Article

Health Maintenance Organization Act

W. Va. Code § 33-25A-1— Short title and purpose
W. Va. Code § 33-25A-2— Definitions
W. Va. Code § 33-25A-3— Application for certificate of authority
W. Va. Code § 33-25A-3a— Conditions precedent to issuance or maintenance of a certificate of authority; renewal of certificate of authority; effect of bankruptcy proceedings
W. Va. Code § 33-25A-4— Issuance of certificate of authority
W. Va. Code § 33-25A-5— Powers of health maintenance organizations
W. Va. Code § 33-25A-6— Governing body
W. Va. Code § 33-25A-7— Fiduciary responsibilities of officers; fidelity bond; approval of contracts by commissioner
W. Va. Code § 33-25A-7a— Provider contracts
W. Va. Code § 33-25A-7b— Loss ratio
W. Va. Code § 33-25A-8— Evidence of coverage; charges for health care services; review of enrollee records; cancellation of contract by enrollee
W. Va. Code § 33-25A-8a— Third party reimbursement for mammography, pap smear or human papilloma virus testing
W. Va. Code § 33-25A-8b— Third party reimbursement for rehabilitation services
W. Va. Code § 33-25A-8c— Third party payment for child immunization services
W. Va. Code § 33-25A-8d— Coverage of emergency services
W. Va. Code § 33-25A-8e— Third party reimbursement for colorectal cancer examination and laboratory testing
W. Va. Code § 33-25A-8f— Required coverage for reconstruction surgery following mastectomies
W. Va. Code § 33-25A-8g— Required use of mail-order pharmacy prohibited
W. Va. Code § 33-25A-8h— Third-party reimbursement for kidney disease screening
W. Va. Code § 33-25A-8i— Third-party reimbursement for dental anesthesia services
W. Va. Code § 33-25A-8j— Coverage for diagnosis and treatment of autism spectrum disorders
W. Va. Code § 33-25A-8k— Maternity coverage
W. Va. Code § 33-25A-8l— Deductibles, copayments and coinsurance for anti-cancer medications
W. Va. Code § 33-25A-8m— Eye drop prescription refills
W. Va. Code § 33-25A-8n— Deductibles, copayments and coinsurance for abuse-deterrent opioid analgesic drugs
W. Va. Code § 33-25A-8o— Step therapy
W. Va. Code § 33-25A-8p— Lyme disease to be covered by all health insurance policies
W. Va. Code § 33-25A-8q— Coverage for amino acid-based formulas
W. Va. Code § 33-25A-8r— Substance use disorder
W. Va. Code § 33-25A-8s— Prior authorization
W. Va. Code § 33-25A-8t— Fairness in Cost-Sharing Calculation
W. Va. Code § 33-25A-8u— Mental health parity
W. Va. Code § 33-25A-8v— Incorporation of the Health Benefit Plan Access and Adequacy Act
W. Va. Code § 33-25A-8w— Incorporation of the coverage for 12-month refill for contraceptive drugs
W. Va. Code § 33-25A-8x— Copayments for certain services
W. Va. Code § 33-25A-8y— Coverage of emergency medical services to triage and transport to alternative destination or treat in place
W. Va. Code § 33-25A-9— Annual report
W. Va. Code § 33-25A-10— Information to enrollees
W. Va. Code § 33-25A-11— Open enrollment period
W. Va. Code § 33-25A-12— Grievance procedure
W. Va. Code § 33-25A-13— Investments
W. Va. Code § 33-25A-14— Prohibited advertising practices
W. Va. Code § 33-25A-14a— Other prohibited practices
W. Va. Code § 33-25A-15— Agent licensing and appointment required; regulation of marketing
W. Va. Code § 33-25A-16— Powers of insurers and hospital and medical service corporations
W. Va. Code § 33-25A-17— Examinations
W. Va. Code § 33-25A-17a— Quality assurance
W. Va. Code § 33-25A-18— Suspension or revocation of certificate of authority
W. Va. Code § 33-25A-19— Rehabilitation, liquidation or conservation of health maintenance organization
W. Va. Code § 33-25A-20— Regulations
W. Va. Code § 33-25A-21— Administrative procedures
W. Va. Code § 33-25A-22— Fees
W. Va. Code § 33-25A-23— Penalties and enforcement
W. Va. Code § 33-25A-23a— Civil penalty imposed by commissioner
W. Va. Code § 33-25A-24— Scope of provisions; applicability of other laws
W. Va. Code § 33-25A-24a
W. Va. Code § 33-25A-24b
W. Va. Code § 33-25A-25— Filings and reports as public documents
W. Va. Code § 33-25A-26— Confidentiality of medical information
W. Va. Code § 33-25A-27— Authority to contract with health maintenance organizations under Medicaid
W. Va. Code § 33-25A-28— Required health maintenance organization option
W. Va. Code § 33-25A-29
W. Va. Code § 33-25A-30
W. Va. Code § 33-25A-31— Policies discriminating among health care providers
W. Va. Code § 33-25A-32— Authority of commissioner to promulgate rules and regulations regarding affiliate and subsidiary operating results
W. Va. Code § 33-25A-33— Guaranty fund
W. Va. Code § 33-25A-34— Ambulance services
W. Va. Code § 33-25A-35— Rural health maintenance organizations
W. Va. Code § 33-25A-36— Assignment of certain benefits in dental care insurance coverage