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WV Code § 33-52-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 52. Corporate Governance Annual Disclosure Act|§33-52-2. Definitions

As used in this article:(1) "Board" means the board of directors of an insurer or insurance group.(2) "Corporate Governance Annual Disclosure" or "CGAD" means a confidential report filed by the insurer or insurance group made in accordance with the requirements of this article.(3) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined in §33-27-2 of this code.(4) "Insurer" means every person engaged in the business of making contracts of insurance, except that it shall not include agencies, authorities or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state.(5) "ORSA summary report" means the report filed in accordance with §33-40B-5 of this code.(6) "Senior management" means any corporate officer responsible for reporting information to the board at regular intervals or providing this information to shareholders or regulators and shall include, for example and without limitation, the chief executive officer (CEO), chief financial officer (CFO), chief operations officer (COO), chief procurement officer (CPO), chief legal officer (CLO), chief information officer (CIO), chief technology officer (CTO), chief revenue officer (CRO), chief visionary officer (CVO), or any other "C" level executive.
WV Code § 33-52-5 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 52. Corporate Governance Annual Disclosure Act|§33-52-5. Filing Procedures

(a) An insurer, or the insurance group of which the insurer is a member, required to file a CGAD by §33-52-3 of this code, shall, no later than June 1 of each calendar year, submit to the commissioner a CGAD that contains the information described in §33-52-4 of this code. (b) The insurer or insurance group has discretion regarding the appropriate format for providing the information required by this article and is permitted to customize the CGAD to provide the most relevant information necessary to permit the commissioner to gain an understanding of the corporate governance structure, policies and practices utilized by the insurer or insurance group. (c) Notwithstanding subsection (a) of this section, and as outlined in §33-52-3 of this code, if the CGAD is completed at the insurance group level, then it must be filed with the lead state of the group as determined by the procedures outlined in the most recent financial analysis handbook adopted by the National Association of Insurance Commissioners. In these instances, a copy of the CGAD must also be provided to the chief regulatory official of any state in which the insurance group has a domestic insurer, upon request. (d) An insurer or insurance group may comply with this section by referencing other existing documents, including, but not limited to, ORSA summary report, holding company Form B or F filings, Securities and Exchange Commission (SEC) proxy statements or foreign regulatory reporting requirements, if the documents provide information that is comparable to the information described in §33-52-4 of this code. The insurer or insurance group shall clearly reference the location of the relevant information within the CGAD and attach the referenced document if it is not already filed or available to the commissioner.(e) Each year following the initial filing of the CGAD, the insurer or insurance group shall file an amended version of the previously filed CGAD indicating where changes have been made. If no changes were made in the information or activities reported by the insurer or insurance group, the filing should so state.
WV Code § 33-52-8 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 52. Corporate Governance Annual Disclosure Act|§33-52-8. Sanctions

Any insurer failing, without just cause, to timely file the CGAD as required in this article shall be required, after notice and hearing, to pay a penalty of up to $1,000 for each days delay, to be recovered by the commissioner. Any penalty so recovered shall be paid into the General Revenue Fund of this state. The commissioner may reduce the penalty if the insurer demonstrates to the commissioner that the imposition of the penalty would constitute a financial hardship to the insurer.
WV Code § 33-52-9 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 52. Corporate Governance Annual Disclosure Act|§33-52-9. Effective Date

The requirements of this article are effective on January 1, 2020. The first filing of the CGAD shall be in 2020.
WV Code § 33-53-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 53. Certificates of Insurance|§33-53-1. Short Title

This article shall be known as the "Certificates of Insurance Act".
WV Code § 33-53-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 53. Certificates of Insurance|§33-53-2. Definitions

For purposes of this article:"Certificate of insurance" means a document or instrument, regardless of how titled or described, that is prepared or issued by an insurer or insurance producer as evidence or confirmation of the existence of property or casualty insurance coverage. The term does not include a statement of declaration, policy of insurance, insurance binder, policy endorsement, or automobile insurance identification or information card. "Insurance producer" means a person required to be licensed under the laws of this state to sell, solicit, or negotiate property or casualty insurance."Insurer" means any organization that issues property or casualty insurance."Person" means any individual, partnership, corporation, association, or other legal entity, including any government or governmental subdivision or agency.
WV Code § 33-53-3 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 53. Certificates of Insurance|§33-53-3. Certificate Forms

