West Virginia Code
Article 25A. Health Maintenance Organization Act
§33-25A-28. Required Health Maintenance Organization Option

(1) Each employer shall offer no less than once every year to every employee and dependent entitled to receive health care under an existing health benefit plan supported in whole or in part by such employer the opportunity to become enrollees in certified health maintenance organizations which have the capacity to provide basic health services in health maintenance organization service areas in which at least twenty-five such employees reside: Provided, That nothing herein shall require an employer to contribute more on behalf of an employee seeking to enroll in a health maintenance organization than would be contributed on the employee's behalf to the existing health plan.
(2) If any employees of an employer are represented by a collective bargaining representative or other employee representative designated or selected under any law of this state, the offer described in subsection (1) of this section should be made to such collective bargaining representatives or other employee representative, and only if such representative approves the offer should it be made to employees represented by such representatives.
(3) If there is more than one certified health maintenance organization which meets the requirements of subsection (1) of this section and such health maintenance organizations have service areas contemporaneously covering the same twenty-five or more employees, the employer shall offer such employees at least one health maintenance organization which provides health services primarily through staff physicians, or medical groups, or a combination of both; and one health maintenance organization which provides health services through other means.
(4) Any employer who knowingly fails to comply with any of the requirements of this section shall be subject to a fine of not more than $10,000 for every thirty-day period that such violation continues.
(5) The commissioner is authorized, in addition to the remedy provided in subsection (4) of this section, to seek an injunction in a court of competent jurisdiction to compel compliance with the provisions of this section.

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