VirginiaHB6182026 Regular SessionHouseWALLET

Health insurance; reporting requirements.

Sponsored By: Jen Kiggans - to resign 12/31 (Republican)

Became Law

Summary

Health insurance; reporting requirements. Amends various reporting requirements related to health insurance, including by requiring the State Corporation Commission to maintain and publicly post an inventory of mandated benefits and providers, requiring health carriers to report annually on provider terminations and reinstatements, and consolidating reports related to balance billing and arbitration. The bill repeals reporting requirements related to the Comparable Health Care Service Incentive Program and Virginia Health Savings Account Plan. This bill is identical to SB 626.

Your PRIA Score

Score Hidden

Personalized for You

How does this bill affect your finances?

Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.

Free to start

Bill Overview

Analyzed Economic Effects

11 provisions identified: 9 benefits, 0 costs, 2 mixed.

Early childhood therapy and hearing tests

For dependents from birth to age three who are certified under IDEA Part H, the plan covers early intervention services like speech, occupational, and physical therapy and assistive devices. The plan cannot deny these services for preexisting conditions, and their costs do not count against lifetime maximums. The plan also pays for newborn hearing screening and any needed follow‑up tests. Follow‑up must be recommended by a qualified practitioner and done by a licensed audiologist using FDA‑approved methods.

Stronger drug coverage and pharmacy rules

Plans using a drug list must decide exception requests in one business day and cover a needed nonformulary drug without extra cost‑sharing when appropriate. A plan may choose one mail‑order pharmacy for deliveries. The plan covers FDA‑approved contraceptives and diabetes equipment, supplies, and self‑management education when prescribed. It cannot deny cancer drugs or other drugs for covered uses that are supported by standard compendia or strong peer‑reviewed research. Since July 1, 2002, each covered worker gets a prescription benefit card, and the plan must update it when key data change.

State employee health plan and choices

The state runs a health plan for employees and retirees and pays plan costs as provided by law. Part-time workers may enroll but must pay the full premium. You can buy family or dependent coverage, and the state may pay part or all of it. Each planning district must offer at least two unrelated plan options; by July 1, 2006, one must be a high‑deductible plan that qualifies for an HSA. All plan money goes into a separate trust fund used only to pay claims and plan costs.

Cancer trials and screening coverage

The plan covers your patient costs in qualifying cancer clinical trials, with payment terms no less favorable than other care. It covers colorectal screening per the latest medical guidelines. It covers one PSA test every 12 months and digital rectal exams at age 50+, and at age 40+ if you are high‑risk under American Cancer Society guidelines. It covers screening mammograms by age and frequency and may limit payment to $50 per mammogram. It also covers an annual Pap smear and, starting July 1, 1999, annual testing with any FDA‑approved gynecologic cytology technology.

Incentives to choose lower‑cost care

Beginning with plans offered or renewed on or after January 1, 2021, insurers must pay incentives if you pick a lower‑cost, comparable in‑network provider. Incentives can be cash, gift cards, credits, or lower copays, deductibles, or premiums. Insurers do not have to pay when their saved cost is $25 or less. Insurers must show you how to request average allowed‑amount information and file program details with the Commission. Each year, insurers report program data by April 1, and the Commission issues an aggregate report by November 1 starting within 18 months.

Maternity and surgery stay protections

After birth, the plan covers inpatient care and home visits under current perinatal and OB‑GYN standards, and updates when those standards change. It guarantees at least 48 hours in the hospital after a radical or modified radical mastectomy, and at least 24 hours after a total mastectomy or a partial mastectomy with node removal, unless you and your doctor choose earlier discharge. It guarantees at least a 23‑hour stay after a laparoscopy‑assisted vaginal hysterectomy and 48 hours after a vaginal hysterectomy, unless you and your doctor agree on a shorter stay. It also covers reconstructive breast surgery tied to mastectomy on or after July 1, 1998.

Mental health and obesity coverage parity

For listed biologically based mental illnesses, the plan must use the same deductibles, copays, coinsurance, and limits as for other illnesses. Medical necessity is decided the same way as for other care. The plan must also offer coverage for treating morbid obesity, including gastric bypass. It cannot require diets or other limits that the NIH has not approved. The law defines morbid obesity using BMI, weight, and comorbidity rules.

