West Virginia Code § 33-25C-3

Notice of certain enrollee rights
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All managed care plans must on or after July 1, 2002, provide to enrollees a notice of certain
enrollee rights. The notice shall be provided to enrollees on a yearly basis on a form
prescribed by the commissioner and shall include, but not be limited to:
(a) The enrollee's rights to a description of his or her rights and responsibilities, plan
benefits, benefit limitations, premiums, and individual cost-sharing requirements;
(b) The enrollee's right to a description of the plan's grievance procedure and the right to
pursue grievance and hearing procedures without reprisal from uthe managed care plan;
(c) A description of the method in which an enrollee can obtain a listing of the plan's
provider network, including the names and credentials of all participating providers, and the
method in which an enrollee may choose providers witahin the plan;
(d) The enrollee's right to privacy and confidentialilty;
(e) The right to full disclosure from the enrollee's health care provider of any information
relating to his or her medical condition or treatment plan, and the ability to examine and
offer corrections to the enrollee's medical records;
(f) The enrollee's right to be informed of plan policies and any charges for which the enrollee
will be responsible;
(g) The right of enrolleeLs to have coverage denials involving medical necessity or
experimental treatment reviewed by appropriate medical professionals who are
knowledgeable abou t the recommended or requested health service, as part of an external
review as provided in this article;
(h) A description of the method in which an enrollee can obtain access to a summary of the
planW's accreditation report;
(i) The right of an enrollee to have medical advice or options communicated to him or her
without any limitations or restrictions being placed upon the provider or primary care
physician by the managed care plan;
(j) A list of all other legally mandated benefits to which the enrollee is entitled, including
coverage for services provided pursuant to sections eight-a, eight-b, eight-c, eight-d, eight-e,
article twenty-five-a of this chapter, article twenty-five-e of this chapter, and article forty-two
of this chapter, and all rules promulgated pursuant to this chapter regulating managed care
plans.
(k) Any other areas the commissioner may propose in accordance with section nine of this
article.

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