{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3445.04.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3445.04.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3445.04.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3445.04.html"}],"law_id":55717,"edition_id":1,"section_id":55717,"structure_id":13819,"section_number":"38.2-3445.04","catch_line":"Transparency","history":"2020, cc. 1080, 1081.","full_text":"A\n\nThe Commission, in consultation with health carriers, health care providers, and consumers, shall develop standard template language for a notice of consumer rights notifying consumers of the following:1\n\nThe prohibition against balance billing is applicable to health benefit plans issued by health carriers in Virginia and self-funded group health plans issued by entities that elect to participate pursuant to § 38.2-3445.01.2\n\nConsumers cannot be balance billed for the health care services described in § 38.2-3445.01 and will receive the protections provided for in § 38.2-3445.01.3\n\nConsumers may be balance billed for health care services under circumstances other than those described in subsection A of § 38.2-3445.01 or if they are enrolled in a health plan to which the provisions of § 38.2-3445.01 do not apply and steps to take if the consumer is balance billed.4\n\nConsumers may contact the Commission if they believe they have been balance billed in violation of § 38.2-3445.01.5\n\nThe relevant contact information for the Commission.B\n\nThe Commission shall determine, by regulation, when and in what format health carriers, health care providers, and health care facilities shall provide consumers with the notice required by this section.C\n\nA health care provider shall post the following information on its website, if one is available, or, if one is not available, provide to a consumer upon written or oral request:1\n\nThe listing of the carrier health plan provider networks with which the provider contracts or with which the facility is an in-network provider; and2\n\nThe notice of consumer rights required by subsection A.\n\t\t\t\tPosting or otherwise providing the information required in this subsection shall not relieve a health care provider of its obligation to comply with the provisions of § 38.2-3445.01.D\n\nNot less than 30 days prior to executing a contract with a carrier, a health care facility shall provide the carrier with a list of the nonemployed providers or provider groups contracted to provide surgical or ancillary services at the facility. The facility shall notify the carrier within 30 days of a removal from or addition to such list and shall provide an updated list of nonemployed providers and provider groups within 14 calendar days of a request for an updated list by a carrier.E\n\nAn in-network provider shall submit accurate information to a carrier regarding the provider’s network status in a timely manner, consistent with the terms of the contract between the provider and the carrier.F\n\nA carrier shall update its website and provider directory no later than 30 days after the addition or termination of a provider.G\n\nA carrier shall provide an enrollee with (i) a clear description of the health plan’s out-of-network health benefits, (ii) the notice of consumer rights required by subsection A, and (iii) notification that if the enrollee receives services from an out-of-network-provider, under circumstances other than those described in subsection A of § 38.2-3445.01, the enrollee shall have the financial responsibility for the applicable services provided outside the health plan’s network in excess of applicable cost-sharing amounts and that the enrollee may be responsible for any costs in excess of those allowed by the health plan.","order_by":null,"text":{"0":{"id":204209,"text":"The Commission, in consultation with health carriers, health care providers, and consumers, shall develop standard template language for a notice of consumer rights notifying consumers of the following:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":204210,"text":"The prohibition against balance billing is applicable to health benefit plans issued by health carriers in Virginia and self-funded group health plans issued by entities that elect to participate pursuant to § 38.2-3445.01.","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":204211,"text":"Consumers cannot be balance billed for the health care services described in § 38.2-3445.01 and will receive the protections provided for in § 38.2-3445.01.","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":204212,"text":"Consumers may be balance billed for health care services under circumstances