reglab/housing_qa huggingface dataset:
WV Code § 33-25D-29 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25D. Prepaid Limited Health Service Organization Act|§33-25D-29. Authority to Contract With Prepaid Limited Health Service Organizations Under Medicaid

The Department of Health and Human Resources is authorized to enter into contracts with prepaid limited health service organizations certified and permitted to market under the laws of this state, and to furnish to recipients of medical assistance under Title XIX of the Social Security Act, 42 U.S.C. §1396, et seq., limited health services offered to such recipients under the medical assistance plan of West Virginia. The children's health policy board, the Department of Health and Human Resources, and the Division of Juvenile Services within the Department of Military Affairs and Public Safety are further authorized to enter into contracts with prepaid limited health service organizations to furnish behavioral health services to adults and children who are eligible to receive such services under chapter five, chapter sixteen, chapter twenty-seven or chapter forty-nine of this code.
WV Code § 33-25D-30 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25D. Prepaid Limited Health Service Organization Act|§33-25D-30. Authority of Commissioner to Propose Rules Regarding Affiliate and Subsidiary Operating Results

The commissioner may after notice and hearing propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code to define the commissioner's authority to consider the operating results of an insurer's affiliates and subsidiaries in the rate making and solvency determination of that insurer.
WV Code § 33-25E-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25E. Patients' Eye Care Act|§33-25E-1. Short Title

This article may be referred to as the patients' eye care act.
WV Code § 33-25E-3 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25E. Patients' Eye Care Act|§33-25E-3. Limitations on Conditions of Coverage

(a)Health benefits policies may not require that an optometrist hold hospital staff privileges.(b)When any health benefits policy provides for the payment of eye care benefits or vision care benefits, such policy shall be construed to include payment to all eye care providers who provide benefits within the scope of their providers' licenses.(c)Any limitation or condition placed upon services, diagnosis or treatment by or payment to a particular type of licensed provider shall apply equally to all licensed providers without unfair discrimination as to the usual and customary treatment procedures of an eye care provider.(d)Any health benefits policy that includes eye care benefits, including a diabetic retinal examination, shall provide each covered person diagnosed with diabetes direct access to an eye care provider of their choice from the insurer's panel of providers independent of, and without referral from, any other provider or entity for one annual diabetic retinal examination. The eye care provider shall provide copies of the results of the examination to the covered person's primary care physician. No other services shall be provided to the covered person by the eye care provider without the prior authorization of the insurer or of its designee. This benefit shall be subject to all coinsurance, deductibles, copayments and other policy requirements. When the diabetic retinal examination reveals the beginning stages of an abnormal condition, access to future examinations shall be subject to prior authorization from a primary care physician.(e)Any health benefits policy that includes eye care benefits or vision care benefits shall include both optometrists and ophthalmologists.(f)This article may not be construed to require any health benefits policy to cover any specific health care service.(g)This article may not be construed to require a health benefit plan or an insurer to include on the insurer's panel of providers all providers willing to meet the terms and conditions of participation as a plan provider.
WV Code § 33-25E-4 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25E. Patients' Eye Care Act|§33-25E-4. Required Disclosure

Every health benefits policy that is issued, delivered, issued for redelivery or renewed in this state on or after January 1, 2001, that provides for eye care benefits, including a diabetic retinal examination, shall disclose in writing, in clear and accurate language, to enrollees, subscribers, providers and insureds that any covered person diagnosed with diabetes has the right to direct access to an eye care provider of their choice from the insurer's panel of providers for an annual diabetic retinal examination.
WV Code § 33-25G-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25G. Provider Sponsored Networks|§33-25G-1. Legislative Findings

The Legislature finds that, in light of the need to provide health care to a Medicaid population that is expected to rise dramatically in the near future, new models of managed care should be explored in order to enhance the state's ability to improve health outcomes and to manage the financial risk associated with the provision of such care. This article provides a licensing and regulatory scheme for provider sponsored networks, an alternative managed care model recognized in federal law, that recognizes the unique features of such entities.
WV Code § 33-25G-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25G. Provider Sponsored Networks|§33-25G-2. Definitions

