General Assembly>Division of Legislative Services>Publications>Session Summaries>2004>Insurance

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Insurance

Passed

P HB221

Miscellaneous casualty insurance. Defines "miscellaneous casualty insurance" as insurance against liability, and against loss, damage, or expense arising out of injury to the economic interests of any person. It does not include any other statutorily-specified class of insurance, and would not include insurance that is contrary to law or public policy.
Patron - Hargrove

P HB322

Health insurance carriers; fair business practices; retroactive denials. Prohibits a health insurance carrier from imposing any retroactive denial of payment or seeking recovery or refund of a previously paid claim unless the carrier specifies in writing the specific claim for which the retroactive denial is to be imposed or the recovery or refund is sought. The carrier must also explain why the claim is being retroactively adjusted.
Patron - Griffith

P HB363

Legal services plans. Transfers responsibility for regulating legal services plan sellers from the State Corporation Commission's Bureau of Insurance to the Department of Agriculture and Consumer Services. The bill establishes requirements for the registration of legal services plan sellers, authorizes the Board of Agriculture and Consumer Services to prescribe regulations relating to legal services plan sellers, and authorizes the Department to investigate violations. Legal services plan sellers must make contract records available to the Department upon request and maintain a true copy of each contract for its term. A seller who knowingly and willfully violates the requirement shall be guilty of a Class 3 misdemeanor.
Patron - Hargrove

P HB460

Powers of attorney; fidelity and surety insurers. Eliminates the requirements that powers of attorney binding fidelity and surety insurers be recorded. The power of attorney must be attached to the bond or other obligation. The bill does not apply to surety bail bondsmen.
Patron - Drake

P HB553

Insurance; rates. Allows insurers, other than workers' compensation insurers, to limit the amount of a premium increase applicable to the renewal of a policy, and to phase in the increase over a specified period.
Patron - Hargrove

P HB596

Virginia Property and Casualty Insurance Guaranty Association. Recognizes the existence of Virginia Property and Casualty Insurance Guaranty fund coverage for certain qualifying claims that have been assumed as direct obligations of the insolvent insurer prior to the insurer's being declared insolvent. The bill clarifies that certain transactions, including routine reinsurance transactions and surplus lines transactions, are not novations that would establish a direct obligation of the insurer to the insured. The bill also expands the definition of "insolvent insurer" to include an insurer that is licensed in Virginia when the obligation with respect to the covered claim was assumed.
Patron - Dudley

P HB609

Fire insurance; flood coverage; notices. Requires insurers issuing a new or renewal contract or policy of fire insurance that excludes coverage for damage due to flood or any other overflow of a body of water to provide written notice to the policyholder that contents coverage may be available with the flood policy for an additional premium. An insurer is required to notify a policyholder when flood coverage is excluded from a policy or contract and that flood insurance is available from the insurer, insurance agent or the National Flood Insurance Program. The requirement applies to policies issued or renewed on or after October 1, 2004. The bill incorporates HB 1371.
Patron - Gear

P HB818

Homeowners insurance; nonrenewal. Prohibits an insurer from refusing to renew a homeowners insurance policy solely because a claim was made more than 60 months prior to the policy expiration date. This bill incorporates HB 731.
Patron - Drake

P HB898

Homeowners insurance deductibles. Requires an insurer who unilaterally changes the deductible on a policy insuring an owner-occupied dwelling to provide written notice to the insured stating that the deductible has been changed and explaining how the new deductible will be applied. This section will apply to policies renewed in Virginia on or after October 1, 2004.
Patron - Wardrup

P HB1007

Homeowners insurance; exclusions for dangerous or vicious animals. Authorizes the issuer of a homeowner's policy, with the insured's written consent, to exclude from coverage any liability resulting from an injury caused by a dangerous or vicious animal owned by or in the care, custody, or control of the insured if such animal has bitten, attacked, or inflicted injury on a person or companion animal. This bill incorporates HB 1332.
Patron - Rust

