reglab/housing_qa huggingface dataset:
VA Code § 38.2-3467 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3467. (Effective October 1, 2020) Prohibited conduct by carriers and pharmacy benefits managers

A. No carrier on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager shall:1. Cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue;2. Charge a pharmacist or pharmacy a fee related to the adjudication of a claim other than a reasonable fee for an initial claim submission;3. Reimburse a pharmacy or pharmacist an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for providing the same pharmacist services, calculated on a per-unit basis using the same generic product identifier or generic code number and reflecting all drug manufacturer's rebates, direct and indirect administrative fees, and costs and any remuneration; or4. Penalize or retaliate against a pharmacist or pharmacy for exercising rights provided pursuant to the provisions of this article.B. No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall restrict participation of a pharmacy in a pharmacy network for provider accreditation standards or certification requirements if a pharmacist meets such accreditation standards or certification standards.C. No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall include any mail order pharmacy or pharmacy benefits manager affiliate in calculating or determining network adequacy under any law or contract in the Commonwealth.D. No carrier, on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager, shall conduct spread pricing in the Commonwealth.E. Each carrier on its own or through its contracted pharmacy benefits manager or representative of a pharmacy benefits manager shall comply with the provisions of this section in addition to complying with the provisions of § 38.2-3407.15:1.2020, cc. 219, 1288.
VA Code § 38.2-3468 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3468. (Effective October 1, 2020) Examination of books and records; reports; access to records

A. Each carrier, on its own or through its contract for pharmacy benefits, shall ensure that the Commissioner may examine or audit the books and records of a pharmacy benefits manager providing claims processing services or other prescription drug or device services for a carrier that are relevant to determining if the pharmacy benefits manager is in compliance with this article. The carrier shall be responsible for the charges incurred in the examination, including the expenses of the Commissioner or his designee and the expenses and compensation of his examiners and assistants.B. Any carrier, on its own or through its contract for pharmacy benefits, shall report to the Commissioner on a quarterly basis for each health benefit plan the following information:1. The aggregate amount of rebates received by the pharmacy benefits manager;2. The aggregate amount of rebates distributed to the appropriate health benefit plan;3. The aggregate amount of rebates passed on to the enrollees of each health benefit plan at the point of sale that reduced the enrollees' applicable deductible, copayment, coinsurance, or other cost-sharing amount;4. Upon the request of the Commission, the individual and aggregate amount paid by the health benefit plan to the pharmacy benefits manager for services itemized by pharmacy, by product, and by goods and services; and5. Upon the request of the Commission, the individual and aggregate amount a pharmacy benefits manager paid for services itemized by pharmacy, by product, and by goods and services.C. All working papers, documents, reports, and copies thereof, produced by, obtained by or disclosed to the Commission or any other person in the course of an examination made under this article and any analysis of such information or documents shall be given confidential treatment, are not subject to subpoena, and may not be made public by the Commission or any other person. Access may also be granted to (i) a regulatory official of any state or country; (ii) the National Association of Insurance Commissioners (NAIC), its affiliate, or its subsidiary; or (iii) a law-enforcement authority of any state or country, provided that those officials are required under their law to maintain its confidentiality. Any such disclosure by the Commission shall not constitute a waiver of confidentiality of such papers, documents, reports or copies thereof. Any parties receiving such papers must agree in writing prior to receiving the information to provide to it the same confidential treatment as required by this section.2020, cc. 219, 1288.
VA Code § 38.2-3469 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3469. (Effective October 1, 2020) Enforcement; regulations

A. The Commission shall enforce this article.B. Pursuant to the authority granted by § 38.2-223, the Commission may promulgate such rules and regulations as it may deem necessary to implement this article.2020, cc. 219, 1288.
VA Code § 38.2-3470 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3470. (Effective October 1, 2020) Scope of article

This article shall not apply with respect to claims under (i) an employee welfare benefit plan as defined in section 3 (1) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002(1), that is self-insured or self-funded; (ii) coverages issued pursuant to Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (Medicaid); or (iii) prescription drug coverages issued pursuant to Part D of Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq. (Medicare Part D).2020, cc. 219, 1288.
VA Code § 38.2-3500 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3500. Form of policy

