A health maintenance organization issuing coverage in this state pursuant to the provisions of this article shall make available as benefits to all subscribers and members coverage on an expense-incurred basis and individual and group service or indemnity type contracts issued by a nonprofit corporation shall provide coverage for long-term antibiotic therapy for a patient with Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient’s symptoms, diagnostic test results, or response to treatment.
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