VirginiaHB3282026 Regular SessionHouseWALLET

Health insurance; essential health benefits benchmark plan selection.

Sponsored By: Richard C. "Rip" Sullivan, Jr. (Democratic)

Signed by Governor

Summary

Health insurance; essential health benefits benchmark plan. Requires the Bureau of Insurance to select a new essential health benefits benchmark plan for the 2028 plan year, or the soonest plan year thereafter as permitted by the Centers for Medicare and Medicaid Services, that includes, in addition to the essential health benefits package included in the existing benchmark plan, coverage for (i) doula care services; (ii) the treatment of iatrogenic infertility; (iii) fertility treatment and diagnosis, including a maximum of three cycles per lifetime of assisted reproductive technology; (iv) hearing aids for individuals of all ages; (v) pasteurized donor human breast milk; (vi) the prophylaxis, diagnosis, and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome; and (vii) the treatment of polycystic ovary syndrome. Such mandate for coverage does not apply to the individual or small group markets. The bill has a delayed effective date pursuant to approval by the Centers for Medicare and Medicaid Services of certain coverage as outlined in the bill. As introduced, this bill was a recommendation of the Health Insurance Reform Commission.

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 3 benefits, 0 costs, 1 mixed.

Broader health coverage standards for Virginians

Effective April 22, 2026, Virginia's Bureau of Insurance must select a new essential health benefits benchmark, the state's coverage standard. It applies for 2028, or the first later plan year the federal Centers for Medicare & Medicaid Services (CMS) permits. Required benefits include doula care, infertility diagnosis and treatment, and up to three lifetime assisted-reproductive-technology cycles. They also include specified fertility preservation services and services for infertility caused by medical treatment. Other required benefits are hearing aids for all ages, pasteurized donor human breast milk, and polycystic ovary syndrome treatment. The benchmark also includes PANS/PANDAS prevention, diagnosis, and treatment, using the terms in the referenced laws or bills. When the benchmark includes a benefit described in the separate PANS/PANDAS mandate, that mandate no longer separately applies to individual and small-group plans to that extent; benchmark coverage remains.

Hearing aid coverage for Virginia children

Covered plans must pay up to $1,500 per hearing aid for children age 18 or younger. Coverage includes one aid per affected ear every 24 months, when an ear, nose, and throat doctor recommends it. Plans cannot charge a copayment or fee for this coverage. Families can pay the difference for a higher-priced aid without financial or contractual penalty. The rule covers plans delivered, issued for delivery, or renewed in Virginia. It excludes individual and small-group policies, short-term travel, accident-only, limited- or specified-disease coverage, Medicare-related and similar governmental coverage. It also excludes short-term nonrenewable policies lasting no more than six months. Coverage begins January 1 of the plan year for which CMS approves a new Virginia benchmark containing the specified hearing-aid and PANS/PANDAS benefits.

Stronger coverage for children's neuropsychiatric care

Covered Virginia plans must cover prevention, diagnosis, and treatment for the pediatric neuropsychiatric conditions PANS and PANDAS. Covered care includes antimicrobials, medicines, behavioral therapies, immune-modifying medicines, plasma exchange, and intravenous immunoglobulin therapy. Plans cannot impose separate or stricter deductibles, limits, copayments, coinsurance, or yearly benefit maximums than for other illnesses. They cannot deny or delay coverage because of past treatment or a different diagnostic name. They cannot limit immune-modifying therapies against the specified evidence-based guidelines or require symptom-only therapy trials before authorizing them. Plans cannot deny out-of-state treatment when the service is unavailable in Virginia. These rules apply when covered plans are delivered, issued, reissued, extended, or have a term or premium changed in Virginia. They exclude individual and small-group policies, short-term travel, accident-only, limited- or specified-disease coverage, Medicare-related and similar federal governmental coverage. The rules begin January 1 of the plan year for which CMS approves a new Virginia benchmark containing the specified hearing-aid and PANS/PANDAS benefits.

