reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 141 - RULES GOVERNING ACCIDENT AND SICKNESS EXCEPTED BENEFITS POLICIES; SHORT-TERM LIMITED DURATION INSURANCE › Section 14VAC5-141-110 - Specified disease insurance

Current through Register Vol. 40, No. 24, July 15, 2024
A. Specified disease insurance is a policy
				that pays benefits for the diagnosis or treatment of a specifically named
				disease or a critical illness.
B.
				Specified disease insurance benefits shall be provided under a separate policy,
				certificate, or contract of insurance.
C. Any policy provision that provides for the
				coordination or reduction of benefits because benefits are payable under any
				other health insurance coverage is prohibited.
D. A specified disease policy shall not
				exclude coverage for any subtype of disease or illness covered under the
				policy. The dollar value of benefits may only be limited based on the severity
				of the disease or illness where the insurer shows actuarial justification for
				the lower amount.
E. As a condition
				for eligibility for benefits under the policy, a clinical diagnosis shall be
				accepted if a pathological diagnosis cannot be reasonably obtained.
F. If a policy provides convalescent care or
				extended care benefits following hospitalization, qualification for benefits
				for the convalescent care or extended care facility shall not require admission
				less than 14 days after discharge from the hospital.
G. Policy benefits shall begin with the first
				day of care or confinement if the care or confinement is for a covered disease
				or illness even though a diagnosis is made at a later date. The retroactive
				application of coverage may not be limited to less than 90 days prior to the
				diagnosis.
H. If a specified
				disease policy contains a return of premium or cash value benefit, it shall not
				be reduced by an amount greater than the aggregate of claims paid under the
				policy. The insurer shall also demonstrate that the reserve basis for the
				policy is adequate.
Statutory Authority: §§ 12.1-13 and 38.2-223 of
					 the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 141 - RULES GOVERNING ACCIDENT AND SICKNESS EXCEPTED BENEFITS POLICIES; SHORT-TERM LIMITED DURATION INSURANCE › Section 14VAC5-141-120 - Hospital indemnity or other fixed indemnity insurance

Current through Register Vol. 40, No. 24, July 15, 2024
A. Hospital indemnity or other fixed
				indemnity insurance means a policy that provides supplementary benefits that
				are paid to the insured in a single lump sum or a fixed dollar amount per
				specified event, per day, or per other period of hospitalization or illness
				regardless of the amount of expenses incurred. The policy shall not be a
				substitute for major medical coverage.
B. Hospital indemnity or other fixed
				indemnity insurance that is offered in the individual market shall meet the
				following criteria:
1. Benefits shall be
				provided under a separate policy, certificate, or contract of
				insurance;
2. Benefits paid may be
				a single lump sum or a fixed dollar amount per service, per specified event,
				per day, or per other period of time. Benefits shall be determined based on the
				category of services and not the billed amount. Dollar amounts shall be
				expressed in the policy;
3. There
				is no coordination between the provision of benefits and an exclusion of
				benefits under any other health coverage;
4. A pregnancy that exists on the effective
				date of coverage may be considered a preexisting condition;
5. No waiting period shall be applied to loss
				due to accidental injury; and
6. In
				addition to the notice required in
				14VAC5-141-30 A, the following
				notice shall be displayed prominently on the face of the policy: "THIS IS A
				SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL
				COVERAGE."
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 141 - RULES GOVERNING ACCIDENT AND SICKNESS EXCEPTED BENEFITS POLICIES; SHORT-TERM LIMITED DURATION INSURANCE › Section 14VAC5-141-130 - Similar supplemental coverage

Current through Register Vol. 40, No. 24, July 15, 2024
A. Similar supplemental coverage that
				qualifies as excepted benefits is coverage that supplements and fills gaps in a
				group health plan. The supplemental coverage shall:
1. Cover benefits that are not covered by the
				primary coverage and are not essential health benefits as described in §
				38.2-3451 of the Code of Virginia; or
2. Fill gaps in cost-sharing for primary
				coverage, including copayments, coinsurance, and deductibles.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 141 - RULES GOVERNING ACCIDENT AND SICKNESS EXCEPTED BENEFITS POLICIES; SHORT-TERM LIMITED DURATION INSURANCE › Section 14VAC5-141-140 - Short-term limited-duration insurance coverage

