HB 5301 increases funding for West Virginia's Children's Health Insurance Program (CHIP) by $871,991 using unused state funds. It specifically adds $422,562 for CHIP administrative costs and $449,429 for CHIP services under the Department of Human Services. This supplemental appropriation draws from the unappropriated balance in the State Fund, General Revenue, to cover existing program expenses during fiscal year 2026. The bill does not change CHIP eligibility or benefits but ensures current funding levels for administration and services.
HB 5349 requires West Virginia's Public Employees Insurance Agency (PEIA) and other health insurers to provide mental health, behavioral health, and substance use disorder coverage that is equally comprehensive as coverage for physical health conditions. It mandates specific protections, including annual screenings for depression and substance use, fair access to providers (like coverage for non-participating providers when needed), and clear denial notices explaining parity rights. The bill directly affects public employees covered by PEIA and all health insurance providers operating in West Virginia under state regulations. It also requires annual reporting on compliance and sets an effective date of June 1, 2026.
HB 5430 regulates pharmacy benefit managers (PBMs) for West Virginia's Public Employees Insurance Agency (PEIA), directly affecting state employees covered by PEIA, PBMs, and pharmacies providing services to them. The bill requires PBMs to submit detailed quarterly reports on claim payments, including costs charged to PEIA versus amounts paid to pharmacies, and prohibits certain PBM contracts that limit transparency. It also mandates PBMs to implement a cost containment tool and requires a study on pharmacy pricing. The law aims to increase transparency in pharmacy billing and control costs for state health insurance programs.
HB 5185 requires most health insurance plans in West Virginia to cover contraceptive drugs, devices, and related services without cost-sharing (like copays or deductibles) for enrollees. It mandates coverage for all FDA-approved contraceptives (including therapeutic equivalents), up to a 12-month supply at once, and includes sterilization procedures, counseling, and follow-up care. The law applies to plans renewed or delivered on or after January 1, 2027, and does not affect coverage for contraceptives prescribed for non-contraceptive medical reasons (e.g., treating ovarian cancer). This bill directly affects health insurance plans and their enrollees, excluding dependent children from the definition of "covered person."
HB 4810 requires dental insurance companies in West Virginia to publicly report how they spend premiums collected from enrollees, similar to federal health insurance rules. It mandates annual reports detailing patient care spending versus administrative costs, prohibits insurers from restricting payment methods to dentists, and requires rebates to customers if less than 80% of premiums are spent on dental care. The bill directly affects dental insurers, licensed dentists, and patients enrolled in private dental plans (excluding Medicaid). Key provisions include transparency requirements for premium expenditures, rules against unfair payment restrictions, and automatic premium reductions when patient care spending falls below the 80% threshold.
HB 4781 requires most health insurance plans in West Virginia to cover medically necessary laser hair removal starting January 1, 2027. The bill applies to group and individual health insurance policies, as well as managed care plans, that are amended, issued, or renewed after that date. Coverage is mandated only for procedures deemed medically necessary and prescribed under generally accepted medical standards, not for cosmetic purposes. This policy change directly affects health insurers operating in West Virginia and their policyholders seeking covered medical treatments.
HB 5004 requires Medicaid and private health insurance plans in West Virginia to cover medically necessary diagnosis and treatment for Pediatric Acute-Onset Neuroimmune Disorders (PANS and PANDAS), as defined by the National Institutes of Health. This directly affects Medicaid enrollees and patients with these conditions, ensuring coverage for diagnostic testing, medications, immune-related treatments, and behavioral services when ordered by a physician and supported by medical evidence. The bill mandates coverage parity for behavioral symptoms, preventing insurers from restricting care solely due to psychiatric manifestations. It also requires the state health department to educate providers on recognizing PANS/PANDAS symptoms, including acute onset, association with strep infections, and neurological symptoms. The legislation applies to all health benefit plans subject to West Virginia's insurance laws.
HB 4061 requires West Virginia's Public Employees Insurance Agency (PEIA) and other health insurers to pay mental health and behavioral health providers the same rate as medical/surgical providers for comparable services. This applies to licensed practitioners (like therapists and counselors) covered under the bill’s definitions of "serious mental illness." Insurers must submit claims using standard codes and identifiers, and cannot reduce payments to physicians to comply with this law. The bill directly affects mental health providers and insurers by mandating equal reimbursement rates for services like therapy and counseling, aligning them with physical health care payments.
SB 673 imposes a 3-cent tax per milligram of nicotine on all e-cigarette products sold in West Virginia, replacing a previous tax based on product type. This tax applies to both disposable (closed-system) and refillable (open-system) devices, with fallback rates (40mg per unit for disposables, 6mg/mL for refillables) if labeling is unclear. All revenue generated will be directed to the Public Employees Insurance Agency (PEIA) to reduce or stabilize state employees' health insurance premiums, without replacing existing employer contributions. The bill directly affects e-cigarette distributors and manufacturers in the state, effective July 1, 2026.
HB 4869 creates two guaranteed periods for West Virginia seniors to purchase Medicare Supplement (Medigap) policies without medical underwriting or pre-existing condition exclusions. It provides a 60-day window annually around each individual’s birthday for current policyholders to switch to a policy with the same or fewer benefits, and a 63-day window starting the day after Medicaid eligibility ends for those turning 65 or losing Medicaid. Insurers must offer coverage during these periods but are not required to provide new policies or alter existing benefit structures. The bill also mandates annual reports on Medigap premium trends for legislative review but does not change Medicare Advantage plans or require insurers to offer specific rates.
