reglab/housing_qa huggingface dataset:
WV Code § 33-15-4f (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-4f. Third Party Reimbursement for Colorectal Cancer Examination and Laboratory Testing

(a) Notwithstanding any provision of any policy, provision, contract, plan or agreement applicable to this article, reimbursement or indemnification for colorectal cancer examinations and laboratory testing may not be denied for any nonsymptomatic person fifty years of age or older, or a symptomatic person under fifty years of age, when reimbursement or indemnity for laboratory or X-ray services are covered under the policy and are 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. The tests are as follows: An annual fecal occult blood test, a flexible sigmoidoscopy repeated every five years, a colonoscopy repeated every ten years and a double contrast barium enema repeated every five years.(b) A symptomatic person is defined as: (i) An individual who experiences a change in bowel habits, rectal bleeding or stomach cramps that are persistent; or (ii) an individual who poses a higher than average risk for colorectal cancer because he or she has had colorectal cancer or polyps, inflammatory bowel disease, or an immediate family history of such conditions.(c) The same deductibles, coinsurance, network restrictions and other limitations for covered services found in the policy, provision, contract, plan or agreement of the covered person may apply to colorectal cancer examinations and laboratory testing.
WV Code § 33-15-4h (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-4h. Coverage for Patient Cost of Clinical Trials

The provisions relating to clinical trials established in article twenty-five-f of this chapter shall apply to the individual market regulated by this article.
WV Code § 33-15-4i (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-4i. Third-Party Reimbursement for Kidney Disease Screening

(a) Notwithstanding any provision of any policy, provision, contract, plan or agreement applicable to this article, reimbursement or indemnification for annual kidney disease screening and laboratory testing as recommended by the National Kidney Foundation may not be denied for any person when reimbursement or indemnity for laboratory or X-ray services are covered under the policy and are performed for kidney disease screening or diagnostic purposes at the direction of a person licensed to practice medicine and surgery by the board of Medicine. The tests are as follows: Any combination of blood pressure testing, urine albumin or urine protein testing and serum creatinine testing.(b) The same deductibles, coinsurance, network restrictions and other limitations for covered services found in the policy, provision, contract, plan or agreement of the covered person may apply to kidney disease screening and laboratory testing.
WV Code § 33-15-4j (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-4j. Required Coverage for Dental Anesthesia Services

(a) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article shall, on or after July 1, 2009, provide as benefits to all subscribers and members coverage for dental anesthesia services as hereinafter set forth.(b) For purposes of this article and section, "dental anesthesia services" means general anesthesia for dental procedures and associated outpatient hospital or ambulatory facility charges provided by appropriately licensed health care individuals in conjunction with dental care provided to an enrollee or insured if the enrollee or insured is:(A) Seven years of age or younger or is developmentally disabled and is an individual for whom a successful result cannot be expected from dental care provided under local anesthesia because of a physical, intellectual or other medically compromising condition of the enrollee or insured and for whom a superior result can be expected from dental care provided under general anesthesia; or(B) A child who is twelve years of age or younger with documented phobias, or with documented mental illness, and with dental needs of such magnitude that treatment should not be delayed or deferred and for whom lack of treatment can be expected to result in infection, loss of teeth or other increased oral or dental morbidity and for whom a successful result cannot be expected from dental care provided under local anesthesia because of such condition and for whom a superior result can be expected from dental care provided under general anesthesia.(c) Prior authorization. -- An entity subject to this section may require prior authorization for general anesthesia and associated outpatient hospital or ambulatory facility charges for dental care in the same manner that prior authorization is required for these benefits in connection with other covered medical care.(d) An entity subject to this section may restrict coverage for general anesthesia and associated outpatient hospital or ambulatory facility charges unless the dental care is provided by:(1) A fully accredited specialist in pediatric dentistry; (2) A fully accredited specialist in oral and maxillofacial surgery; and(3) A dentist to whom hospital privileges have been granted.(e) Dental care coverage not required. -- The provisions of this section may not be construed to require coverage for the dental care for which the general anesthesia is provided.(f) Temporal mandibular joint disorders. -- The provisions of this section do not apply to dental care rendered for temporal mandibular joint disorders.(g) A policy, provision, contract, plan or agreement may apply to dental anesthesia services the same deductibles, coinsurance and other limitations as apply to other covered services.
WV Code § 33-15-4k (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-4k. Maternity Coverage

Notwithstanding any provision of any policy, provision, contract, plan or agreement applicable to this article, any health insurance policy subject to this article, issued or renewed on or after January 1, 2014, which provides health insurance coverage for maternity services, shall provide coverage for maternity services for all persons participating in or receiving coverage under the policy. To the extent that the provisions of this section require benefits that exceed the essential health benefits specified under section 1302(b) of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended, the specific benefits that exceed the specified essential health benefits are not required of a health benefit plan when the plan is offered by a health care insurer in this state. Coverage required under this section may not be subject to exclusions or limitations which are not applied to other maternity coverage under the policy.
WV Code § 33-15-4m (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-4m. Eye Drop Prescription Refills

