{"data":{"id":"us-va/14vac5-405-70","jurisdiction":"us-va","citation":"14VAC5-405-70","heading":"Notification to consumers","body":"A. The notice of consumer rights shall be in a standard format provided by the commission and available on the commission's website.\n\nB. A health carrier shall provide an enrollee with:\n\n1. A clear description of the  managed care plan's out-of-network health benefits outlined in the plan documents that also explains the circumstances under which the enrollee may have payment responsibility in excess of cost-sharing amounts for services provided out-of-network;\n\n2. The notice of consumer rights delivered with the plan documents; and\n\n3. An explanation of benefits  that clearly indicates whether the enrollee may or may not be subject to balance billing if it contains claims from out-of-network providers.\n\nC. A health carrier shall update its website and provider directory no later than 30 days after the addition or termination of a participating provider.\n\nD. A health care facility shall provide the notice of consumer rights to an enrollee at the time any nonemergency service is scheduled and also along with the bill. A health care facility shall provide the notice of consumer rights to an enrollee with any bill for an emergency service. The notice may be provided electronically. However, a posted notice on a website will not satisfy this requirement.\n\nE. A health care provider shall provide a notice of consumer rights upon request and post the notice on its website, along with a list of carrier provider networks with which it contracts. If no website is available, a health care provider shall provide to each consumer a list of carrier provider networks with which it contracts and the notice of consumer rights. This list shall be updated on a regular basis.","path":["Title 14. Insurance","Agency 5. State Corporation Commission, Bureau of Insurance","Chapter 405. Rules Governing Balance Billing for Out-of-Network Health Care Services"],"source_url":"https://law.lis.virginia.gov/admincode/title14/agency5/chapter405/section70/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:52:02Z","sha256":"c4fbe2427b600eeed7384a573cb8bea07aa77ec6c3b850fd2c1d2fc3ff37ae9e","source_id":"us-va-vac","stale":false,"prev":"us-va/14vac5-405-60","next":"us-va/14vac5-405-80"},"notice":"GroundRules: Original legal text. Not legal advice."}