Islets of Hope state diabetes insurance coverage laws
Information for this article was compiled and edited by Lahle A. Wolfe, Islets of Hope.
This information for general information purposes only.
It is not intended to be used a recommendation or endorse- ment of any program or entity
This information is not intended to serve as any form of medical or legal advice.
Government Accountability Office (GAO) report number GAO-05-210 entitled "Managing Diabetes: Health Plan Coverage of Services and Supplies;" released on March 28, 2005.
West Virginia - State Diabetes Insurance Coverage Laws
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West Virginia has mandated coverage for diabetes care.
For laws on managed care in West Virginia, see West Virginia Managed Care Regulations (HMOs)
§33-16-16 (major medical) - 1996 law. Requires health insurance policies to provide coverage for specified medically necessary equipment and supplies.; includes education in self-management diet.
Summary of Provisions
§33-16-16. Insurance for diabetics.
(a) Except as provided in section six, article fifteen of this chapter, any policy which provides major medical or similar comprehensive-type medical coverage shall include coverage for the following equipment and supplies for the treatment and/or management of diabetes for both insulin dependent and noninsulin dependent persons with diabetes and those with gestational diabetes, if medically necessary and prescribed by a licensed physician: Blood glucose monitors, monitor supplies, insulin, injection aids, syringes, insulin infusion devices, pharmacological agents for controlling blood sugar, orthotics and any additional items as promulgated by rule, pursuant to the provisions of chapter twenty-nine-a of this code, by the insurance commissioner, with the advice of the commissioner of the bureau of public health.
(b) All policies affected by the provisions of this
section shall also include coverage for diabetes self-management education to
ensure that persons with diabetes are educated as to the proper self-management
and treatment of their diabetes, including information on proper diets. Coverage
for self-management education and education relating to diet and prescribed by a
licensed physician shall be limited to: (1) Visits medically necessary upon the
diagnosis of diabetes; (2) visits under circumstances whereby a physician
identifies or diagnoses asignificant change in the patient's symptoms or
conditions that necessitates changes in a patient's self-management; and (3)
where a new medication or therapeutic process relating to the person's treatment
and/or management of diabetes has been identified as medically necessary by a
licensed physician: Provided, That coverage for reeducation or refresher
education shall be limited to one hundred dollars annually.
(d) Any deductible or coinsurance billed for any service as provided in this section shall apply on an equal basis with all other coverages provided by the insurer but not included in this section.
Page Updated 03/09/2007