other than those described in subsection A of § 38.2-3445.01 or if they are enrolled in a health plan to which the provisions of § 38.2-3445.01 do not apply and steps to take if the consumer is balance billed.","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"A4"},"4":{"id":204213,"text":"Consumers may contact the Commission if they believe they have been balance billed in violation of § 38.2-3445.01.","type":"section","prefixes":["A","4"],"prefix":"4","entire_prefix":"A4","prefix_anchor":"A4","level":2,"prior_prefix":"A3","next_prefix":"A5"},"5":{"id":204214,"text":"The relevant contact information for the Commission.","type":"section","prefixes":["A","5"],"prefix":"5","entire_prefix":"A5","prefix_anchor":"A5","level":2,"prior_prefix":"A4","next_prefix":"B"},"6":{"id":204215,"text":"The Commission shall determine, by regulation, when and in what format health carriers, health care providers, and health care facilities shall provide consumers with the notice required by this section.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A5","next_prefix":"C"},"7":{"id":204216,"text":"A health care provider shall post the following information on its website, if one is available, or, if one is not available, provide to a consumer upon written or oral request:","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"C1"},"8":{"id":204217,"text":"The listing of the carrier health plan provider networks with which the provider contracts or with which the facility is an in-network provider; and","type":"section","prefixes":["C","1"],"prefix":"1","entire_prefix":"C1","prefix_anchor":"C1","level":2,"prior_prefix":"C","next_prefix":"C2"},"9":{"id":204218,"text":"The notice of consumer rights required by subsection A.\n\t\t\t\tPosting or otherwise providing the information required in this subsection shall not relieve a health care provider of its obligation to comply with the provisions of § 38.2-3445.01.","type":"section","prefixes":["C","2"],"prefix":"2","entire_prefix":"C2","prefix_anchor":"C2","level":2,"prior_prefix":"C1","next_prefix":"D"},"10":{"id":204219,"text":"Not less than 30 days prior to executing a contract with a carrier, a health care facility shall provide the carrier with a list of the nonemployed providers or provider groups contracted to provide surgical or ancillary services at the facility. The facility shall notify the carrier within 30 days of a removal from or addition to such list and shall provide an updated list of nonemployed providers and provider groups within 14 calendar days of a request for an updated list by a carrier.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C2","next_prefix":"E"},"11":{"id":204220,"text":"An in-network provider shall submit accurate information to a carrier regarding the provider’s network status in a timely manner, consistent with the terms of the contract between the provider and the carrier.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"F"},"12":{"id":204221,"text":"A carrier shall update its website and provider directory no later than 30 days after the addition or termination of a provider.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E","next_prefix":"G"},"13":{"id":204222,"text":"A carrier shall provide an enrollee with (i) a clear description of the health plan’s out-of-network health benefits, (ii) the notice of consumer rights required by subsection A, and (iii) notification that if the enrollee receives services from an out-of-network-provider, under circumstances other than those described in subsection A of § 38.2-3445.01, the enrollee shall have the financial responsibility for the applicable services provided outside the health plan’s network in excess of applicable cost-sharing amounts and that the enrollee may be responsible for any costs in excess of those allowed by the health plan.","type":"section","prefixes":["G"],"prefix":"G","entire_prefix":"G","prefix_anchor":"G","level":1,"prior_prefix":"F"}},"ancestry":[{"id":13819,"edition_id":1,"name":"Federal Market Reforms","identifier":"6","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:45:59","date_modified":"2026-06-26 03:45:59","permalink":{"id":215457,"object_type":"structure","relational_id":13819,"identifier":"6","token":"38.2\/34\/6","url":"\/38.2\/34\/6\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12993,"edition_id":1,"name":"Provisions Relating to Accident and Sickness Insurance","identifier":"34","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214887,"object_type":"structure","relational_id":12993,"identifier":"34","token":"38.2\/34","url":"\/38.2\/34\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":57210,"structure_id":13819,"section_number":"38.2-3438","catch_line":"Definitions","url":"\/38.2-3438\/","token":"38.2\/34\/6\/38.2-3438","metadata":false},{"id":55902,"structure_id":13819,"section_number":"38.2-3439","catch_line":"Dependent