A. No individual accident and sickness insurance policy shall be delivered or issued for delivery to any person in this Commonwealth unless:1. The entire consideration for the policy is expressed in the policy;2. The time at which the insurance takes effect and terminates is expressed in the policy;3. The policy insures only one person, except that it may insure eligible family members, originally or by subsequent amendment, upon the application of an adult member of a family who shall be deemed the policyowner;4. The exceptions and reductions are set forth in the policy and, except those that are set forth in §§ 38.2-3503 through 38.2-3508, are printed with the benefit provisions to which they apply, or under an appropriate caption, but if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of the exception or reduction shall be included with that benefit provision;5. Each form, including riders and endorsements, is identified by a form number in the lower left-hand corner of the first page of the form;6. It contains no provision making any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy unless that portion is set forth in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short-rate table filed with the Commission; and7. It contains a statement about the provisions of subsections A and B of § 32.1-325.2 regarding the status of the Department of Medical Assistance Services as the payor of last resort.B. If any policy is issued by an insurer domiciled in this Commonwealth for delivery to a person residing in another state, and if the insurance supervisory official of the other state advises the Commission that any such policy is not subject to approval or disapproval by such official, the Commission may by ruling require that such policy meet the standards set forth in this chapter.C. "Eligible family member" means the (i) spouse, (ii) dependent children, without regard to whether such children reside in the same household as the policyowner, (iii) children under a specified age not greater than 19 years, and (iv) any person dependent on the policyowner.D. The provisions of this section shall not apply in any instance in which the provisions of this section are inconsistent or in conflict with a provision of Article 6 (§ 38.2-3438 et seq.) of Chapter 34.1952, c. 317, § 38.1-348; 1986, cc. 550, 562; 1993, c. 306; 1994, c. 316; 2011, c. 882.
VA Code § 38.2-3501 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3501. Policy forms; powers of Commission

A. Individual accident and sickness insurance policy forms and the rate manuals showing rules and classification of risks applicable to individual accident and sickness insurance policy forms shall be subject to the provisions of § 38.2-316. The Commission, subject to § 38.2-316, may disapprove or withdraw approval of any such policy form if it finds that the benefits provided in the policy form are or are likely to be unreasonable in relation to the premium charged. If the Commission disapproves a policy form or withdraws approval of a form, an insurer may proceed as indicated in § 38.2-1926.B. The provisions of this section shall not apply in any instance in which the provisions of this section are inconsistent or in conflict with a provision of Article 6 (§ 38.2-3438 et seq.) of Chapter 34.1979, c. 726, § 38.1-362.8; 1986, c. 562; 2013, c. 751.
VA Code § 38.2-3502 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3502. Notice to be printed on policy; return of policy to insurer

A. Any individual accident and sickness insurance policy delivered or issued for delivery in this Commonwealth shall have printed on it a notice stating substantially:"THIS POLICY MAY NOT APPLY WHEN YOU HAVE A CLAIM! PLEASE READ! This policy was issued based on the information entered in your application, a copy of which is attached to the policy. If you know of any misstatement in your application, or if any information concerning the medical history of any insured person has been omitted, you should advise the Company immediately regarding the incorrect or omitted information; otherwise, your policy may not be a valid contract.RIGHT TO RETURN POLICY WITHIN 10 DAYS. If for any reason you are not satisfied with your policy, you may return this policy to the Company within ten days of the date you received it and the premium you paid will be promptly refunded."B. If a policyowner returns the policy within ten days from the date of receipt, coverage under that policy shall become void from its inception upon the mailing or delivery of the policy to the insurer or its agent.C. If the first paragraph of the notice required in subsection A of this section is inapplicable or partially inapplicable to a particular form of policy, the insurer may modify or omit the notice with the Commission's approval.D. Nothing in this section shall prohibit an insurer from extending the right to examine period to more than ten days if the period is stated in the policy.1966, c. 342, § 38.1-348.4; 1986, c. 562.
VA Code § 38.2-3505 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3505. Inapplicable or inconsistent provisions

