reglab/housing_qa huggingface dataset:
WV Code § 33-16D-10 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16D. Marketing and Rate Practices for Small Employer Accident and Sickness Insurance Policies|§33-16D-10. Suspension of Requirements

The commissioner may suspend all or part of the requirements of this article, other than sections four, seven, eight and twelve, applicable to one or more health benefit plans for one or more rating periods upon a filing by the small employer carrier and a finding by the commissioner that either the suspension is reasonable in light of the financial condition of the carrier or that the suspension would enhance the efficiency and fairness of the marketplace for small employer health insurance.
WV Code § 33-16D-11 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16D. Marketing and Rate Practices for Small Employer Accident and Sickness Insurance Policies|§33-16D-11. Effective Date

Except as otherwise provided, the provisions of this article shall apply to each health benefit plan for a small employer situate in the State of West Virginia that is delivered, issued for delivery, renewed or continued after the effective date of this article. For purposes of this section, the date a plan is continued is the first rating period which commences after the effective date of this article.
WV Code § 33-16D-13 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16D. Marketing and Rate Practices for Small Employer Accident and Sickness Insurance Policies|§33-16D-13. Obligations of Employer; Discrimination as to Benefits Paid

Any employer subscribing to a health care benefit plan for or on behalf of its employees pursuant to this chapter shall not discriminate against any eligible employee on the basis of such employee's status with the employer by paying for all or part of the health care benefit plan premiums in a manner different from that provided any other eligible employee: Provided, That any participating small employer must pay at least twenty-five percent of each eligible employee's health care benefit plan premiums.
WV Code § 33-16D-14 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16D. Marketing and Rate Practices for Small Employer Accident and Sickness Insurance Policies|§33-16D-14. Child Immunization Services Coverage

All policies issued pursuant to this article shall cover the cost of child immunization services as described in section five, article three, chapter sixteen of this code, including the cost of the vaccine, if incurred by the health care provider, and all costs of vaccine administration. These services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies or contracts. This section does not require that other health care services provided at the time of immunization be exempt from any deductible and/or copayment provisions.
WV Code § 33-16D-15 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16D. Marketing and Rate Practices for Small Employer Accident and Sickness Insurance Policies|§33-16D-15. Continuation of Coverage Under Small Plans

The Legislature finds that the provisions of this article do not address continuing coverage under a health benefit plan. Therefore, the commissioner is to perform or have performed a study to determine the feasibility and advisability of implementing continuation of coverage under health benefit plans issued to small employers with fewer than twenty employees. The commissioner shall make a report of findings, conclusions and recommendations to the Legislature during its regular session in the year one thousand nine hundred ninety-eight.
WV Code § 33-16E-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16E. Contraceptive Coverage|§33-16E-1. Findings; Short Title

(a) This article may be referred to as the "Prescription Fairness Act of 2005."(b) The Legislature hereby finds and declares that:(1) Contraceptives prevent unintended pregnancy;(2) Planned pregnancies lead to healthier pregnancies, children and families; and(3) Contraceptive coverage provides West Virginians with critical access to birth control.(4) Therefore, the Legislature finds that prescription contraceptives are basic health-care for West Virginia's women and families and that health insurance plans which include a prescription drug plan should be required to cover contraceptives.
WV Code § 33-16E-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16E. Contraceptive Coverage|§33-16E-2. Definitions

For the purposes of this article, these definitions are applicable unless a different meaning clearly appears from the context.(1) "Contraceptives" means drugs or devices approved by the food and drug administration to prevent pregnancy.(2) "Covered person" means the policyholder, subscriber, certificate holder, enrollee or other individual who is participating in, or receiving coverage under a health insurance plan. For the purposes of this article, covered person does not include a dependent child.(3) "Health insurance plan" means benefits consisting of medical care provided directly, through insurance or reimbursement, or indirectly, including items and services paid for as medical care, under any hospital or medical expense incurred policy or certificate; hospital, medical or health service corporation contract; health maintenance organization contract; fraternal benefit society contract; plan provided by a multiple-employer trust or a multiple-employer welfare arrangement; or plan provided by the West Virginia Public Employees Insurance Agency pursuant to article sixteen, chapter five of this code.(4) "Outpatient contraceptive services" means consultations, examinations, procedures and medical services, provided on an outpatient basis and related to the use of prescription contraceptive drugs and devices to prevent pregnancy issued under a health insurance plan that provides benefits for prescription drugs or prescription devices in a prescription drug plan.(5) "Religious employer" is an entity whose sincerely held religious beliefs or sincerely held moral convictions are central to the employer's operating principles, and the entity is an organization listed under 26 U.S.C. 501 (c)(3), 26 U.S.C. 3121, or listed in the Official Catholic Directory published by P.J. Kennedy and Sons.
WV Code § 33-16E-3 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16E. Contraceptive Coverage|§33-16E-3. Applicability