(a) The Commissioner of Insurance shall prohibit the use of a certificate of insurance form if the form:(1) Is unfair, misleading, or deceptive, or violates public policy; or(2) Violates any law, including any rule promulgated by the commissioner.(b) A certificate of insurance is not a policy of insurance and does not affirmatively or negatively amend, extend, or alter the coverage afforded by the policy to which the certificate of insurance makes reference. A certificate of insurance does not confer to any person new or additional rights beyond what the referenced policy of insurance expressly provides.
WV Code § 33-53-4 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 53. Certificates of Insurance|§33-53-4. Limitations on Use

(a) A person may not:(1) Prepare, issue, or request or require the issuance of a certificate of insurance that contains any false or misleading information concerning the policy of insurance to which the certificate of insurance refers; or(2) Prepare, issue, or request or require the issuance of a certificate of insurance that purports to affirmatively or negatively alter, amend, or extend the coverage provided by the policy of insurance to which the certificate of insurance refers.(b) A certificate of insurance may not warrant that the policy of insurance referenced in the certificate comply with the insurance or indemnification requirements of a contract and the inclusion of a contract number or description within a certificate of insurance may not be interpreted as doing such.
WV Code § 33-53-5 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 53. Certificates of Insurance|§33-53-5. Notice Requirements

A person is entitled to notice of cancellation, nonrenewal, or any material change, and to any similar notice concerning a policy of insurance only if the person has such notice rights under the terms of the policy of insurance or any endorsement to the policy. The terms and conditions of the notice are governed by the policy of insurance or endorsement and may not be altered by a certificate of insurance.
WV Code § 33-53-6 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 53. Certificates of Insurance|§33-53-6. Applicability

(a) The provisions of this article apply to all certificates of insurance issued in connection with a property or casualty insurance policy issued or renewed on or after July 1, 2020, and in connection with property, operations, or risks located in this state, regardless of where the policyholder, insurer, insurance producer, or person requesting or requiring the issuance of a certificate of insurance is located.(b) A certificate of insurance or any other document or correspondence prepared, issued, requested, or required in violation of this article is void.
WV Code § 33-53-7 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 53. Certificates of Insurance|§33-53-7. Enforcement, Penalties and Rulemaking

(a) The Commissioner of Insurance shall examine and investigate the activities of any person that the commissioner reasonably believes has been or is engaged in an act or practice prohibited by this article.(b) The commissioner may enforce the provisions of this article by any means permissible in this chapter, including by issuing orders to cease and desist. Any person who violates a provision of this article may, after notice and hearing pursuant to 33-2-13 of this code, be fined by the commissioner a sum not to exceed $1,000 per violation.(c) The commissioner may propose rules for legislative approval in accordance with the provisions of 29A-3-1 et seq. of this code, necessary or reasonable to carry out the provisions of this article.
WV Code § 33-54-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 54. Requiring Accountable Pharmaceutical Transparency, Oversight, and Reporting Act|§33-54-1. Short Title

This article shall be known and cited as the Requiring Accountable Pharmaceutical Transparency, Oversight, and Reporting Act.
WV Code § 33-54-3 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 54. Requiring Accountable Pharmaceutical Transparency, Oversight, and Reporting Act|§33-54-3. Drug Manufacturer Reporting Requirements

(a) Not later than January 15 of each calendar year, a drug manufacturer shall submit a report to the Auditor stating the following information for each brand-name, specialty, and generic drug manufactured by the drug manufacturer and sold in the state directly by the drug manufacturer or a wholesale drug distributor: Provided, That the requirements of this section only apply to: (1) Generic, brand-name, or specialty drugs with a wholesale acquisition cost of at least $100 for a 30-day supply; and (2) A generic, brand-name, or specialty drug manufactured by a drug manufacturer that recognizes a wholesale acquisition cost increase of 40 percent or greater over the preceding three calendar years, or 15 percent or greater in the previous calendar year. (b) The report shall include: (1) The name of the drug;(2) Whether the drug is a brand-name drug or generic drug;(3) The effective date of any change or any reportable change in the wholesale acquisition cost price;(4) The introductory price of the prescription drug when it was approved for marketing by the United States Food and Drug Administration;(5) The national drug code for the specific drug;(6) Aggregate company-level research and development costs for the most recent calendar year for which final audit data is available;(7) The name and annual U.S. sales/revenue of each drug manufacturers prescription drugs that lost patent exclusivity in the United States in the previous three calendar years; and(8) A statement regarding the factor or factors that caused any increase in the wholesale acquisition cost. (c) If the drug manufacturer is subject to reporting requirements established by the Securities and Exchange Commission, the quality and types of information submitted to the Auditor under this section must be consistent with the information that the drug manufacturer includes in the drug manufacturers annual report submitted on Form 10-K to the Securities and Exchange Commission.
WV Code § 33-54-4 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 54. Requiring Accountable Pharmaceutical Transparency, Oversight, and Reporting Act|§33-54-4. Health Benefit Plan Issuer Reporting Requirements