If any provision of this article is inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the Commission's approval, shall omit or modify the inapplicable or inconsistent provision to make that provision consistent with the coverage provided by the policy.1952, c. 317, § 38.1-351; 1986, c. 562.
VA Code § 38.2-3506 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3506. Order of certain policy provisions

The provisions that are the subject of §§ 38.2-3503 and 38.2-3504, or any corresponding provisions that are used instead of them in accordance with these sections, shall be printed in the consecutive order of the provisions in such sections. However, any such provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related, provided the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered or issued.1952, c. 317, § 38.1-352; 1986, c. 562.
VA Code § 38.2-3507 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3507. Third-party ownership

The word "insured," as used in this article, shall not be construed to prevent a person with a proper insurable interest from applying for and owning a policy covering another person or from being entitled to any indemnities, benefits and rights provided under the policy.1952, c. 317, § 38.1-353; 1986, c. 562.
VA Code § 38.2-3508 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3508. Requirements of other jurisdictions

A. Any individual accident and sickness insurance policy delivered or issued for delivery to any person in this Commonwealth by a foreign or alien insurer may contain any provision that is prescribed or required by the insurer's domiciliary jurisdiction and that is not less favorable than the provisions of this article to the insured or the beneficiary.B. Any individual accident and sickness insurance policy delivered or issued for delivery by a domestic insurer in any other jurisdiction may contain any provision permitted or required by the laws of the other jurisdiction.Code 1950, § 38-224; 1952, c. 317, § 38.1-354; 1986, c. 562.
VA Code § 38.2-3509 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3509. Denial or reduction of benefits because of existence of other like insurance

A. No individual accident and sickness insurance policy, nor any subscription contract as provided for in Chapter 42 (§ 38.2-4200 et seq.) of this title, delivered or issued for delivery in this Commonwealth shall contain any provision for the denial or reduction of benefits because of the existence of other like insurance except to the extent that the aggregate benefits, with respect to the covered medical expenses incurred under the policy or plan and all other like insurance with other insurers, exceed all covered medical expenses incurred.B. The term "other like insurance" may include group insurance or coverage provided by hospital or medical service organizations, union welfare plans, employer or employee benefit organizations, or workers' compensation insurance.1970, c. 378, § 38.1-355; 1986, c. 562.
VA Code § 38.2-3510 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3510. Conforming to statute

No individual accident and sickness insurance policy provision that is not subject to this article shall make an individual accident and sickness insurance policy, or any portion of the policy, less favorable in any respect to the insured or the beneficiary than the provisions that are subject to this article.Code 1950, § 38-223; 1952, c. 317, § 38.1-356; 1986, c. 562.
VA Code § 38.2-3511 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3511. Application

A. The insured shall not be bound by any statement made in an application for an individual accident and sickness policy unless a copy of the application is attached to or endorsed on the policy when issued as a part of the policy. If any such policy delivered or issued for delivery in this Commonwealth is reinstated or renewed, and the insured, beneficiary or assignee of the policy makes a written request to the insurer for a copy of the reinstatement or renewal application, if any, the insurer shall within fifteen days after the receipt of the request, deliver or mail to the person making the request, a copy of the application. If a copy is not so delivered or mailed, the insurer shall be precluded from introducing the application as evidence in any action or proceeding based upon or involving the policy or its reinstatement or renewal.B. No alteration of any written application for any such policy shall be made by any person other than the applicant without his written consent, except that insertions may be made by the insurer, for administrative purposes only, in a manner indicating clearly that such insertions are not to be ascribed to the applicant.C. The falsity of any statement in the application for any policy covered by this article may not bar the right to recovery under the policy unless the false statement materially affected either the acceptance of the risk or the hazard assumed by the insurer.1952, c. 317, § 38.1-357; 1986, c. 562.
VA Code § 38.2-3512 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3512. Notice; waiver

The acknowledgment by any insurer of the receipt of notice given under any individual accident and sickness insurance policy, the furnishing of forms for filing proofs of loss, the acceptance of such proofs, or the investigation of any claim thereunder shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under the policy.1952, c. 317, § 38.1-358; 1986, c. 562.
VA Code § 38.2-3513 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3513. Age limit

