West Virginia Code
Article 16. West Virginia Public Employees Insurance Act
§5-16-16. Preferred Provider Plan

The director shall, on or before April 1, 1988, or as soon as practicable, establish a preferred provider system for the delivery of health care to plan participants by all health care providers, which may include, but not be limited to, medical doctors, chiropractors, physicians, osteopathic physicians, surgeons, hospitals, clinics, nursing homes, pharmacies and pharmaceutical companies.
The director shall establish the terms of the preferred provider system and the incentives therefor. The terms and incentives may include multiyear renewal options as are not prohibited by the Constitution of this state and capitated primary care arrangements which are not subject to the provisions of article twenty-five-a of chapter thirty-three of this code.

Structure West Virginia Code

West Virginia Code

Chapter 5. General Powers and Authority of the Governor, Secretary of State and Attorney General; Board of Public Works; Miscellaneous Agencies, Commissions, Offices, Programs, etc.

Article 16. West Virginia Public Employees Insurance Act

§5-16-1. Short Title; Legislative Intent

§5-16-2. Definitions

§5-16-3. Composition of Public Employees Insurance Agency; Appointment, Qualification, Compensation and Duties of Director of Agency; Employees; Civil Service Coverage

§5-16-4. Public Employees Insurance Agency Finance Board Continued; Qualifications, Terms, and Removal of Members; Quorum; Compensation and Expenses; Termination Date

§5-16-5. Purpose, Powers and Duties of the Finance Board; Initial Financial Plan; Financial Plan for Following Year; and Annual Financial Plans

§5-16-5a. Retiree Premium Subsidy From Retiree Health Benefit Trust for Hires Prior to July 1, 2010

§5-16-5b. Creation of Trust for Retirees Hired on or After July 1, 2010

§5-16-7. Authorization to Establish Group Hospital and Surgical Insurance Plan, Group Major Medical Insurance Plan, Group Prescription Drug Plan, and Group Life and Accidental Death Insurance Plan; Rules for Administration of Plans; Mandated Benefits...

§5-16-7a. Additional Mandated Benefits; Third Party Reimbursement for Colorectal Cancer Examination and Laboratory Testing

§5-16-7b. Coverage for Telehealth Services

§5-16-7c. Required Coverage for Reconstruction Surgery Following Mastectomies

§5-16-7d. Coverage for Patient Cost of Clinical Trials

§5-16-7e. Definitions

§5-16-7f. Prior Authorization

§5-16-7g. Coverage for Prescription Insulin Drugs

§5-16-8. Conditions of Insurance Program

§5-16-8a. Air-Ambulance Fees

§5-16-9. Authorization to Execute Contracts for Group Hospital and Surgical Insurance, Group Major Medical Insurance, Group Prescription Drug Insurance, Group Life and Accidental Death Insurance, and Other Accidental Death Insurance; Mandated Benefit...

§5-16-10. Contract Provisions for Group Hospital and Surgical, Group Major Medical, Group Prescription Drug and Group Life and Accidental Death Insurance for Retired Employees, Their Spouses and Dependents

§5-16-11. To Whom Benefits Paid

§5-16-12. Misrepresentation by Employer, Employee or Provider; Penalty

§5-16-12a. Inspections; Violations and Penalties

§5-16-12b. Privileges and Immunity

§5-16-13. Payment of Costs by Employer and Employee; Spouse and Dependent Coverage; Involuntary Employee Termination Coverage; Conversion of Annual Leave and Sick Leave Authorized for Health or Retirement Benefits; Authorization for Retiree Participa...

§5-16-14. Program Qualifying for Favorable Federal Income Tax Treatment

§5-16-15. Optional Dental, Optical, Disability and Prepaid Retirement Plan and Audiology and Hearing-Aid Service Plan

§5-16-16. Preferred Provider Plan

§5-16-17. Preexisting Conditions Not Covered; Defined

§5-16-18. Payment of Costs by Employer; Schedule of Insurance; Special Funds Created; Duties of Treasurer With Respect Thereto

§5-16-19. Authorization to Take Advantage of Acts of Congress, Accept Gifts, Grants and Matching Funds

§5-16-20. Expense Fund

§5-16-21. No Member or Employee of Public Employees Insurance Agency Shall Gain Directly or Indirectly From Any Contract or Contracts Provided for Hereunder; Criminal Penalties

§5-16-22. Permissive Participation; Exemptions

§5-16-23. Members of Legislature May Be Covered, if Cost of the Entire Coverage Is Paid by Such Members

§5-16-24. Rules for Administration of Article; Eligibility of Certain Retired Employees and Dependents of Deceased Members for Coverage; Employees on Medical Leave of Absence Entitled to Coverage; Life Insurance

§5-16-24a. Paper Transactions

§5-16-25. Reserve Fund

§5-16-26. Quarterly Report

§5-16-28. Incorporation of the Coverage for 12-Month Refill for Contraceptive Drugs

§5-16-29. Limitation on Peia Participation