Bill Text: VA SB337 | 2022 | Regular Session | Prefiled
Bill Title: Accident and sickness insurance; minimum standards.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2022-04-11 - Governor: Acts of Assembly Chapter text (CHAP0531) [SB337 Detail]
Download: Virginia-2022-SB337-Prefiled.html
Be it enacted by the General Assembly of Virginia:
1. That §§38.2-3516 through 38.2-3519 of the Code of Virginia are amended and reenacted as follows:
§38.2-3516. Purpose.
The purpose of this article is to authorize the Commission, pursuant to the authority granted in §38.2-223, to issue rules and regulations to:
1. Provide reasonable
standardization and simplification of terms and coverages of individual
accident and sickness insurance policies Establish the minimum standards for filing of
policy forms for individual and small group health benefit plans as defined in
§38.2-3438;
2. Facilitate public
understanding and comparison
Establish the minimum standards, terms, and coverages for individual and group
accident and sickness policies known as excepted benefits,
as defined in §38.2-3431;
and
3. Eliminate
provisions contained in individual accident and sickness insurance policies
which may be misleading or unreasonably confusing in connection either with the
purchase of coverages or with the settlement of claims;
and
4. Provide for full
disclosure in the sale of individual accident and sickness policies Establish the minimum standards for short-term
limited-duration insurance.
The Commission shall ensure that policy standards are simple and understandable and are not misleading or unreasonably confusing and that the sale of such policies provides for full disclosure.
§38.2-3517. Definitions.
As used in this article:
"Form" means policies,
contracts, riders, endorsements, and applications a policy, rider, endorsement, amendment,
application, enrollment form, certificate of insurance, evidence of coverage,
group agreement, supplemental agreement, or any other form
required to be filed with or approved by the Commission.
"Policy" means
the entire contract between the insurer and the insured, including the policy
riders, endorsements, and the application, if attached an insurance policy, contract, certificate,
evidence of coverage, or other agreement of insurance, including any attached rider,
endorsement, or application.
§38.2-3518. Standards for policy provisions.
A. Pursuant to the authority granted in §38.2-223, the
Commission may issue rules and regulations to establish
specific standards, including
standards of full and fair disclosure, for the sale of
individual and group
accident and sickness insurance policies. These rules and regulations shall be
in addition to and in accordance with applicable laws of this the Commonwealth, including
Chapter 34 (§38.2-3400 et seq.) and Articles, Article 1 (§38.2-3500 et
seq.) and 2 (§38.2-3516 et seq.) of this
chapter which may cover but shall not be limited to:, this article, and Article 3
(§38.2-3521.1
et seq.)
1. Terms of
renewability;
2. Initial and
subsequent conditions of eligibility;
3. Nonduplication of
coverage provisions;
4. Coverage of
dependents;
5. Coverage of
persons eligible for Medicare by reason of age;
6. Preexisting
conditions;
7. Termination of
insurance;
8. Probationary
periods;
9. Limitations;
10. Exceptions;
11. Reductions;
12. Elimination
periods;
13. Requirements for
replacement;
14. Recurrent
conditions; and
15. Definition of
terms including but not limited to the following: hospital, accident, sickness,
injury, physician, accidental means, total disability, partial disability,
nervous disorder, guaranteed renewable, and noncancellable.
For the purposes of
this article, "licensed health care practitioners", to the extent
required by law, shall be deemed physicians.
B. Pursuant to the authority granted in §38.2-223, the Commission may issue rules and regulations that specify prohibited policies or policy provisions not otherwise specifically authorized by statute that in the opinion of the Commission are unjust, unfair, or unfairly discriminatory to the policyowner, beneficiary, or any person insured under the policy.
§38.2-3519. Minimum standards for excepted benefits.
A. Pursuant to the authority granted in §38.2-223, the
Commission may issue rules and regulations establishing minimum standards for
benefits under each any of the
following categories of
coverage in individual policies of accident and sickness insurance:
1. Basic hospital
expense coverage;
2. Basic
medical-surgical expense coverage;
3. Hospital confinement
indemnity coverage;
4. Major medical
expense coverage;
5. Disability income
protection coverage;
6. Accident only
coverage;
7. Specified disease
or specified accident coverage;
8. Medicare
supplement coverage; and
9. Limited benefit
health coverage.
B. Nothing in this
section shall preclude the issuance of any policy that combines two or more of the categories of
coverage enumerated in subdivisions 1 through 6 of subsection A of this section policies known as excepted benefits.
C. B. No excepted benefits
policy shall be delivered or issued for delivery in
this the
Commonwealth that does not meet the prescribed minimum standards for the categories of coverage listed in
subdivisions 1 through 9 of subsection A of this section established by the Commission
or does not meet the requirements set forth in §38.2-3501.
D. C. The
Commission may prescribe the method of identification of policies based upon
coverages provided.