P HB1155

Interstate Insurance Product Regulation Compact. Provides that Virginia is a Compacting State under the Interstate Insurance Product Regulation Compact. The Compact is intended to: (i) promote and protect the interest of consumers of individual and group annuity, life insurance, disability income, and long-term care insurance products; (ii) develop uniform standards for those insurance products; (iii) act as a central clearinghouse to review insurance products and advertisements; (iv) approve product filings and advertisements; (v) improve coordination of regulatory resources and expertise among state insurance departments regarding uniform standards and review of relevant insurance products; (vi) create the Interstate Insurance Product Regulation Commission, and (vii) perform other related functions consistent with state regulation of the business of insurance. This bill also appoints the Commissioner of Insurance as the Commonwealth's representative to the Interstate Insurance Product Regulation Commission.
Patron - Morgan

P HB1181

Insurance; annuity nonforfeiture. Incorporates model provisions adopted by the National Association of Insurance Commissioners' Standard Nonforfeiture Law for Individual Deferred Annuities. The bill also establishes a formula that uses an index-based interest rate to determine the minimum nonforfeiture amounts for individual deferred annuity contracts issued on or after July 1, 2005, and details application of the formula, including that it may be applied to certain contracts issued before July 1, 2005.
Patron - Bryant

P HB1186

Insurance; actuarial opinions. Requires every insurer to submit annually an actuarial opinion and supporting documents, including a summary of opinion or issues, memoranda, and work papers prepared in conformity with appropriate National Association of Insurance Commissioners annual statement instructions. The documents shall be privileged and confidential and not discoverable or admissible in a civil action. The new requirements apply to fraternal benefit societies, health services plans, health maintenance organizations, and dental or optometric services plans.
Patron - Bryant

P HB1238

Virginia Insurance Continuing Education Board; Virginia Association of Health Underwriters. Adds one representative from the Virginia Association of Health Underwriters to the Virginia Insurance Continuing Education Board and decreases, from two to one, the number of representatives on the Board from the Virginia Association of Insurance and Financial Advisors.
Patron - Griffith

P HB1327

Insurance; multiple employer welfare arrangements. Excludes from the State Corporation Commission's regulatory jurisdiction any multiple employer welfare arrangement (MEWA) comprised only of banks and their employees that (i) is duly licensed as a MEWA by the insurance regulatory agency of a state contiguous to the Commonwealth, (ii) files with the Commission a copy of its certificate of authority or other proper license from the contiguous state, and (iii) has no more than 50 Virginia residents who are employees of its member banks enrolled in or receiving accident and sickness benefits as insureds, members, enrollees, or subscribers of the MEWA.
Patron - Dudley

P HB1342

Motor vehicle insurance; unfair settlement practices. Provides, with respect to a glass claim arising under a motor vehicle insurance policy, that an insurer's failure to disclose (i) the true nature of a third party representative; (ii) that an insured is not required to use the facility, service or products recommended by the insurer; or (iii) that the insured or its third-party representative has a financial interest in the recommended replacement or repair facility, an unfair settlement practice, constitutes unfair settlement practices. The referring insurer is accountable for any violations by the third party representative.
Patron - Morgan

P HB1404

Insurance; group accident and sickness insurance coverage for dependent children. Allows insurers, at the policyholder's election, to extend coverage under a group accident and sickness insurance policy to include any child of an insured group member, regardless of the child's age.
Patron - Byron

P HB1407

Virginia Birth-Related Neurological Injury Compensation Act. Increases assessments for participating physicians and hospitals, and nonparticipating physicians on an incremental basis beginning in 2005, to maximums of $5,500, $200,000, and $300, respectively. The bill also eliminates the authority to pay attorney's fees to applicants who are not admitted into the birth injury fund program.
Patron - Tata

P HB1408

Accident and sickness insurance; claims experience. Requires health maintenance organizations to provide, upon request, to those health care plan policyholders which employed an average of at least 100 insured, subscribers or enrollees in the preceding 12-month period, as part of the insured's claims experience record, (i) a summary of claims charges incurred and the amount paid for each claim for the most recent available 24-month period; (ii) a listing of the number of insured or subscribers for whom combined medical costs or claims exceeded $100,000 in the most recently available 12-month period; and (iii) total enrollment in each membership category. The existing disclosure requirements applicable to group accident and sickness insurance policies and subscription contracts are amended to incorporate the new provisions regarding the size of the group policyholder that may request the information and to increase the threshold enrollees for whom information must be disclosed from those with payments or costs in excess of $50,000 to those in excess of $100,000. The bill becomes effective on January 1, 2005.
Patron - Carrico

