Any law to the contrary notwithstanding, nonprofit, nonstock corporations may be organized in accordance with the provisions of article one, chapter thirty-one of the Code of West Virginia, for the sole purpose of providing any or all of the following direct health care services, at the expense of the corporation, to its members and subscribers through contracts with duly licensed physicians and surgeons, osteopathic physicians and surgeons, chiropractors, chiropodists, nurses, dentists, optometrists and pharmacists, and any others who are licensed to engage in the practice of the healing arts, as well as hospitals, clinics, convalescent centers, nursing homes, and any other persons, corporations, associations, and institutions engaged in the business of providing facilities, appliances, supplies and services incidental to such health care.
No such corporation shall include in its name the words "insurance," "casualty," "surety," "health and accident," "accident and sickness," "mutual," or any other words, which in the opinion of the commissioner are descriptive of the insurance, casualty or surety business, or deceptively similar to the name or description of any insurance or surety corporation doing business in the state.
A corporation shall provide only direct health care services to the subscribers to its health care plan and shall not provide for the payment of any cash or cash indemnity to or on behalf of a subscriber: Provided, That a corporation may provide a cash reimbursement to a subscriber who employs or obtains in the event of an emergency the health care services of any person, corporation, association or institution named or referred to in this section and located outside the territorial boundaries within which the corporation is licensed to operate.
Structure West Virginia Code
Article 25. Health Care Corporations
§33-25-1. Declaration of Policy
§33-25-3. Incorporation; Purposes; Name; Limitations
§33-25-5. Exemption From Taxes
§33-25-6. Supervision and Regulation by Insurance Commissioner; Exemption From Insurance Laws
§33-25-6a. Applicability of Insurance Fraud Prevention Act
§33-25-8a. Third Party Reimbursement for Mammography or Pap Smear or Human Papilloma Virus Testing
§33-25-8b. Third Party Reimbursement for Rehabilitation Services
§33-25-8c. Third Party Payment for Child Immunization Services
§33-25-8d. Coverage of Emergency Services
§33-25-8e. Third Party Reimbursement for Colorectal Cancer Examination and Laboratory Testing
§33-25-8f. Required Use of Mail-Order Pharmacy Prohibited
§33-25-8g. Third-Party Reimbursement for Kidney Disease Screening
§33-25-8h. Required Coverage for Dental Anesthesia Services
§33-25-8j. Deductibles, Copayments and Coinsurance for Anti-Cancer Medications
§33-25-8k. Eye Drop Prescription Refills
§33-25-8l. Deductibles, Copayments and Coinsurance for Abuse-Deterrent Opioid Analgesic Drugs
§33-25-8n. Coverage for Amino Acid-Based Formulas
§33-25-8o. Substance Use Disorder
§33-25-8p. Prior Authorization
§33-25-8q. Fairness in Cost-Sharing Calculation
§33-25-8r. Mental Health Parity
§33-25-8s. Incorporation of the Health Benefit Plan Network Access and Adequacy Act
§33-25-8t. Incorporation of the Coverage for 12-Month Refill for Contraceptive Drugs
§33-25-11. Rules and Regulations
§33-25-14. Advancement of Money to Corporation
§33-25-16. Disposition of Fees and Charges
§33-25-17. Bonds of Corporation Officers and Employees
§33-25-18. Annual Audited Financial Report
§33-25-19. Administrative Supervision
§33-25-20. Policies Discriminating Among Health Care Providers
§33-25-22. Assignment of Certain Benefits in Dental Care Insurance Coverage