West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-18 - Reg Relating To Supplemental Insurance Coverage For Continum Of Care Services For Elderly, Disabled And Terminally Ill › Section 114-18-3 - Coverage Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
3.01.
				Availability - Any insurance policy, contract or certificate specified in Section
				2.01 of this regulation which is delivered or issued for delivery in West Virginia
				on or after the first day of April, 1984, shall make available to the policyholder,
				subscriber or certificateholder supplemental insurance coverage for continuum, of
				care services consistent with the provisions of this regulation. Any insurance
				policy, contract or certificate specified in Section 2.01 of this regulation which
				was delivered or issued for delivery in West Virginia before the first day of April,
				1984, shall make available to the policyholder, subscriber, or certifi-cateholder,
				in the manner hereinafter prescribed, supplemental insurance coverage for continuum
				of care services consistent with the provisions of this regulation. The
				policyholder, subscriber or certificateholder shall be notified in writing not less
				than thirty (30) calendar days prior to the first anniversary renewal date of the
				policy, contract or certificate immediately subsequent to April 1, 1984, that such
				supplemental insurance coverage is available without underwriting qualification if
				the supplemental insurance coverage is elected no later than thirty (30) calendar
				days immediately subsequent to the renewal date. Underwriting qualification may be
				required if the supplemental insurance coverage is elected at any subsequent
				anniversary renewal; provided, however, any underwriting criteria shall not be
				unfairly discriminatory.
3.02. Minimum
				Benefit Standards - Supplemental insurance coverage for continuiim of care services
				shall include the following minimum benefits:
(A)
				Benefits for services determined to be necessary and appropriate by the case manager
				or responsible member of the comprehensive hospice care program, in accordance with
				the case management system or comprehensive hospice care program established by the
				West Virginia Continuum of Care Board pursuant to the provisions of Chapter 16,
				Article 5D of the Code of West Virginia of 1931, as amended.
(1) Provided, however, that benefits for counsel
				ing services may be limited as follows:
(a)
				Counseling benefits in general for the policyholder, subscriber-or certificate- ,
				holder and his immediate family, including his spouse, children, parentsr siblings
				and children of his spouse, may be limited to a maximum of twelve sessions
				collectively at a total benefit payment not to exceed one thousand dollars
				($1,000.00) during each twelve (12) month period.
(i) There shall be no requirement that any
				immediate family member be a named insured under the policy, contract or certificate
				as a prerequisite to receipt of counseling benefits.
(ii) There shall be no deductible or coinsurance
				requirement in regard to the counseling benefits either for the
				policyholder,'subscriber or certificateholder or his immediate family members.