Virginia’s decision to have a federal exchange but conduct plan management functions

(HB1769 - and SB922 -  

Governor McDonnell declared to the federal Secretary of Health and Human Resources that Virginia opted to have a federal exchange and would not create either a state-based exchange or a partnership exchange.  

However, the General Assembly did approve legislation stating that the Virginia Bureau of Insurance, a division of the State Corporation Commission (the SCC), should oversee the management of the plans that are a part of the federal exchange as the SCC now does in the commercial market. The SCC will enter into a memorandum of understanding with the appropriate federal agency that can allow the Bureau to approve and set rates for the plans within the federal exchange. In addition, the Bureau is authorized to certify, decertify, and recertify plans and the collection of data necessary to perform such functions.  

Creation of a Joint Commission to oversee implementation of health reform

(HB2138 -

This legislation creates the Health Insurance Reform Commission (the Commission) as a legislative commission.  

The Commission will be compromised of ten members, including eight legislative members and two nonvoting ex-officio members, the Secretary of Health and Human Resources and the Commissioner of Insurance. The Commission will be responsible for the following:

  • monitoring the implementation of the PPACA
  • determining whether Virginia should establish a state-run health benefit exchange and under what conditions
  • recommending what health benefits should be required to be included as essential health benefits provided under health insurance products offered in the Commonwealth
  • providing an assessment of the existing and proposed mandated health insurance benefits and providers
  • developing recommendations to increase access to health insurance coverage, ensure that the costs of health insurance coverage are reasonable, and encourage a robust market for health insurance products  

The Commission will expire on July 1, 2017. The measure eliminates the Commission on Mandated Health Insurance Benefits.  

Legislation to conform Virginia law to PPACA requirements

(HB1900 - and SB921 -  

This bill states that Virginia law should include:

  • premium rate restrictions on health benefit plans providing individual and small group health insurance coverage
  • prohibition of discrimination based on health status
  • the requirement that individual and small group health insurance coverage include the essential health benefits
  • a limit of the waiting periods for health plans offering group health insurance coverage to 90 days
  • authorization for the SCC to establish geographic rating areas  

There has been some discussion and speculation that the Governor may amend one of the bills to include language that the plans within the Exchange will not be required to provide coverage for abortions. This could lead to a debate during the reconvened session.  

Legislation to regulate Health Insurance Navigators assisting individuals who are enrolling in plans within a heath exchange

(HB2246 - and SB1261-  

This legislation creates parameters under which navigators are able to advise people enrolling in plans within an exchange and ensures that they are not performing the duties of a licensed insurance agent.