West Virginia Code § 33-16-3f

Required policy provisions -- Treatment of temporomandibular joint
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disorder and craniomandibular disorder.
(a) The Legislature hereby finds that there is a need to provide guidelines regarding the
coverage of temporomandibular joint disorder and craniomandibular disorder in policies
issued pursuant to this article and article fifteen of this chapter, in order to provide for the
health of our citizens. The purpose of this section is to require the Insurancee Commissioner
to develop standards regarding temporomandibular joint disorder and craniomandibular
disorder and to require that all insurers writing accident and sickness prolicies which are
covered by this article or article fifteen of this chapter, and the Public Employees Insurance
Agency as set forth in article sixteen of chapter five make available this coverage to the
policyholder or sponsor of each such policy. For purposes of this section, the Public
Employees Insurance Agency is the policyholder. t
(b) The Insurance Commissioner shall promulgate rules and regulations regarding the
diagnosis and treatment for temporomandibular joint disorder and craniomandibular
disorder coverage in accident and sickness policies covered by this article and article fifteen
of this chapter. Such regulations shall prescrisbe the manner by which such coverage shall be
offered to the policyholder or sponsor; that benefits shall apply whether administered by a
physician or dentist, and findings regarding the projected actuarial costs of implementing
said regulations. g
(c) The regulations shall be deeveloped by the Insurance Commissioner with the advice of a
six-member panel to be appointed by the commissioner. Such panel shall consist of a general
practicing dentist who sLhall be recommended by the West Virginia Dental Association, an
oral and maxillofacial surgeon who shall be recommended by the West Virginia Society for
Oral and Maxillofacial Dentists, a physician who shall be recommended by the West Virginia
State Medical Association, a member from a Health Services Corporation who shall be
recommended by the Health Services Corporation in this state, a member representing
commercial health insurers who shall be recommended by the association representing
accWident and sickness insurance, and a representative of the Public Employees Insurance
Association.
The Insurance Commissioner shall make his appointments to the panel based solely upon
said recommendations thirty days after this section takes effect.
(d) This section shall only apply to policies of insurance which provide hospital, surgical or
major medical expense insurance or any combination of these coverages.

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