Virginia legislation · 2026 Regular Session
Virginia HB1450: An Act to amend and reenact § 38.2-3540.1 of the Code of Virginia, relating to health insurance; claims experience information.
Status: Chaptered, April 22, 2026
Health insurance; claims experience information. Provides that provisions requiring insurers to provide policyholders with certain claims experience information apply to all employee welfare benefit plans and include pharmacy benefits claims. The bill does not become effective unless reenacted by the 2027 Session of the General Assembly.
What the bill says
An Act to amend and reenact § 38.2-3540.1 of the Code of Virginia, relating to health insurance; claims experience information. [H 1450] Approved April 22, 2026 1. That § 38.2-3540.1 of the Code of Virginia is amended and reenacted as follows: § 38.2-3540.1. Claims experience. A. As used in this section, "employee welfare benefit plan" has the same meaning as provided in 29 U.S.C. § 1002(1). B. Each [DELETED: group] [DELETED: accident] [DELETED: and] [DELETED: sickness] [DELETED: insurance] [DELETED: policy] [DELETED: and] [DELETED: health] [DELETED: care] employee welfare benefit plan shall c.
From the enrolled text, April 22, 2026:
An Act to amend and reenact § 38.2-3540.1 of the Code of Virginia, relating to health insurance; claims experience information. [H 1450] Approved April 22, 2026 1. That § 38.2-3540.1 of the Code of Virginia is amended and reenacted as follows: § 38.2-3540.1. Claims experience. A. As used in this section, "employee welfare benefit plan" has the same meaning as provided in 29 U.S.C. § 1002(1). B. Each [DELETED: group] [DELETED: accident] [DELETED: and] [DELETED: sickness] [DELETED: insurance] [DELETED: policy] [DELETED: and] [DELETED: health] [DELETED: care] employee welfare benefit plan shall contain a provision [DELETED: which] that provides that the insurer, third-party administrator, or pharmacy benefits manager with respect to pharmacy claims, upon request, shall provide a policyholder that employed an average of at least 100 individuals who were insureds, subscribers, or enrollees on business days during the preceding 12-month period with a complete record of the policyholder's medical claims experience or medical costs incurred, including pharmacy benefits claims experience or pharmacy costs under the [DELETED: group] [DELETED: policy,] [DELETED: contract] [DELETED: or] employee welfare benefit plan. This record shall include all claims incurred for the lesser of (i) the period of time since the [DELETED: policy,] [DELETED: contract] [DELETED: or] employee welfare benefit plan was issued or issued for delivery or (ii) the period of time since the [DELETED: …