Current through Register Vol. 40, No. 24, July 15, 2024
A. Short-term limited-duration insurance is
				health insurance coverage in which the period of coverage or policy duration is
				three months or less. Based on the insured's eligibility, coverage may be
				renewed or extended so that coverage may not exceed six months in any 12-month
				period in accordance with § 38.2-3407.21 of the Code of Virginia. An
				application form shall include a question on whether the applicant had any
				short-term limited-duration coverage within 12 months of the application
				date.
B. A short-term
				limited-duration insurance policy issued by a health maintenance organization
				shall cover basic health care services as defined in § 38.2-4300 of the
				Code of Virginia. A short-term limited-duration insurance policy issued by any
				health carrier other than a health maintenance organization shall include at a
				minimum emergency services, hospital and physician care, outpatient medical
				services, surgical benefits, and radiology and laboratory benefits.
C. Short-term limited-duration insurance
				coverage may be nonrenewable or renewable, but not guaranteed renewable in
				accordance with § 38.2-3514.2 of the Code of Virginia.
1. A nonrenewable short-term limited-duration
				policy shall include all applicable state mandates that do not specifically
				exempt short-term nonrenewable policies.
2. A renewable short-term limited-duration
				policy shall include all applicable state mandates, including those mandates
				that exempt short-term nonrenewable policies.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 141 - RULES GOVERNING ACCIDENT AND SICKNESS EXCEPTED BENEFITS POLICIES; SHORT-TERM LIMITED DURATION INSURANCE › Section 14VAC5-141-150 - Requirements for replacement of an individual policy

Current through Register Vol. 40, No. 24, July 15, 2024
A. The application form for an excepted
				benefits or short-term limited-duration policy shall include a question
				regarding whether the insurance to be issued is intended to replace any other
				insurance presently in force.
B. An
				insurer may not replace any policy that qualifies as minimum essential coverage
				with an excepted benefits or a short-term limited-duration policy unless
				specifically requested in writing by the insured.
C. If the sale will involve replacement, an
				insurer or its agent shall furnish to the applicant prior to issuance or
				delivery of the policy the notice required in subsection D of this section. A
				direct response insurer shall deliver the notice to the applicant upon issuance
				of the policy. A copy signed by the applicant shall be retained by the
				insurer.
D. Notice to applicants
				shall be provided in substantially the following form:
"NOTICE TO APPLICANT REGARDING REPLACEMENT OF AN INSURANCE
				  POLICY
According to your application, you intend to lapse or
				  otherwise terminate an existing policy and replace it with an excepted benefits
				  or short-term limited-duration policy issued by (insert Company Name). In
				  accordance with the terms of your policy, you may have at least 10 days to
				  decide without cost whether you desire to keep the policy. For your own
				  protection you should consider certain factors that may affect the insurance
				  provisions available to you under the new policy.
1. Preexisting conditions may not be
				immediately or fully covered under the new policy. This could result in denial
				or delay of a claim for benefits under the new policy, where a similar claim
				may have been payable under your present policy.
2. You may wish to consult with your present
				insurer or its agent regarding the proposed replacement of your present policy.
				It is your right and in your best interest to make sure you understand all the
				factors involved in replacing your present coverage.
3. If you still wish to terminate your
				present policy and replace it with new coverage, carefully check all the
				information in the application before you sign it.
The above "Notice to Applicant" was delivered to the
				  applicant on (date).
(Applicant's signature _______________)"
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 141 - RULES GOVERNING ACCIDENT AND SICKNESS EXCEPTED BENEFITS POLICIES; SHORT-TERM LIMITED DURATION INSURANCE › Section 14VAC5-141-160 - Severability

Current through Register Vol. 40, No. 24, July 15, 2024
If any provision of this chapter or the application thereof
				  to any person or circumstance is for any reason held to be invalid, the
				  remainder of the chapter and the application of such provision to other persons
				  or circumstances shall not be affected.
Statutory Authority: §§ 12.1-13 and 38.2-223 of
					 the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 150 - CHAPTER 150 RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO MEDICARE PROGRAM REVISIONS › Section 14VAC5-150-10 - Purpose

Current through Register Vol. 40, No. 24, July 15, 2024
This chapter (14VAC5-150-10 et
				  seq.) is designed to:
1. Ensure the
				orderly implementation and conversion of Medicare supplement insurance benefits
				and premiums due to changes in the federal Medicare program;
2. Provide for the reasonable standardization
				of the coverage, terms and benefits of Medicare supplement policies or
				contracts;
3. Facilitate public
				understanding of such policies or contracts;
4. Eliminate provisions contained in such
				policies or contracts which may be misleading or confusing in connection with
				the purchase of such policies or contracts;
5. Modify or eliminate policy or contract
				provisions which may duplicate medicare benefits;
6. Provide full disclosure of policy or
				contract benefits and benefit changes; and
7. Provide for refunds of premiums associated
				with benefits duplicating medicare program benefits.
Statutory Authority
§§ 38.2-223, 38.2-3516 through 38.2-3520,
					 38.2-3600 through 38.2-3607 and 38.2-514 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 150 - CHAPTER 150 RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO MEDICARE PROGRAM REVISIONS › Section 14VAC5-150-20 - Reserved

