Source: https://law.lis.virginia.gov/admincodeexpand/title14/agency5/chapter190/
Timestamp: 2020-01-23 17:38:42
Document Index: 171828718

Matched Legal Cases: ['§ 38', '§ 1', '§ 2', '§ 514', '§ 1144', '§ 38', '§ 38', '§ 3', '§ 4', '§ 5', '§ 6', '§ 7', '§ 8']

14VAC5-190-10. Purpose.
The purpose of this regulation is to implement § 38.2-3419.1 of the Code of Virginia with respect to mandated health insurance benefits and providers. This regulation is designed to:
1. Provide the format for the reporting of costs and utilization associated with mandated benefits and providers;
2. Define the information that is required to be reported; and
3. Describe general data reporting elements related to costs and utilization associated with mandated benefits and mandated providers.
Derived from Regulation 38, Case No. INS910044, § 1, eff. October 1, 1991; amended, Case No. INS940147, Virginia Register Volume 11, Issue 8, eff. December 7, 1994; Volume 33, Issue 14, eff. March 1, 2017.
14VAC5-190-20. Scope.
This regulation shall apply to every health insurance issuer licensed to issue policies of accident and sickness insurance, subscription contracts, or evidences of coverage in this Commonwealth.
Derived from Regulation 38, Case No. INS910044, § 2, eff. October 1, 1991; amended, Case No. INS940147, Virginia Register Volume 11, Issue 8, eff. December 7, 1994; Volume 33, Issue 14, eff. March 1, 2017.
14VAC5-190-30. Definitions.
"Applicable policy" or "contract" means any accident and sickness insurance policy providing hospital, medical and surgical, or major medical coverage on an expense incurred basis or any accident and sickness subscription contract or evidence of coverage or any health care plan provided by a health maintenance organization issued or issued for delivery in the Commonwealth of Virginia.
"Covered lives" means the total number of covered lives reported by a health insurance issuer on the National Association of Insurance Commissioners (NAIC) Supplemental Health Care Exhibit for Individual Comprehensive Health Coverage, Small Group Employer Comprehensive Health Coverage, and Large Group Employer Comprehensive Health Coverage combined as defined in the NAIC Annual Statement Instructions, or equivalents in a successor form.
"Health insurance issuer" means an insurance company or insurance organization (including a health maintenance organization) that is licensed to engage in the business of insurance in the Commonwealth and is subject to the laws of the Commonwealth that regulate insurance within the meaning of § 514(b)(2) of the Employee Retirement Income Security Act of 1974 (29 USC § 1144 (b)(2)). Such term does not include a group health plan.
"Incurred claims" means the total losses sustained whether paid or unpaid.
"Mandated benefits" means those benefits that must be included or offered in policies delivered or issued for delivery in the Commonwealth as required by §§ 38.2-3409 through 38.2-3419 of the Code of Virginia.
"Mandated providers" means those practitioners that are listed in §§ 38.2-3408 and 38.2-4221 of the Code of Virginia.
"Paid claims" means the aggregate of loss payments, less deductions for all credits, except that no deduction is made for reinsurance recoveries, during a given period.
"Reporting period" means the two individual calendar years immediately preceding the May 1 reporting date, reported separately.
Derived from Regulation 38, Case No. INS910044, § 3, eff. October 1, 1991; amended, Case No. INS940147, Virginia Register Volume 11, Issue 8, eff. December 7, 1994; Volume 33, Issue 14, eff. March 1, 2017.
14VAC5-190-40. (Repealed.)
Derived from Regulation 38, Case No. INS910044, § 4, eff. October 1, 1991; amended, Case No. INS940147, Virginia Register Volume 11, Issue 8, eff. December 7, 1994; repealed, Virginia Register Volume 33, Issue 14, eff. March 1, 2017.
Derived from Regulation 38, Case No. INS910044, § 5, eff. October 1, 1991; amended, Case No. INS940147, Virginia Register Volume 11, Issue 8, eff. December 7, 1994; Volume 33, Issue 14, eff. March 1, 2017.
Derived from Regulation 38, Case No. INS910044, § 6, eff. October 1, 1991; amended, Case No. INS940147, Virginia Register Volume 11, Issue 8, eff. December 7, 1994; Volume 33, Issue 14, eff. March 1, 2017.
Derived from Regulation 38, Case No. INS910044, § 7, eff. October 1, 1991; amended, Case No. INS940147, Virginia Register Volume 11, Issue 8, eff. December 7, 1994; Volume 33, Issue 14, eff. March 1, 2017.
Derived from Regulation 38, Case No. INS910044, § 8, eff. October 1, 1991; amended, Case No. INS940147, Virginia Register Volume 11, Issue 8, eff. December 7, 1994.
APPENDIX A. (Repealed.)
APPENDIX B. (Repealed.)