SESSION ENROLLED VIRGINIA ACTS OF ASSEMBLY ––-- 2022 SESSION CHAPTER E556 An Act to amend and reenact § 38.2-6506 of the Code of Virginia, relating to qualified health plans;

R O [S 449] Approved LApril L11, 2022 Be it enacted by the General Assembly of Virginia:

E § 38.2-6506.

DA. health plan, unless the Exchange determines that making the plan available through the Exchange is notd in the interest of qualified individuals and qualified employers in the Commonwealth, if:

The Exchange, in consultation with the Bureau, shall certify a health benefit plan as a qualified health plan, unless the Exchange determines that making the plan available through the Exchange is not in the interest of qualified individuals and qualified employers in the Commonwealth, if:

The plan shall not may provide any state-mandated health benefit that is not provided in the essential health benefits package and (ii) the.

The plan is not required to provide benefits that duplicate the minimumminimumlth benefits of qualified dental plans, as set forth in subsection F, if (a) (i) the Exchange has determined that at least one qualified dental plan is available to supplement the plan's coverage and (b) Bii)(ii) the health carrier makes prominent disclosure at the time it offers the plan, in a form approved by4theby the Bureau, that such plan does not provide the full range of pediatric dental benefits included in the essential health benefits package and that qualified dental plans providing those benefits and Etherother dental benefits not covered by such plan are offered through the Exchange;

R 2.

The plan's cost-sharing requirements do not exceed the limits established under § 1302(c)(1) of the Fed5.Federal Act;

5.

Charges the same premium rate for each qualified health plan without regard to whether the plan is d.offered through the Exchange or directly by the health carrier or through an agent;

d.

basisB. that the plan is a fee-for-service plan, (ii) through the imposition of premium price controls by the Exchange, or (iii) on the basis that the health benefit plan provides treatments necessary to prevent patients' deaths in circumstances that the Exchange determines are inappropriate or too costly.

The Exchange shall not refuse to certify a health benefit plan as a qualified health plan (i) on the basis that the plan is a fee-for-service plan, (ii) through the imposition of premium price controls by the Exchange, or (iii) on the basis that the health benefit plan provides treatments necessary to prevent patients' deaths in circumstances that the Exchange determines are inappropriate or too costly.

The Exchange shall establish and publish a transparent, objective process for decertifying qualified health plans if it is determined that it is not in the public interest to permit such plans to be offD.offered through the Exchange.

TheD. Exchange shall require each health carrier seeking certification of a health benefit plan as a qualified health plan to permit individuals to learn, in a timely manner upon the request of the of 2 individual, the amount of cost-sharing, including deductibles, copayments, and coinsurance, under the individual's plan or coverage that such individual would be responsible for paying with respect to the furnishing of a specific item or service by a participating provider.

The Exchange shall require each health carrier seeking certification of a health benefit plan as a qualified health plan to permit individuals to learn, in a timely manner upon the request of the individual, the amount of cost-sharing, including deductibles, copayments, and coinsurance, under the individual's plan or coverage that such individual would be responsible for paying with respect to the of 2 furnishing of a specific item or service by a participating provider.