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 150 - CHAPTER 150 RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO MEDICARE PROGRAM REVISIONS › Section 14VAC5-150-30 - Applicability and scope

Current through Register Vol. 40, No. 24, July 15, 2024
This chapter (14VAC5-150-10 et
				  seq.) shall take precedence over other rules and requirements relating to
				  medicare supplement policies or contracts only to the extent necessary to
				  assure that benefits are not duplicated, that applicants receive adequate
				  notice and disclosure of changes in medicare supplement policies and contracts,
				  that appropriate premium adjustments are made in a timely manner, and that
				  premiums are reasonable in relation to benefits.
This chapter shall apply to:
1. All Medicare supplement policies and
				contracts delivered, or issued for delivery within this Commonwealth, or which
				are otherwise subject to the jurisdiction of this Commonwealth, and
2. All certificates issued under group
				medicare supplement policies as provided in 1 above.
This chapter applies to all Medicare supplement policies,
				  contracts, and certificates as described in 1 and 2, above, delivered, or
				  issued for delivery on or after the effective date hereof. In addition,
				  14VAC5-150-50 applies to all
				  medicare supplement policies, contracts and certificates as described in 1 and
				  2, above, in effect on August 31, 1988.
Statutory Authority
§§ 38.2-223, 38.2-3516 through 38.2-3520,
					 38.2-3600 through 38.2-3607 and 38.2-514 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 150 - CHAPTER 150 RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO MEDICARE PROGRAM REVISIONS › Section 14VAC5-150-40 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
For purposes of this chapter (14VAC5-150-10 et seq.):
"Applicant" means:
1. In the case of an individual Medicare
				supplement policy or contract, the person who seeks to contract for insurance
				benefits, and
2. In the case of a
				group Medicare supplement policy or contract, the proposed certificateholder.
"Certificate" means any certificate issued under a group
				  Medicare supplement policy.
"Medicare supplement policy" means an individual or group
				  policy of accident and sickness insurance or an individual or group subscriber
				  contract of a health services plan, or health maintenance organization or a
				  certificate issued under a group policy or group subscriber contract, offered
				  to individuals who are entitled to have payment made under Medicare, which is
				  designed primarily to supplement Medicare by providing benefits for payment of
				  hospital, medical or surgical expenses, or is advertised, marketed or otherwise
				  purported to be a supplement to Medicare. Such term shall not include:
1. A policy or contract of one or more
				employers or labor organizations, or of the trustees of a fund established by
				one or more employers or labor organizations, or combination thereof, for
				employees or former employees, or combination thereof, or for members or former
				members, or combination thereof, of the labor organizations; or
2. A policy or contract of any professional,
				trade or occupational association for its members or former or retired members,
				or combination thereof, if such association:
a. Is composed of individuals all of whom are
				actively engaged in the same profession, trade or occupation;
b. Has been maintained in good faith for
				purposes other than obtaining insurance; and
c. Has been in existence for at least two
				years prior to the date of its initial offering of such policy or plan to its
				members.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 150 - CHAPTER 150 RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO MEDICARE PROGRAM REVISIONS › Section 14VAC5-150-50 - Benefit conversion requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A. Effective 60 days after enactment of
				federal law mandating Medicare benefit changes, no Medicare supplement
				insurance policy, contract, or certificate subject to this chapter, in effect
				on the effective date of this chapter (14VAC5-150-10 et seq.) shall
				contain benefits which duplicate benefits provided by Medicare.
B. General requirements.
1. On the later of:
a. Thirty days prior to the effective date of
				Medicare benefit changes, or
b.
				Sixty days after enactment of federal law mandating Medicare benefit changes,
every insurer, health services plan, health maintenance
				  organization or other entity providing Medicare supplement insurance or
				  benefits shall notify its policyholders, contract holders, and certificate
				  holders of modifications it has made to Medicare supplement insurance policies
				  or contracts. Such notice shall be in a format prescribed in Exhibit A and be
				  written in outline form in clear and simple terms so as to facilitate
				  comprehension. Such notice shall not contain or be accompanied by any
				  solicitation.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 150 - CHAPTER 150 RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO MEDICARE PROGRAM REVISIONS › Section 14VAC5-150-60 - Requirements for new policies and certificates

