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HB 5527

Relating to Wellness Reimbursement Programs

2026 Regular Session Introduced by Mike Hite and 1 co-sponsor

West Virginia now requires licensure and state-level oversight for wellness reimbursement program administrators, with bonding, reporting, and penalties to enforce ERISA and tax co

Chapter 189, Acts, Regular Session, 2026
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Bill Summary · HB 5527

Summary of HB 5527 (2026) – West Virginia

Title: Relating to Wellness Reimbursement Programs

Jurisdiction: West Virginia
Session: 2026
Sponsor(s): Delegates Kyle and Hite (Co-sponsors: Mike Hite, Jonathan Kyle)

Origin: Committee on Finance; enacted into law on April 2, 2026

Purpose (main intent)
- Create a new framework to authorize, license, regulate, and enforce wellness reimbursement programs that are self-insured medical plans or wellness integrated medical plan expense reimbursement plans.
- Subject these programs to state and federal law, while ensuring oversight by the West Virginia Insurance Commissioner.
- Establish licensure requirements for wellness reimbursement program administrators and provide for penalties, enforcement, and reporting.

Key Provisions and Changes

  1. Definitions (Article 64, §33-64-1)
  2. Wellness reimbursement program: A self-insured medical reimbursement plan or a wellness integrated medical plan expense reimbursement plan meeting specific IRS references (e.g., 26 C.F.R. 1.105-11, 26 U.S.C. 105) and marketed as an ancillary product to an underlying individual or group health coverage.
  3. Wellness reimbursement program administrator: Any person who manages the operation of such a program.
  4. Exclusions: The article does not apply to the underlying health insurance coverage or self-insured health plans themselves.

  5. Broker: Independent health insurance agent licensed in WV.

  6. Licensure of Wellness Reimbursement Program Administrators (Article 64, §33-64-2)

  7. Licensure required prior to selling, offering, marketing, promoting, or operating a wellness reimbursement program.

  8. Application and fees: Initial license fee of $5,000; renewal application fee of $500. Applicants must provide two prior years of financial statements and any documents the Commissioner requires.

  9. Compliance with ERISA and federal tax/employee benefits approvals: Administrators must provide documentation showing compliance (ERISA or IRS/DOL approval for the specific program).

  10. Recordkeeping and examinations: Administrators must maintain full records; the Commissioner may inspect at least every three years; exam costs borne by the administrator.

  11. Surety bond: Administrators must file a surety bond in favor of the state; bond requirements set by the Commissioner.

  12. Qualifications: Applicants must be competent, financially responsible, reputable; must not have had WV insurance licenses revoked/suspended/denied in the preceding five years; no criminal conviction relevant to licensing activities.

  13. Licensure discipline: Commissioner may revoke/suspend licenses for cause or impose civil penalties up to $1,000 per offense (in lieu of license action).

  14. Penalty for operating without license: Violators face penalties under §33-64-5 and license revocation.

  15. Compliance with Laws (Article 64, §33-64-3)

  16. Administrators must attest to compliance with federal/state laws.

  17. Prohibition on false or misleading advertising or representations.

  18. If the program creates a taxable event for employer or employee, the administrator must defend and indemnify the employer and employees against related claims or suits.

  19. Brokers (Article 64, §33-64-4)

  20. Brokers may receive commissions without registering as wellness reimbursement program administrators.

  21. Brokers are not employees of the administrator; they facilitate partnerships with employee groups.

  22. Prohibition on deceptive advertising by brokers; brokers must deal in good faith.

  23. Enforcement and Penalties (Article 64, §33-64-5)

  24. The Insurance Commissioner enforces the article.

  25. Violations constitute a misdemeanor with penalties up to $20,000 fine, up to one year in jail, or both; may also result in license revocation.

  26. Commissioner may propose legislative rules/regulations.

  27. Exemption for Health Plans (Article 64, §33-64-6)

  28. The article does not apply to individual or group health plans or wellness programs offered by such plans to enrollees.

  29. Reporting (Article 64, §33-64-7)

  30. The Commissioner must file a biennial (every three years) report to the Legislature on implementation and related information, with additional data as requested.

Affected Parties

  • Wellness reimbursement program administrators: Subject to licensure, ongoing reporting, and compliance requirements; may face enforcement actions and penalties.
  • Employers and employees: Potentially impacted via defense/indemnification requirements if the program triggers taxable events.
  • Brokers/independent agents: May participate in program partnerships and earn commissions; must avoid deceptive practices.
  • Insurance Commissioner and state regulators: Responsible for licensing, oversight, examinations, and enforcement.
  • General public/consumers: Protections against misleading marketing and recourse through penalties and enforcement.

Procedural and Timeline Highlights

  • Licensing process includes initial license, ongoing annual filings, and financial statements (two prior years) with a $5,000 initial fee and $500 renewal fee.
  • Compliance with ERISA and federal approvals required for program operations.
  • Regular recordkeeping, possible examinations at least every three years.
  • Possible penalties up to $1,000 per offense (civil) or up to $20,000 fine and/or up to one year in jail for violations.
  • Biennial to triannual reporting by the Insurance Commissioner to the Legislature.
  • Effective date: Law enacted and in effect by April 2, 2026; provisions work in tandem with federal law to regulate these programs as standalone wellness reimbursement products.

Overall Impact

HB 5527 establishes a formal regulatory framework for wellness reimbursement programs in West Virginia, introducing licensure, compliance, and enforcement mechanisms to ensure these programs operate within federal tax/ERISA guidelines and state consumer protections. It clarifies roles for administrators and brokers and creates accountability through bonding, examinations, and periodic reporting. The bill explicitly excludes underlying health plans from its scope.

Compiled from official sources — confirm details with the bill’s official record.

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