{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3445.2.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3445.2.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3445.2.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3445.2.html"}],"law_id":63588,"edition_id":1,"section_id":63588,"structure_id":13819,"section_number":"38.2-3445.2","catch_line":"Out-of-network claims; reporting requirements","history":"2020, cc. 1080, 1081.","full_text":"A\n\nAny health carrier providing individual or group health insurance coverage shall report to the State Corporation Commission’s Bureau of Insurance (the Bureau) no later than September 1, 2020, the number of out-of-network claims for emergency services paid pursuant to subdivision A 4 of § 38.2-3445 in fiscal years 2017, 2018, and 2019. Thereafter, any health carrier providing individual or group health insurance coverage shall report to the Bureau, no later than November 1 of each year, the number of out-of-network claims for services described in subsection A of § 38.2-3445.01 for the previous fiscal year.B\n\nAny health carrier providing individual or group health insurance coverage shall report to the Bureau no later than September 1 of each year the number and identity of health care providers in the health carrier’s network of emergency services providers and surgical or ancillary providers whose participation in the network was terminated by either the health carrier or the health care provider in the previous year and, if applicable, whether participation was subsequently reinstated in the same year. For any terminated health care providers identified by the health carrier in such report, the health carrier shall include (i) a description of the health care provider’s or health carrier’s stated reason for terminating participation and (ii) a description of the nature and extent of differences in payment levels for emergency services and surgical or ancillary services prior to termination and after reinstatement, if applicable, including a determination of whether such payment levels after reinstatement were higher or lower than those applied prior to termination.C\n\nThe Bureau shall notify the Chairmen of the House Committee on Labor and Commerce and the Senate Committee on Commerce and Labor of the information reported to the Bureau pursuant to subsections A and B and other information specified in this subsection no later than December 1, 2021, and annually thereafter. Such notice shall include (i) the number of out-of-network claims for services described in subsection A of § 38.2-3445.01 for the previous fiscal year; (ii) the number and identity of health care providers in the health carrier’s network of emergency services providers and surgical or ancillary services providers whose participation in the network was terminated by the health carrier or the health care provider in the previous year and whether participation was subsequently reinstated in the same year; (iii) a summary of the stated reasons for terminating participation; (iv) a summary of the nature and extent of differences in payment levels prior to termination and after reinstatement, if applicable, including a determination of whether such payment levels after reinstatement were higher or lower than those applied prior to termination; (v) an assessment by the Bureau of the potential impact of any changes in network participation or payment levels for emergency services on health insurance premiums in the time period to which the report applies; and (vi) the number and type of claims resolved by arbitration and aggregate information on the disposition of those arbitrations, including in which category group’s favor the dispute was resolved, and aggregate information on the variation between the initial payment and final settlement amounts.","order_by":null,"text":{"0":{"id":231679,"text":"Any health carrier providing individual or group health insurance coverage shall report to the State Corporation Commission’s Bureau of Insurance (the Bureau) no later than September 1, 2020, the number of out-of-network claims for emergency services paid pursuant to subdivision A 4 of § 38.2-3445 in fiscal years 2017, 2018, and 2019. Thereafter, any health carrier providing individual or group health insurance coverage shall report to the Bureau, no later than November 1 of each year, the number of out-of-network claims for services described in subsection A of § 38.2-3445.01 for the previous fiscal year.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":231680,"text":"Any health carrier providing individual or group health insurance coverage shall report to the Bureau no later than September 1 of each year the number and identity of health care providers in the health carrier’s network of emergency services providers and surgical or ancillary providers whose participation in the network was terminated by either the health carrier or the health care provider in the previous year and, if applicable, whether participation was subsequently reinstated in the same year. For any terminated health care providers identified by the health carrier in such report, the health carrier shall include (i) a description of the health care provider’s or health carrier’s stated reason for terminating participation and (ii) a description of the nature and extent of differences in payment levels for emergency services and surgical or ancillary services prior to termination and after reinstatement, if applicable, including a determination of whether such payment levels after reinstatement were higher or lower than those applied prior to termination.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":231681,"text":"The Bureau shall notify the Chairmen of the House Committee on Labor and Commerce and the Senate Committee on Commerce and Labor of the information reported to the Bureau pursuant to subsections A and B and other information specified in this subsection no later than December 1, 2021, and annually thereafter. Such notice shall include (i) the number of out-of-network claims for services described in subsection A of § 38.2-3445.01 for the previous fiscal year; (ii) the number and identity of health care providers in the health carrier’s network of emergency services providers and surgical or ancillary services providers whose participation in the network was terminated by the health carrier or the health care provider in the previous year and whether participation was subsequently reinstated in the same year; (iii) a summary of the stated reasons for terminating participation; (iv) a summary of the nature and extent of differences in payment levels prior to termination and after reinstatement, if applicable, including a determination of whether such payment levels after reinstatement were higher or lower than those applied prior to termination; (v) an assessment by the Bureau of the potential impact of any changes in network participation or payment levels for emergency services on health insurance premiums in the time period to which the report applies; and (vi) the number and type of claims resolved by arbitration and aggregate information on the disposition of those arbitrations, including in which category group’s favor the dispute was resolved, and aggregate information on the variation between the initial payment and final settlement amounts.