§5-16-21. No Member or Employee of Public Employees Insurance Agency Shall Gain Directly or Indirectly From Any Contract or Contracts Provided for Hereunder; Criminal Penalties
No elected or appointed official of the State of West Virginia; nor any member, officer, or employees of the Legislature; nor any officer, agent, servant or employee in the executive branch of state government shall have any interest, direct or indirect, in the gain or profits arising from any contract or contracts provided for in […]
§5-16-8a. Air-Ambulance Fees
(a) The plan shall reimburse any air-ambulance provider that provides emergency air transportation or related emergency medical or treatment services to an employee or dependent of an employee covered by the plan the amount then in effect for the federal Medicare program, including any applicable Geographic Practice Cost Index. (b) Nothing in this section limits […]
§5-16-22. Permissive Participation; Exemptions
The provisions of this article are not mandatory upon any employee or employer who is not an employee of, or is not, the State of West Virginia, its boards, agencies, commissions, departments, institutions or spending units, or a county board of education, and nothing contained in this article compels any employee or employer to enroll […]
§5-16-9. Authorization to Execute Contracts for Group Hospital and Surgical Insurance, Group Major Medical Insurance, Group Prescription Drug Insurance, Group Life and Accidental Death Insurance, and Other Accidental Death Insurance; Mandated Benefits; Limitations; Awarding of Contracts; Reinsurance; Certificates for Covered Employees; Discontinuance of Contracts
(a) The director is given exclusive authorization to execute such contract or contracts as are necessary to carry out the provisions of this article and to provide the plan or plans of group hospital and surgical insurance coverage, group major medical insurance coverage, group prescription drug insurance coverage, and group life and accidental death insurance […]
§5-16-10. Contract Provisions for Group Hospital and Surgical, Group Major Medical, Group Prescription Drug and Group Life and Accidental Death Insurance for Retired Employees, Their Spouses and Dependents
Any contract or contracts entered into hereunder may provide for group hospital and surgical, group major medical, group prescription drug and group life and accidental death insurance for retired employees and their spouses and dependents as defined by rules and regulations of the Public Employees Insurance Agency, and on such terms as the director may […]
§5-16-11. To Whom Benefits Paid
Any benefits payable under any group hospital and surgical, group major medical and group prescription drug plan or plans may be paid either directly to the attending physician, hospital, medical group, or other person, firm, association or corporation furnishing the service upon which the claim is based, or to the insured upon presentation of valid […]
§5-16-12. Misrepresentation by Employer, Employee or Provider; Penalty
(a) It shall be a violation of this article for any person to: (1) Knowingly secure or attempt to secure benefits payable under this article to which they are not entitled;
§5-16-12a. Inspections; Violations and Penalties
(a) Employers and employees participating in any of the Public Employees Insurance Agency plans shall provide, to the director, upon request, all documentation reasonably required for the director to discharge the responsibilities under this article. This documentation includes, but is not limited to, employment or eligibility records sufficient to verify actual full-time employment and eligibility […]
§5-16-12b. Privileges and Immunity
(a) Any person who makes a report or furnishes information, written or oral, concerning suspected, anticipated or fraudulent activity to secure benefits payable under this article, or to secure greater benefits than those to which the person or provider is entitled, is entitled to those privileges and immunities existing under common or statutory law, as […]
§5-16-13. Payment of Costs by Employer and Employee; Spouse and Dependent Coverage; Involuntary Employee Termination Coverage; Conversion of Annual Leave and Sick Leave Authorized for Health or Retirement Benefits; Authorization for Retiree Participation; Continuation of Health Insurance for Surviving Dependents of Deceased Employees; Requirement of New Health Plan, Limiting Employer Contribution
(a) Cost-sharing. — The director shall provide under any contract or contracts entered into under the provisions of this article that the costs of any group hospital and surgical insurance, group major medical insurance, group prescription drug insurance, group life and accidental death insurance benefit plan or plans shall be paid by the employer and […]