Insurance

Insurance

P Passed

P 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 a coordinated program of home and inpatient care provided directly or under the direction of a licensed hospice and includes palliative and supportive physical, psychological, psychosocial and other health services to individuals with a terminal illness, utilizing a medically directed interdisciplinary team. "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 elects to receive palliative rather than curative care. The bill stipulates that documentation requirements for hospice coverage must be no 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 where 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 short-term nonrenewable policies of not more than six months duration or to Medicare supplement policies.

Patron - Callahan

P 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 disclosures concerning credit insurance coverages; (iii) permit the Commission, when setting credit insurance rates, to consider the following factors, in addition to loss ratios: (a) actual and expected loss experience, (b) general and administrative expenses, (c) loss settlement and adjustment expenses, (d) reasonable creditor compensation, (e) investment income, (f) the manner in which premiums are charged, (g) other acquisition costs, reserves, taxes, regulatory license fees and fund assessments, and (h) other relevant data consistent with generally accepted actuarial standards; and (iv) 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

P HB871

State employees' health insurance plan and managed care health insurance plans generally. Implements comprehensive reforms in health insurance plans (including group or individual insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis, individual or group subscription contracts provided by nonstock corporations, and health care plans for health care services provided by health maintenance organizations) and the state employees' health plan by providing for increased benefits and protections for covered persons. The bill establishes, within the State Corporation Commission's Bureau of Insurance, a process of independent external review for individuals denied a course of treatment by their health insurance plan. If the person seeking review is determined by the Bureau of Insurance to (i) have coverage by the health plan, (ii) be seeking a treatment that appears to be covered by the plan and costs more than $500, (iii) have exhausted all available utilization review complaint and appeals procedures and (iv) have provided all information necessary to begin review, an impartial health entity shall review the final adverse decision to determine whether the decision is objective clinically valid, compatible with established principles of health care, and contractually appropriate. Each individual seeking such review will pay a filing fee of $50, which is nonrefundable. Insurers writing accident and sickness insurance in Virginia will pay an assessment not to exceed 0.015 percent of the direct gross premium income during the preceding year to fund such appeals process. The impartial health entity will issue a written recommendation within thirty days of the acceptance of the appeal by the Bureau of Insurance, and the State Corporation Commission will issue a binding order carrying out the recommendation of the impartial health entity. These appeals provisions become effective either (i) 90 days following the promulgation of regulations by the State Corporation Commission or (ii) July 1, 2000. A similar appeals process is available, within the Department of Personnel and Training, for state employees who receive health care coverage through the state health insurance plan. An Office of Managed Care Ombudsman within the Bureau of Insurance is established. The Managed Care Ombudsman is charged with promoting and protecting the interests of covered persons under health insurance plans in Virginia. The duties of the Managed Care Ombudsman include assisting persons in understanding their rights and processes available to them under their managed care plan, developing information on the types of managed health insurance plans available in Virginia, and monitoring and providing information to the General Assembly on managed care issues. The Department of Personnel and Training is also required to appoint an Ombudsman to similarly assist state health insurance plan participants.

Health insurance plans and the state employees' health plan may develop closed prescription drug formularies only after consultation with a pharmacy and therapeutics committee. This pharmacy and therapeutics committee will have a majority of its members who are physicians, pharmacists, and other health care providers. Additionally, these health plans must allow a covered person to obtain, without additional cost-sharing beyond that provided for formulary prescription drugs within the covered benefits, a specific medically necessary nonformulary prescription drug if, after reasonable investigation and consultation with the prescribing physician, the formulary drug is determined to be an inappropriate therapy for the medical condition of the enrollee. The insurer, corporation, or health maintenance organization must act on such requests within one business day of receipt of the request.

Health insurance plans and the state employees' health plan must provide 90 days notice to enrollees prior to terminating providers, and must allow enrollees to continue using a terminated provider for 90 days. Pregnant women may continue receiving treatment from a terminated provider through delivery, and the terminally ill may continue receiving treatment from such a provider until death. Health insurance plans and the state employees' health plan are required to provide coverage for patient costs associated with clinical trials for treatment studies on cancer, including ovarian cancer. Patient costs covered include the costs of medically necessary health care services required in conjunction with the clinical trials. Costs not covered include the costs of research management or the cost of an investigational drug or device. The clinical trials must be approved by the National Cancer Institute, the Department of Veteran's Affairs, the Food and Drug Administration or the other specified organizations. Phases II, III and IV cancer trials would be covered. Coverage of Phase I trials would be on a case-by-case basis. Women covered under a health insurance plan or the state health plan will receive a minimum hospital stay of 23 hours when undergoing a laparoscopy-assisted vaginal hysterectomy, and a minimum stay of 48 hours for a vaginal hysterectomy, unless the attending physician, in consultation with the patient, decides that a shorter period of hospital stay is appropriate. Health insurance plans and the state employees' health plan may not refuse to accept or make reimbursement pursuant to an assignment of benefits made to a dentist or oral surgeon by a covered person. An "assignment of benefits" means the transfer of dental care coverage reimbursement benefits or other rights under an insurance policy, subscription contract or dental services plan by a covered person. Such covered person must notify the insured, subscriber or enrollee in writing of the assignment. Finally, the bill 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. This specific provision must be reenacted by the 2000 General Assembly prior to becoming effective.

