Relating to cost-sharing requirements for breast examinations

2026 Regular Session Introduced by Laura Chapman

SB 518 would adjust cost-sharing for breast examinations to reduce out-of-pocket costs for insured individuals and standardize payer coverage rules.

To Finance

#insurance

Summary of SB 518 (West Virginia, 2026)

Purpose and intent

SB 518 seeks to modify cost-sharing requirements related to breast examinations. The bill appears aimed at reducing or clarifying the financial burden on patients seeking breast health services, with a focus on examinations. The exact statutory language is not provided here, but the measure is described as addressing cost-sharing aspects (e.g., copayments, coinsurance, deductibles) tied to breast examinations.

Key provisions (as indicated by the title and context)

Adjust or establish cost-sharing rules for breast examinations provided within the state’s health system.

Potentially set uniform minimums or maximums for patient cost-sharing, or specify coverage standards for breast exams under state programs or private insurers.

Clarify applicability of the cost-sharing requirements to different payer types (e.g., private plans, public programs, or both).

Provide definitions related to breast examinations to ensure consistent application of the cost-sharing provisions.

Note: The exact text of the bill will determine whether the changes apply to screening versus diagnostic exams, mandated coverage, exemptions, or timelines for implementation.

Who would be affected

Patients seeking breast examinations and related diagnostic services in West Virginia.

Health insurers, including private plans and possibly state programs, that cover breast imaging and examinations.

Healthcare providers who perform breast examinations and may bill under the new cost-sharing framework.

State health or insurance departments responsible for enforcement and guidance.

Procedural and timeline aspects

Filed for introduction on January 20, 2026.

Referred to Health and Human Resources, then Finance committees during its consideration process.

On January 23, 2026, the bill was reported "do pass" but first to Finance, indicating initial committee approval and a recommendation to advance with potential fiscal review.

The sponsor listed is a co-sponsor: Laura Chapman, signaling collaborative support across members.

Potential impact (high-level)

If enacted, the bill could reduce out-of-pocket costs for breast examinations for some or all insured individuals, improving access to preventive breast health services.

It may affect insurers’ benefit designs, requiring adjustments to coverage rules and patient cost-sharing for breast exams.

Administrative implications for state agencies and health plans, including potential rulemaking, guidance, and compliance monitoring.

Considerations for readers

The precise scope (whether it covers screening vs. diagnostic exams, and which payer types are affected) depends on the final statutory language.

The fiscal impact on state\nbudgets or on private insurance premiums would be clarified in fiscal notes accompanying the bill and during legislative analyses.

Stakeholders—patients, healthcare providers, insurers—will want to watch for amendments that delineate coverage requirements, exemptions, and enforcement mechanisms.

If you’d like, I can include a more detailed breakdown once the full text or fiscal note is available.