Healthcare (Insurance)

in committee · West Virginia · House of Delegates Jan 14, 2026

HB 4248: Relating to authorizing the Insurance Commissioner to promulgate a legislative rule relating to mental health parity.

This bill authorizes West Virginia's Insurance Commissioner to implement an existing proposed rule (114 CSR 64) regarding mental health parity. It formally approves a rule filed on April 16, 2025, which requires health insurance plans to provide equal coverage for mental health services as they do for physical health services. The rule directly affects insurance companies and mental health providers by mandating parity in coverage. This is a procedural authorization of an already proposed rule, not a new policy change.

Topics ✓ HealthcareSupports HealthcareMandates equal insurance coverage for mental health services as physical health, advancing parity and patient rights per the rule requiring equal treatment.95% confidence

Sub-Topics Insurance Mental Health

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in committee · West Virginia · Senate Jan 14, 2026

SB 107: Requiring medical insurance providers to include infertility services in policies

This bill requires all health insurance providers in West Virginia to cover infertility diagnosis, treatment, and fertility preservation services. It mandates coverage for medically necessary fertility care - including evaluations, medications, and donor services - and specifically requires coverage for fertility preservation (like egg or sperm freezing) before medical treatments known to impair fertility, such as chemotherapy. The law applies to all group health insurance policies and prohibits insurers from imposing separate deductibles, copays, or limits on these covered services. This directly affects West Virginia residents with infertility diagnoses or those needing fertility preservation before medical procedures, ensuring access to these services through their insurance plans.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for infertility services, expanding patient access to fertility care and treatment per bill's explicit requirements.95% confidence

Sub-Topics Insurance

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in committee · West Virginia · Senate Jan 16, 2026

SB 464: Requiring insurance coverage for biomarker testing

SB 464 requires health insurance plans in West Virginia, including the Public Employees Insurance Act, to cover biomarker testing when ordered by a physician for diagnosis, treatment, or monitoring of a disease, provided the test is medically indicated and has clinical utility. Biomarker testing - such as analyzing tissue or blood samples to identify gene mutations or protein markers that guide treatment decisions - must be based on evidence like FDA approvals, national medical guidelines (e.g., from the National Comprehensive Cancer Network), or Medicare coverage determinations. Insurers must provide a clear online process for appealing coverage denials and avoid requiring multiple biopsies that disrupt care. The bill does not cover routine screening before a diagnosis and mandates the Public Employees Insurance Agency to report implementation costs to the legislature after one year.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for medically necessary biomarker testing, expanding patient access to diagnostic services without financial barriers.95% confidence

Sub-Topics Insurance Medicare

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in committee · West Virginia · House of Delegates Jan 14, 2026

HB 4197: Mandating health insurance coverage treatment of pediatric patients diagnoced with PANDAS or PANS

HB 4197 requires all health insurance plans in West Virginia to cover medically necessary treatments for pediatric patients diagnosed with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) or PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). The bill mandates coverage for specific treatments including antibiotics, medications, behavioral therapies, immunomodulating medicines, plasma exchange, and IVIG therapy, without higher copays or deductibles than other covered services. Insurers cannot deny or delay coverage based on prior treatment history, alternative diagnoses (like autoimmune encephalopathy), or previous coverage for similar conditions. This applies to all group health insurance plans and managed care organizations issued or renewed in West Virginia on or after January 1, 2027.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for specific pediatric treatments without higher copays, expanding access to necessary care for PANDAS/PANS patients.95% confidence

Sub-Topics Children's Health Insurance

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in committee · West Virginia · Senate Jan 23, 2026

SB 518: Relating to cost-sharing requirements for breast examinations

West Virginia's SB 518 prohibits health insurance plans from requiring copays, deductibles, or other out-of-pocket costs for specific breast examinations. It applies to "diagnostic" exams (used to evaluate suspicious findings) and "supplemental" exams (high-risk screening based on personal/family history), covering services like mammograms, ultrasounds, or MRIs. The law takes effect for all new or renewed insurance policies in West Virginia starting July 1, 2027, and includes one exception for Health Savings Account plans under federal rules. This directly affects insurers selling health coverage in West Virginia and patients needing these medically necessary breast exams.

Topics ✓ HealthcareSupports HealthcareBill eliminates cost-sharing for breast exams (mammograms, ultrasounds), expanding access to preventive care and protecting patient rights by removing out-of-pocket barriers.95% confidence

Sub-Topics Insurance

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in committee · West Virginia · House of Delegates Jan 19, 2026

HB 4539: Requiring health insurers provide price information to consumers timely prior to rate change

HB 4539 requires health insurers in West Virginia to send written notices to policyholders at least 30 days before open enrollment about upcoming premium rate changes. The notice must clearly show the exact dollar amount and percentage increase, the new effective date, and any changes to benefits or plan details - all in bold 16-point font - along with information about public health programs like Medicaid. Insurers cannot implement rate changes until after open enrollment closes. This bill directly affects all consumers with health insurance policies in the state who face premium adjustments.