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B"}},"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; 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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":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},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3445.2\/","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":60836,"section_number":"38.2-3445","catch_line":"Patient access to emergency services","order_by":null,"url":"\/38.2-3445\/"},{"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":215523,"object_type":"law","relational_id":63588,"identifier":"38.2-3445.2","token":"38.2\/34\/6\/38.2-3445.2","url":"\/38.2-3445.2\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3445.2\/","token":"38.2\/34\/6\/38.2-3445.2","dublin_core":{"Title":"Out-of-network claims; reporting requirements","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3445.2","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Any health carrier providing individual or group health insurance coverage shall report to the State<\/span> Corporation Commission<\/span>’s Bureau of Insurance<\/span> (the Bureau) no later than September 1, 2020, the number of out-of-network claims for emergency services paid pursuant to subdivision A 4 of § 38.2-3445<\/a> in fiscal years 2017, 2018, and 2019. Thereafter, any health carrier providing individual or group health insurance coverage shall report to the Bureau, no later than November 1 of each year, the number of out-of-network claims for services described in subsection A of § 38.2-3445.01<\/a> for the previous fiscal year. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Any health carrier providing individual or group health insurance coverage shall report to the Bureau no later than September 1 of each year the number and identity of health care providers in the health carrier’s network of emergency services providers and surgical or ancillary providers whose participation in the network was terminated by either the health carrier or the health care provider in the previous year and, if applicable, whether participation was subsequently reinstated in the same year. For any terminated health care providers identified by the health carrier in such report, the health carrier shall include (i) a description of the health care provider’s or health carrier’s stated reason for terminating participation and (ii) a description of the nature and extent of differences in payment levels for emergency services and surgical or ancillary services prior to termination and after reinstatement, if applicable, including a determination of whether such payment levels after reinstatement were higher or lower than those applied prior to termination. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> The Bureau shall notify the Chairmen of the House Committee on Labor and Commerce and the Senate Committee on Commerce and Labor of the information reported to the Bureau pursuant to subsections A and B and other information specified in this subsection no later than December 1, 2021, and annually thereafter. Such notice shall include (i) the number of out-of-network claims for services described in subsection A of § 38.2-3445.01<\/a> for the previous fiscal year; (ii) the number and identity of health care providers in the health carrier’s network of emergency services providers and surgical or ancillary services providers whose participation in the network was terminated by the health carrier or the health care provider in the previous year and whether participation was subsequently reinstated in the same year; (iii) a summary of the stated reasons for terminating participation; (iv) a summary of the nature and extent of differences in payment levels prior to termination and after reinstatement, if applicable, including a determination of whether such payment levels after reinstatement were higher or lower than those applied prior to termination; (v) an assessment by the Bureau of the potential impact of any changes in network participation or payment levels for emergency services on health insurance premiums in the time period to which the report applies; and (vi) the number and type of claims resolved by arbitration and aggregate information on the disposition<\/span> of those arbitrations, including in which category group’s favor the dispute was resolved, and aggregate information on the variation between the initial payment and final settlement<\/span> amounts. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nOUT-OF-NETWORK CLAIMS; REPORTING REQUIREMENTS (\u00a7 38.2-3445.2)\n\nA. Any health carrier providing individual or group health insurance coverage\nshall report to the State Corporation Commission’s Bureau of Insurance\n(the Bureau) no later than September 1, 2020, the number of out-of-network\nclaims for emergency services paid pursuant to subdivision A 4 of §\n38.2-3445 in fiscal years 2017, 2018, and 2019. Thereafter, any health carrier\nproviding individual or group health insurance coverage shall report to the\nBureau, no later than November 1 of each year, the number of out-of-network\nclaims for services described in subsection A of § 38.2-3445.01 for the\nprevious fiscal year.\n\nB. Any health carrier providing individual or group health insurance coverage\nshall report to the Bureau no later than September 1 of each year the number and\nidentity of health care providers in the health carrier’s network of\nemergency services providers and surgical or ancillary providers whose\nparticipation in the network was terminated by either the health carrier or the\nhealth care provider in the previous year and, if applicable, whether\nparticipation was subsequently reinstated in the same year. For any terminated\nhealth care providers identified by the health carrier in such report, the\nhealth carrier shall include (i) a description of the health care\nprovider’s or health carrier’s stated reason for terminating\nparticipation and (ii) a description of the nature and extent of differences in\npayment levels for emergency services and surgical or ancillary services prior\nto termination and after reinstatement, if applicable, including a determination\nof whether such payment levels after reinstatement were higher or lower than\nthose applied prior to termination.\n\nC. The Bureau shall notify the Chairmen of the House Committee on Labor and\nCommerce and the Senate Committee on Commerce and Labor of the information\nreported to the Bureau pursuant to subsections A and B and other information\nspecified in this subsection no later than December 1, 2021, and annually\nthereafter. Such notice shall include (i) the number of out-of-network claims\nfor services described in subsection A of § 38.2-3445.01 for the previous\nfiscal year; (ii) the number and identity of health care providers in the health\ncarrier’s network of emergency services providers and surgical or\nancillary services providers whose participation in the network was terminated\nby the health carrier or the health care provider in the previous year and\nwhether participation was subsequently reinstated in the same year; (iii) a\nsummary of the stated reasons for terminating participation; (iv) a summary of\nthe nature and extent of differences in payment levels prior to termination and\nafter reinstatement, if applicable, including a determination of whether such\npayment levels after reinstatement were higher or lower than those applied prior\nto termination; (v) an assessment by the Bureau of the potential impact of any\nchanges in network participation or payment levels for emergency services on\nhealth insurance premiums in the time period to which the report applies; and\n(vi) the number and type of claims resolved by arbitration and aggregate\ninformation on the disposition of those arbitrations, including in which\ncategory group’s favor the dispute was resolved, and aggregate information\non the variation between the initial payment and final settlement amounts.\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}}