P SB44

Health insurance; mandated coverage for biologically based mental illness. Repeals the scheduled July 1, 2004, sunsetting of the mandated health insurance benefit that requires the same coverage for biologically based mental illness as is provided for other illnesses, conditions or disorders. This bill is identical to SB 67.
Patron - Martin

P SB154

Fire Programs Fund. Requires the Executive Director of the Department of Fire Programs to establish written standards for determining the extent to which clients outside the Commonwealth shall be financially responsible for the cost of fire and emergency services training provided by the Department of Fire Programs. Revenues generated shall be retained in the Fire Programs Fund and used solely for providing additional training to members of Virginia's fire and emergency services.
Patron - Edwards

P SB156

Insurance; dental plan organizations. Establishes a new regulatory system specifically for dental plan organizations, pursuant to which companies that provide a dental plan are required to be licensed. The bill also establishes required and optional dental benefit contract provisions, required provisions for plan dentist contracts, and requirements relating to the filing of premium rates and subscription fees.
Patron - Potts

P SB266

Long-term care partnership plan. Requires the Board of Medical Assistance Services to establish, consistent with federal law, a long-term care partnership program that will encourage the private purchase of long-term care insurance as the primary source of funding the participant's long-term care. The program must provide protection from estate recovery as authorized by federal law.
Patron - Edwards

P SB355

Insurance; domestic reciprocals. Requires prior written approval of material transactions, and timely disclosure of most other transactions, between a domestic reciprocal and a related party and, when the transaction is material to the reciprocal, between any two or more of the reciprocal's related parties. The bill requires the annual filing of a related parties summary and that a reciprocal's surplus, following any dividends or distribution to any of the reciprocal's related parties, shall be reasonable in relation to the reciprocal's outstanding liabilities and adequate to its financial needs.
Patron - Colgan

P SB372

Health maintenance organizations. Provides that, for purposes of health maintenance organization regulation, "net worth" and "capital and surplus" have the same meaning. Persons owning or having the right to acquire five percent or more of voting securities or subordinated debt of an entity applying for a license to establish or operate a health maintenance organization are required to disclose such fact when applying for a license.
Patron - Miller

P SB535

Insurance; funding agreements. Authorizes insurers licensed to write life insurance or annuities in Virginia to issue funding agreements. A funding agreement authorizes the insurer to accept funds and provides for an accumulation of funds for the purpose of making one or more payments in fixed or variable amounts, or both, that are not based on mortality or morbidity contingencies. The issuance of funding agreements constitutes transacting an insurance business in the Commonwealth. In a liquidation of an insurer, the holders of a funding agreement will receive the same priority that is currently accorded to policyholders.
Patron - Stosch

P SB618

Insurance; provider panels. Allows a health insurance provider to send a provider directory electronically to its insureds. If the directory is provided electronically, it shall be updated monthly.
Patron - Wagner

P SB687

Failed

F HB439

Property and casualty insurance; windstorm and hail coverage. Authorizes the Virginia Property Insurance Association (VPIA) to issue windstorm or windstorm and hail insurance policies. The bill also authorizes property insurers underwriting in the voluntary market of Virginia's coastal areas to exclude (in new policies only) from coverage on owner-occupied dwellings any losses resulting from windstorm or windstorm and hail, provided the insurer (i) issues premium credits for such exclusions and (ii) furnishes written disclosures to insureds describing the exclusions and informing insureds that coverage for windstorm or windstorm and hail can be obtained through the VPIA. This bill is identical to SB 433.
Patron - Suit

F HB731

Homeowners insurance; grounds for nonrenewal. Prohibits an insurer from refusing to renew a homeowners insurance policy solely because of claims made on the policy more than 48 months prior to the next anniversary date of the policy. This bill is incorporated into HB 818.
Patron - Joannou

F HB736

Motor vehicle insurance; exclusion for punitive damages. Allows insurers that issue motor vehicle liability insurance to exclude coverage for punitive damages. The bill also excludes punitive damages from uninsured motorist coverage.
Patron - Hargrove

