Health insurance; calculation of enrollee's contribution, high deductible health plan.
Impact
By amending §38.2-3407.20 of the Code of Virginia, the bill redefines the parameters within which health care providers must operate, specifically in relation to high deductible health plans (HDHPs). This change is crucial for enrollees who utilize health savings accounts (HSAs), as it ensures that their contributions count towards their overall out-of-pocket expenses. Moreover, the implementation of this bill affects existing contracts made after January 1, 2020, thereby impacting not only current health plans but those renewed or created in the near future.
Summary
House Bill 1081 focuses on health insurance regulations, specifically addressing how carriers calculate an enrollee's contribution to out-of-pocket maximums and cost-sharing requirements. The bill mandates that in these calculations, carriers must include any financial contributions made by enrollees or on their behalf to ensure a more accurate representation of an enrollee's true costs. This legislation aims to improve transparency and fairness in health insurance by ensuring that all costs associated with obtaining health services are considered in the calculation process.
Sentiment
The sentiment surrounding HB 1081 appears to be predominantly positive among stakeholders in the health insurance industry. Supporters suggest that the bill enhances consumer protections and aligns with federal regulations surrounding HSAs and HDHPs. However, there may still be pockets of concern regarding the administrative burden this could impose on smaller insurance carriers who struggle to comply with additional regulatory requirements.
Contention
Despite the recognition of its benefits, there are notable points of contention primarily focused on the administrative implications for health care providers and insurers. Detractors worry that the increased obligations associated with calculating contributions to out-of-pocket maximums might lead to higher costs for insurers, which could ultimately be passed down to consumers through increased premiums or reduced policy offerings. Additionally, ensuring continued eligibility for HSAs complicates matters, especially for those enrollees whose plans may already be facing constraints under federal law.
Requires third-party discounts and payments for individuals covered by health benefits plans to apply to copayments, coinsurance, deductibles, or other out-of-pocket costs for covered benefits.
Requires third-party discounts and payments for individuals covered by health benefits plans to apply to copayments, coinsurance, deductibles, or other out-of-pocket costs for covered benefits.