(a) The provisions of this article apply to individual and group health insurance plans issued by accident and sickness insurers; health maintenance organizations; fraternal benefit societies; hospital service corporations; the West Virginia Public Employees Insurance Agency; health-care service corporations; health service corporations; multiple employee trusts; and multiple employer welfare arrangements. The provisions of this section shall not apply to persons eligible for coverage under Title XIX of the Social Security Act, known as Medicaid (42 U.S.C. §1396a et seq.), or for any other similar coverage under state or federal governmental plans.(b) The provisions of this article do not apply to:(1) Any policy of liability insurance or contract supplemental thereto; coverage only for accident or disability income insurance or any combination thereof; automobile medical payment insurance; credit-only insurance; coverage for on-site medical clinics; workers' compensation insurance; or other similar insurance under which benefits for medical care are secondary or incidental to other insurance benefits;(2) If offered separately, a policy providing benefits for long-term care, nursing home care, home health care, community-based care or any combination thereof, dental or vision benefits, or other similar, limited benefits;(3) If offered as independent, noncoordinated benefits under separate policies or certificates, specified disease or illness coverage, hospital indemnity or other fixed indemnity insurance, or coverage, such as Medicare supplement insurance, supplemental to a group health plan; or(4) A policy of accident and sickness insurance covering a period of less than one year.
WV Code § 33-16E-4 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16E. Contraceptive Coverage|§33-16E-4. Parity for Contraceptive Drugs, Devices and Outpatient Services

(a) Health insurance plans that provide benefits for prescription drugs or prescription devices in prescription drug plans may not exclude or restrict benefits to covered persons for any prescription contraceptive drug or prescription contraceptive device approved by the federal Food and Drug Administration. All customary benefit management rules, including, but not limited to, drug formularies and coverage criteria may be applied by the health insurance plan.(b) Health insurance plans that provide benefits for prescription drugs or prescription devices in a prescription drug plan and that provide benefits for outpatient services provided by a health care professional may not exclude or restrict outpatient contraceptive services for covered persons for prescription contraceptives or prescription devices.
WV Code § 33-16E-5 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16E. Contraceptive Coverage|§33-16E-5. Extraordinary Surcharges Prohibited

A health insurance plan is prohibited from:(1) Imposing deductibles, copayments, other cost-sharing mechanisms, or waiting periods for prescription contraceptive drugs or devices greater than deductibles, copayments, other cost-sharing mechanisms or waiting periods for other covered prescription drugs or devices.(2) Imposing deductibles, copayments, other cost-sharing mechanisms or waiting periods for outpatient contraceptive services greater than such deductibles, copayments, other cost-sharing mechanisms or waiting periods for other covered outpatient services.
WV Code § 33-16E-6 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16E. Contraceptive Coverage|§33-16E-6. Additional Prohibitions

A health insurance plan is prohibited from:(1) Denying eligibility, enrollment or renewal of coverage to any individual because of their use or potential use of contraceptives.(2) Providing monetary payments or rebates to covered persons to encourage them to accept less than the minimum protections available under this section.(3) Penalizing, or otherwise reducing or limiting the reimbursement of a health care professional because such professional prescribed contraceptive drugs or devices, or provided contraceptive services.(4) Providing incentives, monetary or otherwise, to a health-care professional to induce such professional to withhold contraceptive drugs, devices or services from covered persons.
WV Code § 33-16E-7 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16E. Contraceptive Coverage|§33-16E-7. Religious Employer Exemption

