Chapter 33, Chapter 33

(a) A policy, endorsement or contract providing coverage for the peril of flood must provide notice that flood insurance coverage is available from the National Flood Insurance Program. (b) Any limitations on flood coverage or policy limits as to the peril of flood, including, bu…

A policy, endorsement or contract providing coverage for the peril of flood must require the insurer to give 45-days' prior written notice of cancellation or nonrenewal to the insured and any regulated lending institution or federal agency that is a mortgagee. An insurer or insur…

(a) In addition to any other applicable requirements, an insurer providing flood coverage in this state must: (1) Notify the office at least thirty days before writing flood insurance in this state; and (2) File a plan of operation and financial projections or revisions to such p…

With respect to the regulation of flood insurance coverage written in this state by private insurers, this article supersedes any other provision in this chapter in the event of a conflict.

If federal law or rule requires a certification by a state insurance regulatory official as a condition of qualifying for private flood insurance or disaster assistance, the commissioner shall provide the certification, and the certification is not subject to review under section…

For the purposes of this article, the following words and terms mean the following: (1) "Commissioner" means the West Virginia Insurance Commissioner. (2) "Consumer" means an individual or family purchasing insurance coverage through the exchange. (3) "Exchange" means the West Vi…

(a) The commissioner shall on his or her website provide information regarding the qualified health plans being offered for sale through the exchange in a format easily found by a consumer on such website. Information may be provided through links to specific information, includi…

The commissioner may propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code to implement the provisions of this article.

This article may be cited and known as the Pharmacy Audit Integrity Act.

The Insurance Commissioner shall propose rules for legislative approval in accordance with §29A-3-1 et seq. of this code that are necessary to effectuate the provisions of this article.

(a) A pharmacy benefits manager, may not: (1) Prohibit or limit any covered individual from selecting a pharmacy or pharmacist of his or her choice who has agreed to participate in the health benefit plan according to the terms offered by the health benefit plan; (2) Deny a pharm…

(a) A pharmacy benefits manager shall report to the commissioner on an annual basis, or more often as the commissioner deems necessary, for each health plan or covered entity the following information: (1) The aggregate amount of rebates received by the pharmacy benefits manager;…

Notwithstanding any other effective date to the contrary, the amendments to this article enacted during the 2022 regular legislative session shall apply to all policies, contracts, plans, or agreements subject to this section that are delivered, executed, amended, adjusted, or re…

The Office of the Insurance Commissioner shall conduct a study of the cost to dispense outpatient prescription drugs in West Virginia by soliciting data and relevant information from licensed pharmacies and analyzing similar studies conducted in surrounding states within the prev…

This article covers any audit of the records of a pharmacy conducted by a managed care company, third-party payer, pharmacy benefits manager or an entity that represents a covered entity, or health benefit plan, the registration of auditing entities, and the licensure and regulat…

For purposes of this article: "340B entity" means an entity participating in the federal 340B drug discount program, as described in 42 U.S.C. § 256b, including its pharmacy or pharmacies, or any pharmacy or pharmacies, contracted with the participating entity to dispense drugs p…

(a) An entity conducting a pharmacy audit under this article shall conform to the following rules: (1) Except as otherwise provided by federal or state law, an auditing entity conducting a pharmacy audit may have access to a pharmacy’s previous audit report only if the report was…

A pharmacy may appeal a final audit report in accordance with the procedures established by the entity conducting the pharmacy audit.

(a) The provisions of this article do not apply to an investigative audit of pharmacy records when: (1) Fraud, waste, abuse or other intentional misconduct is indicated by physical review or review of claims data or statements; or (2) Other investigative methods indicate a pharma…

(a) Prior to conducting business in the State of West Virginia, except as provided in subsection (d) of this section, an auditing entity shall register with the Insurance Commissioner. The commissioner shall make an application form available on its publicly accessible Internet w…

(a) A person or organization may not establish or operate as a pharmacy benefits manager in the state of West Virginia without first obtaining a license from the Insurance Commissioner pursuant to this section: Provided, That a pharmacy benefit manager registered pursuant to §33-…

(a) A pharmacy, a pharmacist, and a pharmacy technician shall have the right to provide a covered individual with information related to lower cost alternatives and cost share for the covered individual to assist health care consumers in making informed decisions. Neither a pharm…

(a) This article may be cited as the "Corporate Governance Annual Disclosure Act". (b) The purpose of this article is to: (1) Provide the commissioner a summary of an insurer’s or insurance group’s corporate governance structure, policies and practices to permit the commissioner …

As used in this article: (1) "Board" means the board of directors of an insurer or insurance group. (2) "Corporate Governance Annual Disclosure" or "CGAD" means a confidential report filed by the insurer or insurance group made in accordance with the requirements of this article.…

(a) An insurer, or the insurance group of which the insurer is a member, shall annually submit to the commissioner a CGAD that contains the information described in §33-52-4 of this code. Notwithstanding any request from the commissioner made pursuant to subsection (c) of this se…