No later than March 1 of each calendar year, each health benefit plan issuer shall submit to the Auditor a report providing the following information for the immediately preceding calendar year: Provided, That nothing in this article should be construed as to requiring a health benefit plan issuer to disclose confidential health information protected by the Health Insurance Portability and Accountability Act:(1) The names of the 25 most frequently prescribed prescription drugs across all plans;(2) The percent increase in annual net spending for prescription drugs across all plans;(3) The percent increase in premiums that were attributable to prescription drugs across all plans;(4) The percentage of specialty drugs with utilization management requirements across all plans; and(5) The premium reductions that were attributable to specialty drug utilization management.
WV Code § 33-54-5 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 54. Requiring Accountable Pharmaceutical Transparency, Oversight, and Reporting Act|§33-54-5. Auditor S Searchable Pharmaceutical Transparency Website Created

(a) By July 1, 2021, the Auditor shall create a searchable pharmaceutical price transparency website, containing the information specified in §33-54-3 and §33-54-4 of this code, available to the public at no cost, and presented in a consumer-friendly, searchable format.(b) Effective July 1, 2021, the Auditor shall update the information displayed on the searchable pharmaceutical price transparency website within 30 days of receiving updated or revised information from a drug manufacturer or health benefit plan issuer.(c) Each drug manufacturer or health benefit plan issuer shall submit to the Auditor in writing contact information for those entities or individuals employed by the health benefit plan issuer or drug manufacturer responsible for complying with reporting requirements specified in §33-54-3 of this code, and shall notify the Auditor within 30 days of any changes to this information.(d) The Auditor shall publish the identity of any drug manufacturer or health benefit plan issuer who fails to comply with the requirements of this article or who submits false or inaccurate information to the Auditor.(e) The Auditor shall compile a report regarding information submitted pursuant to the provisions of §33-54-4 of this code and submit this analysis to the Legislative Oversight Commission on Health and Human Resources Accountability created pursuant to §16-29E-1 et seq. of this code beginning on December 30, 2022, and annually thereafter.
WV Code § 33-55-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 55. Health Benefit Plan Network Access and Adequacy Act|§33-55-2. Applicability and Scope

(a) Except as provided in subsection (b) of this section, this article applies to all health carriers that offer network plans.(b) The following provisions of this article do not apply to health carriers that offer network plans that consist solely of limited scope dental plans or limited scope vision plans:(1) 33-55-3(a)(2) of this code;(2) 33-55-3(f)(7)(E), 33-55-3(f)(8)(B) and 33-55-3(f)(11) of this code;(3) 33-55-4(b)(2) and (3) of this code; and (4) 33-55-4(c)(1)(A) and (B), 33-55-4(c)(2), 33-55-4(c)(3), 33-55-4(d)(1)(B) and 33-55-4(d)(1)(C) of this code.
WV Code § 33-55-5 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 55. Health Benefit Plan Network Access and Adequacy Act|§33-55-5. Intermediaries

A contract between a health carrier and an intermediary shall satisfy all the requirements contained in this section. (a) A health carriers statutory responsibility to monitor the offering of covered benefits to covered persons may not be delegated or assigned to the intermediary. (b) A health carrier has the right to approve or disapprove participation status of a subcontracted provider in its own or a contracted network for the purpose of delivering covered benefits to the carriers covered persons. (c) A health carrier shall maintain copies of all intermediary health care subcontracts at its principal place of business in the state, or ensure that it has access to all intermediary subcontracts, including the right to make copies to facilitate regulatory review, upon 20 days prior written notice from the health carrier. (d) If applicable, an intermediary shall transmit utilization documentation and claims-paid documentation to the health carrier. The carrier shall monitor the timeliness and appropriateness of payments made to providers and health care services received by covered persons. (e) If applicable, an intermediary shall maintain the books, records, financial information, and documentation of services provided to covered persons at its principal place of business in the state and preserve them for two years in a manner that facilitates regulatory review. (f) An intermediary shall allow the commissioner access to the intermediarys books, records, financial information, and any documentation of services provided to covered persons, as necessary to determine compliance with this article. (g) A health carrier has the right, in the event of the intermediarys insolvency, to require the assignment to the health carrier of the provisions of a providers contract addressing the providers obligation to furnish covered services. If a health carrier requires assignment, the health carrier remains obligated to pay the provider for furnishing covered services under the same terms and conditions as the intermediary prior to the insolvency. (h) Notwithstanding any other provision of this section, to the extent the health carrier delegates its responsibilities to the intermediary, the carrier shall retain full responsibility for the intermediarys compliance with the requirements of this article.
WV Code § 33-55-6 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 55. Health Benefit Plan Network Access and Adequacy Act|§33-55-6. Filing Requirements and State Administration

