Bill Text: WV HB2051 | 2018 | Regular Session | Introduced
Bill Title: Authorizing insurance to married workers without children at reduced rates under the West Virginia Public Employees Insurance Act
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2018-01-10 - To House Banking and Insurance [HB2051 Detail]
Download: West_Virginia-2018-HB2051-Introduced.html
FISCAL
NOTE
WEST virginia Legislature
2017 regular session
By
[
to the Committee on Banking and Insurance then Finance.
A BILL to amend and
reenact §5-16-7 of the Code of West Virginia, 1931, as amended, relating to the
West Virginia Public Employees Insurance Act; and authorizing insurance to
married workers without children at reduced rates.
Be it enacted by the
Legislature of West Virginia:
That §5-16-7 of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7. Authorization to establish group hospital and
surgical insurance plan, group major medical insurance plan, group prescription
drug plan and group life and accidental death insurance plan; rules for
administration of plans; mandated benefits; what plans may provide; optional
plans; separate rating for claims experience purposes.
(a) The agency shall establish a group hospital and surgical
insurance plan or plans, a group prescription drug insurance plan or plans, a
group major medical insurance plan or plans and a group life and accidental
death insurance plan or plans for those employees herein made eligible, and to
establish and promulgate rules for the administration of these plans, subject
to the limitations contained in this article.
Those plans shall include:
(1) Coverages and benefits for Xray and laboratory services
in connection with mammograms when medically appropriate and consistent with
current guidelines from the United States Preventive Services Task Force; pap
smears, either conventional or liquid-based cytology, whichever is medically
appropriate and consistent with the current guidelines from either the United
States Preventive Services Task Force or The American College of Obstetricians
and Gynecologists; and a test for the human papilloma virus (HPV) when
medically appropriate and consistent with current guidelines from either the
United States Preventive Services Task Force or The American College of
Obstetricians and Gynecologists, when performed for cancer screening or
diagnostic services on a woman age eighteen or over;
(2) Annual checkups for prostate cancer in men age fifty and
over;
(3) Annual screening for kidney disease as determined to be
medically necessary by a physician using any combination of blood pressure
testing, urine albumin or urine protein testing and serum creatinine testing as
recommended by the National Kidney Foundation;
(4) For plans that include maternity benefits, coverage for
inpatient care in a duly licensed health care facility for a mother and her
newly born infant for the length of time which the attending physician
considers medically necessary for the mother or her newly born child: Provided, That no plan may deny
payment for a mother or her newborn child prior to forty-eight hours following
a vaginal delivery, or prior to ninety-six hours following a caesarean section
delivery, if the attending physician considers discharge medically
inappropriate;
(5) For plans which provide coverages for post-delivery care
to a mother and her newly born child in the home, coverage for inpatient care
following childbirth as provided in subdivision (4) of this subsection if
inpatient care is determined to be medically necessary by the attending
physician. Those plans may also include,
among other things, medicines, medical equipment, prosthetic appliances and any
other inpatient and outpatient services and expenses considered appropriate and
desirable by the agency; and
(6) For plans which provide coverage for each eligible
employee who is married but without covered children, at a lesser premium cost
than benefits for eligible employees who are married with children; and
(6) (7) Coverage for treatment
of serious mental illness.
(A) The coverage does not include custodial care, residential
care or schooling. For purposes of this
section, "serious mental illness" means an illness included in the
American Psychiatric Association's diagnostic and statistical manual of mental
disorders, as periodically revised, under the diagnostic categories or
subclassifications of: (i) Schizophrenia
and other psychotic disorders; (ii) bipolar disorders; (iii) depressive disorders;
(iv) substance-related disorders with the exception of caffeine-related
disorders and nicotine-related disorders; (v) anxiety disorders; and (vi)
anorexia and bulimia. With regard to any
covered individual who has not yet attained the age of nineteen years,
"serious mental illness" also includes attention deficit
hyperactivity disorder, separation anxiety disorder and conduct disorder.
(B) Notwithstanding any other provision in this section to
the contrary, in the event that the agency can demonstrate that its total costs
for the treatment of mental illness for any plan exceeded two percent of the
total costs for such plan in any experience period, then the agency may apply
whatever additional cost-containment measures may be necessary, including, but
not limited to, limitations on inpatient and outpatient benefits, to maintain
costs below two percent of the total costs for the plan for the next experience
period.
(C) The agency shall not discriminate between medical-surgical
benefits and mental health benefits in the administration of its plan. With regard to both medical-surgical and
mental health benefits, it may make determinations of medical necessity and
appropriateness, and it may use recognized health care quality and cost
management tools, including, but not limited to, limitations on inpatient and
outpatient benefits, utilization review, implementation of cost-containment
measures, preauthorization for certain treatments, setting coverage levels,
setting maximum number of visits within certain time periods, using capitated
benefit arrangements, using fee-for-service arrangements, using third-party
administrators, using provider networks and using patient cost sharing in the
form of copayments, deductibles and coinsurance.
(7) (8) Coverage for general
anesthesia for dental procedures and associated outpatient hospital or
ambulatory facility charges provided by appropriately licensed health care
individuals in conjunction with dental care if the covered person is:
(A) Seven years of age or younger or is developmentally
disabled, and is an individual for whom a successful result cannot be expected
from dental care provided under local anesthesia because of a physical,
intellectual or other medically compromising condition of the individual and
for whom a superior result can be expected from dental care provided under
general anesthesia;
(B) A child who is twelve years of age or younger with
documented phobias, or with documented mental illness, and with dental needs of
such magnitude that treatment should not be delayed or deferred and for whom
lack of treatment can be expected to result in infection, loss of teeth or
other increased oral or dental morbidity and for whom a successful result
cannot be expected from dental care provided under local anesthesia because of
such condition and for whom a superior result can be expected from dental care
provided under general anesthesia.
(b) The agency shall make available to each eligible
employee, at full cost to the employee, the opportunity to purchase optional
group life and accidental death insurance as established under the rules of the
agency. In addition, each employee is
entitled to have his or her spouse and dependents, as defined by the rules of
the agency, included in the optional coverage, at full cost to the employee,
for each eligible dependent; and with full authorization to the agency to make
the optional coverage available and provide an opportunity of purchase to each
employee.
(c) The finance board may cause to be separately rated for
claims experience purposes:
(1) All employees of the State of West Virginia;
(2) All teaching and professional employees of state public
institutions of higher education and county boards of education;
(3) All nonteaching employees of the Higher Education Policy
Commission, West Virginia Council for Community and Technical College Education
and county boards of education; or
(4) Any other categorization which would ensure the stability
of the overall program.
(d) The agency shall maintain the medical and prescription
drug coverage for Medicare eligible retirees by providing coverage through one
of the existing plans or by enrolling the Medicare eligible retired employees
into a Medicare specific plan, including, but not limited to, the Medicare/Advantage
Prescription Drug Plan. In the event
that a Medicare specific plan would no longer be available or advantageous for
the agency and the retirees, the retirees shall remain eligible for coverage
through the agency.
NOTE: The purpose of this bill is
to authorize insurance to married workers without children at reduced rates
under the West Virginia Public Employees Insurance Act.
Strike-throughs indicate language
that would be stricken from a heading or the present law and underscoring
indicates new language that would be added.