RD575 - Comparable Health Care Service Incentive Program – November 1, 2023

Executive Summary:

Pursuant to § 38.2-3462 of the Code of Virginia ("Code"), beginning with health benefit plans offered or renewed on or after January 1, 2021, each health carrier offering a small group health benefit plan in Virginia must develop and implement a Comparable Health Care Service Incentive Program (referred to in this report as the “Shared Savings Program") providing incentives for covered persons1 (referred to as “enrollees" in this report) to shop for comparable health care services from health care providers that are paid less than the average in-network allowed amounts for that service.

In 2022, eight Virginia health carriers participated in the program. These health carriers reduced their paid costs by $607,072, of which $87,675 was paid in incentives to participating enrollees, for a net savings of $519,397. On average, participating enrollees received $32 in incentives, or 14.4 cents in incentives for every $1 reduction in carrier-paid costs.