(a) At the time a health carrier files its access plan, the health carrier shall file for approval with the commissioner sample contract forms proposed for use with its participating providers and intermediaries. (b) A health carrier shall submit material changes to a contract that would affect a provision required under this article or implementing regulations to the commissioner for approval at least 30 days prior to use. (c) The health carrier shall maintain provider and intermediary contracts at its principal place of business in the state, or the health carrier shall have access to all contracts and provide copies to facilitate regulatory review upon 20 days prior written notice from the commissioner.
WV Code § 33-55-7 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 55. Health Benefit Plan Network Access and Adequacy Act|§33-55-7. Contracting

(a) The execution of a contract by a health carrier does not relieve the health carrier of its liability to any person with whom it has contracted for the provision of services, nor of its responsibility for compliance with the law or applicable regulations. (b) All contracts shall be in writing and subject to review. (c) All contracts shall comply with applicable requirements of the law and applicable regulations.
WV Code § 33-55-8 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 55. Health Benefit Plan Network Access and Adequacy Act|§33-55-8. Enforcement

(a) If the commissioner determines that a health carrier has not contracted with a sufficient number of participating providers to assure that covered persons have accessible health care services in a geographic area, or that a health carriers network access plan does not assure reasonable access to covered benefits, or that a health carrier has entered into a contract that does not comply with this article, or that a health carrier has not complied with a provision of this article, the commissioner shall require a modification to the access plan or institute a corrective action plan, as appropriate, that shall be followed by the health carrier, or may use any of the commissioners other enforcement powers to obtain the health carriers compliance with this article. (b) The commissioner will not act to arbitrate, mediate, or settle disputes regarding a decision not to include a provider in a network plan or in a provider network or regarding any other dispute between a health carrier, its intermediaries, or one or more providers arising under or by reason of a provider contract or its termination.
WV Code § 33-55-9 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 55. Health Benefit Plan Network Access and Adequacy Act|§33-55-9. Rulemaking

The commissioner shall propose a rule for legislative approval in accordance with the provisions of 29A-3-1 et seq. of this code to implement the provisions of this article.
WV Code § 33-55-10 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 55. Health Benefit Plan Network Access and Adequacy Act|§33-55-10. Penalties

A violation of this article shall be penalized in accordance with 33-4-11 of this code.
WV Code § 33-56-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 56. Health Care Services Provided by Pharmacists|§33-56-1. Services Provided by Pharmacists

(a) For health plans, policies, contracts, or agreements issued, amended, adjusted, or renewed on or after January 1, 2021:(1) Benefits may not be denied for any health care service performed by a pharmacist licensed under 30-5-1 et seq. of this code if:(A) The service performed was within the lawful scope of the pharmacists license;(B) The plan would have provided benefits if the service had been performed by another health care provider; and(C) The pharmacist is included in the plans network of participating providers.(2) The health plan shall include an adequate number of pharmacists in its network of participating health care providers.(b) The participation of pharmacies in the plan networks drug benefit does not satisfy the requirement that plans include pharmacists in their network of participating health care providers.(c) Health benefit plans, policies, contracts, or agreements issued, amended, adjusted, or renewed on or after January 1, 2020, but before January 1, 2021, that delegate credentialing agreements to contracted health care facilities shall accept credentialing for pharmacists employed or contracted by those facilities. Health plans shall reimburse facilities for covered services provided by network pharmacists within the pharmacists scope of practice per negotiations with the facility.(d) For purposes of this section, health plans, policies, contracts, or agreements do not include Medicaid or Children's Health Insurance Program health plans, policies, contracts, or agreements that are approved by the Department of Health and Human Resources Bureau of Medical Services.