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§5-16-7f. Prior Authorization

(a) As used in this section, the following words and phrases have the meanings given to them in this section unless the context clearly indicates otherwise: “Episode of Care” means a specific medical problem, condition, or specific illness being managed including tests, procedures and rehabilitation initially requested by health care practitioner, to be performed at, […]

§5-16-7g. Coverage for Prescription Insulin Drugs

(a) A policy, plan, or contract that is issued or renewed on or after July 1, 2020, shall provide coverage for prescription insulin drugs pursuant to this section. (b) For the purposes of this subdivision, “prescription insulin drug” means a prescription drug that contains insulin and is used to treat diabetes, and includes at least […]

§5-16-20. Expense Fund

The Legislature shall annually appropriate such sums as may be necessary to pay the proportionate share of the administrative costs for the state as an employer, and each division, agency, board, commission or department of the state which operates out of special revenue funds or federal funds or both shall pay its proportionate share of […]

§5-16-8. Conditions of Insurance Program

The insurance plans provided for in this article shall be designed by the Public Employees Insurance Agency: (1) To provide a reasonable relationship between the hospital, surgical, medical and prescription drug benefits to be included and the expected reasonable and customary hospital, surgical, medical and prescription drug expenses as established by the director to be […]

§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 […]

§5-16-5. Purpose, Powers and Duties of the Finance Board; Initial Financial Plan; Financial Plan for Following Year; and Annual Financial Plans

(a) The purpose of the finance board created by this article is to bring fiscal stability to the Public Employees Insurance Agency through development of annual financial plans and long-range plans designed to meet the agency's estimated total financial requirements, taking into account all revenues projected to be made available to the agency and apportioning […]