Healthcare (Insurance)

in committee · West Virginia · Senate Jan 15, 2026

SB 295: Insurance Commissioner rule relating to mental health parity

This bill authorizes West Virginia's Insurance Commissioner to implement a specific rule (114 CSR 64) regarding mental health parity. It formally incorporates an existing rule, filed April 16, 2025, into state law under §64-7-1 of the Code. The rule requires health insurance plans to cover mental health services at the same level as physical health care, directly affecting insurance companies and policyholders in West Virginia. The bill itself does not change the coverage requirements but legally authorizes the Commissioner to enforce the existing parity rule.

Topics ✓ HealthcareSupports HealthcareRequires equal mental health insurance coverage parity, strengthening patient access to mental health services under state law per existing rule 114 CSR 64.95% confidence

Sub-Topics Insurance Mental Health

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in committee · West Virginia · Senate Jan 20, 2026

SB 526: Relating to PEIA Cost Sharing Provisions

SB 526 modifies how public employee health insurance premiums are calculated under West Virginia's Public Employees Insurance Agency (PEIA). It requires the finance board to develop annual financial plans with actuarial review, ensuring plans cover all costs including claims. The bill establishes specific reimbursement rates (110% of Medicare for providers), sets employer/employee cost-sharing percentages, and allows different cost levels based on ability to pay for current employees and retirees. It also permits subsidizing retired employees' coverage through employer premiums. This directly affects all West Virginia public employees, retirees, state employers, and healthcare providers participating in PEIA.

Topics ✓ HealthcareSupports HealthcareEnsures PEIA covers all costs via actuarial review, sets reimbursement rates, and adjusts cost-sharing to stabilize public employee health insurance program, supporting coverage sustainability.90% confidence

Sub-Topics Insurance Medicare

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signed · West Virginia · House of Delegates Jun 29, 2026

HB 4009: Relating to the creation of the Portable Benefit Account Act

HB 4009, the Portable Benefit Account Act, creates a new legal framework allowing independent contractors to access portable benefits through individually managed accounts. It directly affects independent contractors and hiring parties (businesses that contract with them), enabling voluntary contributions from hiring parties to fund benefits like health insurance, retirement plans, life insurance, and income replacement. Key provisions require written, opt-in agreements for contributions, prohibit using account contributions to determine worker classification, and mandate that accounts remain tied to the contractor - not the employer - when changing jobs. The bill establishes definitions for terms like "portable benefit account" and "provider," and requires administrative oversight by the Bank Commissioner.

Topics ✓ HealthcareSupports HealthcareBill explicitly includes health insurance as a covered benefit in portable accounts, enabling independent contractors to access coverage through voluntary employer contributions.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentCreates portable benefits access for independent contractors, expanding health/retirement options typically unavailable to this workforce segment.92% confidence

Sub-Topics Insurance Gig Economy

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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