- Title
- 1992 Session Engrossed: Senate Bill No. 382
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- Document Title
- 1992 Session Engrossed: Senate Bill No. 382, Amendment in the Nature of A Substitute
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- Date
- 1992
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- Creator
- ["Unknown"]
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- Source
- L. Douglas Wilder Collection, L. Douglas Wilder Library, Virginia Union University, Richmond, VA
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1992 Session Engrossed: Senate Bill No. 382
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SP2945629
1992 SESSION
ENGROSSED
1 SENATE BILL NO. 382
2 AMENDMENT IN THE NATURE OF A SUBSTITUTE
3 (Proposed by the Senate Committee on Commerce and Labor)
4 (Patron Prior to Substitute — Senator Chichester)
5 Senate Amendments in [ ] - January 31, 1992
6 A BILL to amend and reenact §§ 38.2-3425 and 38.2-4319 of the Code of Virginia, relating
7 to limited mandated benefit accident and sickness insurance policies, subscription
8 contracts and health care plans.
9 Be it enacted by the General Assembly of Virginia:
10 1. That §§ 38.2-3425 and 38.2-4319 of the Code of Virginia are amended and reenacted as
11 follows:
12 § 38.2-3425. Issuance of limited mandated benefit accident and sickness insurance
13 policies and subscription contracts permitted.— A. Insurers and health services plans may
14 issue limited mandated benefit accident and sickness insurance policies or subscription
15 contracts meeting the criteria set forth in this article.
16 B. For purposes of this article, “limited mandated benefit accident and sickness
17 insurance policy or subscription contract” means a policy or subscription contract which
18 the insurer or health services plan may choose to offer to individuals, families, or groups
19 of less than fifty members formed for purposes other than obtaining insurance coverage,
20 and which meets the following criteria:
21
и
The individual, family, or group obtaining coverage under the policy or subscription
22 contract shall have been without accident aod sickness insurance coverage, health services
23 plan, or employer sponsored health care coverage for aH of the twelve-month period
24 immediately preceding the effective date of the limited mandated benefit accident and
25 sickness insurance policy of subscription contract, provided that for groups in existence for
26 less than twelve months, the group shall have been without accident and sickness insurance
27 coverage, health services plan, of employer sponsored health care coverage since inception
28 of the groupr
29 l. The insurer or health services plan shall include the following managed care
30 provisions to control costs:
31 a. An exclusion for services that are not medically necessary or are not covered
32 preventive health services; and
33 b. A procedure for preauthorization by the insurer or health services plan, or its
34 designees.
35 3r 2. The insurer or health services plan may include the following managed care
36 provisions to control costs:
37 a. A preferred panel of providers pursuant to §§ 38.2-3407 and 38.2-4209 who have
38 entered into written agreements with the insurer or health services plan to provide services
39 at specified levels of reimbursement. Any such written agreement between a provider and
40 an insurer or health services plan shall contain a provision under which the parties agree
41 that the insured individual or covered member will have no obligation to make payment
42 for any medical service rendered by the provider that is determined not to be medically
43 necessary;
44 b. Provisions requiring a second surgical opinion;
45 c. A procedure for utilization review by the insurer or health services plan or its
46 designees.
47 Nothing herein shall be construed to prohibit an insurer or health services plan from
48 including in its policy or subscription contract additional managed care and cost control
49 provisions which, subject to the approval of the Commission, have the potential to control
50 costs in a manner which does not result in inequitable treatment of insureds or subscribers.
51 4t 3. The policy or subscription contract shall provide basic levels of primary,
52 preventive, and hospital care for covered individuals, including, but not limited to, the
53 following:
54 a. A minimum of thirty days of inpatient hospitalization coverage per policy year;
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