coverage for individuals to age 26","url":"\/38.2-3439\/","token":"38.2\/34\/6\/38.2-3439","metadata":false},{"id":59514,"structure_id":13819,"section_number":"38.2-3440","catch_line":"Lifetime and annual limits","url":"\/38.2-3440\/","token":"38.2\/34\/6\/38.2-3440","metadata":false},{"id":74720,"structure_id":13819,"section_number":"38.2-3441","catch_line":"Rescissions","url":"\/38.2-3441\/","token":"38.2\/34\/6\/38.2-3441","metadata":false},{"id":81548,"structure_id":13819,"section_number":"38.2-3442","catch_line":"Preventive services","url":"\/38.2-3442\/","token":"38.2\/34\/6\/38.2-3442","metadata":false},{"id":54833,"structure_id":13819,"section_number":"38.2-3443","catch_line":"Choice of a health care professional","url":"\/38.2-3443\/","token":"38.2\/34\/6\/38.2-3443","metadata":false},{"id":68187,"structure_id":13819,"section_number":"38.2-3444","catch_line":"Preexisting condition exclusions","url":"\/38.2-3444\/","token":"38.2\/34\/6\/38.2-3444","metadata":false},{"id":60836,"structure_id":13819,"section_number":"38.2-3445","catch_line":"Patient access to emergency services","url":"\/38.2-3445\/","token":"38.2\/34\/6\/38.2-3445","metadata":false},{"id":57195,"structure_id":13819,"section_number":"38.2-3445.01","catch_line":"Balance billing for certain services; prohibited","url":"\/38.2-3445.01\/","token":"38.2\/34\/6\/38.2-3445.01","metadata":false},{"id":74656,"structure_id":13819,"section_number":"38.2-3445.02","catch_line":"Arbitration","url":"\/38.2-3445.02\/","token":"38.2\/34\/6\/38.2-3445.02","metadata":false},{"id":57491,"structure_id":13819,"section_number":"38.2-3445.03","catch_line":"Data sets for determining commercially reasonable payments","url":"\/38.2-3445.03\/","token":"38.2\/34\/6\/38.2-3445.03","metadata":false},{"id":55717,"structure_id":13819,"section_number":"38.2-3445.04","catch_line":"Transparency","url":"\/38.2-3445.04\/","token":"38.2\/34\/6\/38.2-3445.04","metadata":false},{"id":67926,"structure_id":13819,"section_number":"38.2-3445.05","catch_line":"Enforcement","url":"\/38.2-3445.05\/","token":"38.2\/34\/6\/38.2-3445.05","metadata":false},{"id":66467,"structure_id":13819,"section_number":"38.2-3445.06","catch_line":"Applicability of certain sections","url":"\/38.2-3445.06\/","token":"38.2\/34\/6\/38.2-3445.06","metadata":false},{"id":72898,"structure_id":13819,"section_number":"38.2-3445.07","catch_line":"Rules and regulations","url":"\/38.2-3445.07\/","token":"38.2\/34\/6\/38.2-3445.07","metadata":false},{"id":68114,"structure_id":13819,"section_number":"38.2-3445.1","catch_line":"Repealed","url":"\/38.2-3445.1\/","token":"38.2\/34\/6\/38.2-3445.1","metadata":false},{"id":63588,"structure_id":13819,"section_number":"38.2-3445.2","catch_line":"Out-of-network claims; reporting requirements","url":"\/38.2-3445.2\/","token":"38.2\/34\/6\/38.2-3445.2","metadata":false},{"id":86937,"structure_id":13819,"section_number":"38.2-3446","catch_line":"Applicability of federal law","url":"\/38.2-3446\/","token":"38.2\/34\/6\/38.2-3446","metadata":false},{"id":66501,"structure_id":13819,"section_number":"38.2-3447","catch_line":"(Effective January 1, 2026) Restrictions relating to premium rates","url":"\/38.2-3447\/","token":"38.2\/34\/6\/38.2-3447","metadata":false},{"id":79799,"structure_id":13819,"section_number":"38.2-3448","catch_line":"Guaranteed availability","url":"\/38.2-3448\/","token":"38.2\/34\/6\/38.2-3448","metadata":false},{"id":78815,"structure_id":13819,"section_number":"38.2-3449","catch_line":"Prohibiting discrimination based on health status","url":"\/38.2-3449\/","token":"38.2\/34\/6\/38.2-3449","metadata":false},{"id":67706,"structure_id":13819,"section_number":"38.2-3449.1","catch_line":"Prohibited discrimination based on gender identity or status as a transgender individual","url":"\/38.2-3449.1\/","token":"38.2\/34\/6\/38.2-3449.1","metadata":false},{"id":64622,"structure_id":13819,"section_number":"38.2-3450","catch_line":"Genetic information and testing","url":"\/38.2-3450\/","token":"38.2\/34\/6\/38.2-3450","metadata":false},{"id":83154,"structure_id":13819,"section_number":"38.2-3451","catch_line":"Essential health benefits","url":"\/38.2-3451\/","token":"38.2\/34\/6\/38.2-3451","metadata":false},{"id":76537,"structure_id":13819,"section_number":"38.2-3452","catch_line":"Waiting periods","url":"\/38.2-3452\/","token":"38.2\/34\/6\/38.2-3452","metadata":false},{"id":86395,"structure_id":13819,"section_number":"38.2-3453","catch_line":"Clinical