West Virginia licenses administrators of wellness reimbursement programs

Administrators must get a license before selling, offering, marketing, promoting, or operating a covered program. This covers administrators of programs that pay reimbursements for qualified medical expenses and are offered as add-ons to individual or group health coverage or self-insured group plans. It does not cover the underlying health plans or wellness activities those plans offer to enrollees. Applicants must pay a $5,000 initial fee and $500 renewal fee, submit financial reports for the prior two years, and meet the commissioner's licensing requirements. Administrators must comply with federal ERISA requirements or submit a document from the IRS or U.S. Department of Labor approving the specific program. Administrators must keep business records for inspection and file a surety bond; the commissioner must inspect the records at least every three years. A license is required before an administrator sells, offers, markets, promotes, or operates a covered program.

Administrators must attest that covered programs follow state and federal law and must not allow misleading promotions. These duties apply to administrators of wellness reimbursement programs, arrangements, or benefit plans covered by the article. If a program causes a taxable event for an employer or employee, its administrator must defend them against related claims or lawsuits and cover resulting losses or judgments.

Brokers may receive commissions without registering as program administrators, and must deal fairly and avoid misleading promotions. These rules cover brokers who help connect a program administrator with an employee group enrolling in a covered program. A broker is an independent health insurance agent licensed in West Virginia.