Topics ✓ HealthcareSupports HealthcareMandates transparent insurer rate change notices with clear pricing details, protecting consumer rights and improving access to healthcare cost information per bill's requirements.85% confidence

Sub-Topics Insurance Medicaid Public Health

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in committee · West Virginia · Senate Jan 14, 2026

SB 68: Creating Voluntary Portable Benefit Account Act

SB 68 creates the "Voluntary Portable Benefit Account Act" in West Virginia, allowing independent contractors to open personal accounts to fund benefits like health insurance, retirement, or life insurance. Businesses hiring independent contractors (called "hiring parties") may voluntarily contribute to these accounts, but only with the contractor’s explicit written agreement and opt-in consent. The bill explicitly prohibits using these contributions to determine a worker’s employment classification as an independent contractor. It defines key terms and ensures contributions cannot be used as a factor in worker classification decisions.

Topics ✓ HealthcareSupports HealthcareEnables independent contractors to fund health insurance via portable accounts, expanding access to coverage for a group typically lacking employer-provided benefits.85% confidence ✓ Labor & EmploymentSupports Labor & EmploymentCreates voluntary portable benefits for independent contractors, expanding access to health/retirement coverage and preventing misclassification as employment status.75% confidence

Sub-Topics Insurance Gig Economy

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in committee · West Virginia · House of Delegates Jan 21, 2026

HB 4627: Mandate free cancer screenings for professional firefighters.

HB 4627 requires health insurance plans and self-insured employer health plans in West Virginia to cover preventive cancer screenings for professional firefighters without cost-sharing (such as copays or deductibles), except in high-deductible health plans where standard deductibles apply. The bill applies to all firefighters employed by state, county, or municipal entities and mandates coverage based on the International Association of Fire Fighters' current screening guidelines. This ensures firefighters can access regular cancer screenings at no additional cost, promoting early detection and health monitoring for this occupational group.

Topics ✓ HealthcareSupports HealthcareMandates no-cost cancer screenings for firefighters via insurance coverage, expanding access to preventive healthcare under public safety health protections.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentMandates free cancer screenings for firefighters (high-risk occupation), improving workplace safety and protecting workers' health without cost-sharing per IAF firefighters guidelines.95% confidence

Sub-Topics Insurance

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in committee · West Virginia · Senate Jan 16, 2026

SB 434: PEIA Stability and Sustainability Act of 2026

SB 434 creates the PEIA Stability and Sustainability Act of 2026 to stabilize West Virginia's Public Employees Insurance Agency (PEIA), which covers over 200,000 state employees, teachers, public workers, and retirees. It establishes a PEIA Stabilization Reserve Fund funded by 2% of the state's General Revenue each year, sets employer contributions at 82% (minimum 80%) and employee contributions at 18%, and protects retirees by capping premiums at $100/month for those with under $40,000 annual pension income or covering full Medicare Advantage premiums. The bill mandates public transparency for rate changes (with 30-day notice and actuarial justification), creates an independent oversight board with employee and retiree representation, and requires annual accountability reports. These provisions aim to prevent premium spikes, ensure long-term solvency, and maintain affordable coverage for beneficiaries.

Topics ✓ Budget & TaxesSupports Budget & TaxesFunds PEIA stabilization via 2% General Revenue allocation, caps retiree premiums under $40k, promoting fiscal responsibility and tax relief for low-income retirees.92% confidence ✓ HealthcareSupports HealthcareStabilizes PEIA coverage for 200k+ state workers/retirees, caps retiree premiums at $100/month, and funds reserve to protect existing healthcare access.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentCovers 200k+ public workers; caps retiree premiums at $100/month; stabilizes health insurance funding to protect benefits95% confidence

Sub-Topics Pensions Revenue Insurance Medicare

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in committee · West Virginia · House of Delegates Feb 17, 2026

HB 4760: Requiring insurance to cover certain nutrition and dietary needs

HB 4760 requires West Virginia health insurance plans to cover dietary supplements and nutrition prescriptions recommended by a patient's physician. This applies to all health insurance policies sold in the state and covers items defined as "nutritional wellness and prevention" (like vitamins, minerals, and dietary counseling) that improve health, strengthen immunity, or prevent disease. Insurance companies must cover these items only if they appear on an annual list maintained by the West Virginia Insurance Commission. The bill directly affects insurers, policyholders seeking these services, and the Insurance Commission responsible for updating the coverage list.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for physician-recommended nutrition/dietary services, expanding preventive health access per bill's requirement for 'nutritional wellness and prevention' coverage.95% confidence

Sub-Topics Insurance

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