Bill Text: VA SB642 | 2010 | Regular Session | Introduced
Bill Title: Health insurance, basic; HMOs to offer plans that do not include state-mandated benefits.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2010-04-12 - Governor: Acts of Assembly Chapter text (CHAP0687) [SB642 Detail]
Download: Virginia-2010-SB642-Introduced.html
10104254D Be it enacted by the General Assembly of Virginia: 1. That §§38.2-3406.1 and 38.2-4319 of the Code of Virginia are amended and reenacted as follows: §38.2-3406.1. Application of requirements that policies offered by small employers include state-mandated health benefits. A. As used in this section: "Eligible individual" means an individual who is employed by a small employer and has satisfied applicable waiting period requirements. "Health insurance coverage" means benefits consisting of coverage for costs of medical care, whether directly, through insurance or reimbursement, or otherwise, and including items and services paid for as medical care under a group policy of accident and sickness insurance, hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract, which coverage is subject to this title or is provided under a plan regulated under the Employee Retirement Income Security Act of 1974. "Health insurer" means any insurance company that
issues accident and sickness insurance policies providing hospital, medical and
surgical, or major medical coverage on an expense-incurred basis "Small employer" means, with respect to a calendar year and a plan year, an employer located in the Commonwealth that employed at least two but not more than 50 eligible individuals on business days during the preceding calendar year and who employs at least two eligible individuals on the date a policy under this section becomes effective. "State-mandated health benefit" means coverage required under this title or other laws of the Commonwealth to be provided in a policy of accident and sickness insurance or a contract for a health-related condition that (i) includes coverage for specific health care services or benefits; (ii) places limitations or restrictions on deductibles, coinsurance, copayments, or any annual or lifetime maximum benefit amounts; or (iii) includes a specific category of licensed health care practitioners from whom an insured is entitled to receive care. "State-mandated health benefit" includes, without limitation, any coverage, or the offering of coverage, of a benefit or provider pursuant to §§38.2-3407.5 through 38.2-3407.6:1, 38.2-3407.9:01, 38.2-3407.9:02, 38.2-3407.11 through 38.2-3407.11:3, 38.2-3407.16, 38.2-3408, 38.2-3411 through 38.2-3414.1, 38.2-3418 through 38.2-3418.14, or §38.2-4221. For purposes of this article, "state-mandated health benefit" does not include a benefit that is mandated by federal law. B. 1. Shall not be required to include coverage, or the offer of coverage, for any state-mandated health benefit, except for: a. Coverage for mammograms pursuant to §38.2-3418.1 b. Coverage for pap smears pursuant to §38.2-3418.1:2 c. Coverage for PSA testing pursuant to §38.2-3418.7; and d. Coverage for colorectal cancer screening pursuant to § 38.2-3418.7:1. 2. May include any, or none, of the state-mandated health benefits as the health insurer and the small employer shall agree. Notwithstanding any provision of this section to the contrary, if any plan authorized by this section includes and offers health care services covered by the plan that may be legally rendered by a health care provider listed in §38.2-3408, that plan shall allow for the reimbursement of such covered services when rendered by such provider. Unless otherwise provided in this section, this provision shall not require any benefit be provided as a covered service. C. Any application and any enrollment form used in connection with coverage under this section shall prominently disclose that the policy or contract is not required to provide state-mandated health benefits, shall prominently disclose any and all state-mandated health benefits that the policy or subscription contract does not provide, and shall clearly describe all eligibility requirements. D. A policy form or subscription contract issued under this section to a small employer shall prominently disclose any and all state-mandated health benefits that the policy or subscription contract does not provide. Such disclosure shall also be included in certificate forms or other evidences of coverage furnished to each participant. Health insurers proposing to issue forms providing coverage under this section shall clearly disclose the intended purposes for such policies or contracts when submitting the forms to the Commission for approval in accordance with § 38.2-316. E. The Commission shall adopt any regulations necessary to implement this section. §38.2-4319. Statutory construction and relationship to other laws. A. No provisions of this title except this chapter and,
