An Act to amend and reenact §§ 38.2-3407.20 and 38.2-3418.7 of the Code of Virginia, relating to health insurance; application of cost-sharing prohibitions.
HB813 amends Virginia health insurance law to clarify when cost-sharing prohibitions apply and how enrollee spending is counted toward out-of-pocket limits. The bill provides that any statutory prohibition on a carrier imposing cost sharing for a health care service applies only when the service is received from a participating provider under the health plan. It also requires carriers, to the extent allowed by federal law, to count amounts paid by the enrollee or on the enrollee’s behalf toward out-of-pocket maximums and other cost-sharing requirements.
The bill also preserves an exception for high-deductible health plans that are intended to qualify for health savings accounts. If applying the cost-sharing rules would make a plan ineligible for HSA treatment under federal law, the prohibition does not apply to the deductible until the enrollee meets the federal minimum deductible, except for preventive care, which remains exempt from cost sharing. In addition, the bill continues Virginia’s requirement that insurers, subscription contracts, and health maintenance organizations cover prostate cancer screening for specified age and high-risk groups under applicable policies and plans.
HB813 amends §§ 38.2-3407.20 and 38.2-3418.7 of the Code of Virginia, affecting health insurers, health maintenance organizations, and other carriers offering regulated health plans in the Commonwealth. It narrows and clarifies the operation of cost-sharing bans, requires aggregation of third-party payments toward enrollee cost-sharing limits where permitted, and preserves compatibility with federal HSA-qualified high-deductible health plans. The bill also maintains state-mandated prostate cancer screening coverage requirements for individual and group accident and sickness policies, subscription contracts, and HMO plans.
The available record shows no committee transcript or recorded votes, so there is no documented debate or roll-call sentiment to assess. Based on the enacted text, the bill appears to be a technical and consumer-protection measure aimed at clarifying insurance cost-sharing rules while preserving existing preventive-care and cancer-screening coverage. Its structure suggests a generally policy-neutral or incremental approach rather than a controversial overhaul.
The main potential point of contention is the balance between stronger cost-sharing protections for enrollees and preserving the federal tax status of HSA-qualified high-deductible health plans. Insurers and plan sponsors may also focus on the requirement to count third-party payments toward out-of-pocket maximums, while consumer advocates would likely support that provision as reducing surprise costs. The prostate cancer screening mandate is another area where coverage requirements could raise cost concerns for carriers, though no specific opposition is documented in the provided materials.