An insurance policy issued by an insurer pursuant to this article for prescription topical eye medication may not deny coverage for the refilling of a prescription for topical eye medication when:(1) The medication is to treat a chronic condition of the eye;(2) The refill is requested by the insured prior to the last day of the prescribed dosage period and after at least 70% of the predicted days of use; and(3) A person licensed under chapter thirty and authorized to prescribe topical eye medication indicates on the original prescription that refills are permitted and that the early refills requested by the insured do not exceed the total number of refills prescribed.
WV Code § 33-15-4n (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-4n. Deductibles, Copayments and Coinsurance for Abuse-Deterrent Opioid Analgesic Drugs

(a) As used in this section:(1) “Abuse-deterrent opioid analgesic drug product” means a brand name or generic opioid analgesic drug product approved by the United States Food and Drug Administration with abuse-deterrent labeling that indicates its abuse-deterrent properties are expected to deter or reduce its abuse; (2) “Cost-sharing” means any coverage limit, copayment, coinsurance, deductible or other out-of-pocket expense requirements;(3) “Opioid analgesic drug product” means a drug product that contains an opioid agonist and is indicated by the United States Food and Drug Administration for the treatment of pain, regardless of whether the drug product:(A) Is in immediate release or extended release form; or(B) Contains other drug substances.(b) Notwithstanding any provision of any accident and sickness insurance policy issued by an insurer, on or after January 1, 2017:(1) Coverage shall be provided for at least one abuse-deterrent opioid analgesic drug product for each active opioid analgesic ingredient;(2) Cost-sharing for brand name abuse-deterrent opioid analgesic drug products shall not exceed the lowest tier for brand name prescription drugs on the entity’s formulary for prescription drug coverage;(3) Cost-sharing for generic abuse-deterrent opioid analgesic drug products covered pursuant to this section shall not exceed the lowest cost-sharing level applied to generic prescription drugs covered under the applicable health plan or policy; and (4) An entity subject to this section may not require an insured or enrollee to first use an opioid analgesic drug product without abuse-deterrent labeling before providing coverage for an abuse-deterrent opioid analgesic drug product covered on the entity's formulary for prescription drug coverage. (c) Notwithstanding subdivision (3), subsection (b) of this section, an entity subject to this section may undertake utilization review, including preauthorization, for an abuse-deterrent opioid analgesic drug product covered by the entity, if the same utilization review requirements are applied to nonabuse-deterrent opioid analgesic drug products and with the same type of drug release, immediate or extended.(d) For purposes of subsection (b) of this section, the lowest tier and the lowest cost-sharing level shall not mean the cost-sharing tier applicable to preventive care services which are required to be provided at no cost-sharing under the Patient Protection and Affordable Care Act.
WV Code § 33-15-4p (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-4p. Lyme Disease to Be Covered by All Health Insurance Policies

Any insurer who, on or after January 1, 2019, delivers or issues a policy of accident and sickness insurance in this state under the provisions of this article shall make available as benefits to all subscribers and members coverage on an expense-incurred basis and individual and group service or indemnity type contracts issued by a nonprofit corporation shall provide coverage for long-term antibiotic therapy for a patient with Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient’s symptoms, diagnostic test results, or response to treatment.
WV Code § 33-15-4q (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-4q. Coverage for Amino Acid-Based Formulas

(a) A policy, plan, or contract that is issued or renewed on or after January 1, 2019, and that is subject to this article shall provide coverage, through the age of 20, for amino acid-based formula for the treatment of severe protein-allergic conditions or impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract. This includes the following conditions, if diagnosed as related to the disorder by a physician licensed to practice in this state pursuant to either §30-3-1 et seq. or §30-14-1 et seq. of this code: (1) Immunoglobulin E and Nonimmunoglobulin E-medicated allergies to multiple food proteins; (2) Severe food protein-induced enterocolitis syndrome; (3) Eosinophilic disorders as evidenced by the results of a biopsy; and(4) Impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract (short bowel).(b) The coverage required by §33-15-4p(a) of this code shall include medical foods for home use for which a physician has issued a prescription and has declared them to be medically necessary, regardless of methodology of delivery.(c) For purposes of this section, “medically necessary foods” or “medical foods” shall mean prescription amino acid-based elemental formulas obtained through a pharmacy: Provided, That these foods are specifically designated and manufactured for the treatment of severe allergic conditions or short bowel. (d) The provisions of this section shall not apply to persons with an intolerance for lactose or soy.
WV Code § 33-15-4t (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-4t. Fairness in Cost-Sharing Calculation

