Insurance Passed HB542 Accident and sickness insurance; minimum hospital stays for patients following mastectomy and for lymph node dissection for the treatment of breast cancer. Requires the state employee health insurance plan, the Virginia Medicaid plan, and health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for at least a 48-hour hospital stay following a radical or modified radical mastectomy and not less than 24 hours of inpatient care following a total mastectomy or a partial mastectomy with lymph node dissection for the treatment of breast cancer. Notwithstanding these requirements, the attending physician and the patient can determine that a shorter stay in the hospital is appropriate. The bill's provisions are applicable to policies, plans, and contracts delivered, issued for delivery, or renewed on and after July 1, 1998. 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. Patron - Hamilton HB565 Insurance; insurer investment limits. Modifies the investment restrictions imposed on insurance companies domesticated in Virginia. For purposes of distinguishing between Category 1 and Category 2 investments, this measure would increase the caps on foreign investments, investments graded Category 4 by the Securities Valuation Office (the "SVO") of the National Association of Insurance Commissioners (securities are rated from 2 [high grade] to 6 [lower grade]), investments in local government obligations, and investments in any one agency of the U.S. government. The bill (i) treats as Category 1 investments, investments of up to nine percent of admitted assets in foreign securities rated high grade and of up to one percent in such securities rated medium grade, (ii) increases the cap on investments in any one U.S. political subdivision from two to five percent, (iii) increases the aggregate cap on investments in federal, state and local government obligations from 20 percent to 30 percent, and (iv) authorizes investment of up to two percent of admitted assets in securities rated 4 by the SVO. In addition, the bill provides that Category 2 assets can be treated as admitted assets to the extent that they do not exceed 75 percent of surplus in excess of minimum capital and surplus. Patron - Woodrum HB567 Insurance; viatical settlements. Specifies that the application and license fees (including renewal fees) collected from viatical settlement providers and viatical settlement brokers must be deposited to the fund for the maintenance of the Virginia State Corporation Commission's (SCC) Bureau of Insurance. Current law does not specify where such fees should be directed. The SCC's Bureau of Insurance has oversight responsibility for the viatical industry--an industry which brokers the purchase of life insurance policies from terminally ill individuals. The bill also makes technical amendments. Patron - Van Landingham HB673 Accident and sickness insurance; coverage for hemophilia and congenital bleeding disorders. Requires health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for hemophilia and congenital bleeding disorders. The benefits mandated include coverage for expenses incurred with the treatment of routine bleeding episodes, and coverage for the purchase of blood products and blood infusion equipment required for home treatment of routine bleeding episodes when the home treatment is conducted under the supervision of the state-approved hemophilia treatment center. The bill's provisions are applicable to policies, plans and contracts delivered, issued for delivery or renewed on and after July 1, 1998. They are not applicable to short-term travel, accident only, limited or specified disease policies, policies or contracts designed for issuance to persons eligible for coverage under Medicare, or to short-term nonrenewable policies of not more than six months' duration. Patron - Hargrove HB675 Insurance; misrepresentation in insurance documents and communications. Expands insurance consumer protection laws governing misrepresentations in insurance documents and communications. Under current law, only misrepresentations in insurance applications are explicitly proscribed. The bill (i) extends prohibitions against misrepresentations contained in current law to all insurance documents and all forms of insurance-related communications, (ii) prohibits agents and others from forging signatures of proposed insureds, insurance applicants, policyowners, claimants and others, and (iii) prohibits agents and others from obtaining signatures under false pretenses, and using such changes to accomplish insurance-related changes not actually authorized by the individuals whose signatures are thus obtained. Patron - Hargrove HB781 Health insurance; conformity with the Health Insurance Portability Act; technical amendments. Provides technical amendments and clarifications to provisions of Virginia law enacted by the 1997 General Assembly implementing the federal Health Insurance Portability Act. Patron - DeBoer HB782 Individual health insurance; guaranteed availability; preexisting conditions. Requires that those persons qualified as "eligible individuals" between April 29, 1997, and January 1, 1998, and who are currently neither eligible for nor enrolled in (i) a group health plan which would provide coverage for preexisting conditions or (ii) Part A or Part B of Title XVIII of the Social Security Act, be afforded the guaranteed availability and preexisting conditions provisions of Virginia law that became effective January 1, 1998, even if such individuals have already obtained individual health insurance coverage. These guaranteed availability and preexisting conditions provisions ordinarily apply only to individuals moving from insurance coverage under a group or similar health plan. The bill also has a sunset clause; its provisions expire on January 1, 1999. The bill has an emergency clause. Patron - DeBoer HB854 Accident and sickness insurance; small employer market. Provides that essential and standard health benefit plans issued to small employers be rated on a "modified community" basis. Small employers consist of groups of two to 50 employees. Currently, modified community rating is applicable only to standard and essential health benefit plans issued by health insurance issuers to primary small employers, which are groups of two to 25 employees. Modified community rating uses demographic factors, such as age, gender, and geographic area. A group's rate can be adjusted 20 percent higher or lower based on claims experience, health status, duration or other risk classification factors. Patron - Morgan HB855 Group life and group accident and sickness insurance policies; delivery requirements. Amends the requirements for delivery or issue for delivery of certain group life and group accident and sickness insurance policies. Group life and group accident and sickness insurance policies which are issued outside of the Commonwealth but cover Virginia residents must meet certain requirements if the policy is issued to a group other than one of the following: an employer, a creditor, a labor union or similar employee organization, certain trusts and associations, or a credit union. Group life and group accident and sickness insurance policies which are issued out-of-state to groups other than those listed above and which cover Virginia residents shall not be delivered in this Commonwealth unless the State Corporation Commission (SCC) finds that (i) the issuance of such group policy is not contrary to Virginia's public policy and is in the best interest of the citizens of this Commonwealth; (ii) the issuance of the group policy would result in economies of acquisition or administration; and (iii) the benefits are reasonable in relation to the premium charged. An insurer which files a certification with the SCC that another state has made a determination that such requirements have been met may issue