VirginiaSB6262026 Regular SessionSenateWALLET

Health insurance; reporting requirements.

Sponsored By: Mark D. Obenshain (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 HB 618.

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

10 provisions identified: 8 benefits, 0 costs, 2 mixed.

Coverage for diabetes and obesity treatment

If prescribed, the plan covers diabetes equipment, supplies, and outpatient training, including medical nutrition therapy. It also covers treatment for morbid obesity, including gastric bypass, using NIH‑recognized methods. You qualify if you are at least 100 pounds over ideal weight, have a BMI of 35 with a related condition, or have a BMI of 40 or more. Cost‑sharing and limits for these treatments must be no worse than for other illnesses.

State employee health plan and funding

The Department of Human Resource Management runs the health plan for state employees and retirees. The Commonwealth pays the plan costs it includes, funded by appropriations; part‑time workers must pay the full price themselves. Retirees can buy coverage, with optional dental and vision; the state may pay some cost but does not have to. Premiums and appropriations go to a separate trust fund, and claims incurred but reported later are paid from appropriations. Every planning district must have at least two plan choices, and by July 1, 2006 one option must be a high‑deductible plan that qualifies for a Health Savings Account.

Cancer trials and needed drugs covered

Plans cover patient care costs in qualifying Phase II–IV cancer clinical trials (Phase I case‑by‑case) approved by the National Cancer Institute, FDA IND, VA, or other listed bodies. Coverage excludes the investigational drug or device and research management costs. Plans must not deny FDA‑approved cancer drugs used off‑label when a standard compendium supports the use. Plans also must cover other FDA‑approved drugs for covered conditions when a compendium or major peer‑reviewed articles support the use.

Equal coverage for mental health care

Plans must cover biologically based mental illnesses on the same terms as other illnesses. This includes copays, coinsurance, deductibles, limits, and medical‑necessity rules. Covered diagnoses include schizophrenia, bipolar disorder, major depression, panic disorder, OCD, ADHD, autism, and substance use disorders.

Keep your doctor and appeal denials

You can go directly to a participating specialist and ask for a standing referral when needed. If your in‑network provider is dropped without cause, you can stay up to 90 days; through postpartum if you were in your second trimester; for life if terminally ill. The plan must publish an appeals process and offer fast emergency appeals. Independent review organizations make final, binding decisions when consistent with law and policy. The Office of the Managed Care Ombudsman helps with questions, appeals, and complaints.

Preventive screenings, birth control, and child services

Plans cover key preventive care. Low‑dose mammograms: ages 35–39 once; 40–49 every two years; 50+ yearly (a plan may cap at $50). They also cover annual Pap tests and colorectal screening per American College of Gastroenterology and American Cancer Society guidance. One PSA test and a digital rectal exam are covered every 12 months for age 50+, and for age 40+ if high‑risk per ACS rules. The plan covers FDA‑approved prescription contraceptives. Newborns get hearing screening and needed follow‑up by a licensed audiologist. Children under age three who are certified for Part H early intervention get speech, occupational, and physical therapy and assistive technology; these do not count toward lifetime limits, and prior coverage cannot be denied for a preexisting condition.

Stronger maternity and surgery recovery coverage

The plan covers postpartum inpatient care and at least one home visit using the latest professional guidelines. After a radical or modified radical mastectomy, at least 48 hospital hours are covered. After a total or partial mastectomy with lymph node dissection, at least 24 hours are covered, unless you and your doctor agree to shorter. After a laparoscopy‑assisted vaginal hysterectomy, at least 23 hours are covered; after a vaginal hysterectomy, at least 48 hours. Reconstructive breast surgery related to a mastectomy is covered for surgeries on or after July 1, 1998.

Cash rewards for lower-cost care

Beginning January 1, 2021, health carriers must run a program that pays you when you choose in‑network providers priced below the plan’s average. Small group plans must include this and tell you each year at enrollment or renewal that rewards are taxable under IRS rules. Incentives can be cash, gift cards, or credits that lower your premium, copay, or deductible; no payment is required when the carrier’s savings are $25 or less. You can prove you shopped with a price quote or by using the carrier’s cost website or toll‑free number. Carriers must file the program with the Commission first and can get exemptions for very limited networks. Every year, carriers report program results by April 1, and the Commission reports to lawmakers by November 1.

Drug cards, formularies, and doctor access

Since July 1, 2002, employees get a prescription benefit card or similar technology, and plans must reissue it when key data change. DHRM self‑insured plans may use a drug list, but a pharmacist‑doctor committee must review it at least yearly. You can get a medically necessary nonformulary drug without extra cost‑sharing, and the plan must decide within one business day. A plan may choose one mail‑order pharmacy whose main business is mail delivery. Plans cannot bar a doctor only because the Board of Medicine issued a reprimand or censure.

Old insurance code sections repealed

The law repeals Code sections 38.2‑3419.1, 38.2‑3445.2, and 38.2‑5601. The real‑world effect depends on what those sections used to do.

Sponsors & Cosponsors

Sponsor

  • Mark D. Obenshain

    Republican • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 211 • No: 0

House vote 2/24/2026

Passed House Block Vote

Yes: 98 • No: 0

House vote 2/19/2026

Reported from Labor and Commerce

Yes: 20 • No: 0

Senate vote 1/30/2026

Read third time and passed Senate Block Vote

Yes: 38 • No: 0

Senate vote 1/29/2026

Engrossed by Senate Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote 1/28/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote 1/28/2026

Constitutional reading dispensed Block Vote (on 1st reading)

Yes: 40 • No: 0

Senate vote 1/26/2026

Reported from Commerce and Labor

Yes: 15 • No: 0

Actions Timeline

  1. Acts of Assembly Chapter text (CHAP0188)

    4/6/2026Governor
  2. Approved by Governor-Chapter 188 (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

    3/10/2026Senate
  5. Fiscal Impact Statement from State Corporation Commission (SB626)

    3/2/2026Senate
  6. Bill text as passed Senate and House (SB626ER)

    2/26/2026Senate
  7. Enrolled

    2/26/2026Senate
  8. Signed by President

    2/26/2026Senate
  9. Signed by Speaker

    2/26/2026House
  10. Passed House Block Vote (98-Y 0-N 0-A)

    2/24/2026House
  11. Read third time

    2/24/2026House
  12. Read second time

    2/23/2026House
  13. Reported from Labor and Commerce (20-Y 0-N)

    2/19/2026House
  14. Referred to Committee on Labor and Commerce

    2/4/2026House
  15. Read first time

    2/4/2026House
  16. Placed on Calendar

    2/4/2026House
  17. Read third time and passed Senate Block Vote (38-Y 0-N 0-A)

    1/30/2026Senate
  18. Engrossed by Senate Block Vote (Voice Vote)

    1/29/2026Senate
  19. Read second time

    1/29/2026Senate
  20. Passed by for the day Block Vote (Voice Vote)

    1/28/2026Senate
  21. Constitutional reading dispensed Block Vote (on 1st reading) (40-Y 0-N 0-A)

    1/28/2026Senate
  22. Passed by for the day

    1/28/2026Senate
  23. Rules suspended

    1/28/2026Senate
  24. Reported from Commerce and Labor (15-Y 0-N)

    1/26/2026Senate
  25. Fiscal Impact Statement from State Corporation Commission (SB626)

    1/25/2026Senate

Bill Text

Related Bills

Back to State Legislation