Calculation of Cost-Sharing

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 »