Bill Summary – FastDemocracy

WEST VIRGINIA LEGISLATURE
REGULAR SESSION
                 Introduced House Bill 3487
         By Delegates Summers and Tully [Introduced February 14, 2023; Referred to the Committee on Health and Human Resources then Finance]
     Introduced HB 3487
  A BILL to amend and reenact §33-15-4t of the Code of West Virginia, 1931, as amended; to
          amend and reenact §33-16-3ee of said code; to amend and reenact §33-24-7t of said
          code; to amend and reenact §33-25-8q of said code; and to amend and reenact §33-25A-
          8t of said code, all relating to cost-sharing calculations for certain Health Savings Account-
          qualified High Deductible Health Plans.
     Be it enacted by the Legislature of West Virginia:
     ARTICLE            15.        ACCIDENT              AND          SICKNESS              INSURANCE.
     §33-15-4t. Fairness in Cost-Sharing Calculation.
          (a) As used in this section:
          "Cost sharing" means any copayment, coinsurance, or deductible required by or on behalf
  of an insured in order to receive a specific health care item or service covered by a health plan.
          "Drug" means the same as the term is defined in §30-5-4(19) of this code.
          "Person" means a natural person, corporation, mutual company, unincorporated
  association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit
  corporation, unincorporated organization, or government or governmental subdivision or agency.
          "Pharmacy benefits manager" means the same as that term is defined in §33-51-3 of this
  code.
         (b) When calculating an insured’s contribution to any applicable cost sharing requirement,
 including, but not limited to, the annual limitation on cost sharing subject to 42 U.S.C. §18022(c)
 and 42 U.S.C. § 300gg-6(b):
         (1) An insurer shall include any cost sharing amounts paid by the insured or on behalf of
 the insured by another person; and
         (2) A pharmacy benefits manger manager shall include any cost sharing amounts paid by
 the insured or on behalf of the insured by another person.
         (c) The commissioner is authorized to may propose rules for legislative approval in
 accordance with §29A-3-1 et seq. of this code, to implement the provisions of this section.
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     Introduced HB 3487
         (d) This section is effective for policy, contract, plans, or agreements beginning on or after
 January 1, 2020. This section applies to all policies, contracts, plans, or agreements, subject to
 this article that are delivered, executed, issued, amended, adjusted, or renewed in this state on or
 after the effective date of this section.
         (e) If, under federal law, application of subsection (b) of this section would result in Health
 Savings Account ineligibility under section 223 of the federal Internal Revenue Code, this
 requirement shall apply for Health Savings Account-qualified High Deductible Health Plans with
 respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible
 under section 223, except for with respect to items or services that are preventive care pursuant to
 section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this
 subsection shall apply regardless of whether the minimum deductible under section 223 has been
 satisfied.
     ARTICLE         16.      GROUP          ACCIDENT          AND       SICKNESS           INSURANCE.
     §33-16-3ee. Fairness in Cost-Sharing Calculation.
          (a) As used in this section:
          "Cost sharing" means any copayment, coinsurance, or deductible required by or on behalf
  of an insured in order to receive a specific health care item or service covered by a health plan.
          "Drug" means the same as the term is defined in §30-5-4(19) of this code.
          "Person" means a natural person, corporation, mutual company, unincorporated
  association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit
  corporation, unincorporated organization, or government or governmental subdivision or agency.
          "Pharmacy benefits manager" means the same as that term is defined in §33-51-3 of this
  code.
         (b) When calculating an insured’s contribution to any applicable cost sharing requirement,
 including, but not limited to, the annual limitation on cost sharing subject to 42 U.S.C. §18022(c)
 and 42 U.S.C. § 300gg-6(b):
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     Introduced HB 3487
         (1) An insurer shall include any cost sharing amounts paid by the insured or on behalf of
 the insured by another person; and
         (2) A pharmacy benefits manger manager shall include any cost sharing amounts paid by
 the insured or on behalf of the insured by another person.
         (c) The commissioner is authorized to may propose rules for legislative approval in
 accordance with §29A-3-1 et seq. of this code, to implement the provisions of this section.
         (d) This section is effective for policy, contract, plans, or agreements beginning on or after
 January 1, 2020. This section applies to all policies, contracts, plans, or agreements, subject to
 this article that are delivered, executed, issued, amended, adjusted, or renewed in this state on or
 after the effective date of this section.
         (e) If, under federal law, application of subsection (b) of this section would result in Health
 Savings Account ineligibility under section 223 of the federal Internal Revenue Code, this
 requirement shall apply for Health Savings Account-qualified High Deductible Health Plans with
 respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible
 under section 223, except for with respect to items or services that are preventive care pursuant to
 section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this
 subsection shall apply regardless of whether the minimum deductible under section 223 has been
 satisfied.
     ARTICLE       24.    HOSPITAL          SERVICE     CORPORATIONS,            MEDICAL        SERVICE
             CORPORATIONS,            DENTAL      SERVICE        CORPORATIONS            AND     HEALTH
             SERVICE                                                                 CORPORATIONS.
     §33-24-7t. Fairness in Cost-Sharing Calculation.
          (a) As used in this section:
          "Cost sharing" means any copayment, coinsurance, or deductible required by or on behalf
  of an insured in order to receive a specific health care item or service covered by a health plan.
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     Introduced HB 3487
          "Drug" means the same as the term is defined in §30-5-4(19) of this code.
          "Person" means a natural person, corporation, mutual company, unincorporated
  association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit
  corporation, unincorporated organization, or government or governmental subdivision or agency.
          "Pharmacy benefits manager" means the same as that term is defined in §33-51-3 of this
  code.