(a) "Federally Qualified Health Center" means an entity as defined in 42 U.S.C. §1396d(l)(2)(B).(b) "Medicaid beneficiary" means any person participating, through either a state plan amendment or waiver demonstration, in any Medicaid program administered by the West Virginia Department of Health and Human Resources or its Bureau for Medical Services.(c) "Participating provider" means a licensed health care provider who has entered into a contract with a provider sponsored network to provide services to Medicaid enrollees.(d) "Provider sponsored network" means an entity that satisfies the definition of a "Medicaid managed care organization" set forth in 42 U.S.C. §1396b(m)(1)(A), is controlled by one or more Federally Qualified Health Centers, as set forth in 42 U.S.C. §1396b(m)(1)(C)(ii)(IV), and provides or otherwise makes available health care services solely to Medicaid beneficiaries or beneficiaries of medicaid or medicare pursuant to contract with the secretary executed in accordance with article two-l, chapter sixteen of this code.(e) "Secretary" means the Secretary of the West Virginia Department of Health and Human Resources.
WV Code § 33-25G-3 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25G. Provider Sponsored Networks|§33-25G-3. Licensing of Provider Sponsored Networks

(a) Except to the extent provided otherwise in this article, a provider sponsored network is subject to the provisions of article twenty-five-a of this chapter to the same extent as an HMO.(b) Notwithstanding the provisions of section four, article twenty-five-a of this chapter, in determining whether a provider sponsored network has demonstrated in its application for a certificate of authority or at a later time that it is financially responsible and may reasonably be expected to meet its obligations to Medicaid beneficiaries, the commissioner may, in his or her sole discretion and after consultation with the secretary, impose lower or different solvency requirements, including lower surplus and capital. In deciding whether to permit lower or different solvency standards, the commissioner shall consider actuarial evaluations and other qualified technical standards and may also consider factors such as a lower risk of insolvency, any transfer of risk to a third party, and the restriction of the provider sponsored network to the provision of Medicaid-related services; these same factors may also be considered in reviewing and acting upon a provider sponsored network's RBC report.(c) A provider sponsored network may at any time seek to convert its certificate of authority granted pursuant to this article to a certificate of authority to operate as an HMO by filing an application in accordance with the provisions of article twenty-five-a of this chapter.
WV Code § 33-25G-4 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25G. Provider Sponsored Networks|§33-25G-4. Provider Participation

(a) Any willing physician or licensed behavioral health provider is entitled to participate in a provider sponsored network provided that he or she is willing to participate in the health care delivery approach designed by the provider sponsored network and such other applicable requirements of the Department of Health and Human Resources.(b) As a condition of provider participation, including participation by hospitals, a provider sponsored network may require that its care management protocols be observed, including provisions for designations of certain services that may be provided only by designated providers or classes of providers, requirements that providers be credentialed before they may provide certain services, and requirements that providers comply with utilization management programs and referral systems as established by the provider sponsored network. A provider sponsored network may not require a participating physician provider to sell or transfer ownership of his, her or its assets or practice operations to the provider sponsored network or any of its participating providers as a condition of participation or of being permitted access or use of the provider sponsored network's medical home resources and care management systems.(c) A participating provider shall have the right to participate in, and contract with, other networks or other managed care organizations to provide services to Medicaid beneficiaries.
WV Code § 33-25G-5 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25G. Provider Sponsored Networks|§33-25G-5. Rules

The commissioner may promulgate emergency rules and shall propose for legislative approval legislative rules, in accordance with the provisions of article three, chapter twenty-nine-a of this code, as are necessary to provide for implementation and enforcement of the provisions of this article.
WV Code § 33-26-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-1. Short Title

This article may be cited as the "West Virginia Insurance Guaranty Association Act."
WV Code § 33-26-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-2. Purpose

The purpose of this article is to provide a mechanism for the payment of covered claims under certain insurance policies to avoid excessive delay in payment and to the extent provided in this article, minimize financial loss to claimants or policyholders because of the insolvency of an insurer, and to permit and to provide an association to assess the cost of this protection among insurers.
WV Code § 33-26-3 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-3. Scope

