This bill amends the Code of West Virginia to improve fairness in cost-sharing calculations for health insurance. It introduces new definitions for terms such as "average allowed amount," "cost sharing," and "discounted cash price," which clarify how insurers should determine the costs that insured individuals are responsible for when accessing healthcare services. The bill mandates that insurers must account for any cost-sharing amounts paid by the insured or on their behalf when calculating the insured's contribution to cost-sharing requirements. Additionally, if a covered person chooses a healthcare service at a discounted cash price below the average allowed amount, they will receive credit toward their in-network cost-sharing as if the service was provided by an in-network provider.

Moreover, the bill prohibits insurers from discriminating against covered persons based on the payment form for in-network healthcare services, especially when the referral originates 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. The bill also addresses the relationship between state requirements and federal law regarding Health Savings Accounts (HSAs), clarifying that certain provisions will only apply to High Deductible Health Plans after the enrollee meets the minimum deductible, while preventive care requirements will still be enforced regardless of deductible status. Overall, the bill aims to streamline health insurance regulations while ensuring compliance with federal standards.

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