Each contract made by the corporation with participating hospitals, physicians, dentists and other health agencies shall contain the following provisions:
(a) That the hospital, physician, dentist or other health agency will render to any subscriber such service as he may be entitled to under the terms and conditions of the contract issued to the subscriber by the corporation.
(b) That in submitting bills to the corporation for services rendered to subscribers under the terms of their contracts, the hospitals, physicians, dentists and other health agencies will make only such charges as are set forth in an agreed schedule of fees to be paid by the corporation.
Structure West Virginia Code
§33-24-1. Declaration of Policy
§33-24-4. Exemptions; Applicability of Insurance Laws
§33-24-4a. Coverage for Patient Cost of Clinical Trials
§33-24-4b. Applicability of Insurance Fraud Prevention Act
§33-24-5. Licenses; Name of Corporation
§33-24-6. Commissioner to Enforce Article; Approval of Contracts, Forms, Rates and Fees
§33-24-7a. Contracts to Cover Nursing Service
§33-24-7b. Third Party Reimbursement for Mammography, Pap Smear or Human Papilloma Virus Testing
§33-24-7c. Third Party Reimbursement for Rehabilitation Services
§33-24-7e. Coverage of Emergency Services
§33-24-7f. Third Party Reimbursement for Colorectal Cancer Examination and Laboratory Testing
§33-24-7g. Required Coverage for Reconstruction Surgery Following Mastectomies
§33-24-7h. Required Use of Mail-Order Pharmacy Prohibited
§33-24-7i. Third-Party Reimbursement for Kidney Disease Screening
§33-24-7j. Required Coverage for Dental Anesthesia Services
§33-24-7k. Coverage for Diagnosis and Treatment of Autism Spectrum Disorders
§33-24-7m. Deductibles, Copayments and Coinsurance for Anti-Cancer Medications
§33-24-7n. Eye Drop Prescription Refills
§33-24-7o. Deductibles, Copayments and Coinsurance for Abuse-Deterrent Opioid Analgesic Drugs
§33-24-7q. Coverage for Amino Acid-Based Formulas
§33-24-7r. Substance Use Disorder
§33-24-7s. Prior Authorization
§33-24-7t. Fairness in Cost-Sharing Calculation
§33-24-7u. Mental Health Parity
§33-24-7v. Incorporation of the Health Benefit Plan Network Access and Adequacy Act
§33-24-7w. Incorporation of the Coverage for 12-Month Refill for Contraceptive Drugs
§33-24-9. Payroll Deduction for Governmental Employees
§33-24-10. Investments; Bonds of Corporate Officers and Employees, Minimum Statutory Surplus
§33-24-11. Reciprocity With Other Service Plans; Payment Authorized
§33-24-12. Creation of Subsidiary Corporation or Corporations
§33-24-13. Continuum of Care Services
§33-24-14. Delinquency Proceedings
§33-24-43. Policies Discriminating Among Health Care Providers
§33-24-45. Assignment of Certain Benefits in Dental Care Insurance Coverage