F HB800

Health insurance; mandated coverage for hearing aids for minors. Requires health insurers, health maintenance organizations, and corporations providing health care coverage subscription contracts to provide coverage for hearing aids and related services for children from birth to age 18 when a licensed audiologist prescribes such hearing aids and related services. Such coverage shall include one hearing aid per hearing-impaired ear, up to a cost of $1,400, every 36 months. The insured may choose a higher priced hearing aid and pay the difference in cost above $1,400, with no penalty to the insured or the hearing aid provider. No co-payment will apply. Hearing aids are not to be considered durable medical equipment.
Patron - Petersen

F HB914

Insurance; workers' compensation rates; cap for coal mining classifications. Caps the workers' compensation insurance rates and loss costs for the surface and underground coal classifications for the voluntary markets at the levels existing on July 1, 2004. Such rates shall remain in effect until the General Assembly authorizes a rate increase. The bill also caps at the July 1, 2004, level the coal-classifications rates for the assigned risk market. The State Corporation Commission retains its authority to decrease such rates and loss costs.
Patron - Phillips

F HB1328

Homeowners insurance; dangerous or vicious dogs. Prohibits insurers from refusing to issue or refusing to renew a homeowner's or renter's policy solely on the basis that the insured's or prospective insured's dog is one of a particular breed. Nothing prohibits an insurer from refusing to issue or refusing to renew such a policy if the insured's or prospective insured's dog is declared dangerous or vicious.
Patron - Dudley

F HB1332

Homeowners insurance; exclusions for attractive nuisances and dangerous or vicious animals. Authorizes the issuer of a homeowner's policy, with the insured's written consent, to exclude from coverage any liability resulting from an injury caused by a dangerous or vicious animal owned by or in the care, custody, or control of the insured if such animal has bitten, attacked, or inflicted injury on a person or companion animal. This bill is incorporated into HB 1007.
Patron - Tata

F HB1371

Fire insurance; flood coverage; notices. Requires insurers issuing a new or renewal contract or policy of fire insurance that excludes coverage for damage due to flood, surface water, waves, tidal water, or any other overflow of a body of water, to provide written notice to the policyholder that contents coverage may be available with the flood policy for an additional premium. Current law requires an insurer to notify a policyholder when flood coverage is excluded from a policy or contract and that flood insurance is available from the insurance agent or the National Flood Insurance Program. This bill is incorporated into HB 609.
Patron - Rapp

F HB1438

Self-insured rental vehicles; rental used as substitute for a vehicle being repaired or serviced; secondary coverage. Makes the bodily injury and property damage liability protection provided the driver of a self-insured rental vehicle, when the self-insured vehicle is rented as a substitute for a motor vehicle being repaired or serviced, secondary to any insurance coverage that insures the driver for the same loss.
Patron - Athey

F SB67

Health insurance; mandated coverage for biologically based mental health illnesses. Repeals the scheduled July 1, 2004, sunsetting of the mandated health insurance benefit that requires the same coverage for biologically based mental illness as is provided for other illnesses, conditions or disorders. This bill is identical to SB 44.
Patron - Martin

F SB68

Motor vehicle insurance; assessment for Fire Programs Fund. Requires insurance companies that write motor vehicle insurance to pay an assessment of one percent of the total direct gross premium income from such insurance. The assessments will be paid into the Fire Programs Fund, which is administered by the Department of Fire Programs under policies established by the Virginia Fire Services Board.
Patron - Puckett

F SB105

Health insurance; refusal to accept assignments prohibited; physicians. Prohibits health insurers, health maintenance organizations, and the state employees' health care plan from refusing to accept an assignment of benefits made to a physician. A similar provision currently prohibits health insurers from refusing to accept assignments of benefits made to dentists and oral surgeons.
Patron - Williams

F SB255

Health insurance; mandated coverage for infertility treatments. Requires the state health plan, health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for the treatment of infertility. The bill's provisions are applicable to policies, plans, and contracts delivered, issued for delivery, or renewed on and after July 1, 2004. They are not applicable to short-term travel, accident-only, limited, or specified disease policies, or to short-term nonrenewable policies of not more than six months' duration. This bill is identical to HB 619.
Patron - Puckett

F SB291

Health insurance; notice of change in provider reimbursement rates. Requires insurers issuing individual or group accident and sickness insurance policies and other carriers using provider panels to provide written notification to health care providers at least 30 days prior to a change in the rates or fees that will be paid to providers for health care services.
Patron - O'Brien

