WV| West Virginia Insurance Bulletin 26-02 highlights 2026 legislation affecting insurance regulation, claims, benefits, taxation, and program oversight in the state.
Passed Legislation:
- Senate Bill 556 – Makes garage-type policies (vehicles owned by entities selling/repairing/servicing autos) secondary to an individual’s own auto liability coverage.
- Senate Bill 645 – Requires commercial health plans (from 1/1/2027) to pay out-of-network ground ambulance services at 200% of Medicare or billed charges (whichever is less), bans balance billing to members, and imposes prompt-pay and denial-notice standards.
- House Bill 4089 – Mandates coverage of scalp cooling systems used with chemotherapy for policies issued or renewed on or after 1/1/2027, subject to standard deductibles and coinsurance.
- House Bill 4245 – Repeals three outdated Insurance Commissioner rules, extends the sunset date of four key rules to August 1, 2036, and updates Insurance Holding Company Systems rules to incorporate group capital calculation with specified exemptions and reporting authority.
- House Bill 4869 – Establishes birthday-based guaranteed issue rights for Medigap policies (with 24‑month continuous coverage rules), adds protections for individuals losing Medicaid eligibility, and requires an annual OIC report on Medigap premium trends.
- House Bill 5430 – Tightens PBM practices by banning use of GPOs to evade the Act, capping PBM charges at NADAC (or actual pharmacy paid amount), and directing the Commissioner to study outpatient prescription drug dispensing costs with biennial reporting.
- House Bill 5459 – Creates a 2.5% quarterly gross premiums tax on HMOs (with certain plan exceptions), effective July 1, 2027, contingent on federal approval as a permissible health care-related tax.
- House Bill 5462 – Clarifies that mine subsidence insurance payments must first be applied to property damage, caps fund liability at the $200,000 reinsurance limit for unpaid loss, and bars actions against insurers on claims reported to BRIM under the program.
- House Bill 5515 – Modernizes workers’ compensation statutes in Chapter 23 by revising outdated provisions and repealing obsolete sections.
- House Bill 5527 – Requires licensing and regulation of wellness reimbursement programs that reimburse or provide wellness benefits as ancillary products to health insurance or self‑insured health plans.