the policy. Group life and group accident and sickness insurance policies which are issued to a type of group other than those listed above and which do not meet the above requirements shall be subject to the statutory requirements of Title 38.2. Such policies failing to meet these provisions may only be marketed by agents holding a valid insurance agent license. The SCC may review the records of any insurer to determine compliance with the requirements of this bill. Patron - Morgan HB883 Motor vehicle insurance; cancellation and nonrenewal. Eliminates the current statutory prohibition of motor vehicle insurance nonrenewal because of a single claim filed by an insured under his medical payments coverage in connection with a not-at-fault accident. The bill also modifies policy cancellation provisions concerning driver's license suspension or revocation during a motor vehicle insurance policy period. Cancellation of a renewal policy due to such suspension or revocation under the bill's provisions would be permitted during the policy period or the 90 days immediately preceding the last effective date, rather than the 90 days immediately preceding the last anniversary of the effective date. Patron - Hargrove HB884 Insurance; written notification of cancellation of policy. Provides that named insureds or their duly constituted attorneys-in-fact must cancel or not renew insurance policies in writing only in circumstances where the insurer requires such written notification. Patron - Hargrove HB915 Health and related insurance for state employees; State Plan for Medical Assistance Services; accident and sickness insurance; prostate-related procedures. Requires health care coverage companies (including health insurers and HMOs), together with the health care coverage plan for state employees and the state plan for Medicaid, to provide coverage for PSA testing and digital rectal examinations to persons age 50 and over and to persons age 40 and over who are at high risk for prostate cancer according to American Cancer Society guidelines. These tests and examinations are conducted for the purpose of detecting and treating prostate cancer. "PSA testing" means the analysis of a blood sample to determine the level of prostate-specific antigen. The provisions of this bill are not applicable to (i) short-term travel, accident only, limited or specified disease policies other than cancer policies; (ii) short-term nonrenewable policies of not more than six months' duration; or (iii) Medicare policies or contracts or any other similar coverage under state or federal governmental plans. The bill also makes a clarifying amendment in statutes governing the health care coverage plan for state employees. Patron - Reid HB1075 Health maintenance organizations; point-of-service plans. Requires health maintenance organizations (HMOs) to include a point of service (POS) benefit to be offered in conjunction with the HMO's health care plan as an additional benefit for the enrollee, at the enrollee's option, individually to accept or reject. HMOs may contract with another health insurance carrier to provide the POS benefit required by the legislation. Premiums charged to enrollees who choose the POS benefit may be different from those charged to enrollees who do not choose the POS benefit. The premiums charged for the POS benefit must be actuarially sound and supported by a sworn certification of an officer of each carrier offering the POS benefit. Unless otherwise directed or authorized by the group contract holder, (i) any enrollee who selects the POS benefit is responsible for the additional premium cost, and (ii) no portion of the additional cost for the POS benefit may be reflected in the premium charged by the carrier to the group contract holder for a health benefit plan without the POS benefit. Generally, different co-insurance, co-payments, deductibles and other cost-sharing arrangements for the POS benefit can be imposed so long as these requirements are consistent with similar provisions in other POS benefit plans actively marketed by the carrier. The co-insurance required of the POS enrollees cannot exceed the greater of 30 percent of the carrier's allowable charge or the co-insurance amount that would have been required had the covered items or services been received through the provider panel. Reimbursement to providers for services received through the POS benefit must be at least as favorable as (i) reimbursement made to similar providers in another POS benefit plan which is regulated under Title 38.2 and is offered and actively marketed in the Commonwealth, or (ii) reimbursement made to similar providers on the HMO's provider panel. Additionally, the scope of POS benefits must be as great as the corresponding benefits provided through the health care plan for a particular group, and marketing materials must reflect that scope. HMOs are not required to offer the POS benefit if the HMO determines in good faith that the group contract holder will be concurrently offering another POS benefit plan to its enrollees. The POS requirement applies only to group health benefit plans issued in the commercial group market, and does not apply to (i) the individual market, (ii) Medicare, (iii) Medicaid, (iv) federal employees, (v) CHAMPUS, (vi) state employee health benefits program, (vii) self-insured or self-funded health benefit plans which allow enrollees to access care from their provider of choice whether or not the provider is a member of the health maintenance organization's panel, and (viii) other limited types of policies. The State Corporation Commission is authorized to issue regulations consistent with the provisions of the legislation. Patron - Melvin HB1234 Accident and sickness insurance; health services plans, licensed acupuncturists. Requires health insurers and health service plan providers who furnish coverage for acupuncture treatment to provide equal coverage for such services when provided by acupuncturists licensed by the Virginia Board of Medicine. Patron - Shuler HB1253 Fire Programs Fund. Provides that moneys in the Fire Programs Fund may not be diverted or expended for any purpose not specifically set forth in the statute establishing the Fund, unless authorized by a specific act of assembly other than the general appropriation act. Patron - Barlow HB1281 Insurance; pet accident, sickness and hospitalization. Authorizes the Bureau of Insurance of the Virginia State Corporation Commission (SCC) to issue restricted insurance agent licenses to individuals selling pet accident, sickness and hospitalization insurance. These licenses may be issued without examination to individuals making application for them who must, however, meet other general requirements for agent licensing as administered by the Bureau of Insurance. Under current law, since pet insurance is a property and casualty insurance product (pets are deemed property), agents selling it must be licensed as property and casualty insurance agents. Patron - Hargrove HB1353 Liability insurance; private pleasure watercraft. Requires insurers to offer, with any new or renewed policy of liability insurance for private pleasure watercraft, optional uninsured operator coverage. Patron - Armstrong HB1399 Health care plan for state employees; diabetes coverage. Requires the health care plan for state employees to provide coverage for equipment, supplies and outpatient self-management training and education, including medical nutrition therapy, required for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and non-insulin-using diabetes if prescribed by a health care professional legally authorized to prescribe such items. To qualify for coverage under the provisions of this bill, diabetes outpatient self-management training and education must be provided by a certified, registered or licensed health care professional. Patron - Orrock HB1413 Accident and