W. Va. Code R. § 114-78-6

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-78-6 - Benefits

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

6.2. 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.

e. Primary care.

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

6.4. 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 § 33-15D-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.

W. Va. Code R. § 114-78-6