SB 512
Relating to cost-sharing calculations on behalf of insured persons
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Sign in to take action- Introduced
- Passed Senate
- Passed House of Delegates
- To Governor
- Became Law
Bill overview
This bill aims to standardize how insurance companies calculate and handle cost-sharing expenses for insured individuals in West Virginia. It requires insurers to include any cost-sharing payments made by the insured or on their behalf, regardless of the payment method. The bill also ensures that individuals receiving healthcare at discounted cash prices receive credit toward their in-network cost-sharing, and prohibits discrimination in payment forms based on referrals to out-of-network providers. The bill applies to various types of health insurance plans, including those administered by pharmacy benefits managers.
Key provisions
- Requires insurers to include all cost-sharing payments made by or on behalf of an insured in their calculations.
- Mandates credit toward in-network cost-sharing for individuals receiving healthcare at discounted cash prices.
- Prohibits insurers from discriminating in payment forms based on out-of-network referrals.
- Defines terms related to cost-sharing, such as ‘average allowed amount’ and ‘cost sharing’.
- Allows the insurance commissioner to establish methodologies for calculating the ‘average allowed amount’.
- Applies to Accident and Sickness Insurance, Group Accident and Sickness Insurance, Hospital Service Corporations, Medical Service Corporations, Dental Service Corporations, and Health Service Corporations.
- Sets an effective date of January 1, 2027, for the amendments.
- Addresses potential conflicts with Health Savings Account eligibility under federal law.
Who is affected
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