sickness insurance; coverage for early intervention services. Requires health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for medically necessary early intervention services. "Early intervention services" means medically necessary speech and language therapy, occupational therapy, physical therapy, and assistive technology services and devices for dependents from birth to age three who are certified by the Department of Mental Health, Mental Retardation and Substance Abuse Services as eligible for services under Part H of the Individuals with Disabilities Education Act (20 U.S.C. § 1471 et seq.). "Medically necessary early intervention services for the population certified by the Department of Mental Health, Mental Retardation and Substance Abuse Services" means those services designed to help an individual attain or retain the capability to function age-appropriately within his environment, and includes services which enhance functional ability without effecting a cure. This coverage is limited to a benefit of $5,000 per insured or member per policy or calendar year. This bill also requires that the cost of these medically necessary early intervention services not be applied to any contractual provision limiting the total amount of coverage paid by the insurer to or on behalf of the insured during the insured's lifetime. Additionally, copayments, coinsurance or deductibles resulting from receiving early intervention services may be paid by federal, state, or local funds. The bill's provisions are applicable to policies, plans and contracts delivered, issued for delivery or renewed on and after July 1, 1998. They are not applicable to short-term travel, accident only, limited or specified disease policies, policies or contracts designed for issuance to persons eligible for coverage under Medicare, or to short-term nonrenewable policies of not more than six months' duration. Patron - Christian SB40 Insurance; declarations of estimated assessments. Requires all insurers subject to Virginia State Corporation Commission (SCC) maintenance assessments (used to maintain the SCC's Bureau of Insurance) to file quarterly declarations if their estimated annual maintenance assessment liabilities are expected to exceed $3,000. Under current law, these estimates are required only from companies who also file premium tax estimates, effectively excluding entities not liable for premium taxes from maintenance assessment estimate obligations. The bill's provisions will become effective on January 1, 1999. Patron - Colgan SB41 Insurance; automobile clubs. Makes the following changes to Virginia's statutes governing automobile clubs: (i) establishes time frames and fees for licensing automobile clubs that are consistent with the time frames (other entities' licenses renew effective July 1; automobile club licenses currently renew January 1) and fees (other entities pay a $500 nonrefundable application fee and at least a $200 annual renewal fee; automobile clubs pay an initial fee of $100 and an annual renewal fee of $100) for other entities licensed by the Bureau of Insurance; (ii) codifies the specific grounds upon which the Commission may suspend, revoke, or refuse to issue a license to an automobile club; (iii) subjects automobile club agents to the same standards for license qualification as apply to other holders of restricted agent licenses; (iv) subjects automobile club agents to the same licensing and appointment requirements as apply to all other restricted licenses issued by the Bureau, including making the restricted license perpetual (as opposed to annually renewable as of January 1 each year) and imposing upon automobile clubs the same annual appointment renewal fees and quarterly billing for appointments and appointment renewals that are at present applicable to all other licenses and licensees; (v) subjects automobile club agents to the same grounds for license refusal, suspension, or revocation as apply to all other licensees; and (vi) corrects some minor editorial changes in the current law to conform the law internally (e.g., the law refers in some places to "motor clubs" and "holders of service contracts," both terms being outmoded) to provide for consistent use of the terms "automobile club" and "members or subscribers of any such club." Patron - Colgan SB58 Insurance; policy forms filed with Virginia State Corporation Commission. Adds health and life insurance enrollment forms to the types of forms that must be filed with the Virginia State Corporation Commission prior to their use in connection with the sale of insurance within the Commonwealth. Patron - Wampler SB64 Property and Casualty Insurance Guaranty Association. Authorizes Virginia's Property and Casualty Insurance Guaranty Association ("the Association"), whose membership is comprised of insurers writing property and casualty insurance within the Commonwealth, to obtain commitments or lines of credit, and to secure borrowings by pledging future assessments. The bill does, however, limit the amount of Association borrowings, while establishing related approvals required from the Virginia State Corporation Commission (SCC) and providing clarifications in provisions governing the operation of the Association's Safety Fund. The proposed lines of credit could be drawn on only in the event of insurer insolvency following a natural disaster. These funds would enable the Association to respond promptly to claims under policies underwritten by a suddenly insolvent insurer--such as could occur in the event of widespread casualty and property losses from a particularly severe multi-state or coastal hurricane. In addition, the amendments clarify in Chapter 16 of Title 38.2 that guaranty fund coverage is not available for risks insured by risk retention groups. Patron - Chichester SB224 Insurance; private review agents. Transfers responsibility for certificating private review agents from the Virginia State Corporation Commission's Bureau of Insurance to the Department of Health. Private review agents conduct "utilization reviews" for insurers, reviewing the necessity, appropriateness and efficiency of hospital, medical or other health care resources in determining whether a service should be covered by a health care coverage plan. Persons conducting utilization reviews as employees of HMOs, health insurers and other entities offering health care coverage plans are not regulated as private review agents. Such entities, while themselves exempt from regulation as private review agents, are subject--along with their agents and employees--to the utilization review standards and appeals provisions contained in Chapter 54 (§ 38.2-5400 et seq.) of the insurance title. Patron - Stosch SB247 Insurance; retaliatory payments and reports. Establishes a March 1 deadline for foreign and alien insurers' annual "retaliatory" report and payment submissions to the Virginia State Corporation Commission (SCC). Additionally, the bill authorizes the SCC to assess penalties and interest for late payment. This report and payment scheme is related to the SCC's current statutory authorization to equalize regulatory costs between Virginia's domestic insurers doing business as foreign or alien insurers in other states, and their foreign or alien insurer counterparts in Virginia. Current Virginia law requires foreign or alien insurers to annually provide regulatory cost information from their domiciliary states to the SCC for the SCC's use in determining whether Virginia's domestic insurers doing business in other states are subject to comparatively greater regulatory costs in those states. Foreign or alien insurers are assessed "retaliatory" payments by the SCC whenever the SCC determines that such insurers' home states subject Virginia's domestic insurers to greater regulatory costs than would be imposed on a comparable alien or foreign insurer doing business in Virginia. Any