(a) The insurer or insurance group shall be as descriptive as possible in completing the CGAD, with inclusion of attachments or example documents that are used in the governance process, since these may provide a means to demonstrate the strengths of their governance framework an…

(a) An insurer, or the insurance group of which the insurer is a member, required to file a CGAD by §33-52-3 of this code, shall, no later than June 1 of each calendar year, submit to the commissioner a CGAD that contains the information described in §33-52-4 of this code. (b) Th…

(a) Documents, materials or other information, including the CGAD, in the possession or control of the commissioner that are obtained by, created by or disclosed to the commissioner or any other person under this article, are recognized by this state as being proprietary and to c…

(a) The commissioner may retain, at the insurer’s expense, third-party consultants, including attorneys, actuaries, accountants and other experts not otherwise a part of the commissioner’s staff as may be reasonably necessary to assist the commissioner in reviewing the CGAD and r…

Any insurer failing, without just cause, to timely file the CGAD as required in this article shall be required, after notice and hearing, to pay a penalty of up to $1,000 for each day’s delay, to be recovered by the commissioner. Any penalty so recovered shall be paid into the Ge…

The requirements of this article are effective on January 1, 2020. The first filing of the CGAD shall be in 2020.

This article shall be known as the “Certificates of Insurance Act”.

For purposes of this article: “Certificate of insurance” means a document or instrument, regardless of how titled or described, that is prepared or issued by an insurer or insurance producer as evidence or confirmation of the existence of property or casualty insurance coverage. …

(a) The Commissioner of Insurance shall prohibit the use of a certificate of insurance form if the form: (1) Is unfair, misleading, or deceptive, or violates public policy; or (2) Violates any law, including any rule promulgated by the commissioner. (b) A certificate of insurance…

(a) A person may not: (1) Prepare, issue, or request or require the issuance of a certificate of insurance that contains any false or misleading information concerning the policy of insurance to which the certificate of insurance refers; or (2) Prepare, issue, or request or requi…

A person is entitled to notice of cancellation, nonrenewal, or any material change, and to any similar notice concerning a policy of insurance only if the person has such notice rights under the terms of the policy of insurance or any endorsement to the policy. The terms and cond…

(a) The provisions of this article apply to all certificates of insurance issued in connection with a property or casualty insurance policy issued or renewed on or after July 1, 2020, and in connection with property, operations, or risks located in this state, regardless of where…

(a) The Commissioner of Insurance shall examine and investigate the activities of any person that the commissioner reasonably believes has been or is engaged in an act or practice prohibited by this article. (b) The commissioner may enforce the provisions of this article by any m…

This article shall be known and cited as the Requiring Accountable Pharmaceutical Transparency, Oversight, and Reporting Act.

For the purpose of this article: "Auditor" means the State Auditor of West Virginia, by himself or herself, or by any person appointed, designated, or approved by the State Auditor to perform the service. "Brand-name drug" means a prescription drug approved under 21 USC §355(b) o…

(a) Not later than January 15 of each calendar year, a drug manufacturer shall submit a report to the Auditor stating the following information for each brand-name, specialty, and generic drug manufactured by the drug manufacturer and sold in the state directly by the drug manufa…

No later than March 1 of each calendar year, each health benefit plan issuer shall submit to the Auditor a report providing the following information for the immediately preceding calendar year: Provided, That nothing in this article should be construed as to requiring a health b…

(a) By July 1, 2021, the Auditor shall create a searchable pharmaceutical price transparency website, containing the information specified in §33-54-3 and §33-54-4 of this code, available to the public at no cost, and presented in a consumer-friendly, searchable format. (b) Effec…

For purposes of this article: "Authorized representative" means: (A) A person to whom a covered person has given express written consent to represent the covered person; (B) A person authorized by law to provide substituted consent for a covered person; or (C) The covered person’…

A violation of this article shall be penalized in accordance with §33-4-11 of this code.

(a) Except as provided in subsection (b) of this section, this article applies to all health carriers that offer network plans. (b) The following provisions of this article do not apply to health carriers that offer network plans that consist solely of limited scope dental plans …

(a)(1) A health carrier providing a network plan shall maintain a network that is sufficient in numbers and appropriate types of providers, including those that serve predominantly low-income, medically underserved individuals, to assure that all covered services to covered perso…

(a)(1)(A) A health carrier shall post electronically a current and accurate provider directory for each of its network plans with the information and search functions, as described in subsection (b) of this section. (B) In making the directory available electronically, the carrie…

A contract between a health carrier and an intermediary shall satisfy all the requirements contained in this section. (a) A health carrier’s statutory responsibility to monitor the offering of covered benefits to covered persons may not be delegated or assigned to the intermediar…

(a) At the time a health carrier files its access plan, the health carrier shall file for approval with the commissioner sample contract forms proposed for use with its participating providers and intermediaries. (b) A health carrier shall submit material changes to a contract th…