Pursuant to § 38.2-3419.1 of the Code of Virginia (Code), every insurer, health services plan, and health maintenance organization (HMO) meeting the reporting threshold set forth in Commission regulations must submit certain cost and utilization information for each of the mandated benefits and mandated providers contained in §§ 38.2-3408 through 38.2-3419, and § 38.2-4221 of the Code. The Commission is required to consolidate the information into this report of the costs of mandated benefits, the utilization of services under mandated benefits, and any other information the Commission or the General Assembly deems appropriate.

The reporting period for this report is Calendar Years 2022 and 2023, with the initial report issued in 1992. It includes a summary of each mandated benefit and provider requirement in Virginia, together with information assessing the impact of these requirements on cost and utilization. The following chart represents, on an aggregate basis, the average claim cost per individual contract or group certificate and the average percentage of total claims this cost represents across all mandated benefits, offers, and providers.

Individual
Average Annual Claim Cost Per Contract: $723.48
Average Annual Percent of Total Claims: 8.94%

Group
Average Annual Claim Cost Per Certificate: $1,402.42
Average Annual Percent of Total Claims: 15.46%

This chart illustrates that, on average, for an individual health insurance contract or subscription contract providing the type of coverage under which mandated benefits, offers and providers are applicable:

• Companies paid approximately $723 annually for claims attributable to mandated benefits, offers, and providers during the Calendar Year 2022 and 2023 reporting period. This represents approximately 9% annually of all claim payments made under this type of individual contract.

• Companies paid approximately $1,402 annually in claims payments under a group certificate providing applicable contracts or certificates in Virginia, representing approximately 16% of all claim payments made under this type of group contract during the Calendar Year 2022 and 2023 reporting period.

The Bureau continues to monitor insurer compliance with the reporting instructions. However, identification of potential coding issues remains difficult due to changing coding services and the systems utilized by providers to submit claims.