West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-79 - Group Limited Health Benefits Plans
Section 114-79-7 - Benefits

Current through Register Vol. XLI, No. 38, September 20, 2024

7.1. Every policy issued pursuant to this rule must have an annual maximum benefit established by order of the Commissioner.

7.2. Every policy issued pursuant to this rule must provide benefits for at least the following services:

a. Emergency care.

b. Hospital benefits, including physician services while in the hospital.

c. Outpatient benefits, including lab and diagnostics.

d. Preventive care benefits.

e. Primary care benefits.

7.3. Every policy that does not cover prescription drug benefits as part of its basic coverage must offer optional prescription drug benefits coverage.

7.4. Before approving any plan or policy under this rule, the Commissioner must find that the plan or policy furthers the legislative purpose of W. Va. Code § 33-16F-1, et seq., by providing substantial preventative care and primary care benefits. This subsection does not apply to any plan or policy approved by the Commissioner prior to the effective date of this rule unless and until the provider of the plan or policy makes a subsequent filing with regard to such plan or policy.

Disclaimer: These regulations may not be the most recent version. West Virginia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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