summary
Introduced
01/08/2025
01/08/2025
In Committee
01/08/2025
01/08/2025
Crossed Over
Passed
Dead
02/22/2025
02/22/2025
Introduced Session
2025 Regular Session
Bill Summary
Health benefit programs; discrimination; cause of action. Adds licensed outpatient facilities to the types of preferred providers that an insurer is required to establish terms and conditions for and is prohibited from discriminating against with regard to the insurer's health benefit program. The bill removes provisions stating that certain price differences are not considered discrimination. The bill provides for a cause of action for any health care provider that suffers loss as a result of an insurer's violation of provisions related to the health benefit program or an insurer's breach of any provider contract provision. Under the bill, if the court finds that the violation or breach resulted from an insurer's gross negligence or willful conduct, the court may increase damages to an amount not exceeding three times the actual damages sustained, and in addition to any damages awarded, the health care provider may be awarded equitable and injunctive relief and reasonable attorney fees and court costs.
AI Summary
This bill amends Virginia's health insurance regulations by expanding the types of healthcare providers that insurers must include in their preferred provider networks to now explicitly include licensed outpatient facilities, in addition to existing categories like hospitals and physicians. The bill removes previous language that allowed certain price differences among providers, and instead establishes a new legal mechanism for healthcare providers to take action against insurers who discriminate or breach contract provisions. Specifically, if a healthcare provider can prove an insurer violated regulations through gross negligence or willful misconduct, they can sue to recover damages, potentially receiving up to three times their actual losses, as well as equitable relief, attorney fees, and court costs. This legislation aims to provide greater protections for healthcare providers by giving them more robust legal recourse when insurers unfairly limit or exclude them from preferred provider networks, and by ensuring a more inclusive approach to provider selection based on willingness to meet established terms and conditions.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Left in Labor and Commerce (on 02/05/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://lis.virginia.gov/bill-details/20251/HB2274 |
| Fiscal Note/Analysis - Fiscal Impact Statement from Department of Planning and Budget (HB2274) | https://lis.blob.core.windows.net/files/1033538.PDF |
| BillText | https://lis.virginia.gov/bill-details/20251/HB2274/text/HB2274 |
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