payment required from a foreign or alien insurer is the difference between the foreign or alien insurer's Virginia regulatory costs and the regulatory costs imposed on their Virginia-domiciled counterparts by the foreign or alien insurer's home state. Patron - Holland SB248 Insurance; financial regulation of certain insurers. Establishes specific net worth requirements for entities seeking licensure as health maintenance organizations (HMOs), and applies minimum net worth requirements to all HMOs. Additionally, the bill authorizes the SCC to issue notices of financial impairment to HMOs, requiring them to eliminate the impairment within 90 days and prohibiting the issuance of new HMO contracts during the impairment's pendency. A phase-in period for the new minimum capitalization requirements is provided in the bill. The bill broadens HMOs' investment authority and makes their investments subject to SCC oversight and regulation under Chapter 14 (§ 38.2-1400 et seq.) of the insurance title. HMOs are also brought under provisions of Article 5 (§ 38.2-1322 et seq.) of Chapter 13, governing insurance holding companies. These provisions, already applicable to other insurers, (i) require the disclosure of affiliated relationships and (ii) authorize specific SCC regulatory oversight of material transactions within the holding company system. The bill also subjects HMOs to current law requiring prior approval of controlling management and exclusive agency contracts. This amendment also extends the application of this provision to premium finance companies, and to dental and optometric service plans, while clarifying its application to legal services plans. Patron - Holland SB251 Accident and sickness insurance; coverage for hemophilia and congenital bleeding disorders. Requires health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for hemophilia and congenital bleeding disorders. The benefits mandated include coverage for expenses incurred with the treatment of routine bleeding episodes, and coverage for the purchase of blood products and blood infusion equipment required for home treatment of routine bleeding episodes when the home treatment is conducted under the supervision of the state-approved hemophilia treatment center. The bill's provisions are applicable to policies, plans and contracts delivered, issued for delivery or renewed on and after July 1, 1998. They are not applicable to short-term travel, accident only, limited or specified disease policies, policies or contracts designed for issuance to persons eligible for coverage under Medicare, or to short-term nonrenewable policies of not more than six months' duration. Patron - Barry SB372 Genetic information. Repeals the sunset from the genetic privacy act. The act was to expire on July 1, 1998. Patron - Howell SB421 Insurance fraud; delegation of related duties to the Department of State Police. Creates an Insurance Fraud Investigation Unit within the Department of State Police's Bureau of Criminal Investigation to initiate independent inquiries and conduct independent investigations into fraudulent acts involving property and casualty insurance transactions. This activity would be funded by premium assessments on all property and casualty insurance companies writing policies in the Commonwealth. The provisions of this bill become effective on January 1, 1999, and expire on January 1, 2003. Patron - Colgan SB422 Insurance; continuing education requirements for insurance agents. Addresses insurance agent and consultant continuing education requirements. The bill requires sponsors of continuing education courses to indicate to agents enrolling in continuing education courses whether such courses are determined by the insurance continuing education board ("the Board") to be insurance company or agency-sponsored. Agents may not receive more than 75 percent of their required continuing education requirements from insurance company or agency-sponsored courses. Agents must complete all required courses by December 31 of each even-numbered year and submit proof of compliance on or before the close of the business day on February 28 of the following year. An extension, until March 31, for submitting proof of compliance is allowed if an agent pays, in addition to any other fees ordinarily imposed, a late filing fee of $250. Those agents whose licenses are terminated for failure to satisfy continuing education requirements may appeal the termination in writing within 60 days of the date of termination. The right to appeal is waived if an agent fails to appeal in writing within 60 days of the date of termination. The Board will provide status reports to agents who have not yet satisfied the continuing education requirements both at six months and 45 days prior to the end of the biennium. Additionally, the bill allows agent whose license has been terminated to make application prior to the expiration of the 90-day period, provided that the agent has fulfilled the study course and examination requirements and pays an administrative penalty of $1000. The bill's provisions are subject to an emergency clause, making them effective upon passage. Patron - Colgan SB423 Insurance; motor vehicle rental contract insurance. Requires individuals selling motor vehicle rental contract insurance to obtain a license from the State Corporation Commission and provide written disclosure to prospective renters that (i) summarizes clearly and correctly the material terms of the insurance coverage offered, (ii) advises the prospective renter that the insurance coverage offered may duplicate coverage already owned by the prospective renter, and (iii) states that the purchase of the insurance coverage offered is not required in order to rent a motor vehicle. Patron - Colgan SB462 Uniform consultation referral form. Requires the State Corporation Commission to adopt a uniform consultation referral form for any health care entity identified as a utilization management organization by the Health Care Financing Administration for its Electronic Data Interchange. This uniform referral form will be the sole form authorized for use by any entity which requires its insureds, subscribers or enrollees to obtain referrals in writing. No entity may impose, as a condition of coverage, any requirement to modify the uniform consultation referral form or submit additional consultation referral forms. Patron - Woods SB467 Fire Programs Fund. Provides that moneys in the Fire Programs Fund may not be diverted or expended for any purpose not specifically set forth in the statute establishing the Fund, unless authorized by a specific act of assembly other than the general appropriation act. Patron - Quayle SB553 Accident and sickness insurance; calculation of cost-sharing provisions; out-of-state services. Allows health insurers, health service plans and health maintenance organizations to use, for the purpose of determining an insured's, subscriber's, or enrollee's percentage of the cost of covered service, the cost of services as reported by an out-of-state insurer, health services plan, or health maintenance organization when an insured, subscriber, or enrollee receives covered services by such an out-of-state entity. Patron - Barry SB626 Medical assistance services; operation and oversight of pre-PACE and PACE plans. Establishes operational, jurisdictional, and regulatory parameters for pre-PACE and PACE plans. The Program for All Inclusive Care for the Elderly, or PACE, is a program providing community-based services for elderly individuals and is intended to serve as an alternative to institutionalized care. The bill also identifies the pre-PACE and PACE plans to which insurance regulation will not be applicable. Patron - Schrock SB679 Health and related insurance for state employees; State Plan for Medical Assistance Services, accident and sickness insurance; coverage for reconstructive