This article applies to all kinds of direct insurance, but is not applicable to the following:(1) Life, annuity, health or disability insurance;(2) Mortgage guaranty, financial guaranty or other forms of insurance offering protection against investment risks;(3) Fidelity or surety bonds, or any other bonding obligations;(4) Credit insurance, vendors’ single interest insurance or collateral protection insurance or any similar insurance protecting the interests of a creditor arising out of a creditor-debtor transaction;(5) Insurance of warranties or service contracts including insurance that provides for the repair, replacement or service of goods or property, indemnification for repair, replacement or service for the operational or structural failure of the goods or property due to a defect in materials, workmanship or normal wear and tear, or provides reimbursement for the liability incurred by the issuer of agreements or service contracts that provide such benefits;(6) Title insurance;(7) Ocean marine insurance;(8) Any transaction or combination of transactions between a person, including affiliates of such person, and an insurer, including affiliates of the insurer, which involves the transfer of investment or credit risk unaccompanied by transfer of insurance risk; or(9) Any insurance provided by or guaranteed by a government entity or agency.
WV Code § 33-26-4 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-4. Construction

This article shall be construed to effect the purpose under section two of this article which constitutes an aid and guide to interpretation.
WV Code § 33-26-6 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-6. Creation of the Association

There is created a nonprofit unincorporated legal entity to be known as the West Virginia Insurance Guaranty Association. All insurers defined as member insurers in section five of this article shall be and remain members of the association as a condition of their authority to transact insurance in this state. The association shall perform its functions under a plan of operation established and approved under section nine of this article and shall exercise its powers through a board of directors established under section seven of this article. For purposes of administration and assessment, the association shall establish and maintain three separate accounts:(1) The automobile insurance account;(2) The workers' compensation insurance account; and(3) The account for all other insurance to which this article applies.
WV Code § 33-26-7 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-7. Board of Directors

(1) The board of directors of the association shall consist of not less than five nor more than nine persons serving terms as established in the plan of operation. The members of the board shall be selected by member insurers subject to the approval of the commissioner. Vacancies on the board shall be filled for the remaining period of the term in the same manner as initial appointments. If no members are selected within sixty days after the effective date of this article, the commissioner may appoint the initial members of the board of directors.(2) In approving selections to the board, the commissioner shall consider among other things whether all member insurers are fairly represented.(3) Members of the board may be reimbursed from the assets of the association for expenses incurred by them as members of the board of directors.
WV Code § 33-26-9 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-9. Plan of Operation

(a) The association shall:(1) Submit to the commissioner a plan of operation and any amendments thereto necessary or suitable to assure the fair, reasonable and equitable administration of the association. The plan of operation and any amendments thereto become effective upon approval in writing by the commissioner.(2) If the association fails to submit a suitable plan of operation within ninety days following the effective date of this article or if at any time thereafter the association fails to submit suitable amendments to the plan, the commissioner shall, after notice and hearing, adopt rules for legislative approval as are necessary or advisable to effectuate the provisions of this article. The rules shall continue in force until modified by the commissioner or superseded by a plan submitted by the association and approved by the commissioner. All such rules shall be proposed in accordance with chapter twenty-nine-a of this code.(b) All member insurers shall comply with the plan of operation.(c) The plan of operation shall:(1) Establish the procedures whereby all the powers and duties of the association under section eight of this article will be performed.(2) Establish procedures for handling assets of the association.(3) Establish the amount and method of reimbursing members of the board of directors under section seven of this article.(4) Establish procedures by which claims may be filed with the association and establish acceptable forms of proof of covered claims. (5) Establish regular places and times for meetings of the board of directors.(6) Establish procedures for records to be kept of all financial transactions of the association, its agents and the board of directors.(7) Provide that any member insurer aggrieved by a final action or decision of the association may appeal to the commissioner within thirty days after the action or decision.(8) Establish the procedures whereby selections for the board of directors will be submitted to the commissioner.(9) Contain additional provisions necessary or proper for the execution of the powers and duties of the association.(d) The plan of operation may provide that any or all powers and duties of the association, except those under subdivision (3), subsection (a), and subdivision (2), subsection (b), section eight of this article are delegated to a corporation, association or other organization which performs or will perform functions similar to those of this association, or its equivalent, in two or more states. Such a corporation, association or organization shall be reimbursed as a servicing facility would be reimbursed and shall be paid for its performance of any other functions of the association. A delegation under this subsection may take effect only with the approval of both the board of directors and the commissioner, and may be made only to a corporation, association or organization which extends protection not substantially less favorable and effective than that provided by this article.
WV Code § 33-26-10 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-10. Duties and Powers of the Commissioner