Current through Register Vol. 40, No. 24, July 15, 2024
A. Effective 60 days after enactment of
				federal law mandating Medicare benefit changes no medicare supplement insurance
				policy, contract, or certificate shall be issued or issued for delivery in this
				Commonwealth which provides benefits which duplicate benefits provided by
				Medicare. No such policy, contract or certificate shall provide less benefits
				than those required under Chapter 36 (§ 38.2-3600 et seq.) of Title 38.2,
				or existing, Rules Governing the Implementation of the Individual Accident and
				Sickness Insurance Minimum Standards Act (Chapter 140,
				14VAC5-140-10 et seq. of this
				title) with respect to medicare supplement policies except where duplication of
				Medicare benefits would result.
B.
				General requirements.
1. Within 90 days of
				August 31, 1988, every insurer, health services plan, health maintenance
				organization or other entity required to file its policies or contracts with
				the Commission shall file new medicare supplement insurance policies or
				contracts which eliminate any duplication of medicare supplement benefits with
				benefits provided by Medicare and which provide a clear description of the
				policy or contract benefit.
2. The
				filing required under subdivision 1 above shall provide for loss ratios which
				are in compliance with all statutory or regulatory requirements.
3. Every applicant for a Medicare supplement
				insurance policy, contract, or certificate shall be provided with an outline of
				coverage which in simple accurate terms describes benefits provided by Medicare
				and the medicare supplement policy or contract along with benefit
				limitations.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 150 - CHAPTER 150 RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO MEDICARE PROGRAM REVISIONS › Section 14VAC5-150-70 - Buyer's guide

Current through Register Vol. 40, No. 24, July 15, 2024
No insurer, health services plan, health maintenance
				  organization or other entity shall make use of or otherwise disseminate any
				  buyer's guide or informational brochure which does not accurately outline
				  current Medicare benefits.
Statutory Authority
§§ 38.2-223, 38.2-3516 through 38.2-3520,
					 38.2-3600 through 38.2-3607 and 38.2-514 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 150 - CHAPTER 150 RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO MEDICARE PROGRAM REVISIONS › Section 14VAC5-150-80 - Severability

Current through Register Vol. 40, No. 24, July 15, 2024
If any provision of this chapter (14VAC5-150-10 et seq.), or the
				  application thereof to any person or circumstances is for any reason held to be
				  invalid, the remainder of the chapter and the application of such provision to
				  other persons or circumstances shall not be affected thereby.
Statutory Authority
§§ 38.2-223, 38.2-3516 through 38.2-3520,
					 38.2-3600 through 38.2-3607 and 38.2-514 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 160 - RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO REPEAL OF THE MEDICARE CATASTROPHIC COVERAGE ACT › Section 14VAC5-160-10 - Purpose

Current through Register Vol. 40, No. 24, July 15, 2024
This chapter (14VAC5-160-10 et
				  seq.) is designed to
1. Assure the
				orderly implementation and conversion of Medicare supplement insurance benefits
				and premiums due to changes in the federal Medicare program;
2. Provide for the reasonable standardization
				of the coverage, terms and benefits of Medicare supplement policies or
				contracts;
3. Facilitate public
				understanding of such policies or contracts;
4. Eliminate provisions contained in such
				policies or contracts which may be misleading or confusing in connection with
				the purchase of such policies or contracts;
5. Eliminate policy or contract provisions
				which may duplicate Medicare benefits;
6. Provide for adjustment of required minimum
				benefits for Medicare supplement policies;
7. Provide notice to former policyholders of
				offer to reinstitute coverage;
8.
				Provide full disclosure of policy or contract benefits and benefit changes;
				and
9. Provide for appropriate
				premium adjustments.
Statutory Authority
§§ 38.2-223, 38.2-3516 through 38.2-3520,
					 38.2-3600 through 38.2-3609, 38.2-4214, 38.2-4215 and 38.2-514 of the Code of
					 Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 160 - RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO REPEAL OF THE MEDICARE CATASTROPHIC COVERAGE ACT › Section 14VAC5-160-20 - Reserved

Current through Register Vol. 40, No. 24, July 15, 2024
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 160 - RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO REPEAL OF THE MEDICARE CATASTROPHIC COVERAGE ACT › Section 14VAC5-160-30 - Applicability and scope