F SB376

Motor vehicle insurance policies; assessment for State Police Training and Retention Fund. Imposes an assessment on insurers in an amount of one percent of the direct premium income from motor vehicle insurance policies. The bill also establishes the State Police Training and Retention Fund, into which the assessments will be deposited. Moneys in the Fund will be used to create and support programs for the training and retention of state police officers.
Patron - Deeds

F SB433

Property and casualty insurance; windstorm coverage. Authorizes the Virginia Property Insurance Association (VPIA) to issue windstorm or windstorm and hail insurance policies. The bill also authorizes property insurers underwriting in the voluntary market of Virginia's coastal areas to exclude (in new policies only) from coverage on owner-occupied dwellings any losses resulting from windstorm or windstorm and hail, provided the insurer (i) issues premium credits for such exclusions and (ii) furnishes written disclosures to insureds describing the exclusions and informing insureds that coverage for windstorm or windstorm and hail can be obtained through the VPIA. This bill is identical to HB 439.
Patron - Wagner

F SB594

Health insurance; mandated coverage for prescription contraceptives. Requires health insurers, corporations providing accident and sickness subscription contracts, and health maintenance organizations, whose policies, contracts, or plans include prescription drugs on an outpatient basis, to include coverage for any prescribed drug or device approved by the United States Food and Drug Administration for use as a contraceptive. This bill is identical to HB 469.
Patron - Howell

F SB662

Mandated health insurance benefits. Places a five-year moratorium on new health insurance mandates. This bill is identical to HB 1362.
Patron - Martin

F SB679

State-mandated health insurance; Consumer Choice Benefits Plans. Permits companies offering accident or sickness insurance policies or plans to offer a policy or plan that does not offer or provide all of the existing state-mandated health benefits. Each insurer or health maintenance organization providing such a benefits plan must provide a written disclosure, that must be signed by the prospective or current insured. Any plan must include payment to dentists and certain other health care providers for covered services; coverage of cancer screenings; the prohibition against discrimination; the certificate of quality assurance requirements; coverage of newborn, adopted, and dependent children; coverage of mental health and substance abuse services; coverage for diabetes; and the option relating to conversion coverage. This bill is identical to HB 935.
Patron - Martin

Carried Over

C HB195

Insurance; health maintenance organizations; chiropractors. Requires health maintenance organizations to cover the services provided by a chiropractor if the chiropractor is authorized by law to provide the services in the Commonwealth and the services are covered under the enrollee's evidence of coverage.
Patron - Black

C HB222

Insurance; dental service plans; managed care health insurance plans. Provides that health care services do not include dental services, and that dental service plans do not constitute managed care health insurance plans.
Patron - Hargrove

C HB266

Health insurance; prescription drug coverage; payments to providers. Requires each insurer, corporation, or health maintenance organization whose insurance policy, contract, or plan includes outpatient prescription drug coverage to pay a prescription benefit provider by electronic funds transfer or automated clearinghouse transfer within 30 days of receipt of a claims transmission from the prescription benefit provider. The payment by the insurer, corporation, or health maintenance organization shall be made to an account designated by the prescription benefit provider or its authorized representative. Prior to payment, the insurer, corporation, or health maintenance organization shall provide documentation to the prescription benefit provider of the claims payment information identifying the individual claims that are included in the payment. The claims payment information shall be in a format mutually agreed to by the insurer, corporation, or health maintenance organization and the prescription benefit provider, and shall comply with the Health Insurance Portability and Accountability Act of 1996.
Patron - Morgan

C HB469

C HB607

Homeowners insurance; hurricane deductibles. Authorizes insurers that write policies insuring owner-occupied dwellings to include a separate deductible applicable to damage caused by a hurricane. However, such deductible shall apply only when the measured wind velocity, at the time of the damage, exceeds 74 miles per hour where the damaged property was located, as determined by the National Weather Service's office in Wakefield, Virginia. The bill does not prohibit an insurer from including a deductible applicable to damage caused by wind not otherwise related to a hurricane.
Patron - Gear