Patron - Griffith

P 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 (i) the applicant consents to such additional compensation, in writing, before insurance services are rendered and (ii) a schedule of fees and documentation for services is made available to applicants and policy holders, upon request.

Patron - Barlow

P HB1465

Motor vehicle insurance; physical damage arbitration. Amends provisions in Virginia's motor vehicle insurance laws concerning mandatory, inter-insurer physical damage arbitration as follows: (i) provides that insurers may, by mutual consent and in lieu of arbitration, agree to the trial of any dispute before a court of competent jurisdiction and (ii) authorizes actions to be asserted in courts of competent jurisdiction whenever an insurer is unable to establish proof of its membership in the Nationwide Intercompany Arbitration Agreement (or any successor thereto). Under current law, arbitration of automobile physical damage claims between insurers is mandatory, and all insurers are required to obtain membership in the Nationwide Intercompany Arbitration Agreement for that purpose.

Patron - Woodrum

P HB1543

Health insurance agents; licensure. Eliminates health insurance agents as a category of licensed insurance agents as of July 1, 2000. Health insurance agents are presently licensed by the Bureau of Insurance and may sell health insurance coverage for health maintenance organizations and health service plans. Agents licensed as life and health agents may also sell these types of insurance products. No new health insurance licenses shall be issued after July 1, 1999, and health insurance agents who wish to continue selling health insurance products must obtain a life and health insurance license.

Patron - Hargrove

P HB1555

Virginia Birth-Related Neurological Injury Compensation Act; referral to Workers' Compensation Commission. Establishes procedures for referrals of civil actions from a circuit court to the Workers' Compensation Commission ("Commission") for the purpose of determining applicability of the Virginia Birth-Related Neurological Injury Compensation Act. When a party moves to refer a matter to the Commission for such a determination, the motion to refer and the motion for judgment are to be forwarded to the Commission. The circuit court must stay the proceeding pending notification by the Commission on the disposition of the motion to refer, which is communicated by the Commission in due course.

Patron - Woodrum

P HB1556

Birth-Related Neurological Injury Compensation Fund; disposition of benefits. Provides that benefits paid for loss of earnings from the Birth-Related Neurological Injury Fund are not assignable and may not be garnished or attached.

Patron - Woodrum

P HB1557

Birth-Related Neurological Injury Compensation Program; board of directors; quorum; board terms. Staggers the terms of the members of the board of directors for the Birth-Related Neurological Injury Compensation Program. The bill also reduces from five to four the number of board members required for a quorum.

Patron - Woodrum

P HB1558

Birth-Related Neurological Injury Compensation Program; notification of possible beneficiaries. Requires insurance companies and self-insured entities to report to the Birth-Related Neurological Injury Compensation Program any claims alleging a possible birth-related neurological injury or severe adverse outcome related to a birth. The program will inform the injured child's parents or guardians of the program and of the eligibility requirements. The report is not admissible in court and is not an inference of liability.

Patron - Woodrum

P HB1559

Birth-Related Neurological Injury Compensation Fund; assets of the Fund. Provides that the assets of the Fund are trust funds to be administered by the board of directors solely to award recipients and execute the Birth-Related Neurological Injury Compensation Program.

Patron - Woodrum

P HB1769

Accident and sickness insurance; claims experience; request for record of policyholder's claims experience. Amends the time period under which a group accident and sickness policyholder may request a complete record of the claims experience incurred under the group policy. Presently, the record must be made available when the request is made more than 60 days prior to the date upon which the contract may be amended. This bill requires such record to be made available when the request is made no less than 30 days prior to the date upon which the contract may be amended.

Patron - Parrish

P HB1901

Uninsured motorist coverage; John Doe actions; tolling of statute of limitations. Provides that the bringing of an action against an unknown owner or operator as John Doe (as provided in the uninsured motorist provisions of Virginia law) shall toll the statute of limitations for purposes of bringing an action against the owner or operator who caused the injury or damages if his identity becomes known.