Current through Register Vol. 40, No. 24, July 15, 2024
This chapter (14VAC5-160-10 et
				  seq.) shall take precedence over other rules and requirements relating to
				  Medicare supplement policies or contracts to the extent necessary to assure
				  that benefits are not duplicated and to adjust minimum required benefits to
				  changes in Medicare benefits, applicants receive adequate notice and disclosure
				  of changes in Medicare supplement policies and contracts, appropriate premium
				  adjustments are made in a timely manner, and premiums are reasonable in
				  relation to benefits.
Except as provided in
				  14VAC5-160-50, this chapter shall
				  apply to:
1. All Medicare supplement
				policies and contracts delivered, or issued for delivery in this Commonwealth,
				or which are otherwise subject to the jurisdiction of this Commonwealth, on or
				after the effective date hereof, and
2. All certificates issued under group
				Medicare supplement policies as provided in subdivision 1 above.
Statutory Authority
§§ 38.2-223, 38.2-3516 through 38.2-3520,
					 38.2-3600 through 38.2-3609, 38.2-4214, 38.2-4215 and 38.2-514 of the Code of
					 Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 160 - RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO REPEAL OF THE MEDICARE CATASTROPHIC COVERAGE ACT › Section 14VAC5-160-40 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
For purposes of this chapter (14VAC5-160-10 et seq.):
"Applicant" means:
1. In the case of an individual Medicare
				supplement policy or contract, the person who seeks to contract for insurance
				benefits, and
2. In the case of a
				group Medicare supplement policy or contract, the proposed certificate holder.
"Certificate" means any certificate issued under a group
				  Medicare supplement policy.
"Medicare supplement policy" means a group or individual
				  policy of accident and sickness insurance or any other contract which is
				  advertised, marketed or designed primarily to provide health care benefits as a
				  supplement to reimbursements under Medicare for the hospital, medical or
				  surgical expenses of persons eligible for Medicare by reason of
				  age.
Statutory Authority
§§ 38.2-223, 38.2-3516 through 38.2-3520,
					 38.2-3600 through 38.2-3609, 38.2-4214, 38.2-4215 and 38.2-514 of the Code of
					 Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 160 - RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO REPEAL OF THE MEDICARE CATASTROPHIC COVERAGE ACT › Section 14VAC5-160-50 - Benefit conversion requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A. Effective January 1, 1990, no Medicare
				supplement insurance policy, contract or certificate in force in this
				Commonwealth shall contain benefits which duplicate benefits provided by
				Medicare.
B. Benefits eliminated by
				operation of the Medicare Catastrophic Coverage Act of 1988 ( Public Law
				100-360, 102 Stat. 683 (July 1, 1988) 42 USC § 1305 ) transition
				provisions shall be restored.
C.
				For Medicare supplement policies subject to the minimum standards adopted by
				the states pursuant to Medicare Catastrophic Coverage Act of 1988, the minimum
				benefits shall be:
1. Coverage of Part A
				Medicare eligible expenses for hospitalization to the extent not covered by
				Medicare from the 61st day through the 90th day in any Medicare benefit
				period;
2. Coverage for either all
				or none of the Medicare Part A inpatient hospital deductible amount;
3. Coverage of Part A Medicare eligible
				expenses incurred as daily hospital charges during use of Medicare's lifetime
				hospital inpatient reserve days;
4.
				Upon exhaustion of all Medicare hospital inpatient coverage including the
				lifetime reserve days, coverage of 90% of all Medicare Part A eligible expenses
				for hospitalization not covered by Medicare subject to a lifetime maximum
				benefit of an additional 365 days;
5. Coverage under Medicare Part A for the
				reasonable cost of the first three (3) pints of blood (or equivalent quantities
				of packed red blood cells, as defined under federal regulations) unless
				replaced in accordance with federal regulations or already paid for under Part
				B.
6. Coverage for the coinsurance
				amount of Medicare eligible expenses under Part B regardless of hospital
				confinement, subject to a maximum calendar year out-of-pocket amount equal to
				the Medicare Part B deductible of $75;
7. Effective January 1, 1990, coverage under
				Medicare Part B for the reasonable cost of the first three pints of blood (or
				equivalent quantities of packed red blood cells, as defined under federal
				regulations), unless replaced in accordance with federal regulations or already
				paid for under Part A, subject to the Medicare deductible amount.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 160 - RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO REPEAL OF THE MEDICARE CATASTROPHIC COVERAGE ACT › Section 14VAC5-160-60 - Form and rate filing requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A. As soon as practicable, but no longer than
				45 days after the effective date of the Medicare benefit changes, every
				insurer, health services plan or other entity providing Medicare supplement
				insurance or contracts in this Commonwealth shall file with the Commission, in
				accordance with the applicable filing procedures of this Commonwealth:
1. Appropriate premium adjustments necessary
				to produce loss ratios as originally anticipated for the applicable policies or
				contracts. Such supporting documents as are necessary to justify the adjustment
				shall accompany the filing.
2. Any
				appropriate riders, endorsements or policy forms needed to accomplish the
				Medicare supplement insurance modifications necessary to eliminate benefit
				duplications with Medicare and to provide the benefits required by
				14VAC5-160-50. Any such riders,
				endorsements or policy forms shall provide a clear description of the Medicare
				supplement benefits provided by the policy or contract.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 160 - RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO REPEAL OF THE MEDICARE CATASTROPHIC COVERAGE ACT › Section 14VAC5-160-70 - Offer of reinstitution of coverage