C HB619

Health insurance; mandated coverage for infertility treatment. Requires the state health plan, health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for the treatment of infertility. The bill's provisions are applicable to policies, plans, and contracts delivered, issued for delivery, or renewed on and after July 1, 2004. They are not applicable to short-term travel, accident-only, limited, or specified disease policies, or to short-term nonrenewable policies of not more than six months' duration. This bill is identical to SB 255.
Patron - Carrico

C HB814

Insurance; homeowners; cancellation or nonrenewal; claims inquiries. Prohibits an insurer from canceling or refusing to renew homeowners insurance policies based solely on inquiries from insureds about potential claims for covered damages.
Patron - Eisenberg

C HB833

Homeowners insurance; cancellations. Prohibits the cancellation of a policy of insurance on an owner-occupied dwelling when such policy is issued prior to closing and the decision to cancel is based solely on information obtained from the Comprehensive Loss Underwriting Exchange or credit information contained in a consumer report. The bill also requires an insurer to make a decision as soon as practicable regarding insurance on an owner-occupied dwelling that is being purchased and, if approved, issue a binder for such coverage and not delay closing the purchase of the dwelling.
Patron - Drake

C HB882

Insurance; disclosures; class of business. Requires all health insurance issuers offering for sale any health benefit to employers to disclose to an employer the class of business, individual or group, for which it has been approved. For consistency with other disclosure provisions, the bill requires health insurance issuers who sell to small employers to provide a description of the plans and the benefits and premiums available under all health benefit plans for which the small employer is qualified.
Patron - Plum

C HB935

C HB1016

Group accident and sickness insurance coverage. Allows coverage under a group accident and sickness insurance policy to be extended to insure any person who the insured group member elects, provided such extension of coverage is agreed to by the insurer and the group policyholder. The bill also specifically authorizes coverage under such group policies to be extended to children of the insured group member who are older than 19, or 25 if a full-time student, as may mutually be agreed upon by the insurer and group policyholder. Currently, group policy coverage may be extended only to the insured group member's spouse and children under 19, or dependent children under 25 who are full-time students.
Patron - Dillard

C HB1019

Homeowners insurance; grounds for nonrenewals. Prohibits an insurer or agent from refusing to renew a homeowner's insurance policy solely because of a claim resulting primarily from other than natural causes, unless the claim is related to a substantial increase in the risk of loss that the insurer assumed under the policy. Currently, an insurer may not refuse to renew a policy due to claims resulting primarily from natural causes, but may do so for claims resulting primarily from any other cause.
Patron - Dillard

C HB1196

Insurance; medical expense coverage; intoxicants and narcotics. Provides that medical expense policies issued, delivered, renewed or extended on or after July 1, 2004, shall not include a provision providing that insurers will not be liable for any loss resulting from the insured's being intoxicated or under the influence of any narcotic unless taken on the advice of a physician. Policy exclusions prohibiting coverage as the result of impairment due to intoxicants or narcotics shall not be included in such policies.
Patron - Scott, J.M.

C HB1216

Health insurance; mandated coverage for treatment of inborn errors of metabolism. Requires health insurers, health care subscription plans, and health maintenance organizations to provide coverage for treatment of inborn errors of metabolism that involve amino acid, carbohydrate, and fat metabolism and for which medically standard methods of diagnosis, treatment, and monitoring exist.
Patron - Landes

C HB1362

Mandated health insurance benefits. Places a five-year moratorium on new health insurance mandates. This bill is identical to SB 662.
Patron - Marshall, D.W.

C HB1416

Health insurance; pharmacies; freedom of choice. Prohibits insurers from imposing upon pharmacies terms or conditions that are not equally required of all pharmacies in the Commonwealth, whether or not such benefits are furnished by pharmacists who are nonpreferred providers. The bill also prohibits insurers from requiring any payment, compensation, or reimbursement structure that results in, or would tend to result in: (i) discrimination in price or services to be rendered; or (ii) direct or indirect discrimination by the insurer, where the effect of such discrimination may be substantially to lessen competition or tend to create a monopoly. Insurers are also prohibited from directly or indirectly paying or accepting incentives between or among the insurer, the insurer's pharmacy benefit manager, or a pharmacy in a manner that would be a violation of state or federal law. Requiring or inducing a person receiving pharmacy benefits to use a mail order pharmacy for maintenance medications is also prohibited unless the pharmacy has not agreed to accept reimbursement for such services at the same rates, terms, and conditions that are applicable to mail order pharmacies.
Patron - Nutter

