This bill amends the Code of West Virginia to enhance the Public Employees Insurance Act by mandating coverage for medically necessary care and treatment related to congenital anomalies associated with cleft lip and cleft palate for newborns up to the age of 19. It introduces new sections that detail eligibility, required coverage, exclusions, and coverage terms, while also amending existing provisions to ensure equitable coverage for various health services, including mental health and substance use disorder treatments. Notably, the bill clarifies the age specification for annual prostate cancer checkups and emphasizes comprehensive coverage for individuals under 20, particularly for severe protein-allergic conditions.

The legislation requires the Public Employees Insurance Agency, Medicaid, and insurance providers to cover a range of treatments, including oral and facial surgery, prosthetic treatment, and orthodontic management, while explicitly excluding cosmetic surgery aimed at improving appearance. Insurers are allowed to apply the same cost-sharing limitations as for other surgical benefits. The provisions will take effect for policies beginning on or after July 1, 2026, ensuring that children affected by these congenital conditions have improved access to necessary medical care.

Statutes affected:
Introduced Version: 5-16-7, 9-5-34, 33-15-4y, 33-16-3ss, 33-24-7z, 33-25-8y, 33-25A-8z