authorized to promote and encourage reciprocity with other
licensed hospitals, medical, dental and health plans, both within
and without the state, in expanding their services to
subscribers. In the event that a subscriber to a plan requires
emergency hospital, medical, dental or health service, or, in the
event that the particular services that he receives are not
available through the plan to which he subscribes, such plan is
hereby authorized to make payment on behalf of such subscribed
for such service on a basis not to exceed its schedule of fees to
be paid hospitals, physicians or dentists previously approved by
the commissioner and on file in his office.
WVC 33 - 24 - 12 §33-24-12. Creation of subsidiary corporation or corporations. In addition to the other rights given a corporation under
the provisions of this article, a health service corporation may,
subject to prior approval of the commissioner, create a
subsidiary corporation or corporations, either nonprofit
corporation or a corporation organized for pecuniary profit, for
any lawful business purpose which is related to and promotes the
purposes for which hospital, medical, dental and health service
corporations are organized: Provided, That no subsidiary
corporation created pursuant to the provisions of this section
shall be entitled to the exemptions established by the provisions
of this article and all such subsidiary corporations shall be
governed by and subject to all other applicable provisions of
this code: Provided, however, That no such subsidiary
corporation shall be entitled to the exemptions provided under
section seven of this article.
WVC 33 - 24 - 13 §33-24-13. Continuum of care services. Any hospital service corporation, medical service corporation
or health service corporation which, on or after the first day of
July, one thousand nine hundred eighty-six, delivers or issues for
delivery in this state any subscriber contract under the provisions
of this article, shall make available for purchase, at a reasonable
rate, supplemental insurance coverage for continuum of care
services pursuant to article five-d, chapter sixteen of this code: Provided, That any insurance carrier required to provide
supplemental insurance coverage for continuum of care services
hereunder shall not be required to expend funds for underwriting
such supplemental coverage until the continuum of care board, in
cooperation with the West Virginia state insurance commissioner,
shall have completed a written master plan related to insurance
coverage as set forth in section five, article five-d, chapter
sixteen of the code of West Virginia, one thousand nine hundred
thirty-one, as amended, including, but not limited to, the specific
standards and coverages to be provided in such supplemental
coverage: Provided, however, That a public hearing shall be held
pursuant to the provisions of chapter twenty-nine-a of this code
applicable to such proceedings prior to the considerations of the
aforesaid plan by said board. The rates for continuum of care
coverage shall accurately reflect the cost of such coverage and
shall not be subsidized by the rate structure for any other
WVC 33 - 24 - 14 §33-24-14. Delinquency proceedings.
From and after the first day of July, two thousand four, any
delinquency proceeding commenced against a corporation subject to
this article for the purpose of liquidating, rehabilitating,
reorganizing or conserving the corporation shall be considered to
be a delinquency proceeding against an insurance company and shall
be undertaken pursuant to the provisions of article ten of this
chapter. Any delinquency proceeding pending against a corporation
subject to this article prior to the first day of July, two
thousand four, will be administered and concluded under the law in
effect at the time the delinquency proceeding was commenced.
WVC 33 - 24 - 15 §33-24-15.
WVC 33 - 24 - 16 §33-24-16.
WVC 33 - 24 - 17 §33-24-17.
WVC 33 - 24 - 18 §33-24-18.
WVC 33 - 24 - 19 §33-24-19.
WVC 33 - 24 - 21 §33-24-21.
WVC 33 - 24 - 22 §33-24-22.
WVC 33 - 24 - 23 §33-24-23.
WVC 33 - 24 - 24 §33-24-24.
WVC 33 - 24 - 25 §33-24-25.
WVC 33 - 24 - 26 §33-24-26.
WVC 33 - 24 - 27 §33-24-27.
WVC 33 - 24 - 28 §33-24-28.
WVC 33 - 24 - 29 §33-24-29.
WVC 33 - 24 - 30 §33-24-30.
WVC 33 - 24 - 31 §33-24-31.
WVC 33 - 24 - 32 §33-24-32.
WVC 33 - 24 - 33 §33-24-33.
WVC 33 - 24 - 34 §33-24-34.
WVC 33 - 24 - 35 §33-24-35.
WVC 33 - 24 - 36 §33-24-36.
WVC 33 - 24 - 37 §33-24-37.
WVC 33 - 24 - 38 §33-24-38.
WVC 33 - 24 - 39 §33-24-39.
WVC 33 - 24 - 40 §33-24-40.
WVC 33 - 24 - 41 §33-24-41.
WVC 33 - 24 - 42 §33-24-42.
WVC 33 - 24 - 43 §33-24-43. Policies discriminating among health care providers.
WVC 33 - 24 - 44 §33-24-44. Authority of commissioner to promulgate rules and
entity regulated by this article, for policies issued or renewed on or after January 1, 2012, delivers, renews or issues a policy of
provisions of this article shall include coverage for diagnosis and
months through eighteen years. To be eligible for coverage and
autism spectrum disorder at age 8 or younger. Such policy shall
psychologist for an individual diagnosed with autism spectrum
disorder, in accordance with a treatment plan developed by a
or reevaluation of the individual, subject to review by the
corporation every six months. Progress reports are required to be
filed with the corporation semi-annually. In order for treatment
to continue, the agency must receive objective evidence or a
clinically supportable statement of expectation that: (1) The individual's condition is improving in response to
treatment; and (2) A maximum improvement is yet to be attained; and (3) There is an expectation that the anticipated improvement
(b) Such coverage shall include, but not be limited to,
applied behavioral analysis provided or supervised by a certified
behavioral analyst: Provided, That the annual maximum benefit for
treatment required by this section shall be in amount not to exceed
$30,000 per individual, for three consecutive years from the date
treatment commences. At the conclusion of the third year, required
coverage shall be in an amount not to exceed $2000 per month, until
the individual reaches eighteen years of age, as long as the
section shall not be construed as limiting, replacing or affecting
any obligation to provide services to an individual under the
Individuals with Disabilities Education Act, 20 U.S.C. 1400 et
seq., as amended from time to time or other publicly funded
programs. Nothing in this section shall be construed as requiring
reimbursement for services provided by public school personnel.
significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the
relationship between environment and behavior. (2) "Autism spectrum disorder" means any pervasive
of treatment, during and/or after treatment is recommended to
quantify progress and support justifications for continued
treatment. Such tools are not required, but their use will enhance
the justification for continued treatment.
(d) The provisions of this section do not apply to small
employers. For purposes of this section a small employer shall be
defined as any person, firm, corporation, partnership or
association actively engaged in business in the state of West
Virginia who, during the preceding calendar year, employed an
average of no more than twenty-five eligible employees.
(e) To the extent that the application of this section for autism spectrum disorder causes an increase of at least one percent
(f) To the extent that the provisions of this section requires
the specified essential health benefits shall not be required of a health benefit plan when the plan is offered by a corporation in