West Virginia Code
Article 25A. Health Maintenance Organization Act
§33-25A-16. Powers of Insurers and Hospital and Medical Service Corporations

(1) An insurance company licensed in this state or a hospital or medical service corporation authorized to do business in this state, after applying for and receiving a certificate of authority as a health maintenance organization, may through a subsidiary or affiliate organize and operate a health maintenance organization under the provisions of this article. Notwithstanding any other law to the contrary, any two or more insurance companies, hospital or medical service corporations, or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance organization. The business of insurance is considered to include the providing of health care by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.
(2) Notwithstanding any provision of insurance and hospital or medical service corporation laws, an insurer or a hospital or medical service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. The enrollees of a health maintenance organization constitute a permissible group under such laws. Among other things, under the contracts, the insurer or hospital or medical service corporation may make benefit payments to health maintenance organizations for health care services rendered by providers.

Structure West Virginia Code

West Virginia Code

Chapter 33. Insurance

Article 25A. Health Maintenance Organization Act

§33-25A-1. Short Title and Purpose

§33-25A-2. Definitions

§33-25A-3. Application for Certificate of Authority

§33-25A-3a. Conditions Precedent to Issuance or Maintenance of a Certificate of Authority; Renewal of Certificate of Authority; Effect of Bankruptcy Proceedings

§33-25A-4. Issuance of Certificate of Authority

§33-25A-5. Powers of Health Maintenance Organizations

§33-25A-6. Governing Body

§33-25A-7. Fiduciary Responsibilities of Officers; Fidelity Bond; Approval of Contracts by Commissioner

§33-25A-7a. Provider Contracts

§33-25A-7b. Loss Ratio

§33-25A-8. Evidence of Coverage; Charges for Health Care Services; Review of Enrollee Records; Cancellation of Contract by Enrollee

§33-25A-8a. Third Party Reimbursement for Mammography, Pap Smear or Human Papilloma Virus Testing

§33-25A-8b. Third Party Reimbursement for Rehabilitation Services

§33-25A-8c. Third Party Payment for Child Immunization Services

§33-25A-8d. Coverage of Emergency Services

§33-25A-8e. Third Party Reimbursement for Colorectal Cancer Examination and Laboratory Testing

§33-25A-8f. Required Coverage for Reconstruction Surgery Following Mastectomies

§33-25A-8g. Required Use of Mail-Order Pharmacy Prohibited

§33-25A-8h. Third-Party Reimbursement for Kidney Disease Screening

§33-25A-8i. Third-Party Reimbursement for Dental Anesthesia Services

§33-25A-8j. Coverage for Diagnosis and Treatment of Autism Spectrum Disorders

§33-25A-8k. Maternity Coverage

§33-25A-8l. Deductibles, Copayments and Coinsurance for Anti-Cancer Medications

§33-25A-8m. Eye Drop Prescription Refills

§33-25A-8n. Deductibles, Copayments and Coinsurance for Abuse-Deterrent Opioid Analgesic Drugs

§33-25A-8o. Step Therapy

§33-25A-8p. Lyme Disease to Be Covered by All Health Insurance Policies

§33-25A-8q. Coverage for Amino Acid-Based Formulas

§33-25A-8r. Substance Use Disorder

§33-25A-8s. Prior Authorization

§33-25A-8t. Fairness in Cost-Sharing Calculation

§33-25A-8u. Mental Health Parity

§33-25A-8v. Incorporation of the Health Benefit Plan Access and Adequacy Act

§33-25A-8w. Incorporation of the Coverage for 12-Month Refill for Contraceptive Drugs

§33-25A-9. Annual Report

§33-25A-10. Information to Enrollees

§33-25A-11. Open Enrollment Period

§33-25A-12. Grievance Procedure

§33-25A-13. Investments

§33-25A-14. Prohibited Advertising Practices

§33-25A-14a. Other Prohibited Practices

§33-25A-15. Agent Licensing and Appointment Required; Regulation of Marketing

§33-25A-16. Powers of Insurers and Hospital and Medical Service Corporations

§33-25A-17. Examinations

§33-25A-17a. Quality Assurance

§33-25A-18. Suspension or Revocation of Certificate of Authority

§33-25A-19. Rehabilitation, Liquidation or Conservation of Health Maintenance Organization

§33-25A-20. Regulations

§33-25A-21. Administrative Procedures

§33-25A-22. Fees

§33-25A-23. Penalties and Enforcement

§33-25A-23a. Civil Penalty Imposed by Commissioner

§33-25A-24. Scope of Provisions; Applicability of Other Laws

§33-25A-25. Filings and Reports as Public Documents

§33-25A-26. Confidentiality of Medical Information

§33-25A-27. Authority to Contract With Health Maintenance Organizations Under Medicaid

§33-25A-28. Required Health Maintenance Organization Option

§33-25A-31. Policies Discriminating Among Health Care Providers

§33-25A-32. Authority of Commissioner to Promulgate Rules and Regulations Regarding Affiliate and Subsidiary Operating Results

§33-25A-33. Guaranty Fund

§33-25A-34. Ambulance Services

§33-25A-35. Rural Health Maintenance Organizations

§33-25A-36. Assignment of Certain Benefits in Dental Care Insurance Coverage