insofar as they are not inconsistent with this chapter, §§38.2-100, 38.2-136,
38.2-200, 38.2-203, 38.2-209 through 38.2-213, 38.2-216, 38.2-218 through
38.2-225, 38.2-229, 38.2-232, 38.2-305, 38.2-316, 38.2-322, 38.2-400, 38.2-402
through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through 38.2-620, Chapter
9 (§38.2-900 et seq.), §§38.2-1016.1 through 38.2-1023, 38.2-1057, Article 2
(§38.2-1306.2 et seq.), §38.2-1306.1, §38.2-1315.1, Articles 3.1 (§
38.2-1316.1 et seq.), 4 (§38.2-1317 et seq.) and 5 (§38.2-1322 et seq.) of
Chapter 13, Articles 1 (§38.2-1400 et seq.) and 2 (§38.2-1412 et seq.) of
Chapter 14, §§38.2-1800 through 38.2-1836, 38.2-3401, 38.2-3405, 38.2-3405.1, 38.2-3406.1, 38.2-3407.2
through 38.2-3407.6:1, 38.2-3407.9 through 38.2-3407.16, 38.2-3411.2,
38.2-3411.3, 38.2-3411.4, 38.2-3412.1:01, 38.2-3414.1, 38.2-3418.1 through 38.2-3418.15,
38.2-3419.1, 38.2-3430.1 through 38.2-3437, 38.2-3500, subdivision 13 of §
38.2-3503, subdivision 8 of §38.2-3504, §§38.2-3514.1, 38.2-3514.2,
38.2-3522.1 through 38.2-3523.4, 38.2-3525, 38.2-3540.1, 38.2-3541.1,
38.2-3542, 38.2-3543.2, Article 5 (§38.2-3551 et seq.) of Chapter 35, Chapter
52 (§38.2-5200 et seq.), Chapter 55 (§38.2-5500 et seq.), Chapter 58 (§
38.2-5800 et seq.) and §38.2-5903 B. For plans administered by the Department of Medical
Assistance Services that provide benefits pursuant to Title XIX or Title XXI of
the Social Security Act, as amended, no provisions of this title except this
chapter and, insofar as they are not inconsistent with this chapter, §§
38.2-100, 38.2-136, 38.2-200, 38.2-203, 38.2-209 through 38.2-213, 38.2-216,
38.2-218 through 38.2-225, 38.2-229, 38.2-232, 38.2-322, 38.2-400, 38.2-402
through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through 38.2-620, Chapter
9 (§38.2-900 et seq.), §§38.2-1016.1 through 38.2-1023, 38.2-1057, §
38.2-1306.1, Article 2 (§38.2-1306.2 et seq.), §38.2-1315.1, Articles 3.1 (§
38.2-1316.1 et seq.), 4 (§38.2-1317 et seq.) and 5 (§38.2-1322 et seq.) of
Chapter 13, Articles 1 (§38.2-1400 et seq.) and 2 (§38.2-1412 et seq.) of
Chapter 14, §§38.2-3401, 38.2-3405, 38.2-3407.2 through 38.2-3407.5,
38.2-3407.6 and 38.2-3407.6:1, 38.2-3407.9, 38.2-3407.9:01, and 38.2-3407.9:02,
subdivisions 1, 2, and 3 of subsection F of §38.2-3407.10, 38.2-3407.11,
38.2-3407.11:3, 38.2-3407.13, 38.2-3407.13:1, and 38.2-3407.14, 38.2-3411.2,
38.2-3418.1, 38.2-3418.2, 38.2-3419.1, 38.2-3430.1 through 38.2-3437,
38.2-3500, subdivision 13 of §38.2-3503, subdivision 8 of §38.2-3504, §§
38.2-3514.1, 38.2-3514.2, 38.2-3522.1 through 38.2-3523.4, 38.2-3525,
38.2-3540.1, 38.2-3542, 38.2-3543.2, Chapter 52 (§38.2-5200 et seq.), Chapter
55 (§38.2-5500 et seq.), Chapter 58 (§38.2-5800 et seq.) and §38.2-5903
shall be applicable to any health maintenance organization granted a license
under this chapter. This chapter shall not apply to an insurer or health
services plan licensed and regulated in conformance with the insurance laws or
Chapter 42 (§38.2-4200 et seq.) C. Solicitation of enrollees by a licensed health maintenance organization or by its representatives shall not be construed to violate any provisions of law relating to solicitation or advertising by health professionals. D. A licensed health maintenance organization shall not be deemed to be engaged in the unlawful practice of medicine. All health care providers associated with a health maintenance organization shall be subject to all provisions of law. E. Notwithstanding the definition of an eligible employee as set forth in §38.2-3431, a health maintenance organization providing health care plans pursuant to §38.2-3431 shall not be required to offer coverage to or accept applications from an employee who does not reside within the health maintenance organization's service area. F. For purposes of applying this section, "insurer"
when used in a section cited in subsections A and B |