trials","url":"\/38.2-3453\/","token":"38.2\/34\/6\/38.2-3453","metadata":false},{"id":81951,"structure_id":13819,"section_number":"38.2-3454","catch_line":"Wellness programs","url":"\/38.2-3454\/","token":"38.2\/34\/6\/38.2-3454","metadata":false},{"id":84250,"structure_id":13819,"section_number":"38.2-3454.1","catch_line":"Renewal of health benefit plans; special exception","url":"\/38.2-3454.1\/","token":"38.2\/34\/6\/38.2-3454.1","metadata":false}],"previous_section":{"id":57491,"structure_id":13819,"section_number":"38.2-3445.03","catch_line":"Data sets for determining commercially reasonable payments","url":"\/38.2-3445.03\/","token":"38.2\/34\/6\/38.2-3445.03","metadata":false},"next_section":{"id":67926,"structure_id":13819,"section_number":"38.2-3445.05","catch_line":"Enforcement","url":"\/38.2-3445.05\/","token":"38.2\/34\/6\/38.2-3445.05","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3445.04\/","history_text":"

This law was first created in 2020. The record of its establishment is cataloged in chapters 1080<\/a> and 1081<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year.<\/p>","references":false,"refers_to":[{"id":57195,"section_number":"38.2-3445.01","catch_line":"Balance billing for certain services; prohibited","order_by":null,"url":"\/38.2-3445.01\/"}],"permalink":{"id":215503,"object_type":"law","relational_id":55717,"identifier":"38.2-3445.04","token":"38.2\/34\/6\/38.2-3445.04","url":"\/38.2-3445.04\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3445.04\/","token":"38.2\/34\/6\/38.2-3445.04","dublin_core":{"Title":"Transparency","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3445.04","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> The Commission<\/span>, in consultation with health carriers, health care providers, and consumers, shall develop standard template language for a notice of consumer rights notifying consumers of the following: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The prohibition against balance billing is applicable to health benefit plans issued by health carriers in Virginia and self-funded group health plans issued by entities that elect to participate pursuant to § 38.2-3445.01<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Consumers cannot be balance billed for the health care services described in § 38.2-3445.01<\/a> and will receive the protections provided for in § 38.2-3445.01<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Consumers may be balance billed for health care services under circumstances other than those described in subsection A of § 38.2-3445.01<\/a> or if they are enrolled in a health plan to which the provisions of § 38.2-3445.01<\/a> do not apply and steps to take if the consumer is balance billed. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Consumers may contact the Commission<\/span> if they believe they have been balance billed in violation of § 38.2-3445.01<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> The relevant contact information for the Commission<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The Commission<\/span> shall determine, by regulation, when and in what format health carriers, health care providers, and health care facilities shall provide consumers with the notice required by this section. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> A health care provider shall post the following information on its website, if one is available, or, if one is not available, provide to a consumer upon written or oral request: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The listing of the carrier health plan provider networks with which the provider contracts<\/span> or with which the facility is an in-network provider; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The notice of consumer rights required by subsection A.\n\t\t\t\tPosting or otherwise providing the information required in this subsection shall not relieve a health care provider of its obligation to comply with the provisions of § 38.2-3445.01<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> Not less than 30 days prior to executing a contract<\/span> with a carrier, a health care facility shall provide the carrier with a list of the nonemployed providers or provider groups contracted to provide surgical or ancillary services at the facility. The facility shall notify the carrier within 30 days of a removal from or addition to such list and shall provide an updated list of nonemployed providers and provider groups within 14 calendar days of a request for an updated list by a carrier. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> An in-network provider shall submit accurate information to a carrier regarding the provider’s network status in a timely manner, consistent with the terms of the contract<\/span> between the provider and the carrier. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> A carrier shall update its website and provider directory no later than 30 days after the addition or termination of a provider. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

