Shown verbatim: the complete text as captured from the official PDF posted by the West Virginia Legislature, fetched 2026-09-25. Page and line markers are part of the official record; nothing is edited or removed. The official bill page.
WEST VIRGINIA LEGISLATURE
2026 REGULAR SESSION
ENROLLED
Committee Substitute
for
House Bill 4869
BY DELEGATES GREEN, HANSHAW (MR. SPEAKER), HOTT,
JEFFRIES, KYLE, ROHRBACH, HALL, WORRELL, HITE,
ELLINGTON, AND STATLER
[Passed March 13, 2026; in effect 90 days from
passage (June 11, 2026)]
Enr CS for HB 4869
1 AN ACT to amend the Code of West Virginia, 1931, as amended, by adding a new article,
2 designated §33-15F-1, relating to Medicare supplement policies; providing definitions;
3 creating access to Medicare supplement policies regardless of health; establishing clearly
4 bounded guaranteed-issue rights for Medicare supplement policies; providing reporting
5 requirements; and authorizing rulemaking.
Be it enacted by the Legislature of West Virginia:
ARTICLE 15F. GUARANTEED ISSUE RIGHTS FOR MEDICARE SUPPLEMENT
POLICIES.
§33-15F-1. Medicare supplement policies.
1 (a) Definitions. – For purposes of this section:
2 "Medicare supplement policy" means a policy or certificate of health insurance issued
3 pursuant to this chapter that is advertised, marketed, or designed to supplement Medicare.
4 “Accepted applications” means that an insurer has actively marketed and issued at least
5 one Medicare supplement policy of the applicable standardized benefit type in this state within
6 the preceding 12 months, and has not formally closed the policy form to new enrollment.
7 "Affiliated insurer" means an insurer that, directly or indirectly, through one or more
8 intermediaries, controls, or is controlled by, or is under common control with the insurer specified.
9 "Birthday" means the anniversary of an individual’s date of birth.
10 "Same or lesser benefits" means a Medicare supplement policy that provides benefits that
11 are identical to, or a subset of, the standardized Medicare supplement benefits authorized under
12 this chapter and applicable federal law.
13 (b) Annual guaranteed issue based on birthday. –
14 (1) Eligibility. – An individual who is enrolled in a Medicare supplement policy issued in
15 this state shall have a guaranteed issue right, subject to the continuous coverage requirement in
16 subdivision (2) of this subsection, once per calendar year to replace that policy.
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17 (2) Continuous coverage requirement. – The guaranteed issue right under this subsection
18 is available only if the individual’s existing Medicare supplement policy has been continuously in
19 force for at least 24 months as of the effective date of the replacement policy. Each replacement
20 policy issued pursuant to this subsection shall thereafter be subject to the same 24 month
21 continuous coverage requirement before it may be replaced under this subsection. For purposes
22 of this subsection, a policy is considered continuously in force if it has been reissued or assumed
23 by the same insurer or an affiliated insurer without a lapse in coverage.
24 (3) Application period. – For purposes of this subsection, the birthday guaranteed issue
25 application period begins on the first day of the month of the individual’s birthday and ends 60
26 days thereafter.
27 (4) Nature of application period. – The birthday guaranteed issue application period
28 constitutes an application window only and does not require that the replacement policy become
29 effective within the 60 day period.
30 (5) Scope of replacement coverage. – During the birthday guaranteed issue application
31 period, the individual may purchase a Medicare supplement policy:
32 (A) Issued by the same insurer that issued the existing policy or by an affiliated insurer;
33 and
34 (B) That provides the same or lesser standardized Medicare supplement benefits as the
35 policy being replaced.
36 (6) Exception when comparable coverage is unavailable. –
37 (A) If neither the issuing insurer nor any affiliated insurer of the individual’s existing policy
38 has accepted applications for a Medicare supplement policy providing the same or lesser
39 standardized benefits for a period of at least 12 months, the individual may purchase a Medicare
40 supplement policy providing the same or lesser standardized benefits from any insurer authorized
41 to issue Medicare supplement policies in this state.
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42 (B) This subdivision does not waive the continuous coverage requirement set forth in
43 subdivision (2) of this subsection and does not permit the purchase of a policy with greater
44 benefits than the policy being replaced.
45 (7) An insurer may not, with respect to a policy issued under this subsection:
46 (A) Deny issuance;
47 (B) Impose medical underwriting; or
48 (C) Impose a pre-existing condition exclusion or waiting period.
49 (8) An individual who is not enrolled in a Medicare supplement policy on the individual’s
50 birthday is not eligible for the guaranteed issue rights under this subsection.