A. If any individual accident and sickness insurance policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if the date falls within a period for which a premium is accepted by the insurer or if the insurer accepts a premium after the date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which the premium has been accepted.B. If the age of the insured has been misstated, and if according to the correct age of the insured, the coverage provided by the policy would not have become effective or would have ceased prior to the acceptance of the premium, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.1952, c. 317, § 38.1-359; 1986, c. 562.
VA Code § 38.2-3514 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3514. When liability not to be denied because of preexisting disease, physical impairment or defect

No insurer that has delivered or issued for delivery in this Commonwealth an accident and sickness insurance policy pursuant to the provisions of this article shall deny liability on any claim otherwise covered under such policy because of the existence of a disease or physical impairment or defect, congenital or otherwise, at the time of the making of the application for such policy, unless it is shown that the applicant knew or might reasonably have been expected to know of such disease, impairment or defect.1966, c. 184, § 38.1-361.1; 1986, c. 562.
VA Code § 38.2-3514.1 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3514.1. Preexisting conditions provisions

A. In determining whether a preexisting conditions provision applies to an insured, all coverage shall credit the time the person was covered under previous individual or group policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis if the previous coverage was continuous to a date not more than thirty days prior to the effective date of the new coverage, exclusive of any applicable waiting period under such coverage.B. As used herein, a "preexisting conditions provision" means a policy provision that limits, denies, or excludes coverage for charges or expenses incurred during a twelve-month period following the insured's effective date of coverage, for a condition that, during a twelve-month period immediately preceding the effective date of coverage, had manifested itself in such a manner as would cause an ordinarily prudent person to seek diagnosis, care, or treatment, or for which medical advice, diagnosis, care, or treatment was recommended or received within twelve months immediately preceding the effective date of coverage or as to pregnancy existing on the effective date of coverage.C. This section shall not apply to the following insurance policies or contracts:1. Short-term travel;2. Accident-only;3. Limited or specified disease contracts;4. Long-term care insurance;5. Short-term nonrenewable policies or contracts of not more than six months' duration which are subject to no medical underwriting or minimal underwriting;6. Policies subject to Article 4.1 (§ 38.2-3430.1 et seq.) of Chapter 34 of this title;7. Policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under state or federal government plans; and8. Disability income.1995, c. 522; 1997, c. 291; 1999, c. 1004.
VA Code § 38.2-3514.2 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3514.2. Renewability of coverage

A. Every individual policy, subscription contract or plan delivered, issued for delivery or renewal in this Commonwealth providing benefits to or on behalf of an individual shall provide for the renewability of such coverage at the sole option of the insured, policyholder, subscriber, or enrollee. The insurer, health services plan or health maintenance organization issuing such policy, subscription contract or plan shall be permitted to refuse to renew the policy, subscription contract or plan only for one or more of the following reasons:1. Nonpayment of the required premiums by the insured, policyholder, subscriber, or enrollee, or such individual's representative;2. In the event that the policy, subscription contract or plan contains a provision requiring the use of network providers, a documented pattern of abuse or misuse of such provision by the insured, policyholder, subscriber, or enrollee, continuing for a period of no less than two years;3. Subject to the time limits contained in subdivision 2 of § 38.2-3503 or in regulations adopted by the Commission governing the practices of health maintenance organizations, for fraud or material misrepresentation by the individual, with respect to his application for coverage;4. Eligibility of an individual insured for Medicare, provided that such coverage may not terminate with respect to other individuals insured under the same policy, subscription contract or plan and who are not eligible for Medicare; and5. The insured, subscriber, or enrollee has not maintained a legal residence in the service area of the insurer, health services plan or health maintenance organization for a period of at least six months.B. This section shall not apply to the following insurance policies, subscription contracts or plans:1. Short-term travel;2. Accident-only;3. Disability income;4. Limited or specified disease contracts;5. Long-term care insurance;6. Short-term nonrenewable policies or contracts of not more than six months' duration which are subject to no medical underwriting or minimal underwriting; and7. Individual health insurance coverage as defined in subsection B of § 38.2-3431.1996, c. 550; 1998, c. 24.