W. Va. Code R. § 114-83-5

Current through Register Vol. XLII, No. 1, January 3, 2025

Section 114-83-5 - Disclosure Requirements

5.1.

5.1.a. Each Discount Medical Plan Organization shall make the following general disclosures, in writing not less than twelve-point font, on the first content page of any advertisements, marketing materials or brochures made available to the public relating to a discount medical plan and along with any enrollment forms given to a prospective member:

5.1.a.1. That the plan is a discount plan and is not insurance coverage;

5.1.a.2. That the range of discounts for medical or ancillary services provided under the plan will vary depending on the type of provider and medical or ancillary service received;

5.1.a.3. That the plan does not make payments to providers for the medical or ancillary services received under the discount medical plan;

5.1.a.4. That the plan member is obligated to pay for all medical or ancillary services, but will receive a discount from those providers that have contracted with the Discount Medical Plan Organization; and

5.1.a.5. The toll-free telephone number and Internet website address for the licensed Discount Medical Plan Organization for prospective members to obtain additional information about and assistance on the discount medical plan and up-to-date lists of providers participating in the discount medical plan.

5.1.b. If the initial contract with a prospective member is by telephone, the disclosures required under subdivision a of this subsection shall be made orally and included in the initial written materials that describe the benefits under the discount medical plan provided to the prospective or new member.

5.2.

5.2.a. In addition to the disclosures required under subsection 5.1 of this section, each Discount Medical Plan Organization shall provide to:

5.2.a.1. Each prospective member, at the time of enrollment, information that describes the terms and conditions of the discount medical plan, including any limitations or restrictions on the refund of any processing fees or periodic charges associated with the discount medical plan; and

5.2.a.2. Each new member a written document that contains the terms and conditions of the discount medical plan.

5.2.b. The written document required under paragraph 2, subdivision a of this subsection shall be clear and include the following information:

5.2.b.1. The name of the member;

5.2.b.2. The benefits to be provided under the discount medical plan;

5.2.b.3. Any processing fees and periodic charges associated with the discount medical plan, including any limitations or restrictions on the refund of any processing fees and periodic charges;

5.2.b.4. The mode of payment of any processing fees and periodic charges, such as monthly, quarterly, etc., and procedures for changing the mode of payment;

5.2.b.5. Any limitations, exclusions or exceptions regarding the receipt of discount medical plan benefits;

5.2.b.6. Any waiting periods for certain medical or ancillary services under the discount medical plan benefits;

5.2.b.7. Procedures for obtaining discounts under the discount medical plan, such as requiring members to contact the Discount Medical Plan Organization to make an appointment with a provider on the member's behalf;

5.2.b.8. Cancellation procedures, including information on the member's thirty-day cancellation rights and refund requirements, procedures for obtaining refunds and the process for cancelling the plan by e-mail in accordance with subdivision b, subsection 4.3 of this rule.

5.2.b.9. Renewal, termination and cancellation terms and conditions;

5.2.b.10. Procedures for adding new members to a family discount medical plan;

5.2.b.11. Procedures for filing complaints under the Discount Medical Plan Organization's complaint system and information that, if the member remains dissatisfied after completing the organization's complaint system, the plan member may contact the Offices of the West Virginia Insurance Commissioner; and

5.2.b.12. The name and mailing address of the licensed Discount Medical Plan Organization or other entity where the member can make inquiries about the plan, send cancellation notices and file complaints.

W. Va. Code R. § 114-83-5