51 (9) Nothing in this subsection shall be construed to:
52 (A) Require an insurer to offer a Medicare supplement policy not otherwise offered in this
53 state;
54 (B) Permit the purchase of a Medicare supplement policy with greater benefits than the
55 policy being replaced; or
56 (C) Alter lawful rating classifications otherwise permitted under this article.
57 (10) A Medicare supplement policy issued under this subsection shall not become
58 effective earlier than the termination date of the policy being replaced and shall be coordinated to
59 prevent duplication of coverage.
60 (11) Delayed effective date. – At the request of the applicant, the effective date of a
61 replacement Medicare supplement policy issued under the birthday guaranteed issue application
62 period may be delayed for a period not to exceed 90 days following the date of application for the
63 purpose of coordinating termination of the existing policy and preventing overlapping premium
64 obligations.
65 (c) Guaranteed issue upon loss of Medicaid eligibility. –
66 (1) An individual who is 65 years of age or older on the date the individual’s Medicaid
67 eligibility ends, is entitled to Medicare, and loses eligibility for medical assistance under Title XIX
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68 of the Social Security Act (Medicaid), including full or partial dual eligibility, shall have a
69 guaranteed issue right to purchase a Medicare supplement policy.
70 (2) The guaranteed issue period under this subsection begins on the date Medicaid
71 eligibility ends and continues for 63 days thereafter.
72 (3) During the guaranteed issue period, the individual may purchase any Medicare
73 supplement policy that is actively offered for sale to new enrollees at the time of application by
74 any insurer authorized to issue Medicare supplement policies in this state.
75 (4) An insurer may not, with respect to a policy issued under this subsection:
76 (A) Deny issuance;
77 (B) Impose medical underwriting; or
78 (C) Impose a pre-existing condition exclusion or waiting period.
79 (5) Guaranteed issue rights under this subsection apply regardless of whether the
80 individual was previously enrolled in a Medicare supplement policy.
81 (6) Guaranteed issue rights under this subsection apply regardless of whether the
82 individual was eligible for or enrolled in Medicaid at the time the individual first became entitled to
83 Medicare.
84 (7) Guaranteed issue rights under this subsection do not arise solely due to disenrollment
85 from a Medicare Advantage plan.
86 (d) Annual reporting by the Insurance Commissioner. –
87 (1) The Insurance Commissioner shall submit an annual written report to the Legislature
88 on Medicare supplement policy premium trends in this state.
89 (2) The report shall be submitted on or before December 1 of each year and provided to:
90 (A) The President of the Senate;
91 (B) The Speaker of the House of Delegates; and
92 (C) The chairs and members of the committees with jurisdiction over insurance matters.
93 (3) The report shall include, at a minimum:
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94 (A) Year-over-year premium changes for Medicare supplement policies, broken out by
95 insurer;
96 (B) Aggregate statewide premium changes for Medicare supplement policies;
97 (C) A summary of premium trends by standardized Medicare supplement plan type; and
98 (D) Any notable market-wide trends or patterns observed.
99 (4) The report shall be informational in nature and may not be construed to authorize
100 premium regulation, rate setting, or modification of rating methodologies.
101 (e) Rulemaking authority. – The Insurance Commissioner may propose legislative rules
102 for promulgation in accordance with the provisions of §29A-3-1 et seq. of this code solely for the
103 purpose of administering this section, including verification of eligibility and coordination of
104 effective dates, but may not expand eligibility, carrier access, benefit scope, rating requirements,
105 or guaranteed issue periods beyond those expressly provided in this section.
106 (f) Construction. – Nothing in this section shall be construed to:
107 (1) Create an open enrollment period beyond those expressly provided;
108 (2) Limit or replace guaranteed issue rights otherwise provided under federal law;
109 (3) Require an insurer to offer a particular premium rate or rating classification not
110 otherwise permitted under this article; or
111 (4) Apply to Medicare Advantage plans.
112 (g) Applicability. – The requirements of this section shall apply to all insurance policies
113 issued by an insurer pursuant to this chapter that are delivered, issued for delivery, reissued, or
114 extended in this state on and after June 1, 2026, or at any time thereafter when any term of the
115 policy, contract, or plan is changed or any premium adjustment is made.
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The Clerk of the House of Delegates and the Clerk of the Senate hereby
certify that the foregoing bill is correctly enrolled.
...............................................................
Clerk of the House of Delegates
...............................................................
Clerk of the Senate
Originated in the House of Delegates.
In effect 90 days from passage.
...............................................................
Speaker of the House of Delegates
...............................................................
President of the Senate
__________
The within is ................................................ this the...........................................
Day of ..........................................................................................................., 2026.
.............................................................
Governor
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