Patron - Joannou

P HB1922

Structured settlements; authorization for transfer. Conditions the direct or indirect transfer of structured settlement payment rights upon the prior authorization of a court of competent jurisdiction or a responsible administrative authority. The court or authority, as appropriate, must make several findings as a precondition to transfer, including a finding that the proposed transfer is in the best interests of the payee and his dependents. The bill also requires the proposed transferee to make disclosures concerning fees, charges and other amounts that will be deducted from the proceeds payable by the transferee to the transferor. The transferee must also disclose to the transferor the structured settlement's discounted present value, together with the discount rate used to compute that value. A structured settlement is an arrangement for periodic payment of damages for personal injuries established by a settlement or judgment in resolution of a tort claim, or for periodic payments in settlement of a workers' compensation claim. Lump sum payments under the Virginia Workers' Compensation Act are not subject to the provisions of this bill. The bill's provisions will expire on July 1, 2001, unless federal legislation has been enacted by that date which establishes a federal hardship standard governing the transfer of structured settlement payment rights.

Patron - Woodrum

P HB1936

Accident and sickness insurance; group policies; notification to employees upon termination of coverage. Requires employers who (i) assume all or part of the cost of their employees' health insurance, or (ii) provide a facility for deducting the health insurance premium amount from their employees' salaries and remitting such premium to the health insurer, to give written notice to employees in the event of termination of the insurance not later than 15 days after the termination of a self-insured plan or not later than 15 days after receipt of a notice of termination of an insurance plan. Any employer who fails to remit funds collected from an employee to the insurer or plan may be subject to civil suit for any medical expenses the employee may become liable for as a result of the employer letting such coverage be terminated. When coverage is terminated due to the nonpayment of premium by the employer, the insurer or health plan may not terminate coverage until the employer has been provided with a written notice of the termination date, which must not be less than 15 days from the mailing of the notice.

Patron - Morgan

P HB2213

Health insurance; fair business practices. Establishes fair business practices standards applicable to the claim reimbursement practices of health insurance carriers, health services plans and HMOs (referred to as "carriers"). The section requires carriers to (i) pay claims within 40 days of claim receipt, unless the claim is not a clean claim, is disputed in good faith, or there is otherwise no obligation to pay, (ii) contact health care providers within 30 days of receiving reimbursement claims if they desire further claim information or documentation, and (iii) establish reasonable policies giving providers notice of and detailed information concerning carriers' required administrative claims processing procedures. The legislation also prohibits retroactive claim denial unless claims are fraudulent, previously paid, or retroactively reviewed within the lesser of 12 months or a period equal to the number of days in which claims must be submitted after a health care service is provided. On and after July 1, 2000, a carrier must notify a provider at least 30 days in advance of any retroactive denial of a claim. The bill also requires that carriers' provider contracts (and any subsequent amendments) disclose carrier reimbursement fee schedules and policies. The legislation establishes private rights of action for providers who suffer actual damages resulting from carrier violations of the bill's provisions. Providers are entitled to recover treble damages for any willful violations. The Virginia State Corporation Commission is given regulatory oversight cncerning the bill's provisions.

Patron - Parrish

P HB2222

Insurance; payment and sharing commissions; trade names. Allows insurance agents to receive commissions or other valuable consideration in their trade name so long as the trade name has been properly filed with the Bureau of Insurance.

Patron - Behm

P HB2283

Accident and sickness insurance; guaranteed availability of individual health insurance coverage. Requires health insurance issuers to include questions on forms for individual health insurance that will enable the health insurance issuer to determine whether an applicant qualifies as an "eligible individual." "Eligible individuals" must be issued individual health insurance coverage without a preexisting conditions limitation if the coverage is issued within 63 days of termination of coverage under a prior group health insurance contract. The bill also limits 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. The bill's provisions stipulate that limitations for preexisting conditions exclusions for health insurance coverage offered by a health insurance issuer in the individual market must be the same as that offered by a health insurance issuer in connection with a group plan in the small or large group market. The bill also reduces the preexisting conditions exclusion period from 12 to six months, and from 18 to 12 months for a late enrollee. Finally, the bill redefines an "eligible individual" to reduce the aggregate of the periods of creditable coverage from 18 or more months to 12 or more months. It also includes individual health insurance coverage in the list of health insurance coverages that will be considered the most recent prior creditable coverage.