         (b) When calculating an insured’s contribution to any applicable cost sharing requirement,
 including, but not limited to, the annual limitation on cost sharing subject to 42 U.S.C. §18022(c)
 and 42 U.S.C. § 300gg-6(b):
         (1) An insurer shall include any cost sharing amounts paid by the insured or on behalf of
 the insured by another person; and
         (2) A pharmacy benefits manger manager shall include any cost sharing amounts paid by
 the insured or on behalf of the insured by another person.
         (c) The commissioner is authorized to may propose rules for legislative approval in
 accordance with §29A-3-1 et seq. of this code, to implement the provisions of this section.
         (d) This section is effective for policy, contract, plans, or agreements beginning on or after
 January 1, 2020. This section applies to all policies, contracts, plans, or agreements, subject to
 this article that are delivered, executed, issued, amended, adjusted, or renewed in this state on or
 after the effective date of this section.
         (e) If, under federal law, application of subsection (b) of this section would result in Health
 Savings Account ineligibility under section 223 of the federal Internal Revenue Code, this
 requirement shall apply for Health Savings Account-qualified High Deductible Health Plans with
 respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible
 under section 223, except for with respect to items or services that are preventive care pursuant to
 section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this
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     Introduced HB 3487
 subsection shall apply regardless of whether the minimum deductible under section 223 has been
 satisfied.
     ARTICLE                25.              HEALTH                CARE               CORPORATIONS.
     §33-25-8q. Fairness in Cost-Sharing Calculation.
          (a) As used in this section:
          "Cost sharing" means any copayment, coinsurance, or deductible required by or on behalf
  of an insured in order to receive a specific health care item or service covered by a health plan.
          "Drug" means the same as the term is defined in §30-5-4(19) of this code.
          "Person" means a natural person, corporation, mutual company, unincorporated
  association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit
  corporation, unincorporated organization, or government or governmental subdivision or agency.
          "Pharmacy benefits manager" means the same as that term is defined in §33-51-3 of this
  code.
         (b) When calculating an insured’s contribution to any applicable cost sharing requirement,
 including, but not limited to, the annual limitation on cost sharing subject to 42 U.S.C. §18022(c)
 and 42 U.S.C. § 300gg-6(b):
         (1) An insurer shall include any cost sharing amounts paid by the insured or on behalf of
 the insured by another person; and
         (2) A pharmacy benefits manger manager shall include any cost sharing amounts paid by
 the insured or on behalf of the insured by another person.
         (c) The commissioner is authorized to may propose rules for legislative approval in
 accordance with §29A-3-1 et seq. of this code, to implement the provisions of this section.
         (d) This section is effective for policy, contract, plans, or agreements beginning on or after
 January 1, 2020. This section applies to all policies, contracts, plans, or agreements, subject to
 this article that are delivered, executed, issued, amended, adjusted, or renewed in this state on or
 after the effective date of this section.
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     Introduced HB 3487
         (e) If, under federal law, application of subsection (b) of this section would result in Health
 Savings Account ineligibility under section 223 of the federal Internal Revenue Code, this
 requirement shall apply for Health Savings Account-qualified High Deductible Health Plans with
 respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible
 under section 223, except for with respect to items or services that are preventive care pursuant to
 section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this
 subsection shall apply regardless of whether the minimum deductible under section 223 has been
 satisfied.
     ARTICLE          25A.        HEALTH          MAINTENANCE               ORGANIZATION               ACT.
     §33-25A-8t. Fairness in Cost-Sharing Calculation.
          (a) As used in this section:
          "Cost sharing" means any copayment, coinsurance, or deductible required by or on behalf
  of an insured in order to receive a specific health care item or service covered by a health plan.
          "Drug" means the same as the term is defined in §30-5-4(19) of this code.
          "Person" means a natural person, corporation, mutual company, unincorporated
  association, partnership, joint venture, limited liability company, trust, estate, foundation, nonprofit
  corporation, unincorporated organization, or government or governmental subdivision or agency.
          "Pharmacy benefits manager" means the same as that term is defined in §33-51-3 of this
  code.
         (b) When calculating an insured’s contribution to any applicable cost sharing requirement,
 including, but not limited to, the annual limitation on cost sharing subject to 42 U.S.C. §18022(c)
 and 42 U.S.C. § 300gg-6(b):
         (1) An insurer shall include any cost sharing amounts paid by the insured or on behalf of
 the insured by another person; and
         (2) A pharmacy benefits manger manager shall include any cost sharing amounts paid by
 the insured or on behalf of the insured by another person.
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     Introduced HB 3487
         (c) The commissioner is authorized to may propose rules for legislative approval in
 accordance with §29A-3-1 et seq. of this code, to implement the provisions of this section.
         (d) This section is effective for policy, contract, plans, or agreements beginning on or after
 January 1, 2020. This section applies to all policies, contracts, plans, or agreements, subject to
 this article that are delivered, executed, issued, amended, adjusted, or renewed in this state on or
 after the effective date of this section.
         (e) If, under federal law, application of subsection (b) of this section would result in Health
 Savings Account ineligibility under section 223 of the federal Internal Revenue Code, this
 requirement shall apply for Health Savings Account-qualified High Deductible Health Plans with
 respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible
 under section 223, except for with respect to items or services that are preventive care pursuant to
 section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this
 subsection shall apply regardless of whether the minimum deductible under section 223 has been
 satisfied.
             NOTE: The purpose of this bill is to update fairness in cost sharing calculations for certain Health Savings Account-qualified High Deductible Health Plans.
             Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.
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Statutes affected: 
Introduced Version: 33-15-4t, 33-16-3ee, 33-24-7t, 33-25-8q