(a) A health maintenance organization issuing coverage in this state pursuant to the provisions of this article may not require any person covered under a contract which provides coverage for prescription drugs to obtain the prescription drugs from a mail-order pharmacy in order to obtain benefits for the drugs.
(b) A health maintenance organization may not violate the provisions of subsection (a) of this section through the use of an agent or contractor or through the action of an administrator of prescription drug benefits.
(c) The Insurance Commissioner may propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code to implement and enforce the provisions of this section.
Structure West Virginia Code
Article 25A. Health Maintenance Organization Act
§33-25A-1. Short Title and Purpose
§33-25A-3. Application for Certificate of Authority
§33-25A-4. Issuance of Certificate of Authority
§33-25A-5. Powers of Health Maintenance Organizations
§33-25A-7a. Provider Contracts
§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-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-10. Information to Enrollees
§33-25A-11. Open Enrollment Period
§33-25A-12. Grievance Procedure
§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-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-21. Administrative Procedures
§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-34. Ambulance Services
§33-25A-35. Rural Health Maintenance Organizations
§33-25A-36. Assignment of Certain Benefits in Dental Care Insurance Coverage