HB 5527 — Relating to Wellness Reimbursement Programs

WESTHB5527 VIRGINIAS LEGISLATUREFIN REGULARAM SESSION#1 ENROLLED3-11Johnson  7909 The Committee Substituteon forFinance Housemoved Billto 5527amend Bthe YDELEGATEKYLEbill AHDITEby [Passedstriking Marchout 14,everything 2026;after the enacting clause and inserting in lieu thereof the following:  ARTICLE 64.

inWellness effectReimbursement 90plans. days from passage (June 12, 2026)] Enr CS for HB 5527 AN ACT to amend the Code of West Virginia, 1931, as amended, by adding a new article, designated §33-64-1, §33-64-2, §33-64-3, §33-64-4, §33-64-5, §33-64-6, and §33-64-7, relating to the authorization of wellness reimbursement plans that are self-insured medical plans or wellness integrated medical plan expense reimbursement plans to be licensed in this state by the Insurance Commissioner and subject to state and federal laws;

providing definitions;

requiring licensure of wellness reimbursement program administrators;

providing requirements for licensure;

providing for revocation or suspension of licenses, civil penalties and criminal penalties;

requiring administrator defense of employers and their employees against any and all claims or suits in certain circumstances;

providing duties of brokers;

authorizing proposal of legislative rules;

providing that provisions do not apply to individual or group health plans;

and reporting to the Legislature.

Be it enacted by the Legislature of West Virginia:

ARTICLE 64.

WELLNESS REIMBURSEMENT PLANS.

As used in this article:article:"Broker" means an independent health insurance agent licensed in this state."Commissioner" means the Insurance Commissioner of West Virginia."Person" means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, not-for-profit corporation, unincorporated organization, government, or governmental subdivision or agency."Wellness reimbursement program, arrangement, or benefit plan” means a plan offered to an employer or employee that provides reimbursement or other wellness-related benefits intended to promote health or wellness, including but not limited to employer-sponsored wellness reimbursement arrangements or other wellness benefit structures offered through insurance or similar benefit models that:(1) Have issued a contract to provide services and pay claims pertaining to reimbursements of qualified medical expenses relating to §26 U.S.C.

"Broker" means an independent health insurance agent licensed in this state.

"Commissioner" means the Insurance Commissioner of West Virginia.

"Person" means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, not-for- profit corporation, unincorporated organization, government, or governmental subdivision or agency.

"Wellness reimbursement program, arrangement, or benefit plan” means a plan offered to an employer or employee that provides reimbursement or other wellness-related benefits intended to promote health or wellness, including but not limited to employer-sponsored wellness Enr CS for HB 5527 reimbursement arrangements or other wellness benefit structures offered through insurance or similar benefit models that:

(1) Have issued a contract to provide services and pay claims pertaining to reimbursements of qualified medical expenses relating to §26 U.S.C.

and (2) Are intended, created, marketed, and sold as an ancillary product to an individual or group health insurance coverage or self-insured group health plan.plan."Wellness reimbursement program, arrangement, or benefit plan" does not include any underlying individual or group health insurance coverage or a self-insured group health plan."Wellness reimbursement program administrator" means any person who manages the operation of a wellness reimbursement program.

"Wellness reimbursement program, arrangement, or benefit plan" does not include any underlying individual or group health insurance coverage or a self-insured group health plan.

"Wellness reimbursement program administrator" means any person who manages the operation of a wellness reimbursement program.

(a) No wellness reimbursement program, arrangement, or benefit plan administrator may sell, offer, market, promote, or operate a wellness reimbursement program, arrangement, or benefit plan as that term is defined in this article without first being licensed by the commissioner.commissioner.(b) Application for a license shall be on forms prescribed by the commissioner and shall be accompanied by an initial license fee of $5,000, annual financial statements or reports for the two preceding calendar years, and any other documents that the commissioner may require to ensure that the wellness reimbursement program, arrangement, or benefit plan administrator meets the requirements for licensure set forth in this article.

(b) Application for a license shall be on forms prescribed by the commissioner and shall be accompanied by an initial license fee of $5,000, annual financial statements or reports for the two preceding calendar years, and any other documents that the commissioner may require to ensure that the wellness reimbursement program, arrangement, or benefit plan administrator meets the requirements for licensure set forth in this article.

These fees shall be retained by the commissioner to offset the costs of administering this article.article.(c) In addition to the documents required under subsection (b) of this section, a wellness reimbursement program, arrangement, or benefit plan administrator shall comply with federal ERISA requirements or submit a letter or document from the Internal Revenue Service or the U.S.

(c)Department Inof additionLabor toapproving the documents required under subsection (b) of thisthe section,specific a wellness reimbursement program, arrangement, or benefit plan administratorin shallquestion. comply with federal ERISA requirements or submit a letter or document from the Internal Revenue Service or the U.S.