Current through Register Vol. 40, No. 24, July 15, 2024
A. Except as provided in subsection B, in the
				case of an individual who had in effect, as of December 31, 1988, a Medicare
				supplement policy with an insurer, as a policyholder or, in the case of a group
				policy, as a certificate holder, and the individual terminated coverage under
				such policy before the date of the enactment of the repeal of the Medicare
				Catastrophic Coverage Act of 1988 ( Public Law 100-360, 102 Stat. 683 (July 1,
				1988) 42 USC § 1305 ), the insurer shall:
1. Provide written notice no earlier than
				December 15, 1989, and no later than January 30, 1990, to the policyholder or
				certificate holder at the most recent available address, of the offer described
				below, and
2. Offer the individual,
				during a period of at least 60 days beginning not later than February 1, 1990,
				reinstitution of coverage, with coverage effective as of January 1, 1990, under
				terms which:
a. Do not provide for any waiting
				period with respect to treatment of pre-existing conditions;
b. Provide for coverage which is
				substantially equivalent to coverage in effect before the date of such
				termination; and
c. Provide for
				classification of premiums on which terms are at least as favorable to the
				policyholder or certificate holder as the premium classification terms that
				would have applied to the policyholder or certificate holder had the coverage
				never terminated.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 160 - RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO REPEAL OF THE MEDICARE CATASTROPHIC COVERAGE ACT › Section 14VAC5-160-80 - Requirements for new policy and certificates

Current through Register Vol. 40, No. 24, July 15, 2024
A. Effective January 1, 1990, no Medicare
				supplement insurance policy, contract or certificate shall be delivered or
				issued for delivery in this Commonwealth which provides benefits which
				duplicate benefits provided by Medicare. No such policy, contract or
				certificate shall provide less benefits than those required under the existing
				law or regulation except where duplication of Medicare benefits would result
				and except as required by these transition provisions.
B. General requirements.
1. Within 90 days of the effective date of
				this chapter, every insurer, health services plan or other entity required to
				file its policies or contracts for approval by the Commission shall file new
				Medicare supplement insurance policies or contracts which eliminate any
				duplication of Medicare supplement benefits with benefits provided by Medicare,
				which adjust minimum required benefits to changes in Medicare benefits, and
				which provide a clear description of the policy or contract benefit;
2. The filing required under
				14VAC5-160-60 A 1 shall provide
				for less ratios which are in compliance with all statutory and regulatory
				requirements; and
3. Every
				applicant for a Medicare supplement insurance policy, contract or certificate
				shall be provided with an outline of coverage which simplifies and accurately
				describes benefits provided by Medicare and policy or contract benefits along
				with benefit limitations.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 160 - RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO REPEAL OF THE MEDICARE CATASTROPHIC COVERAGE ACT › Section 14VAC5-160-90 - Filing requirements for advertising

Current through Register Vol. 40, No. 24, July 15, 2024
Every insurer, health services plan or other entity
				  providing Medicare supplement insurance or benefits in this Commonwealth shall
				  provide a copy of any advertisement intended for use in this Commonwealth
				  whether through written, radio or television medium to the Commission for
				  review. Such advertisement shall comply with all applicable laws of this
				  Commonwealth.
Statutory Authority
§§ 38.2-223, 38.2-3516 through 38.2-3520,
					 38.2-3600 through 38.2-3609, 38.2-4214, 38.2-4215 and 38.2-514 of the Code of
					 Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 160 - RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO REPEAL OF THE MEDICARE CATASTROPHIC COVERAGE ACT › Section 14VAC5-160-100 - Buyer's guide

Current through Register Vol. 40, No. 24, July 15, 2024
No insurer, health services plan or other entity shall make
				  use of or otherwise disseminate any buyer's guide or informational brochure
				  which does not accurately outline current Medicare benefits.
Statutory Authority
§§ 38.2-223, 38.2-3516 through 38.2-3520,
					 38.2-3600 through 38.2-3609, 38.2-4214, 38.2-4215 and 38.2-514 of the Code of
					 Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 160 - RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO REPEAL OF THE MEDICARE CATASTROPHIC COVERAGE ACT › Section 14VAC5-160-110 - Severability