(a) Notwithstanding any other provision of this article, a religious employer may exclude or restrict from any health-care insurance plan contract benefits for any prescription contraceptive drugs and devices that are contrary to the religious employer's religious tenets.(b) Nothing in this article shall be construed to exclude coverage for prescription contraceptive supplies ordered by a health-care provider with prescriptive authority for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for prescription contraception that is necessary to preserve the life or health of an enrollee.(c) The health insurer for every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health-care services the employer refuses to cover for religious reasons. The health insurer shall make available for purchase at the prevailing group rate a rider that provides prescription contraceptive drugs and devices.
WV Code § 33-16F-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16F. Group Limited Health Benefits Plans|§33-16F-1. Legislative Intent

The Legislature finds that the inability of a significant number of state residents to obtain affordable health insurance coverage adversely affects everyone in our state. Therefore, it is the intent of the Legislature to expand the availability of health care options for uninsured residents by developing affordable health care products that emphasize coverage for basic and preventive health care services, provide inpatient hospital and emergency care services and offer optional catastrophic coverage.
WV Code § 33-16F-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16F. Group Limited Health Benefits Plans|§33-16F-2. Definitions

As used in this article:"West Virginia affordable health care plan" means a health insurance plan approved under this article."West Virginia affordable health care plan entity" or "plan entity" means an entity licensed under this chapter that develops and proposes a West Virginia affordable health care plan and, if the plan is approved, is responsible for administering the plan and paying claims of plan enrollees."Enrollee" means an individual who has been determined to be eligible for and is receiving health insurance coverage under a West Virginia affordable health care plan.
WV Code § 33-16F-3 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16F. Group Limited Health Benefits Plans|§33-16F-3. Plan Proposals; Approval of Plans

(a) The commissioner shall announce, no later than July 1, 2009, an invitation to prospective West Virginia affordable health care plan entities to submit West Virginia affordable health care plan proposals. The invitation shall include guidelines for the review of West Virginia affordable health care plan applications, policies and associated rates.(b) In reviewing proposals under this article, the commissioner shall consider the proposed plans' effectiveness in improving the health status of individuals, their impact on maintaining and improving health and their potential to reduce the unnecessary consumption of health care services.
WV Code § 33-16F-4 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16F. Group Limited Health Benefits Plans|§33-16F-4. Required Plan Provisions; Grounds for Disapproval; Alternative Plans

(a) To be approved, plan entities must assure that each proposed plan will provide cost containment through the use of plan design features such as limits on the number of services, caps on benefit payments or copayments for services.(b) To provide consumer choice, plan entities must develop and submit two alternative benefit option plans having different cost and benefit levels, including at least one plan that provides catastrophic coverage. Plans providing catastrophic coverage must, at a minimum, provide coverage for preventive health services and inpatient hospital stays and may also include coverage of one or more of the following: Hospital emergency care services and outpatient facility services; outpatient surgery; or outpatient diagnostic services.(c) All plans must offer prescription drug benefit coverage.(d) Plan enrollment materials must provide information in plain language on policy benefit coverage, benefit limits, cost-sharing requirements, exclusions and a clear representation of what is not covered in the plan. The enrollment materials must include a standard disclosure form developed by the commissioner that must be reviewed and executed by all consumers purchasing West Virginia affordable health care plan coverage.(e) The commissioner shall disapprove any plan that:(1) Contains any ambiguous, inconsistent or misleading provisions or any exceptions or conditions that deceptively affect or limit the benefits purported to be assumed in the general coverage provided by the plan;(2) Provides benefits that are unreasonable in relation to the premium charged; or(3) Contains provisions that are unfair or inequitable, contrary to the public policy of this state, encourage misrepresentation or result in unfair discrimination in sales practices.
WV Code § 33-16F-5 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16F. Group Limited Health Benefits Plans|§33-16F-5. Eligibility of Individuals and Groups

(a) Individuals. –- Eligibility to enroll in an individual West Virginia affordable health care plan is limited to any resident of this state who:(1) Is not covered by a private insurance policy and is not eligible for coverage under an employer-sponsored group plan or through a public health insurance program, such as Medicare, Medicaid or the state Children's Health Insurance Program; and(2) Has not been covered by any health insurance program at any time during the past six months, unless coverage under a health insurance program was terminated within the previous six months due to loss of a job that provided an employer-sponsored health benefit plan or death of, or divorce from, a spouse who was provided an employer-sponsored health benefit plan or, with respect to a public health insurance program, eligibility for such program was lost due to an inability to meet income or categorical requirements: Provided, That an individual may not be excluded from enrollment in a West Virginia affordable health care plan on the ground that he or she is eligible for or is enrolled in a COBRA plan.(b) Group. -– An otherwise eligible group may not obtain coverage under a West Virginia affordable health care plan unless the group has not had coverage under any health insurance plan at any time during the previous six months.
WV Code § 33-16F-6 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16F. Group Limited Health Benefits Plans|§33-16F-6. Regulation and Marketing of Plans