Patron - Morgan

P HB2292

Liability insurance; private pleasure watercraft; optional uninsured private pleasure watercraft coverage. Requires insurers to offer limits of liability for optional uninsured private pleasure watercraft insurance that are equal to the liability limits of the private pleasure watercraft policy. This optional uninsured coverage must include bodily injury and property damage liability, and such coverage will be treated as excess coverage over any other valid and collectible insurance of any kind applicable to the property. No insurer, however, is required to pay damages for uninsured private pleasure watercraft coverage in excess of the limits of uninsured private pleasure watercraft provided by the policy. The requirement to offer any such insurance is limited, by this bill, to insurers offering policies and contracts of marine protection and indemnity insurance. The bill also stipulates that the term "uninsured private pleasure watercraft" does not include any watercraft owned by, furnished to, or available for the regular use of any insured, or owned by and governmental unit or agency. Additionally, the bill prescribes service of process when invoking the uninsured coverage provided by this statute.

Patron - Armstrong

P HB2307

Insurance; unfair settlement practices; replacement and repair; third parties. Holds insurance companies who utilize third parties accountable under the enforcement provisions of Title 38.2. This bill also directs the State Corporation Commission to investigate, with the written authorization of the insured or claimant, all written complaints received regarding replacement and repair facilities, regardless of whether received from individuals or from a repair facility.

Patron - Davis

P HB2345

Health insurance; premium arrearages. Requires health insurers, health services plans, and health maintenance organizations, when accepting premium payments in arrears, to credit such payments to the longest-outstanding arrearage first, and then in succession to the most recent arrearage or payment due. This requirement is applicable to both individual and group policies and plans.

Patron - Marshall

P HB2354

Accident and sickness insurance; coverage of certain pap smears. Requires the state employees' health plan, health insurers, health services plans and HMOs, when providing coverage for pap smears (a mandated benefit), to provide coverage for testing performed by any FDA-approved gynecologic cytology screening technologies.

Patron - Keating

P HB2385

Accident and sickness insurance; requirements for obstetrical care coverage; durational limits, coinsurance factors, copayments. Requires any (i) insurer issuing individual or group accident and sickness insurance (ii) corporation providing individual or group accident and sickness subscription contract, and (iii) health maintenance organization providing a health care plan for health services whose policies, contracts, or plans, including any certificate or evidence of coverage issued in connection with such policies, contracts or plans, include coverage for obstetrical services as an inpatient in a general hospital or obstetrical services by a physician to provide such benefits with durational limits, deductibles, coinsurance factors, and copayments that are no less favorable than for physical illness generally. The bill has an emergency clause; its provisions will be effective upon enactment.

Patron - Keating

P HB2463

Health insurance; small employer market provisions. Allows health insurance issuers who are registered as a health insurance issuer in the small group market and have offered small employer group insurance to the employer as required by law to offer individual health insurance coverage to small employers that differ from the small employer market provisions, so long as the employer does not (i) permit payroll deductions for covered employees and (ii) pay any portion of the premium charged for such coverage. Under current law, the small employer market provisions are applicable to any health insurance issuer who (i) permits payroll deductions for covered employees or (ii) pays any portion of the premiums charged for such coverage. This bill is identical to SB 1217.

Patron - Robinson

P 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, 1999.

Patron - Howell

P SB430

Accident and sickness insurance; mental health coverage. Requires the state health care plans, health insurers, health services plans and health maintenance organizations to provide coverage for biologically-based mental illness. The bill requires that coverage for biologically-based mental illness 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. "Biologically-based mental illness" is any mental or nervous condition caused by a biological disorder of the brain that results in a clinically significant or psychological syndrome or a pattern substantially limiting the person's functioning, including, but not limited to, schizophrenia, schizoaffective disorder, attention deficit hyperactivity disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic disorder, autism, psychotic disorder, and drug and alcohol addiction. The provisions of the bill become effective July 1, 2000, and expire on July 1, 2004. The bill also requires the Department of Personnel and Training to collect data and perform analysis in order to determine the effect of the bill's provisions on claims experience and costs. The Department of Personnel and Training must submit written reports of its findings to the Governor, the General Assembly, and the House Appropriations and Senate Finance Committees no later than December 1, 2001, December 1, 2002, and December 1, 2003. The Special Advisory Commission on Mandated Health Insurance Benefits is directed to collect data, perform studies and convene public hearings to determine the effect of the bill's provisions on claim experience and costs. The Special Advisory Commission on Mandated Health Insurance Benefits must submit written reports of its findings to the Governor and the General Assembly no later than July 1, 2001, December 1, 2002, and December 1, 2003.

