Relating to cost-sharing calculations on behalf of insured persons

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.