SB 422 — Health insurance; tobacco surcharge.

SESSION ENGROSSEDENROLLED 22103427DVIRGINIA SENATEACTS BILLOF NO.ASSEMBLY –– CHAPTER E An Act to amend and reenact § 38.2-3447 of the Code of Virginia, relating to health insurance;

422 Senate Amendments in [ ] - January 27, 2022 Prefiled January 11, 2022 A BILL to amend and reenact § 38.2-3447 of the Code of Virginia, relating to health insurance;

PatronR PriorO to[S Engrossment––Senator422] EdwardsApproved (ByL Request)L –––––––––– Referred to Committee on Commerce and Labor E –––––––––– N Be it enacted by the General Assembly of Virginia:

GE § 38.2-3447.

RD A.this title to the contrary, a health carrier offering a health benefit plan providing individual or small group health insurance coverage shall develop its premium rates based on the following:

Notwithstanding1. any provision of § 38.2-3432.2, 38.2-3501, 38.2-4306, or any other section of this title to the contrary, a health carrier offering a health benefit plan providing individual or small gro1.

on2. the following:

S 2.

and S 3.

E B.

A premium rate shall not vary with respect to any particular health benefit plan by any oDheroBher factor not described in subsection A.

C.2 attributable to each family member covered under the health benefit plan.

Rating variations for family coverage shall be applied based on the portion of the premiumpremiuE that is attributableD. to each family member covered under the health benefit plan.

D.If the proposed area rate factors set forth in a rate filing for individual or small group health insurance coverage by a health carrier for a rating area exceed by more than 15 percent the weighted average of the proposed area rate factors among all rating areas in which the health carrier offers health benefit plans in that market, then:

If the proposed area rate factors set forth in a rate filing for individual or small group health insurance coverage by a health carrier for a rating area exceed by more than 15 percent the weighted benefit plans in that market, then:actors among all rating areas in which the health carrier offers health 1.

The health carrier's rate filing shall include in a publicly available and unredacted forS:form:

A comparison of the area rate factor for individual and small group health benefit plans that utilize the same provider network and provider reimbursement levels of the health benefit plans that ar2are subject to theb. filing;

EA b.detailed disclosure of the area rate factor methodology, which disclosure shall include any third-party resources or representations from a person other than the signing actuary, on which the signing actuary relied, provided that disclosure of third-party resources shall address that the source data only reflects differences in unit cost and provider practice patterns;

A detailed disclosure of the area rate factor methodology, which disclosure shall include any third-party resources or representations from a person other than the signing actuary, on which the signing actuary relied, provided that disclosure of third-party resources shall address that the source data 35 only reflects differences in unit cost and providerc. practice patterns;

andTo areathe forextent that the experiencehealth periodcarrier used:carrier is deriving any area rate factor from experience data, by rating 38area (1)for Thethe (i)experience totalperiod enrollment;used:

(1) The (i) total enrollment;

(iv) incurred claims excluding 39 anticipated or, if available, actual risk adjustment payments or receipts;

(v) incurred claims including anticipatedtheir or,rating ifareas available,in actualthat riskmarket; adjustment payments or receipts;

andandisk (vi)adjustment losspayments ratioor forreceipts; each of their rating areas in that market;

and (vi) loss ratio for each of (2) Aggregated incurred claims for any health system exceeding 30 percent of total incurred claims for that rating area in that market.

indexed3. to the same rating region for both the individual and small group markets, of 15 percent orors, more exists between health benefit plans a carrier intends to offer in the individual market and health benefit plans intended to be offered in the small group market, when those plans utilize the same provider network and provider reimbursement levels and (ii) the methodologies used to calculate the area rate factors are different between the two markets.

The Commission shall not approve the proposed rate filing if (i) a variance in area rate factors, indexed to the same rating region for both the individual and small group markets, of 15 percent or more exists between health benefit plans a carrier intends to offer in the individual market and health provider network and provider reimbursement levels and (ii) the methodologies used to calculate the area rate factors are different between the two markets.

Beginning for plan year 2020, a health carrier with an approved rate filing that contains at least one area rate factor that exceeds by more than 25 percent the weighted average of the area rate factors among all rating areas in a market in which the health carrier offers individual or small group health insurance coverage shall file with the Commission for each calendar quarter during that plan year a report that provides, for each rating area within the market in which the health carrier operates, the plan's (i) enrollment;

(iv) incurred claims excluding anticipated or, if available, actual risk adjustment payments or receipts;

(v) incurred claims including anticipated or, SB422E 2 of 2 if available, actual risk adjustment payments or receipts;

and (vii) aggregate incurred or, claims, for each health system exceeding 25 percent of total incurred claims for that rating area.

The of 2 health carrier shall make each such quarterly report publicly available, without redaction, not later than 45 days after the end of the calendar quarter.

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