Enr CS for HB 5527 Department of Labor approving of the specific wellness reimbursement program, arrangement, or benefit plan in question.

The cost of the examination shall be borne by the wellness reimbursement program, arrangement, or benefit plan administrator.administrator.(e) A wellness reimbursement program, arrangement, or benefit plan administrator shall file and maintain with the commissioner a surety bond in favor of the state executed by a surety company authorized to transact business in this state.

(e)The Acommissioner may set the requirements of the surety bond as necessary.(f) Before granting any license, the commissioner or his designee shall be satisfied that the wellness reimbursement program, arrangement, or benefit plan administrator shallis filecompetent, trustworthy, financially responsible, has a good personal and maintainbusiness withreputation, thehas commissionernot ahad suretyan bondinsurance license revoked, suspended, or denied in favorany ofjurisdiction within the statepreceding executedfive byyears, and has not been convicted of a suretycrime companythat authorizedbears a rational nexus to transactthe businessactivities inlicensed under this state.article in any jurisdiction.

For purposes of this section, "convicted" includes a plea of guilty or a plea of nolo contendere.(g) The commissioner may setrevoke or suspend any license issued to a wellness reimbursement program, arrangement, or benefit plan administrator when he or she finds that any condition exists which would have prohibited issuance of the requirementsoriginal license, that the wellness reimbursement program, arrangement, or benefit plan administrator has violated any provision of this article, or that the suretywellness bondreimbursement asprogram, necessary.arrangement, or benefit plan administrator has deceived or dealt unjustly with the citizens of this state.

(f)In Beforelieu grantingof anyrevocation or suspension of license, the commissioner ormay hisimpose designeea shallcivil bepenalty satisfiednot thatto theexceed $1,000 for each offense.(h) Any wellness reimbursement program, arrangement, or benefit plan administrator who fails to obtain a license is competent,subject trustworthy,to financiallythe responsible,penalties hasunder a§33-64-5 goodof personalthis code and businessis reputation,subject hasto notrevocation hadof anany insurancelicenses licenseissued revoked,by suspended,the orcommissioner.(i) deniedAny inproprietary anyinformation jurisdictionrequired withinby thethis precedingarticle fiveto years,be andprovided hasto, notfiled beenwith, convictedor ofavailable afor crimereview thatby bearsthe acommissioner rationalis nexusconfidential and is not subject to thepublic activitiesdisclosure, licensedincluding underdisclosure thispursuant articleto in§29B-1-1 anyet jurisdiction.seq.

For purposes of this section, "convicted" includes a plea of guilty or a plea of nolo contendere.

(g) The commissioner may revoke or suspend any license issued to a wellness reimbursement program, arrangement, or benefit plan administrator when he or she finds that any condition exists which would have prohibited issuance of the original license, that the wellness reimbursement program, arrangement, or benefit plan administrator has violated any provision of this article, or that the wellness reimbursement program, arrangement, or benefit plan administrator has deceived or dealt unjustly with the citizens of this state.

In lieu of revocation or Enr CS for HB 5527 suspension of license, the commissioner may impose a civil penalty not to exceed $1,000 for each offense.

(h) Any wellness reimbursement program, arrangement, or benefit plan administrator who fails to obtain a license is subject to the penalties under §33-64-5 of this code and is subject to revocation of any licenses issued by the commissioner.

(i) Any proprietary information required by this article to be provided to, filed with, or available for review by the commissioner is confidential and is not subject to public disclosure, including disclosure pursuant to §29B-1-1 et seq.

(a) A wellness reimbursement program, arrangement, or benefit plan administrator shall attest to the commissioner and to the employer or employee that the wellness reimbursement program, arrangement, or benefit plan complies with all federal and state laws.laws.(b) A wellness reimbursement program, arrangement, or benefit plan administrator may not cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading.(c) If the wellness reimbursement program, arrangement, or benefit plan results in a taxable event for either the employer or the employee associated with the wellness reimbursement program, arrangement, or benefit plan, the wellness reimbursement program, arrangement, or benefit plan administrator shall defend the employer and its employees against any and all claims or suits that arise out of or by virtue of the wellness reimbursement program, arrangement, or benefit plan and shall indemnify the employer and its employees for a loss or judgment incurred by them as a result of the claim or suit.

(b) A wellness reimbursement program, arrangement, or benefit plan administrator may not cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading.

(c) If the wellness reimbursement program, arrangement, or benefit plan results in a taxable event for either the employer or the employee associated with the wellness reimbursement program, arrangement, or benefit plan, the wellness reimbursement program, arrangement, or benefit plan administrator shall defend the employer and its employees against any and all claims or suits that arise out of or by virtue of the wellness reimbursement program, arrangement, or benefit plan and shall indemnify the employer and its employees for a loss or judgment incurred by them as a result of the claim or suit.