An Act to amend and reenact § 38.2-3540.1 of the Code of Virginia, relating to health insurance; claims experience information.
HB1450 amends Virginia’s claims-experience disclosure law for group accident and sickness insurance policies and health care employee welfare benefit plans. The bill requires insurers, third-party administrators, and pharmacy benefits managers, upon request, to provide certain large policyholders with a complete record of medical claims experience or medical costs, including pharmacy claims experience or pharmacy costs, for the covered plan. The bill applies to policyholders that averaged at least 100 covered individuals during the prior 12 months and requires the information to be provided before premium or contract changes, subject to limits on disclosure of personal or privileged information.
The bill also adds a more detailed reporting requirement for qualifying policyholders, including a summary of claims charges and amounts paid for the most recent 24 months, a listing of individuals whose claims or costs exceeded $100,000 for the most recent 12-month period and the prior 12 months if not already provided, and total enrollment by membership type. The bill sets deadlines for providing the information and prohibits charging the policyholder for the request. It applies to employee welfare benefit plans issued, renewed, reissued, or extended on or after January 1, 2027, and is subject to reenactment by the 2027 General Assembly, meaning the changes do not take effect permanently unless the legislature approves them again.
HB1450 expands and clarifies the claims-experience data that insurers, third-party administrators, and PBMs must furnish to larger employer policyholders under § 38.2-3540.1 of the Code of Virginia. It affects group accident and sickness insurance policies, health care plans, and employee welfare benefit plans by increasing transparency around medical and pharmacy claims, utilization, high-cost claimants, and enrollment counts, while preserving privacy protections for individual information. The bill creates new administrative obligations for carriers and plan administrators and gives larger employers more data to evaluate premiums, plan design, and renewal negotiations.
The available record shows no committee transcript or recorded votes, so there is no documented floor or committee debate to gauge broad sentiment. Based on the bill’s structure, the measure appears aimed at improving transparency for employers and plan sponsors rather than changing benefit coverage, which may make it attractive to policyholders seeking more information about claims costs. The reenactment requirement and delayed applicability suggest the legislature treated it as a significant but cautious change.
The main points of potential contention are the scope and burden of the reporting requirements and the privacy implications of disclosing high-cost claims data. Insurers, third-party administrators, and pharmacy benefits managers may view the bill as adding administrative complexity and compliance costs, while policyholders and employer groups are likely to support the added visibility into claims and pharmacy spending. Another possible issue is the threshold for eligibility and the timing of disclosures before premium changes, which could affect how useful the information is in renewal negotiations.