This bill amends the Code of West Virginia by introducing six new sections that establish cost-sharing requirements for diagnostic and supplemental breast examinations. It defines key terms such as "cost-sharing requirement," "diagnostic breast examinations," and "supplemental breast examinations," and mandates that health benefit policies providing coverage for these examinations cannot impose any cost-sharing requirements, which includes out-of-pocket expenses like deductibles, coinsurance, or copayments. The bill clarifies that existing utilization reviews are not affected and ensures compliance with federal law regarding Health Savings Accounts, stating that cost-sharing requirements will only apply to certain high-deductible health plans after the minimum deductible is met, except for preventive care services.

Additionally, the bill empowers the Insurance Commissioner to propose rules for legislative approval to implement these provisions in accordance with guidelines from professional medical organizations, such as the National Comprehensive Cancer Network. The new regulations will take effect for all relevant coverage issued or renewed in the state on or after January 1, 2026, or whenever any terms of the policy are changed or premiums adjusted. This legislative effort aims to enhance access to necessary breast health services without imposing financial barriers on patients.

Statutes affected:
Introduced Version: 5-16-7h, 33-15-4y, 33-16-3ii, 33-24-7z, 33-25-8w, 33-25A-8z
Committee Substitute: 5-16-7h, 33-15-4y, 33-16-3ii, 33-24-7z, 33-25-8w, 33-25A-8z