breast surgery. Requires the state employee health insurance plan, the Virginia Medicaid program, and health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to cover reconstructive breast surgery. "Reconstructive breast surgery" means surgery on or after July 1, 1998, coincident to or following a mastectomy performed for breast cancer, to reestablish symmetry between the two breasts. The bill's provisions are applicable to insurance policies, plans and contracts delivered, issued for delivery or renewed on or after July 1, 1998. They are not applicable to short-term travel, accident only, limited or specified disease policies (except policies issued for cancer), policies or contracts designed for issuance to persons eligible for coverage under Medicare or to short-term nonrenewable policies of not more than six months' duration. Patron - Reynolds SB705 Health and related insurance for state employees; State Plan for Medical Assistance Services; accident and sickness insurance; prostate-related procedures. Requires health care coverage companies (including health insurers and HMOs), together with the health care coverage plan for state employees and the state plan for Medicaid, to provide coverage for PSA testing and digital rectal examinations to persons age 50 and over and to persons age 40 and over who are at high risk for prostate cancer according to American Cancer Society guidelines. These tests and examinations are conducted for the purpose of detecting and treating prostate cancer. "PSA testing" means the analysis of a blood sample to determine the level of prostate-specific antigen. The provisions of this bill are not applicable to (i) short-term travel, accident only, limited or specified disease policies other than cancer policies; (ii) short-term nonrenewable policies of not more than six months' duration; or (iii) Medicare policies or contracts or any other similar coverage under state or federal governmental plans. The bill also makes a clarifying amendment in statutes governing the health care coverage plan for state employees. Patron - Stolle Failed HB639 Motor vehicle insurance; accident and conviction surcharges. Requires motor vehicle insurers to include, as part of their rate classification statement, a detailed description of how accidents and convictions may affect the policy premium. Patron - Puller HB754 Insurance agents; prohibition of agency termination; loss ratios; good cause. Prohibits property and casualty insurers from canceling at any time an agency relationship because of an adverse loss ratio on the agent's book of business if (i) the insurer required the agent to submit the application for underwriting approval or accepted policies without prior approval if the application was complete, (ii) all material on the application was complete, and (iii) no information on the application was altered or omitted by the agent. Additionally, the bill prohibits insurer termination of agency contracts with any insurance agent who has been employed by an insurance company for more than five years except for good cause. "Good cause" is defined as criminal misconduct, gross negligence relating to the business, fraud, moral turpitude, abandonment of business, or failure to pay moneys owed to the insurance company. "Good cause" does not include the termination of an agency relationship due to adverse loss ratios. Finally, the bill requires insurance companies terminating any contractual relationship with an agent to notify the agent by certified mail at least 90 days prior to the proposed date of cancellation and to include with such notice a statement of the grounds upon which the insurance company bases the decision to cancel the contractual relationship. Patron - Stump HB1099 Health care provider panels; prohibited practices. Prohibits carriers offering health care provider panels from excluding a provider solely on the basis of a reprimand or censure from the provider's respective licensing board containing terms and conditions that do not limit the ability of the provider to provide services so long as the provider meets the criteria for inclusion on the panel. Patron - Jones, S.C. HB1230 Health insurance; assignment of benefits. Prohibits health care coverage plan providers from refusing to accept assignments of benefits executed by covered individuals in favor of health care providers and hospitals. The bill is applicable to (i) insurers issuing individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis, (ii) corporations providing individual or group accident and sickness subscription contracts, (iii) health maintenance organizations providing health care plans for health care services, and (iv) dental services plan offering or administering prepaid dental services. An "assignment of benefits" is the transfer of health care coverage reimbursement benefits or other rights under an insurance policy, subscription contract or health care plan by an insured, subscriber or plan enrollee to a health care provider or hospital. Patron - Tate HB1283 Insurance; education requirements for insurance agents. Defines "distance education" for purposes of calculating the required 45 hours of study courses that must be completed before registering to take an examination for an insurance license. Each applicant for an insurance license may complete these requirements through any combination of classroom education or distance education. "Distance education" is any instruction delivered or presented under the general supervision of an instructor using electronic media that permit students to have direct electronic contact with the instructor during no less than 75 percent of the required hours. "Distance education" does not include self-study or correspondence courses. Patron - Hargrove SB374 Insurance; unfair settlement practices; replacement and repair. Prohibits insurance companies and their representatives from recommending the use of a designated replacement or repair facility or service or products of a designated manufacturer when settling a claim without first advising the insured or claimant in writing that they are not obligated to use such facilities, services, or materials. Failure to advise the insured or claimant may result in penalties of up to $5,000. The use of such facilities, services or materials alters neither the insurer's nor the insured or claimant's liabilities or obligations under the insurance policy or the law. Patron - Martin SB390 Motor vehicle insurance and disclosure of coverage. Requires insurers to disclose motor vehicle insurance policies' liability limits to persons (or their personal representatives or attorneys) who have made or intend to make claims against such policies on account of bodily injury or death. Patron - Stolle SB456 Health maintenance organizations; authorized providers. Allows a health maintenance organization to include in its network physicians who are licensed in the jurisdiction where the health care services are rendered. Patron - Wampler SB572 Health maintenance organizations; sub-network health care plans. Authorizes health maintenance organizations (HMOs) to offer sub-network health care plans. Such plans are defined as plans with specified limitations on available providers, provided that a full array of providers is included and all current requirements for provider availability and accessibility are met. The specified limitations may include, but are not limited to, providers located in specific geographic areas within HMOs' service areas. Patron - Saslaw SB685 Insurance agents; prohibition of agency termination; loss ratios; good cause. Prohibits property and casualty insurers from canceling at any time an agency relationship because of an adverse loss ratio on the agent's book of business if (i) the insurer required the agent to submit the application for underwriting approval or accepted policies without prior approval if the