G.<\/span> A carrier shall provide an enrollee with (i) a clear description of the health plan’s out-of-network health benefits, (ii) the notice of consumer rights required by subsection A, and (iii) notification that if the enrollee receives services from an out-of-network-provider, under circumstances other than those described in subsection A of § 38.2-3445.01<\/a>, the enrollee shall have the financial responsibility for the applicable services provided outside the health plan’s network in excess of applicable cost-sharing amounts and that the enrollee may be responsible for any costs in excess of those allowed by the health plan. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nTRANSPARENCY (\u00a7 38.2-3445.04)\n\nA. The Commission, in consultation with health carriers, health care providers,\nand consumers, shall develop standard template language for a notice of consumer\nrights notifying consumers of the following:\n\n 1. The prohibition against balance billing is applicable to health benefit\n plans issued by health carriers in Virginia and self-funded group health plans\n issued by entities that elect to participate pursuant to § 38.2-3445.01.\n\n 2. Consumers cannot be balance billed for the health care services described\n in § 38.2-3445.01 and will receive the protections provided for in §\n 38.2-3445.01.\n\n 3. Consumers may be balance billed for health care services under\n circumstances other than those described in subsection A of §\n 38.2-3445.01 or if they are enrolled in a health plan to which the provisions\n of § 38.2-3445.01 do not apply and steps to take if the consumer is\n balance billed.\n\n 4. Consumers may contact the Commission if they believe they have been balance\n billed in violation of § 38.2-3445.01.\n\n 5. The relevant contact information for the Commission.\n\nB. The Commission shall determine, by regulation, when and in what format health\ncarriers, health care providers, and health care facilities shall provide\nconsumers with the notice required by this section.\n\nC. A health care provider shall post the following information on its website,\nif one is available, or, if one is not available, provide to a consumer upon\nwritten or oral request:\n\n 1. The listing of the carrier health plan provider networks with which the\n provider contracts or with which the facility is an in-network provider; and\n\n 2. The notice of consumer rights required by subsection A.\n \t\t\t\tPosting or otherwise providing the information required in this subsection\n shall not relieve a health care provider of its obligation to comply with the\n provisions of § 38.2-3445.01.\n\nD. Not less than 30 days prior to executing a contract with a carrier, a health\ncare facility shall provide the carrier with a list of the nonemployed providers\nor provider groups contracted to provide surgical or ancillary services at the\nfacility. The facility shall notify the carrier within 30 days of a removal from\nor addition to such list and shall provide an updated list of nonemployed\nproviders and provider groups within 14 calendar days of a request for an\nupdated list by a carrier.\n\nE. An in-network provider shall submit accurate information to a carrier\nregarding the provider’s network status in a timely manner, consistent\nwith the terms of the contract between the provider and the carrier.\n\nF. A carrier shall update its website and provider directory no later than 30\ndays after the addition or termination of a provider.\n\nG. A carrier shall provide an enrollee with (i) a clear description of the\nhealth plan’s out-of-network health benefits, (ii) the notice of consumer\nrights required by subsection A, and (iii) notification that if the enrollee\nreceives services from an out-of-network-provider, under circumstances other\nthan those described in subsection A of § 38.2-3445.01, the enrollee shall\nhave the financial responsibility for the applicable services provided outside\nthe health plan’s network in excess of applicable cost-sharing amounts and\nthat the enrollee may be responsible for any costs in excess of those allowed by\nthe health plan.\n\nHISTORY: 2020, cc. 1080, 1081.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}