West Virginia Code § 33-25D-26

Scope of provisions; applicability of other laws
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(a) Except as otherwise provided in this article, provisions of the insurance laws, provisions
of hospital, medical, dental or health service corporation laws and provisions of health
maintenance organization laws are not applicable to any prepaid limited health service
organization granted a certificate of authority under this article. The provisions of this
article do not apply to an insurer, hospital, medical, dental or health servicee corporation, or
health maintenance organization licensed and regulated pursuant to the insurance laws,
hospital, medical, dental or health service corporation laws or health mraintenance
organization laws of this state except with respect to its prepaid limited health service
corporation activities authorized and regulated pursuant to this article. The provisions of
this article do not apply to an entity properly licensed by a reciprocal state to provide a
limited health care service to employer groups, where residetnts of West Virginia are
members of an employer group, and the employer group contract is entered into in the
reciprocal state. For purposes of this subsection, a "reciprocal state" means a state which
physically borders West Virginia and which has subscriber or enrollee hold harmless
requirements substantially similar to those set out in section ten of this article.
(b) Factually accurate advertising or solicitation regarding the range of services provided,
the premiums and copayments charged, the sites of services and hours of operation and any
other quantifiable, nonprofessional agspects of its operation by a prepaid limited health
service organization granted a certificate of authority, or its representative do not violate
any provision of law relating toe solicitation or advertising by health professions: Provided,
That nothing contained in this subsection authorizes any solicitation or advertising which
identifies or refers to anLy individual provider or makes any qualitative judgment concerning
any provider.
(c) Any prepaid limited health service organization authorized under this article is not
considered to be practicing medicine and is exempt from the provision of chapter thirty of
this code relating to the practice of medicine.
(d) The provisions of section nine, article two, examinations; section nine-a, article two, one-
time assessment; section thirteen, article two, hearings; sections fifteen and twenty, article
four, general provisions; section twenty, article five, borrowing by insurers; section
seventeen, article six, noncomplying forms; article six-c, guaranteed loss ratio; article seven,
assets and liabilities; article eight, investments; article eight-a, use of clearing corporations
and Federal Reserve book-entry system; article nine, administration of deposits; article ten,
rehabilitation and liquidation; article twelve, agents, brokers, solicitors and excess line;
section fourteen, article fifteen, individual accident and sickness insurance; section sixteen,
article fifteen, coverage of children; section eighteen, article fifteen, equal treatment of state
agency; section nineteen, article fifteen, coordination of benefits with Medicaid; article
fifteen-b, Uniform Health Care Administration Act; section three, article sixteen, required
policy provisions; section eleven, article sixteen, coverage of children; section thirteen,
article sixteen, equal treatment of state agency; section fourteen, article sixteen,
coordination of benefits with Medicaid; article sixteen-a, group health insurance conversion;
article sixteen-d, marketing and rate practices for small employers; article twenty-seven,
insurance holding company systems; article thirty-three, annual audited financial report;
article thirty-four, administrative supervision; article thirty-four-a, standards and
commissioner's authority for companies considered to be in hazardous financial condition;
article thirty-five, criminal sanctions for failure to report impairment; article thirty-seven,
managing general agents; article thirty-nine, disclosure of material transactions; article
forty-a, risk-based capital for health organizations; and article forty-one, prievileges and
immunity, all of this chapter are applicable to any prepaid limited health service
organization granted a certificate of authority under this article. In circrumstances where the
code provisions made applicable to prepaid limited health service organizations by this
section refer to the insurer, the corporation or words of similar import, the language
includes prepaid limited health service organizations.
(e) Any long-term care insurance policy delivered or issued for delivery in this state by a
prepaid limited health service organization shall comply with the provisions of article fifteen-
a of this chapter.
(f) A prepaid limited health service organizatiosn granted a certificate of authority under this
article is exempt from paying municipal business and occupation taxes on gross income it
receives from its enrollees, or from their employers or others on their behalf, for health care
items or services provided directly ogr indirectly by the prepaid limited health service
organization.

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