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.
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.
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.
SB 512 requires insurers in West Virginia to count cash payments made by insured individuals at discounted rates (below the average in-network rate) toward their in-network cost-sharing requirements. It also prohibits insurers from penalizing patients who receive referrals from out-of-network providers for in-network services. The bill defines key terms like "average allowed amount" (the average payment to in-network providers) and "discounted cash price" to standardize cost-sharing calculations. These changes apply to all health insurance plans delivered in West Virginia starting January 1, 2027, and aim to reduce out-of-pocket costs for consumers using cash-based pricing.
HB 4348 prohibits health insurance companies in West Virginia from denying coverage, increasing premiums, or canceling policies for individuals who have donated an organ while alive (living organ donors). The law specifically applies to sickness, disability, and long-term care insurance policies issued or renewed after July 1, 2026. Insurers cannot refuse coverage, limit benefits, or impose higher costs solely because someone is a living organ donor, even if no additional health risks are present. This directly protects living organ donors from insurance discrimination while ensuring they maintain access to these essential coverage types.
This bill requires health insurance plans in West Virginia to cover annual mammograms for women aged 40 and older without needing a doctor's order first. It also mandates coverage for mammograms for women under 40 with breast cancer risk factors (like family history), based on medical necessity as determined by their provider. These requirements apply to all individual and group health insurance policies delivered, issued, or renewed in West Virginia on or after January 1, 2026. The policy affects all women in the state who have health insurance through these plans, ensuring coverage aligns with current medical guidelines for breast cancer screening.
SB 568, the Oral Health and Cancer Rights Act, requires health insurers in West Virginia to cover medically necessary dental procedures directly related to cancer treatment (such as surgery, chemotherapy, or radiation). This affects cancer patients needing dental care to eat, breathe, speak, or swallow after treatment, and all health benefit plans offered by insurers in the state. The bill mandates that covered services must be billed using the specific modifier "West Virginia Code §33-64-1" (or a unique prescription identifier for medications), ensuring insurers recognize these procedures as covered. The law takes effect July 1, 2027, applying to all nonexempt health insurance contracts.
HB 4733 requires most health insurance plans in West Virginia to cover breastfeeding and lactation consultant services without deductibles, copays, or coinsurance starting January 1, 2026. It applies to enrollees (including children) under health benefit plans, defining covered services as outpatient support during pregnancy and postpartum provided by International Board Certified Lactation Consultants or certified lactation counselors. Medicaid will reimburse providers meeting program requirements, and insurers must include this coverage without reducing other benefits. The mandate excludes dental-only, accident, or long-term care plans, as specified in the bill.
SB 71 requires health insurance plans in West Virginia to cover intravenous immunoglobulin therapy for pediatric patients diagnosed with specific conditions: pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), pediatric acute onset neuropsychiatric syndrome (PANS), and related autoimmune encephalopathies. This applies to all health insurance plans (including Medicaid) issued or renewed after January 1, 2027 (Medicaid) or July 1, 2027 (other plans). The key provision mandates that coverage is only available after a physician obtains prior authorization by demonstrating all other treatments have been exhausted. The bill directly affects children with these conditions and their families, ensuring access to this specific treatment while adding a step to verify medical necessity.
SB 435 requires all health insurance plans in West Virginia (including public employee, individual, group, and hospital service plans) to cover oral health medical procedures necessary as a side effect of cancer treatments. This includes procedures related to eating, breathing, speech, or swallowing - such as evaluations, medications, rehabilitation, and dental devices - following treatments like chemotherapy, radiation, or surgery. Coverage applies to policies issued or renewed on or after January 1, 2027. The bill also mandates annual cost reporting to the legislature one year after implementation.