application was complete, (ii) all material on the application was complete, and (iii) no information on the application was altered or omitted by the agent. Additionally, the bill prohibits insurer termination of agency contracts with any insurance agent who has been employed by an insurance company for more than five years except for good cause. "Good cause" is defined as criminal misconduct, gross negligence relating to the business, fraud, moral turpitude, abandonment of business, or failure to pay moneys owed to the insurance company. "Good cause" does not include termination of an agency relationship due to adverse loss ratios. Finally, the bill requires insurance companies terminating any contractual relationship with an agent to notify the agent by certified mail at least 90 days prior to the proposed date of cancellation and to include with such notice a statement of the grounds upon which the insurance company bases the decision to cancel the contractual relationship. Patron - Reasor Carried Over HB415 Insurance; underinsured motor vehicle coverage. Amends statutory language outlining the formula for calculating underinsurance coverage. The statute's current language provides that a motor vehicle is underinsured when, and to the extent that, the total amount of bodily injury and property damage coverage applicable to the operation or use of the motor vehicle and available for payment for such bodily injury or property damage, including all bonds or deposits of money or securities made pursuant to Article 15 (§ 46.2-435 et seq.) of Chapter 3 of Title 46.2, is less than the total amount of uninsured motorist coverage afforded any person injured as a result of the operation or use of the vehicle. The bill provides that the "total amount of uninsured motorist coverage" may include all uninsured motorist coverage applicable to the operation or use of a motor vehicle occupied by an injured person who is not the vehicle's operator at the time of the accident causing his injuries. Patron - McEachin HB417 Insurance; unfair settlement practices; replacement and repair. Prohibits insurance companies and their representatives from recommending the use of a designated replacement or repair facility or service or products of a designated manufacturer when settling a claim without first (i) advising the insured or claimant, either orally or in writing, that they are not obligated to use such facilities, services, or materials and (ii) disclosing to the insured or claimant the location of the recommended repair or replacement facility. Failure to advise the insured or claimant may result in penalties of up to $5000. The use of such facilities, services or materials alters neither the insurer's nor the insured or claimant's liabilities or obligations under the insurance policy or the law. Patron - Clement HB699 Accident and sickness insurance; coverage for hospice care. Requires health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for hospice care. "Hospice care" means palliative medical care and related services as covered under Medicare, provided by a licensed hospice in accordance with a plan of care established and maintained by the treating hospice. "Terminal illness" means a condition in an individual that has been diagnosed as terminal by a licensed physician, whose medical prognosis is death within six months, and who elect to receive palliative rather than curative care. Reimbursement rates for hospice care must be no less than rates for the same services provided under Medicare and documentation requirements must not be greater than those required for the same services under Medicare. This bill does not prevent insurers, corporations, or health maintenance organizations from offering or providing coverage for hospice services, even if it cannot be demonstrated that the illness is terminal or that the individual's life expectancy is longer than six months. The provisions of this bill do not apply to short-term travel, accident only, limited or specified disease policies, or to short-term nonrenewable policies of not more than six months duration. Patron - Callahan HB721 Credit insurance. Modifies Virginia's credit insurance laws. Included in the bill are provisions which (i) alter disclosure, enrollment request, and readability requirements applicable to the purchase of credit involuntary unemployment insurance, credit life insurance, and credit accident and sickness insurance; (ii) authorize combination credit insurance coverages which combine credit life, credit accident, credit involuntary unemployment and credit personal property insurance coverages under separate or combined policies; (iii) permit lump-sum disability payments (under credit accident and sickness insurance policies) where benefit payments are equal to the total of all future periodic payments; (iv) increase from $70,000 to $225,000 the amount of credit life insurance that may be underwritten on a debtor by one insurance company; (v) reduce required loss ratios for credit accident and sickness insurance from 60 percent to 50 percent or lower and reduce required loss ratios for credit life insurance from 60 percent to 60 percent or less; (vi) eliminate triennial, regulatory hearings by the Virginia State Corporation Commission for the purpose of determining actual insurer loss ratios and adjusting prima facie rates; and (vii) permit employees of a creditor or insurer, or of their respective affiliates or related entities, to enroll debtors under various group credit insurance policies without holding licenses as insurance agents, if no commissions are paid to that employee. Patron - Cantor HB871 Health care coverage networks; any willing provider; hospitals. Requires health insurers and corporations issuing health care coverage policies and subscription contracts administered through preferred provider networks, together with health maintenance organizations (HMOs) to accept any hospital as a preferred or participating provider if it is willing to accept the same terms and conditions of network inclusion applicable to other hospitals accepted as network providers. Patron - Griffith HB931 Accident and sickness insurance; coverage for hospitalization and anesthesia for dental procedures. Requires health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for general anesthesia and hospital charges for dental care provided to a covered person who (i) is under the age of five, (ii) is severely disabled, or (iii) has a medical condition and requires hospitalization or general anesthesia for dental care treatment. The bill also mandates coverage for general anesthesia and treatment rendered by a dentist for any medical condition covered under the contract, policy, or plan. The bill's provisions are applicable to policies, plans and contracts delivered, issued for delivery or renewed on and after July 1, 1998. 