                                 CODE OF VIRGINIA

HEALTH CARE PRICE TRANSPARENCY TOOLS (§ 38.2-3463)

Beginning with health benefit plans offered or renewed on or after July 1, 2020,
each health carrier offering a health benefit plan in the Commonwealth shall
comply with the following requirements:

1. A health carrier shall establish an interactive mechanism on its website that
enables a covered person to request and obtain from the health carrier the
estimated out-of-pocket cost to the covered person for comparable health care
services from network providers, as well as quality data for those providers, to
the extent available. The interactive mechanism shall allow a covered person
seeking information about the cost of a comparable health care service to
compare estimated out-of-pocket costs applicable to that covered person&#8217;s
health benefit plan. The out-of-pocket estimate shall provide a good faith
estimate of the amount the covered person will be responsible to pay
out-of-pocket for a proposed comparable health care service or service that is a
medically necessary covered benefit from a health carrier&#8217;s network
provider, including any copayment, deductible, coinsurance, or other
out-of-pocket amount for any covered benefit, based on the information available
to the health carrier at the time the request is made. A health carrier may
contract with a third-party vendor to satisfy the requirements of this
subdivision.

2. Nothing in this section shall prohibit a health carrier from imposing
cost-sharing requirements disclosed in the covered person&#8217;s covered
benefit plan for unforeseen health care services that arise out of the
comparable health care service or for a procedure or service provided to a
covered person that was not included in an original estimate provided under
subdivision 1.

3. A health carrier shall notify a covered person that an estimate provided
under subdivision 1 is an estimate of costs and that the actual amount the
covered person will be responsible to pay may vary due to the need for
unforeseen services that arise out of the proposed comparable health care
service.

HISTORY: 2019, cc. 666, 684.