 (a) As used in this section:"Cost sharing" means any copayment, coinsurance, or deductible required by or on behalf of an insured in order to receive a specific health care item or service covered by a health plan."Drug" means the same as the term is defined in 30-5-4(19)."Person" means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit corporation, unincorporated organization, or government or governmental subdivision or agency."Pharmacy benefits manager" means the same as that term is defined in 33-51-3 of this code.(b) When calculating an insureds contribution to any applicable cost sharing requirement, including, but not limited to, the annual limitation on cost sharing subject to 42 U.S.C. 18022(c) and 42 U.S.C. 300gg-6(b):(1) An insurer shall include any cost sharing amounts paid by the insured or on behalf of the insured by another person; and(2) A pharmacy benefits manger shall include any cost sharing amounts paid by the insured or on behalf of the insured by another person.(c) The commissioner is authorized to propose rules for legislative approval in accordance with 29A-3-1 et seq. of this code, to implement the provisions of this section.(d) This section is effective for policy, contract, plans, or agreements beginning on or after January 1, 2020. This section applies to all policies, contracts, plans, or agreements, subject to this article that are delivered, executed, issued, amended, adjusted, or renewed in this state on or after the effective date of this section.
WV Code § 33-15-4v (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-4v. Incorporation of the Health Benefit Plan Network Access and Adequacy Act

The provisions of the Health Benefit Plan Network Access and Adequacy Act codified at 33-55-1 et seq. of this code are made applicable to the provisions of this article.
WV Code § 33-15-4w (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-4w. Incorporation of the Coverage for 12-Month Refill for Contraceptive Drugs

The provision requiring coverage for 12-month refill for contraceptive drugs codified at 33-58-1 of this code is made applicable to the provisions of this article.
WV Code § 33-15-6 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-6. Inapplicable or Inconsistent Provisions

If any provision of this article is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the commissioner, shall omit from such policy any inapplicable provision or part of a provision, and shall modify any inconsistent provision or part of the provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.
WV Code § 33-15-7 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-7. Order of Certain Provisions

The provisions which are the subject of sections four and five of this article or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in consecutive order of the provisions in such sections or, at the option of the insurer, any such provisions may appear as a unit in any part of the policy, with other provisions to which it may be logically related, provided the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered or issued.
WV Code § 33-15-8 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-8. Third Party Ownership of Policy Covering Insured

The word "insured" as used in this article, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits and rights provided therein.
WV Code § 33-15-9 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-9. Requirements of Other Jurisdictions

(a) Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of this article and which is prescribed or required by the law of the state under which the insurer is organized.(b) Any policy of a domestic insurer may, when issued for delivery in any other state or country, contain any provision permitted or required by the laws of such other state or country.
WV Code § 33-15-10 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-10. Franchise Insurance

Accident and sickness insurance on a franchise plan is hereby declared to be that form of accident and sickness insurance issued to:(a) Five or more employees of any corporation, copartnership or individual employer or any governmental corporation, agency or department thereof, or(b) Five or more members of any trade or professional association or of a labor union or of any other association having had an active existence for at least two years where such association or union has a Constitution or bylaws and is formed in good faith for purposes other than that of obtaining insurance; where such persons, with or without their dependents, are issued the same form of an individual policy varying only as to amounts and kinds of coverage applied for by such persons, under an arrangement whereby the premiums on such policies may be paid to the insurer periodically by the employer, with or without payroll deductions, or by the association or union for its members, or by some designated person acting on behalf of such employer or association or union. The term "employees" as used in this section shall be deemed to include the officers, managers, employees and retired employees of the employer and the individual proprietor or partners if the employer is an individual proprietor or partnership.
WV Code § 33-15-11 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-11. Hospital Indemnity Policies Not to Exclude Coverage for Confinement in Government Hospital

No policy providing hospital indemnity coverage may exclude coverage because of confinement in a hospital operated by the federal or state government.
WV Code § 33-15-12 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-12. Continuum of Care Services

Any insurer which, on or after July 1, 1986, delivers or issues for delivery in this state any policy of accident and sickness insurance 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, 1931, 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 coverage.
WV Code § 33-15-13 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-13. Policies Not to Terminate Coverage Because of Diagnosis or Treatment of Acquired Immune Deficiency Syndrome

No insurer may cancel or nonrenew the accident and sickness insurance policy of any insured because of diagnosis or treatment of acquired immune deficiency syndrome.
WV Code § 33-15-14 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 15. Accident and Sickness Insurance|§33-15-14. Policies Discriminating Among Health Care Providers

Notwithstanding any other provisions of law, when any health insurance policy, health care services plan or other contract provides for the payment of medical expenses, benefits or procedures, such policy, plan or contract shall be construed to include payment to all health care providers including medical physicians, osteopathic physicians, podiatric physicians, chiropractic physicians, midwives, physician assistants and nurse practitioners who provide medical services, benefits or procedures which are within the scope of each respective provider’s license. Any limitation or condition placed upon services, diagnoses or treatment by, or payment to, any particular type of licensed provider shall apply equally to all types of licensed providers without unfair discrimination as to the usual and customary treatment procedures of any of the aforesaid providers.