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. Patron - Shuler HB1051 Insurance; family abuse. Prohibits life and health insurance policies, health services plans, and health maintenance organizations from using information about family abuse or a covered individual's status as a victim of family abuse in a discriminatory manner. Under the provisions of the bill, such prohibited practices include (i) canceling, refusing to underwrite or renew or refusing to issue a policy or plan, (ii) refusing to pay a claim, (iii) increasing rates, and (iv) adding a surcharge, applying a rating factor, or using any underwriting practice that adversely takes the information about family abuse into account. "Family abuse" means any act of violence, including any forceful detention, which results in physical injury or places one in reasonable apprehension of serious bodily injury and which is committed by a person against such person's family or household member. This is not intended to preclude an insurer from using mental or physical medical conditions, regardless of the cause, in determining the eligibility rate or underwriting classification of the applicant or insured. Additionally, the bill provides immunity to life insurers who, in good faith, issue life insurance to an insured who subsequently becomes a victim of family abuse. Finally, the bill does not require life insurers to (i) make payment to an individual who willfully causes an injury which gives rise to a loss under the policy or (ii) issue a policy, without the consent of the proposed insured, to an applicant known to have inflicted family abuse on the proposed insured. Patron - McEachin HB1052 Accident and sickness insurance; mental health coverage. Requires health insurers, health services plans and health maintenance organizations to provide benefits for inpatient, partial hospitalization, medication management and outpatient treatment of mental disorders that are as favorable as the benefits for any other illness, condition, or disorder that is covered by the policy or contract. "Mental disorders" are all medically recognized mental illnesses, as defined by the Diagnostic and Statistical Manual, Fourth Edition, as updated from time to time. In addition to requiring parity in benefits, the bill also requires that coverage for mental disorders be no different from coverage for other illnesses or conditions for the purpose of determining deductibles, benefit year or lifetime durational limits, lifetime episodes or treatment limits, copayment and coinsurance factors, and benefit year maximums for deductibles and copayment and coinsurance factors. The bill does not prevent the undertaking of usual and customary procedures to determine the appropriateness and medical necessity for the treatment of mental disorders, so long as such procedures are made in the same manner as the determinations made for the treatment of any other illness or condition. Patron - McEachin HB1057 Coverage for certain low protein formulas for individuals diagnosed as having phenylketonuria. Requires each (i) insurer issuing individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis, (ii) corporation providing individual or group accident and sickness subscription contracts, and (iii) health maintenance organization providing a health care plan for health care services, whose policy, contract or plan, including any certificate or evidence of coverage issued in connection with such policy, contract or plan, includes coverage for prescription drugs on an outpatient basis, to offer and make available coverage for low protein (low phenylalanine) formulas prescribed for the treatment of phenylketonuria and approved by the United States Food and Drug Administration for such treatment. The term "prescription drug" is deemed to include low protein formulas prescribed for the treatment of phenylketonuria; however, low protein formulas will not include commercial formulas which may be low in protein but have not been developed for the treatment of phenylketonuria. This new section will not require coverage for experimental drugs for phenylketonuria which are not approved by the United States Food and Drug Administration, or for prescription drugs in any contract, policy or plan that does not otherwise provide such coverage. This provision notes that closed formularies are not precluded so long as such formularies include low protein (low phenylalanine) formulas. This section will not apply to short-term travel, or accident-only policies, or to short-term nonrenewable policies of not more than six months' duration. The bill's provisions will apply to policies, contracts, and plans delivered, issued for delivery or renewed in Virginia on and after July 1, 1998. Patron - McDonnell HB1058 Coverage for certain low protein foods for individuals diagnosed as having phenylketonuria. Requires each (i) insurer issuing individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis; (ii) corporation providing individual or group accident and sickness subscription contracts; and (iii) health maintenance organization providing a health care plan for health care services, whose policy, contract or plan, including any certificate or evidence of coverage issued in connection with such policy, contract or plan, includes coverage for prescription drugs on an outpatient basis, to offer and make available coverage for low protein (low phenylalanine) foods prescribed for the treatment of phenylketonuria and approved by the United States Food and Drug Administration for such treatment. This new section specifically notes that low protein foods prescribed for the treatment of phenylketonuria will be deemed to be prescription drugs; however, commercial food products which are low in protein but were not developed for the treatment of phenylketonuria will not be included. The section will not require coverage for experimental drugs for phenylketonuria which are not approved by the United States Food and Drug Administration, or for prescription drugs in any contract, policy or plan that does not otherwise provide such coverage. This provision notes that closed formularies are not precluded so long as such formularies include low protein (low phenylalanine) foods. This section will not apply to short-term travel, or accident-only policies, or to short-term nonrenewable policies of not more than six months' duration. The bill's provisions will apply to policies, contracts, and plans delivered, issued for delivery or renewed in Virginia on and after July 1, 1998. Patron - McDonnell HB1274 Insurance; rebates and charges in excess of premium prohibited; exceptions. Prohibits insurance agents and other insurer representatives from requesting or receiving from an insurance applicant any compensation in excess of required insurance premium payments, unless the applicant consents to such additional compensation, in writing, before insurance services are rendered. Patron - Barlow HB1337 Long-term care insurance. Requires long-term care policies delivered or issued for delivery in Virginia to provide benefits for home health care. Patron - Diamonstein HB1383 Optional health insurance coverage for acupuncture. Requires any (i) individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis; (ii) corporation providing individual or group accident and sickness subscription contracts; and (iii) health maintenance organization providing a health care plan for health care services to offer and provide coverage for acupuncture treatments administered by a physician acupuncturist. These provisions will not apply to short-term travel, accident only, limited or specified disease, or individual conversion policies or contracts, nor to 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 governmental plans. Such policies, plans and contracts may not impose upon any person receiving acupuncture treatments administered by physician acupuncturists any copayment, coinsurance payment or fee that is not equally imposed upon all individuals in the same benefit category, class, coinsurance level or copayment level receiving benefits for other medical and surgical procedures. These provisions apply to policies, plans, and contracts delivered, issued for delivery or renewed in the Commonwealth after July 1, 1998. Patron - Tata HB1398 Accident and sickness insurance; coverage for diabetes. Requires health insurers, health care subscription plans and health maintenance organizations to provide coverage for diabetes. The coverage required includes benefits for equipment, supplies and outpatient self-management training and education, including medical nutrition therapy, required for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and non-insulin-using diabetes, if prescribed by a health care professional legally authorized to prescribe such items. To qualify for coverage under the provisions of this bill, diabetes outpatient self-management training and