The West Virginia Health Benefit Plan Network Access and Adequacy Act requires insurers that maintain a network of health care providers for its insureds to ensure that the network is sufficient in numbers and has appropriate types of providers in order for all covered services to be accessible without unreasonable travel or delay.   The Act is applicable for plans beginning January 1, 2022.  

• Legislative Rule 114-100
• Dental Insurance Assignment of Benefits Brochure

Network Access Plan Compliance Checklist

West Virginia Network Access Plan forms need to be filed.  Please read Legislative Rule 114-100,

If you should have any questions you may contact us at OICNetworkAdequacy@wv.gov

1. 1-All documentation and templates should be submitted through SERFF. 
2. 2-An explanatory cover letter is required with each submission/resubmission.
3. 3-Inventory list that enumerates each supporting document with a high level summary of the document's purpose/function must be included with each submission/resubmission.
4. 4-Attach the completed templates in excel format in SERFF (do not change to PDF).
5. 5-Attach the sample contracts in SERFF.
6. 6-Please choose the Health, Dental only or Vision only forms below.

Once submitted in SERFF, an email with the SERFF tracking number must be sent to OICNetworkAdequacy@wv.gov .

• Instructions to file in SERFF and attach required information.
• Forms to complete and attach in SERFF:
  • 1- List of Health Plans
  • 2- Provider Locations List
  • 3- Projected Membership by Zip Code
  • 4- Certification of Access Plan for Each Network
  • 5- Providers by County
  • 6- Network Access Plan Compliance Checklist
  • 7- Network Deficiency Template
  • Also, attach copies of Sample Contracts as specified

• Instructions to file in SERFF and attached required information.
• Forms to complete and attach in SERFF:
  • 1- List of Dental Plans
  • 2- Dental Providers Locations List
  • 3- Dental Network by County
  • 4- Network Access Plan Compliance Checklist
  • 5- Certification of Dental Access Plan
  • 6- Network Access Summary Report
  • Also, attach copies of Sample Contracts as specified

• Instructions to file in SERFF and attached required information.
• Forms to complete and attach in SERFF:
  • 1- List of Vision Plans
  • 2- Vision Providers Locations List
  • 3- Vision Network by County
  • 4- Network Access Plan Compliance Checklist
  • 5- Certification of Vision Access Plan
  • 6- Network Access Summary Report
  • Also, attach copies of Sample Contracts as specified