SB 832
Providing for administration of cost-sharing calculations
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Sign in to take action- Introduced
- Passed Senate
- Passed House of Delegates
- To Governor
- Became Law
Bill overview
This bill aims to clarify and standardize how insurance companies calculate and administer cost-sharing amounts for health services. It defines key terms like ‘average allowed amount’ and ‘cost sharing,’ and requires insurers to provide credit to insureds who pay below the average allowed amount for services received at a discounted cash price. The bill also prohibits insurers from discriminating in payment methods based on referrals from out-of-network providers. It applies to various types of insurance plans, including those covered under the Affordable Care Act.
Key provisions
- Defines terms such as ‘average allowed amount,’ ‘cost sharing,’ and ‘discounted cash price’ for use in calculating insurance contributions.
- Requires insurers to include any cost-sharing amounts paid by the insured or on their behalf when calculating contributions.
- Mandates that a pharmacy benefits manager include cost-sharing amounts paid by the insured.
- Establishes a credit for insureds who receive covered health care services at a discounted cash price, equivalent to in-network cost-sharing.
- Prohibits insurers from discriminating in payment for in-network health care services based on referrals from out-of-network providers.
- Authorizes the insurance commissioner to create rules for implementing the bill’s provisions.
- Sets an effective date of January 1, 2026, for the amendments to the code.
Who is affected
- Health insurance consumers
- Insurance companies
- Healthcare providers
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