education must be provided by a certified, registered or licensed health care professional. The bill's provisions are applicable to policies and plans issued on and after July 1, 1998. Patron - Orrock SB86 Health care plan for state employees; accident and sickness insurance; coverage for diabetes. Requires the health care plan for state employees, health insurers, health care subscription plans and health maintenance organizations to provide coverage for diabetes. The coverage required includes benefits for the equipment, supplies and outpatient self-management training and education, including medical nutrition therapy, required for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and non-insulin-using diabetes, if prescribed by a health care professional legally authorized to prescribe such items. To qualify for coverage under this bill, diabetes outpatient self-management training and education must be provided by a certified, registered or licensed health care professional with expertise in diabetes. The bill's provisions would be applicable to accident and sickness insurance policies and plans issued on and after July 1, 1998. Patron - Colgan SB244 Accident and sickness insurance; coverage for diabetes. Requires health insurers, health care subscription plans and health maintenance organizations to provide coverage for diabetes. The coverage required includes benefits for the equipment, supplies and outpatient self-management training and education, including medical nutrition therapy, required for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and non-insulin-using diabetes, if prescribed by a health care professional legally authorized to prescribe such items under law. To qualify for coverage under this bill, diabetes outpatient self-management training and education must be provided by a certified, registered or licensed health care professional. The bill's provisions are applicable to policies and plans issued on and after July 1, 1998. Patron - Howell SB430 Accident and sickness insurance; mental health coverage. Requires health insurers, health services plans and health maintenance organizations to provide benefits for inpatient, partial hospitalization, medication management and outpatient treatment of mental disorders that are as favorable as the benefits for any other illness, condition, or disorder that is covered by the policy or contract. "Mental disorders" are all medically recognized mental illnesses, as defined by the Diagnostic and Statistical Manual, Fourth Edition, as updated from time to time. In addition to requiring parity in benefits, the bill also requires that coverage for mental disorders be no different from coverage for other illnesses or conditions for the purpose of determining deductibles, benefit year or lifetime durational limits, lifetime episodes or treatment limits, copayment and coinsurance factors, and benefit year maximums for deductibles and copayment and coinsurance factors. The bill does not prevent the undertaking of usual and customary procedures to determine the appropriateness and medical necessity for the treatment of mental disorders, so long as such procedures are made in the same manner as the determinations made for the treatment of any other illness or condition. Patron - Houck SB448 Liability insurance on motor vehicles, aircraft, and watercraft; standard provisions. Allows an insurer to limit its liability for bodily injury or property damage resulting from any one accident or occurrence to the limits set forth in the policy for any such accident regardless of the number of insureds under that policy. Patron - Norment SB509 Medical savings accounts; group self-insurance pools. Authorizes the establishment of group self-insurance associations for the purpose of providing high-deductible, catastrophic health care coverage for use in conjunction with medical savings accounts. The self-insurance associations must be unincorporated, and the insurance they provide must be community rated and contain no preexisting conditions exclusions. Additionally, the associations may have no contractual relations with any health care providers or health care facilities. The bill's provisions will become effective on July 1, 1999. In the interval, the Joint Commission on Health Care, assisted by the Bureau of Insurance of the State Corporation Commission and the Department of Taxation, will examine the current provisions of federal and state taxation and insurance laws to determine the feasibility of implementing the provisions of this act. The Joint Commission shall report its findings to the Governor and the 1999 Session of the General Assembly. Patron - Quayle SB555 Insurance agents; continuing education requirements. Provides that bail bond agents may satisfy insurance agent continuing education requirements by completing eight hours of continuing education credits. Patron - Barry SB556 Insurance agent licenses; bail bond agents. Removes bail bond agents from the list of property and casualty insurance agent categories exempt from taking written examinations as a requirement for licensing. Patron - Barry SB584 Health care coverage; infant hearing screenings. Requires health insurers, health maintenance organizations, and corporations providing subscription contracts for health care coverage to provide coverage for infant hearing screenings and all necessary follow-up diagnostic audiological examinations. These requirements are also made applicable to the state's health care coverage plan for state employees, and to the state plan for medical assistance (Medicaid). Patron - Forbes SB649 HMO liability; health care treatment decisions. Establishes a cause of action for persons who suffer damages as a result of a health maintenance organization's failure to exercise ordinary care in making a health care treatment decision affecting such person. Persons may file claims directly with the court and are not required to follow the procedures governing the medical malpractice review panel or the utilization review process. In addition, the medical malpractice liability cap does not apply to such actions. Patron - Edwards SB652 Health care coverage; preexisting conditions. Prohibits the use of preexisting condition exclusions in health care coverage policies and plans issued by Virginia-regulated health insurers, health maintenance organizations, and corporations furnishing subscription contracts for health care coverage. A "preexisting condition exclusion" is generally defined as a limitation or exclusion of benefits relating to a medical condition present before coverage under a policy or plan was applied for or obtained, regardless of whether the condition was diagnosed or treated before that time. Patron - Edwards SB655 Health care coverage; pharmacies. Requires (i) health insurers, (ii) health maintenance organizations, and (iii) corporations offering health care subscription contracts which offer health care coverage policies, contracts or plans with mail order prescription drug benefits to also provide equitable coverage for non-mail order prescription drug services through local pharmacies. Equitable coverage means that mail order and non-mail order coverage must have identical dollar limits, cost sharing provisions, and other provisions concerning cost and coverage. Patron - Edwards SB715 Health care coverage; childhood immunizations. Requires health insurers, health maintenance organizations (HMOs) and corporations providing health care coverage subscription contracts to provide coverage for childhood immunizations. The required benefits apply to children from birth to 36 months of age, and it extends to all routine and necessary immunizations including diphtheria, pertussis, tetanus, polio, hepatitis B, measles, mumps, rubella, and other such immunizations as may be prescribed by the Commissioner of Health. Patron - Reasor < PREVIOUS | CONTENTS | NEXT >