Effective January 1, 2020, HB 2664 requires all sized employers operating a business in Virginia to provide a detailed pay statement to each employee on each regular pay date. The statement may be provided in the form of a paystub or online accounting. The statement must show the name and address of the employer, the number of hours worked during the pay period, the rate of pay, the gross wages earned by the employee during any the pay period, and the amount and purpose of any deductions therefrom. There is an exception for agricultural employers who must only provide statements upon request of its employees detailing gross wages earned by the employee during any pay period and the amount and purpose of any deductions.

This law is not directly related to employee benefits. However, the law likely requires the wage statements to include information on health and retirement benefits since those are generally deductions from employees’ wages. Employers should ensure that they provide an adequate statement to employees pursuant to this rule.

HB 2664 »

Effective for group health insurance policies issued or renewed on or after Jan. 1, 2019, HB 234 requires policies that cover prescription drugs to provide coverage for a partial supply of a prescription drug if the prescribing provider or pharmacist determines the fill or refill to be in the best interest of the participant or for the purpose of medical synchronization. Medical synchronization means the coordination of prescription refills for a patient who is taking two or more maintenance drugs; this is believed to improve medication adherence. The policy is prohibited from denying a prescription refill on the basis that it is being filled too soon if the purpose is medical synchronization. Lastly, the cost-sharing for the partial supply must be prorated accordingly.

HB 234 »

Newly enacted HB 1177 applies to contracts between pharmacies and pharmacy benefit managers or carriers entered into or renewed on or after Jan. 1, 2019. Under the new contracts, an insured cannot be required to pay a charge that exceeds the retail price of the prescription drug. In other words, the insured will pay the plan’s coinsurance amount or the retail price, whichever is lower. Additionally, the pharmacist must be permitted to discuss with the insured information about a more affordable, therapeutically equivalent prescription drug, if available, and sell that drug to the insured.

HB 177 »

On April 6, 2018, Gov. Northam signed SB 672 into law, which revises the definition of small employer for health insurance purposes. The term “small employer” continues to refer to an employer located in the Commonwealth that employed an average of at least one but not more than 50 eligible individuals on business days during the preceding calendar year and who employs at least one eligible individual on the date a policy becomes effective. The new law provides that the term “small employer” includes a self-employed person. An individual who is the sole shareholder of a corporation or sole member of a limited liability company, or an immediate family member of such sole shareholder or member, qualifies as an employee of the corporation or limited liability company if he performed any service for remuneration under a contract of hire for the corporation or limited liability company. Thus, a sole proprietor or other self-employed person – or their family member – may now qualify for a small employer plan.

SB 672 »

On May 4, 2017, the Virginia Bureau of Insurance issued Administrative Letter 2017-2, which summarizes insurance-related legislation enacted by the 2017 General Assembly. We have featured much of this legislation in previous editions of Compliance Corner, including HB 2267 (Coverage for Hormonal Contraceptives; April 18, 2017), HB 1450 (Pharmacy Benefits, April 4, 2017) and HB 1656 (Coverage for Proton Radiation Therapy, April 4, 2017). The letter also highlights HB 2037. This bill was approved by Gov. McAuliffe on March 16, 2017, and requires a health insurer to calculate an insured’s amount payable to a provider based on the established allowed amount (discounted rate) even when there is no amount actually payable by the insurer.

There is no action required from an employer plan sponsor, but this may be welcome news to participants who have been previously liable to pay balances for incurred expenses without the benefit of the discounted allowed amount.

Administrative Letter 2017-2 »
HB 2037 »

On April 26, 2017, Gov. McAuliffe signed H.B. 2053 into law. The new law establishes guidelines for direct primary care agreements, which are agreements between a patient or a patient’s employer and a health care provider for ongoing primary care services in exchange for a monthly fee. If an employer offers such an arrangement, they should be aware that the arrangement is not health insurance and does not satisfy ACA requirements including minimum essential coverage or essential health benefits. It would not satisfy either the individual or employer mandates. Participants of a direct primary care agreement must receive a notification of the arrangement’s limitations.

HB 2053 »

On March 24, 2017, Gov. McAuliffe signed HB2267 into law. The new law requires health insurance plans that provide coverage for hormonal contraceptives to cover up to a 12-month supply of hormonal contraceptives. A plan may not impose utilization controls or other forms of medical management limiting the supply of hormonal contraceptives to an amount less than a 12-month supply. The law is effective for policies issued or renewed on or after Jan. 1, 2018.

HB2267 »

On March 16, 2017, Gov. McAuliffe signed HB 1450 into law. The new law provides health plan participants the freedom to choose a pharmacy from which to receive prescription benefits. If the insurer has a network of preferred providers and the pharmacy is not one of those preferred providers, the insurer must still pay benefits electronically and verify coverage if the pharmacy has agreed in writing to accept the preferred provider reimbursement rates.

The law is effective July 1, 2017.

HB 1450

On March 13, 2017, Gov. McAuliffe signed SB 1033 into law. The new law amends the state’s rules related to notification following a breach of payroll data. Existing rules require an employer to notify any affected residents and the Office of the Attorney General if unencrypted or unredacted personal information was or is reasonably believed to have been accessed and acquired by an unauthorized person and causes or will cause identity theft or another fraud.

"Personal information" means the first name or first initial and last name in combination with any one or more of the following data elements, when the data elements are neither encrypted nor redacted: social security number, driver’s license number or state identification card number, financial account or credit card number in combination with a security code or password.

Under the new law, notification would be required following a breach involving a taxpayer identification number in combination with the income tax withheld for that taxpayer.

The law applies to any employer that owns or licenses computerized data relating to income tax withheld.

SB 1033

On March 3, 2017, Gov. McAuliffe signed HB 1656 into law. The law prohibits group health insurance policies from imposing a higher standard of clinical evidence for proton radiation therapy for benefit coverage decisions as compared to other types of radiation therapy treatment. The law does not require coverage for proton radiation therapy and only applies to policies that already provide coverage for cancer therapy.

The law is effective for plan years issued or renewed on or after Jan. 1, 2018.

HB 1656