Current through Register Vol. 40, No. 24, July 15, 2024
If any provision of this chapter (14VAC5-160-10 et seq.), or the
				  application thereof to any person or circumstances is for any reason held to be
				  invalid, the remainder of the chapter and the application of such provision to
				  other persons or circumstances shall not be affected thereby.
Statutory Authority
§§ 38.2-223, 38.2-3516 through 38.2-3520,
					 38.2-3600 through 38.2-3609, 38.2-4214, 38.2-4215 and 38.2-514 of the Code of
					 Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 170 - RULES GOVERNING MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 14VAC5-170-10 - Purpose

Current through Register Vol. 40, No. 24, July 15, 2024
The purpose of this chapter (14VAC5-170-10 et seq.) is to
				  provide for the reasonable standardization of coverage and simplification of
				  terms and benefits of Medicare supplement policies; to facilitate public
				  understanding and comparison of such policies; to eliminate provisions
				  contained in such policies which may be misleading or confusing in connection
				  with the purchase of such policies or with the settlement of claims; and to
				  provide for full disclosures in the sale of accident and sickness insurance
				  coverages to persons eligible for Medicare.
Statutory Authority
§§ 38.2-223, 38.2-514, 38.2-3516 through
					 38.2-3520, 38.2-3600 through 38.2-3609, 38.2-4214, and 38.2-4215 of the Code of
					 Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 170 - RULES GOVERNING MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 14VAC5-170-20 - Applicability and scope

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Except as otherwise specifically provided in
				14VAC5-170-60,
				14VAC5-170-110,
				14VAC5-170-120,
				14VAC5-170-150 and
				14VAC5-170-200, this chapter shall
				apply to:
1. All Medicare supplement policies
				delivered or issued for delivery in this Commonwealth on or after May 21, 2009;
				and
2. All certificates issued
				under group Medicare supplement policies for which certificates have been
				delivered or issued for delivery in this Commonwealth.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 170 - RULES GOVERNING MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 14VAC5-170-50 - Policy provisions

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Except for permitted preexisting condition clauses as described in
				14VAC5-170-60 B 1,
				14VAC5-170-70 B 1 and
				14VAC5-170-75 B 1, no policy or
				certificate may be advertised, solicited or issued for delivery in this
				Commonwealth as a Medicare supplement policy if the policy or certificate
				contains limitations or exclusions on coverage that are more restrictive than
				those of Medicare.
B. No Medicare
				supplement policy or certificate may use waivers to exclude, limit or reduce
				coverage or benefits for specifically named or described preexisting diseases
				or physical conditions.
C. No
				Medicare supplement policy or certificate in force in this Commonwealth shall
				contain benefits which duplicate benefits provided by Medicare.
D.
1.
				Subject to
				14VAC5-170-60 B 4, 5 and 7 and
				14VAC5-170-70 B 4 and 5, a
				Medicare supplement policy with benefits for outpatient prescription drugs in
				existence prior to January 1, 2006, shall be renewed for current policyholders
				who do not enroll in Part D at the option of the policyholder.
2. A Medicare supplement policy with benefits
				for outpatient prescription drugs shall not be issued after December 31,
				2005.
3. After December 31, 2005, a
				Medicare supplement policy with benefits for outpatient prescription drugs
				shall not be renewed after the policyholder enrolls in Medicare Part D unless:
a. The policy is modified to eliminate
				outpatient prescription coverage for expenses of outpatient prescription drugs
				incurred after the effective date of individual's coverage under a Part D plan;
				and
b. Premiums are adjusted to
				reflect the elimination of outpatient prescription drug coverage at the time of
				Medicare Part D enrollment, accounting for any claims paid, if
				applicable.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 170 - RULES GOVERNING MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 14VAC5-170-85 - Standard plans for 2010 standardized Medicare supplement policies delivered on or after June 1, 2010