(a) The commissioner shall issue guidelines to ensure that West Virginia affordable health care plans meet minimum standards for quality of and access to care.(b) Initial filings and changes in West Virginia affordable health care plan benefits, premiums and policy forms are subject to regulatory oversight by the commissioner.(c) The commissioner shall develop a public awareness program to be implemented throughout the state for the promotion of the plans approved under this article, which may include assistance from state health insurance benefits advisors.(d) Each West Virginia affordable health care plan must maintain enrollment data and provide network data and reasonable records to enable the commissioner to assess the plans.
WV Code § 33-16F-8 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16F. Group Limited Health Benefits Plans|§33-16F-8. Assessment of the West Virginia Program

The commissioner shall:(1) Provide an assessment of the West Virginia affordable health care plans and their potential applicability in other settings;(2) Use West Virginia affordable health care plans to gather more information to evaluate low-income, consumer-driven benefit packages; and(3) Submit by March 1, 2011, and annually thereafter, a report to the Governor, the President of the Senate and the Speaker of the House of Delegates that provides the information specified in this section and recommendations relating to the successful implementation and administration of the program.
WV Code § 33-16F-9 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16F. Group Limited Health Benefits Plans|§33-16F-9. Nonentitlement

Coverage under a West Virginia affordable health care plan is not an entitlement and a cause of action does not arise against the state, a local government entity, any other political subdivision of the state or any agency for failure to make coverage available to eligible persons under this article.
WV Code § 33-16F-10 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16F. Group Limited Health Benefits Plans|§33-16F-10. Emergency and Legislative Rules Authorized

The commissioner may promulgate emergency and legislative rules under the provisions of article three, chapter twenty-nine-a of this code, to prescribe requirements regarding rate making, which may include rules establishing loss ratio standards for the plans; to place limitations on eligibility for coverage under the approved plans; to establish standards to determine whether a plan qualifies as creditable coverage; to determine what medical treatments, procedures and related health services benefits must be included in the plans; and to provide for any other matters deemed necessary to further the intent of this article.
WV Code § 33-16H-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16H. Review of Adverse Determinations|§33-16H-1. Definitions

As used in this article:(1) "Adverse determination" means a determination by a health carrier or its designee utilization review organization that an admission, availability of care, continued stay or other healthcare service that is a covered benefit has been reviewed and, based upon the information provided, does not meet the health carrier's requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness, and the requested service or payment for the service is therefore denied, reduced or terminated.(2) "External review" means a review of a final adverse determination by an independent review organization.(3) "Final adverse determination" means an adverse determination that has been upheld by the issuer at the completion of the internal grievance procedures or an adverse determination with respect to which the internal grievance procedures have been deemed exhausted.(4) "Health benefit plan" means a policy, contract, certificate or agreement entered into, offered or issued by an issuer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including short-term and catastrophic health insurance policies and policies that pay on a cost-incurred basis, but excludes the excepted benefits defined in 42 U. S. C. §300gg-91 and policies, contracts, certificates or agreements excluded by rules promulgated pursuant to section four of this article.(5) "Health plan issuer" or "issuer" means an entity required to be licensed under this chapter that contracts, or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services under a health benefit plan, including an accident and sickness insurance company, a health maintenance corporation, a health care corporation, a health or hospital service corporation, and a fraternal benefit society.(6) "Independent review organization" means an entity approved by the commissioner to conduct external reviews of final adverse determinations.(7) "Utilization review" means a system for the evaluation of the necessity, appropriateness and efficiency of the use of health care services, procedure and facilities.
WV Code § 33-16H-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 16H. Review of Adverse Determinations|§33-16H-2. Issuer Requirements

An issuer shall, in accordance with rules promulgated pursuant to section four of this article, develop processes for utilization review and internal grievance procedures and shall make external review available with respect to all adverse determinations.