This bill amends the West Virginia Code to improve fairness in cost-sharing calculations for health insurance by introducing new definitions for terms such as "average allowed amount," "cost sharing," and "discounted cash price." It requires insurers to consider any cost-sharing amounts paid by the insured or on their behalf when calculating the insured's contribution to cost-sharing. Additionally, if a covered person chooses a healthcare service at a discounted cash price that is below the average allowed amount, they will receive credit towards their in-network cost-sharing as if the service was provided by an in-network provider. The bill also prohibits discrimination against covered persons based on the payment form for in-network services, especially when a referral comes from an out-of-network provider.

The amendments will take effect on January 1, 2026, and will apply to all relevant policies, contracts, plans, or agreements executed or renewed after this date. Furthermore, the bill addresses the relationship between state requirements and federal law regarding Health Savings Accounts (HSAs), stating that certain provisions will only apply to High Deductible Health Plans after the enrollee meets the minimum deductible, while requirements for preventive care services will still apply regardless of the deductible status. The insurance commissioner is authorized to propose rules for legislative approval to ensure effective implementation of these provisions.

Statutes affected:
Introduced Version: 33-15-4t, 33-16-3ee, 33-24-7t, 33-25-8q, 33-25A-8t