Current through Register Vol. 40, No. 24, July 15, 2024
A. The following standard plans are applicable to all Medicare supplement benefit plan policies or certificates delivered or issued for delivery in this Commonwealth with an effective date for coverage on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered, or issued for delivery in this Commonwealth as a Medicare supplement policy or certificate unless it complies with these benefit plan standards. Benefit plan standards applicable to Medicare supplement policies and certificates issued with an effective date for coverage before June 1, 2010, remain subject to the requirements of 14VAC5-170-80.
B. For persons age 65 years or older:
1. An issuer shall make available to each prospective policyholder and certificateholder a policy form or certificate form containing only the basic (core) benefits, as defined in 14VAC5-170-75 C.
2. If an issuer makes available any of the additional benefits described in 14VAC5-170-75 D, or offers standardized benefit Plan K or L (as described in subdivisions F 8 and F 9 of this section), then the issuer shall make available to each prospective policyholder and certificateholder, in addition to a policy form or certificate form with only the basic (core) benefits as described in subdivision 1 of this subsection, a policy form or certificate form containing either standardized benefit Plan C (as described in subdivision F 3 of this section) or standardized benefit Plan F (as described in subdivision F 5 of this section).
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 170 - RULES GOVERNING MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 14VAC5-170-87 - Standard plans for 2020 standardized Medicare supplement policies delivered to individuals newly eligible for Medicare on or after January 1, 2020

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				This section applies only to individuals who are newly eligible for Medicare on
				or after January 1, 2020:
1. By reason of
				attaining age 65 years on or after January 1, 2020; or
2. By reason of entitlement to benefits under
				part A pursuant to § 226(b) or 226A of the Social Security Act, or who is
				deemed to be eligible for benefits under § 226(a) of the Social Security
				Act on or after January 1, 2020.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 170 - RULES GOVERNING MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 14VAC5-170-90 - Medicare select policies and certificates

Current through Register Vol. 40, No. 24, July 15, 2024
A.
1. This
				section shall apply to Medicare Select policies and certificates, as defined in
				this section.
2. No policy or
				certificate may be advertised as a Medicare Select policy or certificate unless
				it meets the requirements of this section.
3. A Medicare Select issuer subject to these
				rules is deemed a health carrier responsible for a "managed care health
				insurance plan" or "MCHIP" as defined in § 38.2-5800 of the Code of
				Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 170 - RULES GOVERNING MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 14VAC5-170-95 - Persons eligible by reason of disability

Current through Register Vol. 40, No. 24, July 15, 2024
A. An issuer that offers individual Medicare supplement policies shall offer to any individual who resides in this Commonwealth, is younger than 65 years of age, is eligible for Medicare by reason of disability as defined by 42 USC §
										426(b) or 42 USC §
										426-1, and is enrolled in Medicare Part A and B, or will be so enrolled by the effective date of coverage in accordance with the provisions of §
									38.2-3610 of the Code of Virginia, at least one of its Medicare supplement plans that it actively markets to individuals. An issuer that offers Medicare supplement policies on a group basis shall offer to issue a Medicare supplement certificate, for at least one of the Medicare supplement plans issued to the group, to any individual who resides in this Commonwealth, is younger than 65 years of age, is eligible for Medicare by reason of disability as defined by 42 USC §
										426(b) or 42 USC §
										426-1, is eligible for enrollment in the group policy, and is enrolled in Medicare Part A and B, or will be so enrolled by the effective date of coverage in accordance with the provisions of §
									38.2-3610 of the Code of Virginia. The Medicare supplement policy or certificate offered shall be guaranteed renewable. Such Medicare supplement policy or certificate shall be offered and issued during the following enrollment periods:
1. Upon the request of the individual during the six-month period beginning with the first month in which the individual is eligible for Medicare by reason of a disability. For those persons who are retroactively enrolled in Medicare Part B due to a retroactive eligibility decision made by the Social Security Administration, the application must be submitted within a six-month period beginning with the month in which the person receives notification of the retroactive eligibility decision; or
2. Upon the request of the individual during the 63-day period following voluntary or involuntary termination of coverage under a group health plan.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 170 - RULES GOVERNING MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 14VAC5-170-100 - Open enrollment ages 65 years and older

Current through Register Vol. 40, No. 24, July 15, 2024
A. An issuer shall neither (i) deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this Commonwealth nor (ii) discriminate in the pricing of such a policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant in the case of an application for a policy or certificate that is submitted prior to or during the six-month period beginning with the first day of the first month in which an individual is both 65 years of age or older and is enrolled for benefits under Medicare Part B. Each Medicare supplement policy and certificate currently available from an issuer shall be made available to all applicants who qualify under this subsection.
B.
1. If an applicant qualifies under subsection A of this section and submits an application during the time period referenced in subsection A and, as of the date of application, has had a continuous period of creditable coverage of at least six months, the issuer shall not exclude benefits based on a preexisting condition.
2. If the applicant qualifies under subsection A of this section and submits an application during the time period referenced in subsection A and, as of the date of application, has had a continuous period of creditable coverage that is less than six months, the issuer shall reduce the period of any preexisting condition exclusion by the aggregate of the period of creditable coverage applicable to the applicant as of the enrollment date. The Secretary shall specify the manner of the reduction under this subsection.