                                 CODE OF VIRGINIA

TRANSPARENCY (§ 38.2-3445.04)

A. 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:

   1. 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 &#xA7; 38.2-3445.01.

   2. Consumers cannot be balance billed for the health care services described
   in &#xA7; 38.2-3445.01 and will receive the protections provided for in &#xA7;
   38.2-3445.01.

   3. Consumers may be balance billed for health care services under
   circumstances other than those described in subsection A of &#xA7;
   38.2-3445.01 or if they are enrolled in a health plan to which the provisions
   of &#xA7; 38.2-3445.01 do not apply and steps to take if the consumer is
   balance billed.

   4. Consumers may contact the Commission if they believe they have been balance
   billed in violation of &#xA7; 38.2-3445.01.

   5. The relevant contact information for the Commission.

B. 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.

C. 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:

   1. 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

   2. The notice of consumer rights required by subsection A.
   				Posting 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 &#xA7; 38.2-3445.01.

D. 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.

E. An in-network provider shall submit accurate information to a carrier
regarding the provider&#8217;s network status in a timely manner, consistent
with the terms of the contract between the provider and the carrier.

F. A carrier shall update its website and provider directory no later than 30
days after the addition or termination of a provider.

G. A carrier shall provide an enrollee with (i) a clear description of the
health plan&#8217;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 &#xA7; 38.2-3445.01, the enrollee shall
have the financial responsibility for the applicable services provided outside
the health plan&#8217;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.

HISTORY: 2020, cc. 1080, 1081.