C HB1417

Insurance; unfair settlement practices. Requires an insurer to pay the estate of a deceased insured 125 percent of a claim settlement if the insurer fails to pay a claim within a reasonable time when liability has become reasonably clear, and the insured dies. A "reasonable time" is defined as one year or sooner.
Patron - Pollard

C HB1455

Health insurance; pharmacies; freedom of choice. Prohibits insurers from imposing upon pharmacies nonprice terms or conditions that are not equally required of all pharmacies in the Commonwealth, whether or not such benefits are furnished by pharmacists who are nonpreferred providers. The bill also prohibits insurers from requiring any payment, compensation, or reimbursement structure that results in, or would tend to result in: (i) discrimination in price or services to be rendered; (ii) the artificial depression of prices to be paid, or proposed to be paid, to a pharmacy providing pharmaceutical benefits; (iii) the establishment or unilateral change of reimbursement rates to a pharmacy that are below such pharmacy's costs or prevailing market rates; or (iv) direct or indirect discrimination by the insurer, where the effect of such discrimination may be substantially to lessen competition or tend to create a monopoly, or to injure, destroy, or prevent competition in the practice of pharmacy. Insurers are also prohibited from directly or indirectly paying or accepting rebates, discounts, or other forms of disclosed or undisclosed incentives between or among the insurer, the insurer's pharmacy benefit manager, or a pharmacy in a manner that would be a violation of state or federal law. Requiring or inducing a person receiving pharmacy benefits to use a mail order pharmacy for maintenance medications is also prohibited unless the pharmacy selected by such person has not agreed to accept reimbursement for such services at the same rates, terms, and conditions that are applicable to mail order pharmacies that have one or more contracts with the insurer.
Patron - Athey

C SB309

Medical malpractice joint underwriting association. Requires, by January 1, 2005, the State Corporation Commission to activate a joint underwriting association for the members of any class, type, or group of providers of health care who, between January 1, 2003, and January 1, 2004, have not been covered for any period of time by reason of insolvency of their previous carrier or cannot purchase or cannot afford to purchase medical malpractice insurance in the voluntary market. The Commission will establish criteria to determine the eligibility of any such class, type, or group of providers of health care to obtain coverage under the joint underwriting association.
Patron - Hawkins

C SB401

Virginia Medical Malpractice Joint Underwriting Association. Establishes the Virginia Medical Malpractice Joint Underwriting Association, which will provide a market for medical malpractice insurance for any provider of health care that cannot otherwise obtain insurance in a form and at a premium acceptable to the provider. On or before September 30, 2004, the directors of the association must submit a plan of proposed operation to the State Corporation Commission for its approval. The bill eliminates the requirements for the establishment of a stabilization reserve fund and the reserve fund charge. The bill allows the Association's rates to include a premium surcharge based on past and prospective loss and expense experience.
Patron - O'Brien

C SB650

Health insurance; exclusion for prophylactic surgical procedures for difficult-to-diagnose pathologies; genetic predisposition. Prohibits health insurers, corporations providing accident and sickness subscription contracts, and health maintenance organizations from refusing to provide coverage for prophylactic surgical procedures and medical services directly related thereto, in cases where the covered person's treating physician has determined that the person has a genetic factor or family history indicating a predisposition to a difficult-to-diagnose pathology, the risks to the covered person of developing the difficult-to-diagnose pathology as a result of such person's predisposition render such services medically appropriate, and coverage for treatment of the difficult-to-diagnose pathology would be provided under the terms of the policy, contract or plan if the difficult-to-diagnose pathology has been diagnosed. A difficult-to-diagnose pathology is a disease that is asymptomatic or otherwise not susceptible to diagnosis until reaching a stage at which the likelihood of successful treatment is significantly less than it would be had the treatment been performed when the disease was asymptomatic or not susceptible to diagnosis. A prophylactic surgical procedure is a surgical procedure that is performed prior to the diagnosis of or presentation of symptoms of a difficult-to-diagnose pathology, in order to prevent, eliminate or reduce the likelihood of the development of the difficult-to-diagnose pathology.
Patron - Deeds

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