West Virginia Code
Article 25. Health Care Corporations
§33-25-8. Commissioner to Enforce Article; Approval of Contracts, Forms and Rates; Reserve Fund; Membership Fee

(a) It shall be the duty of the commissioner to enforce the provisions of this article.
(b) No such corporation shall deliver or issue for delivery any subscriber's contract, changes in the terms of such contract, application, rider or endorsement until a copy thereof and the rates pertaining thereto have been filed with and approved by the commissioner. All such forms filed with the commissioner shall be deemed approved after the expiration of thirty days from the date of such filing unless the commissioner shall have disapproved the same, stating his reasons for such disapproval in writing, except that such period may be extended for an additional period not to exceed fifteen days upon written notice thereof from the commissioner to the applicant. Such forms may be used prior to the expiration of such periods if written approval thereof has been received from the commissioner.
(c) No rates to be charged subscribers shall be used or established by any such corporation unless and until the same have been filed with the commissioner and approved by him The procedure for such filing and approval shall be the same as that prescribed in subsection (b) of this section for the approval of forms. The commissioner shall approve all such rates which are not excessive, inadequate, or unfairly discriminatory.
(d) The commissioner shall pass upon the actuarial soundness of all direct health care services plans.
(e) The corporation shall accumulate a fund to be derived from a minimum of two percent of every subscriber's monthly premium which shall be known as a contingency and liability reserve fund except that the same shall not exceed an amount equal to three months' average obligation of said corporation, nor shall it fall below a minimum of one month's average obligation of said corporation. Said fund shall be expended by the corporation according to rules and regulations to be promulgated by the commissioner.
In addition to the above requirements, every subscriber shall pay into the corporation a membership fee equal to one monthly premium. The membership fee shall be collected in full by said corporation within ninety days of said subscriber's application for membership.
(f) Each such rate filing and each such form filing made with the commissioner pursuant to this section is subject to the filing fee of section thirty-four, article six of this chapter.
§33-25-8. Commissioner to enforce article; approval of contracts, forms and rates; reserve fund; membership fee.
(a) It shall be the duty of the commissioner to enforce the provisions of this article.
(b) No such corporation shall deliver or issue for delivery any subscriber's contract, changes in the terms of such contract, application, rider or endorsement until a copy thereof and the rates pertaining thereto have been filed with and approved by the commissioner. All such forms filed with the commissioner shall be deemed approved after the expiration of sixty days from the date of such filing unless the commissioner shall have disapproved the same, stating his reasons for such disapproval in writing. Such forms may be used prior to the expiration of such periods if written approval thereof has been received from the commissioner.
(c) No rates to be charged subscribers shall be used or established by any such corporation unless and until the same have been filed with the commissioner and approved by him The procedure for such filing and approval shall be the same as that prescribed in paragraph (b) of this section for the approval of forms. The commissioner shall approve all such rates which are not excessive, inadequate, or unfairly discriminatory.
(d) The commissioner shall pass upon the actuarial soundness of all direct health care services plans.
(e) The corporation shall accumulate a fund to be derived from a minimum of two percent of every subscriber's monthly premium which shall be known as a contingency and liability reserve fund except that the same shall not exceed an amount equal to three months' average obligation of said corporation, nor shall it fall below a minimum of one month's average obligation of said corporation. Said fund shall be expended by the corporation according to rules and regulations to be promulgated by the commissioner.
In addition to the above requirements, every subscriber shall pay into the corporation a membership fee equal to one monthly premium. The membership fee shall be collected in full by said corporation within ninety days of said subscriber's application for membership.
(f) Each such rate filing and each such form filing made with the commissioner pursuant to this section is subject to the filing fee of section thirty-four, article six of this chapter.

Structure West Virginia Code

West Virginia Code

Chapter 33. Insurance

Article 25. Health Care Corporations

§33-25-1. Declaration of Policy

§33-25-2. Definitions

§33-25-3. Incorporation; Purposes; Name; Limitations

§33-25-4. Board of Directors

§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

§33-25-7. Licenses

§33-25-8. Commissioner to Enforce Article; Approval of Contracts, Forms and Rates; Reserve Fund; Membership Fee

§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

§33-25-8i. Maternity Coverage

§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

§33-25-8m. Step Therapy

§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

§33-25-9. Annual Report

§33-25-10. Examination of Corporation; Report of Examination; Objections to Report; Access to Books, Records, etc.; Removal of Records, etc., From State

§33-25-10a. Loss Ratio

§33-25-11. Rules and Regulations

§33-25-12. Required Provisions in Contracts Made by Corporation With Physicians, Dentists, etc., Hospitals and Other Health Agencies

§33-25-13. Contracts to Be Furnished to Subscribers; Payments for Subscribers by Others; Wage Deductions

§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

§33-25-21. Authority of Commissioner to Promulgate Rules and Regulations Regarding Affiliate and Subsidiary Operating Results

§33-25-22. Assignment of Certain Benefits in Dental Care Insurance Coverage