Hearing aid funding capped and preserved

Virginia's State Corporation Commission cannot use special funds dedicated to its other work to cover hearing-aid mandate costs. Payments cannot exceed the amount appropriated for that purpose. Unspent appropriated money stays available for those costs at year end instead of returning to the general fund. These limits do not themselves require covered individuals to pay. The rules begin January 1 of the plan year for which CMS approves a new Virginia benchmark containing the specified hearing-aid and PANS/PANDAS benefits.

Sponsors & Cosponsors

Sponsor

  • Richard C. "Rip" Sullivan, Jr.

    Democratic • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 360 • No: 138

Senate vote • 4/22/2026

Senate concurred in Governor's recommendation

Yes: 22 • No: 17

House vote • 4/22/2026

House concurred in Governor's recommendation

Yes: 69 • No: 31

House vote • 3/12/2026

Senate substitute agreed to by House

Yes: 68 • No: 30

Senate vote • 3/11/2026

Passed Senate with substitute

Yes: 24 • No: 16

Senate vote • 3/11/2026

Commerce and Labor Substitute agreed to

Yes: 0 • No: 0

Senate vote • 3/10/2026

Constitutional reading dispensed Block Vote (on 2nd reading)

Yes: 37 • No: 0

Senate vote • 3/10/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote • 3/9/2026

Reported from Finance and Appropriations

Yes: 10 • No: 4

Senate vote • 3/2/2026

Reported from Commerce and Labor with substitute and rereferred to Finance and Appropriations

Yes: 8 • No: 5

House vote • 2/17/2026

Read third time and passed House

Yes: 72 • No: 25

House vote • 2/11/2026

Subcommittee recommends reporting

Yes: 7 • No: 0

House vote • 2/11/2026

Reported from Appropriations

Yes: 22 • No: 0

House vote • 1/29/2026

Reported from Labor and Commerce with amendment(s) and referred to Appropriations

Yes: 15 • No: 7

House vote • 1/27/2026

Subcommittee recommends reporting with amendment(s) and referring to Appropriations

Yes: 6 • No: 3

Actions Timeline

  1. Senate concurred in Governor's recommendation (22-Y 17-N 0-A)

    4/22/2026Senate
  2. House concurred in Governor's recommendation (69-Y 31-N 0-A)

    4/22/2026House
  3. Acts of Assembly Chapter text (CHAP1048)

    4/22/2026Governor
  4. Reenrolled bill text (HB328ER2)

    4/22/2026House
  5. Approved by Governor - Chapter 1048 (effective - see bill)

    4/22/2026Governor
  6. Signed by President

    4/22/2026Senate
  7. Signed by Speaker

    4/22/2026House
  8. Governor's recommendation adopted

    4/22/2026Governor
  9. Governor's recommendation received by House

    4/11/2026Governor
  10. Governor's Action Deadline 11:59 p.m., April 13, 2026

    3/31/2026Governor
  11. Enrolled Bill communicated to Governor on March 31, 2026

    3/31/2026House
  12. Signed by Speaker

    3/31/2026House
  13. Bill text as passed House and Senate (HB328ER)

    3/30/2026House
  14. Enrolled

    3/30/2026House
  15. Signed by President

    3/30/2026Senate
  16. Senate substitute agreed to by House (68-Y 30-N 0-A)

    3/12/2026House
  17. Passed Senate with substitute (24-Y 16-N 0-A)

    3/11/2026Senate
  18. Commerce and Labor Substitute agreed to

    3/11/2026Senate
  19. Engrossed by Senate - committee substitute

    3/11/2026Senate
  20. Read third time

    3/11/2026Senate
  21. Passed by for the day Block Vote (Voice Vote)

    3/10/2026Senate
  22. Constitutional reading dispensed Block Vote (on 2nd reading) (37-Y 0-N 0-A)

    3/10/2026Senate
  23. Rules suspended

    3/10/2026Senate
  24. Reported from Finance and Appropriations (10-Y 4-N)

    3/9/2026Senate
  25. Fiscal Impact Statement from State Corporation Commission (HB328)

    3/5/2026House

Bill Text

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