Out‑of‑network billing arbitration rules

If talks fail, either side can start arbitration within 10 calendar days. The other side sends a final offer within 30 days, and the arbitrator must pick one offer and issue a written decision within 30 days. Fees are set by the Commission and usually split; you do not pay arbitration costs. Parties must sign a confidentiality agreement within 10 business days, and the arbitrator sends decisions and information to the Commission. Arbitrators can weigh patient details and approved data sets. A narrow appeal to the Commission is allowed for corruption, bias, overreach, or serious procedural errors. These cases follow the special health‑insurance rules, not the Uniform Arbitration Act. Insurers also file annual network termination reports by September 1; the Commission posts a yearly summary by December 1.

Patient access, continuity, and appeals

You can see participating specialists directly when allowed by the plan, with standing referrals for ongoing conditions. If your doctor leaves the network for reasons other than misconduct, you can keep care for up to 90 days, with longer help for late pregnancy and terminal illness. The plan must have a clear appeals process and fast emergency appeals. Independent review organizations make final, written decisions on adverse coverage decisions. Plans that use preferred networks cannot drop a doctor solely due to a Board of Medicine reprimand or censure if the doctor meets plan rules.

Help from a Managed Care Ombudsman

The Office of the Managed Care Ombudsman helps people in managed care plans. It answers questions, explains rights, and tracks complaints. With your written consent, it helps with utilization‑review appeals and protects your privacy. It also watches timely access to care, publishes plain‑English information on benefits, and provides material for the Commission’s annual report due January 1.

Retires outdated insurance statutes

The law repeals three named sections of the Virginia Code (38.2‑3419.1, 38.2‑3445.2, and 38.2‑5601). Those rules are removed and replaced by updated provisions elsewhere in the act.

Sponsors & Cosponsors

Sponsor

  • Jen Kiggans - to resign 12/31

    Republican • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 216 • No: 2

Senate vote 2/26/2026

Passed Senate Block Vote

Yes: 40 • No: 0

Senate vote 2/25/2026

Constitutional reading dispensed Block Vote (on 2nd reading)

Yes: 40 • No: 0

Senate vote 2/25/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote 2/23/2026

Reported from Commerce and Labor

Yes: 14 • No: 0

House vote 2/11/2026

Read third time and passed House

Yes: 92 • No: 1

House vote 2/5/2026

Reported from Labor and Commerce

Yes: 21 • No: 1

House vote 2/3/2026

Subcommittee recommends reporting

Yes: 9 • No: 0 • Other: 1

Actions Timeline

  1. Acts of Assembly Chapter text (CHAP0187)

    4/6/2026Governor
  2. Approved by Governor-Chapter 187 (effective 7/1/2026)

    4/6/2026Governor
  3. Governor's Action Deadline 11:59 p.m., April 13, 2026

    3/10/2026Governor
  4. Enrolled Bill communicated to Governor on March 10, 2026

    3/10/2026House
  5. Fiscal Impact Statement from State Corporation Commission (HB618)

    3/5/2026House
  6. Bill text as passed House and Senate (HB618ER)

    3/3/2026House
  7. Enrolled

    3/3/2026House
  8. Signed by President

    3/3/2026Senate
  9. Signed by Speaker

    3/3/2026House
  10. Passed Senate Block Vote (40-Y 0-N 0-A)

    2/26/2026Senate
  11. Read third time

    2/26/2026Senate
  12. Passed by for the day Block Vote (Voice Vote)

    2/25/2026Senate
  13. Constitutional reading dispensed Block Vote (on 2nd reading) (40-Y 0-N 0-A)

    2/25/2026Senate
  14. Rules suspended

    2/25/2026Senate
  15. Reported from Commerce and Labor (14-Y 0-N)

    2/23/2026Senate
  16. Referred to Committee on Commerce and Labor

    2/12/2026Senate
  17. Constitutional reading dispensed (on 1st reading)

    2/12/2026Senate
  18. Read third time and passed House (92-Y 1-N 0-A)

    2/11/2026House
  19. Read second time and engrossed

    2/10/2026House
  20. Read first time

    2/9/2026House
  21. Reported from Labor and Commerce (21-Y 1-N)

    2/5/2026House
  22. Subcommittee recommends reporting (9-Y 0-N)

    2/3/2026House
  23. Fiscal Impact Statement from State Corporation Commission (HB618)

    1/26/2026House
  24. Assigned HCL sub: Subcommittee #1

    1/20/2026House
  25. Referred to Committee on Labor and Commerce

    1/13/2026House

Bill Text

Related Bills

Back to State Legislation