(a) The commissioner shall:(1) Notify the association of the existence of an insolvent insurer not later than three business days after he or she receives notice of the determination of the insolvency.(2) Upon request of the board of directors, provide the association a statement of the net direct written premiums of each member insurer.(b) The commissioner may:(1) Require that the association notify the insureds of the insolvent insurer and any other interested parties of the determination of insolvency and of their rights under this article. The notification shall be by mail at their last known address, where available, but if sufficient information for notification by mail is not available, notice by publication in a newspaper of general circulation is sufficient.(2) Suspend or revoke, after notice and hearing, the certificate of authority to transact insurance in this state of any member insurer which fails to pay an assessment when due or fails to comply with the plan of operation. As an alternative, the commissioner may levy a fine on any member insurer which fails to pay an assessment when due. The fine may not exceed five percent of the unpaid assessment per month, except that no fine may be less than $100 per month.(3) Revoke the designation of any servicing facility if he or she finds that claims are being handled unsatisfactorily.(c) Any final order of the commissioner under this article is subject to judicial review as provided by section fourteen, article two of this chapter.
WV Code § 33-26-13 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-13. Prevention of Insolvencies

To aid in the detection and prevention of insurer insolvencies:(1) The board of directors may, upon majority vote, make recommendations to the commissioner on matters generally related to improving or enhancing regulation for solvency.(2) At the conclusion of any domestic insurer insolvency in which the association was obligated to pay covered claims, the board of directors may, upon majority vote, prepare a report on the history and causes of the insolvency, based on the information available to the association and submit the report to the commissioner.(3) Reports and recommendations provided under this section may not be considered public documents subject to disclosure under chapter twenty-nine-b of this code.
WV Code § 33-26-14 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-14. Examination of Association; Financial Report

The association shall be subject to examination and regulation by the commissioner. The board of directors shall submit, not later than April 30 of each year, a financial report for the preceding calendar year, in a form approved by the commissioner.
WV Code § 33-26-15 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-15. Tax Exemption

The association shall be exempt from payment of all fees and all taxes levied by this state or any of its subdivisions except taxes levied on real or personal property.
WV Code § 33-26-16 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-16. Recognition of Assessments in Rates

The rates and premiums charged for insurance policies to which this article applies shall include amounts sufficient to recoup a sum equal to the amounts paid to the association by the member insurer less any amounts returned to the member insurer by the association and such rates shall not be deemed excessive because they contain an amount reasonably calculated to recoup assessments paid by the member insurer.
WV Code § 33-26-17 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-17. Immunity

There shall be no liability on the part of and no cause of action of any nature shall arise against any member insurer, the association or its agents or employees, the board of directors, or the commissioner or his representatives for any action taken by them in the exercise and performance of their powers and duties under this article.
WV Code § 33-26-18 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 26. West Virginia Guaranty Association Act|§33-26-18. Stay of Proceedings; Reopening of Default Judgments

(a) All proceedings in which the insolvent insurer is a party or obligated to defend a party in any court in this state shall, subject to waiver by the association in specific cases involving covered claims, be stayed for six months and such additional time as may be determined by the court from the date the insolvency is determined to permit proper defense by the association of all pending causes of action.(b) The liquidator, receiver or statutory successor of an insolvent insurer covered by this article shall permit access by the association, or its authorized representative to such of the insolvent insurer’s records that are necessary for the association in carrying out its functions under this article with regard to covered claims. In addition, the liquidator, receiver or statutory successor shall provide the association or its representative with copies of such records upon the request by the association and at the expense of the association.(c) As to any covered claims arising from a judgment under any order, decision, verdict or finding based on the default of the insolvent insurer or its wrongful failure to defend an insured, the association either on its own behalf or on behalf of such insured may apply to have such judgment, order, decision, verdict or finding set aside by the same court or administrator that made such judgment, order, decision, verdict or finding and shall be permitted to defend against such claim on the merits.