Patron - Houck

P 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 liability limits for such coverage set forth in the policy for any such accident regardless of the number of insureds under that policy.

Patron - Norment

P SB892

Insurance licensees; requirement to report to Commission; felony convictions. Requires insurance agents, consultants, reinsurance intermediaries, managing general agents, viatical settlement brokers, and surplus lines brokers to report within 30 days to the State Corporation Commission the facts and circumstances regarding the conviction of a felony. This bill also directs surplus lines agents to report changes of business address to the State Corporation Commission, already a requirement for insurance agents, consultants, reinsurance intermediaries, managing general agents, and viatical settlement brokers.

Patron - Wampler

P SB894

Health maintenance organizations; annual and financial statements. Requires that annual statements, supplemental schedules, and exhibits filed by health maintenance organizations be, as far as practicable, in the form in general use in the United States and, unless otherwise prescribed by the State Corporation Commission, be prepared in accordance with appropriate instructions and publications adopted by the National Association of Insurance Commissioners. The bill also authorizes the State Corporation Commission to require a health maintenance organization to file a copy of its annual statement with the National Association of Insurance Commissioners and copies of financial statements on a quarterly basis. This bill has been incorporated into SB 720.

Patron - Holland

P SB895

Insurance; technical amendments. Clarifies and corrects erroneous cross-references and typographical errors.

Patron - Holland

P SB900

Insurance; consultants and surplus lines brokers; application and renewal fees. Clarifies that the application fees for initial licensure and renewal of insurance consultant and surplus lines broker licenses are nonrefundable processing fees, paid into the fund for the maintenance of the Bureau of Insurance.

Patron - Colgan

P SB901

Accident and sickness insurance; MCHIP; establishment of an MCHIP. Clarifies the applicability of the current law requiring managed care health insurance plans to apply for and be issued (i) a certificate of quality assurance from the Department of Health and (ii) a license from the State Corporation Commission's Bureau of Insurance.

Patron - Colgan

P SB909

Medical malpractice insurance; examinations. Authorizes the State Corporation Commission to make or direct an examination of a medical malpractice joint underwriting association at least once every five years or whenever the State Corporation Commission determines an examination is necessary. Presently, the law requires such examinations on an annual basis.

Patron - Stosch

P SB984

Insurance agents; bail bond agents. Deletes bail bond agents as a category of insurance agents licensed by the State Corporation Commission's Bureau of Insurance. All agents who hold such licenses may remain licensed, but no such licenses which have lapsed or been revoked will be reinstated, and no new or additional licenses of this type will be issued.

Patron - Barry

P SB1015

Insurance, regulation of rates, exemptions; large deductible plans. Establishes that risks generating total estimated standard premiums for workers' compensation of at least $250,000 are large risks and are exempt from rate filing requirements. This requirement previously was $500,000. The bill also exempts large deductible plans from current rate filing requirements. These plans are defined as workers' compensation plans that include a per-claim deductible of at least $100,000.

Patron - Holland

P SB1018

Virginia Birth-Related Neurological Injury Compensation Act. Makes the definition of "birth-related neurological injury" as presently in effect retroactive in application to any child born on and after January 1, 1988, the date for the accruing of claims under the act. The definition included in the original statute was stringent and could not be met by some infants who were neurologically injured in a hospital at birth or immediately thereafter. The 1988 definition required an infant suffering a birth-related neurological injury to be rendered permanently nonambulatory, aphasic, incontinent, and in need of assistance in all "phases" of daily living. In 1990, two bills were passed to revise the definition of "birth-related neurological injury" by striking the requirements to be permanently nonambulatory, aphasic, and incontinent and inserting requirements for permanent motor disabilities and developmental disabilities or cognitive disability. The infant must require permanent assistance in all "activities" of daily living. This bill authorizes the legal representative of a child born between January 1, 1988, and July 1, 1990, to file an application for review by July 1, 2000, upon meeting the conditions that (i) a claim was timely filed for the child and was dismissed on the basis of a determination that although the child's injuries were caused by deprivation of oxygen or mechanical injury occurring in the course of labor, delivery or resuscitation in the immediate post-delivery period in a hospital, the injuries did not meet the earlier definition of nonambulatory, aphasic, incontinent, and in need of assistance in all phases of daily living and (ii) the medical panel's report provided pursuant to the dismissed claim stated that the child's injuries would meet the present definition, i.e., permanently motor disabled and developmentally disabled or cognitively disabled and permanently in need of assistance in all activities of daily living. The application for review may be filed regardless of whether or not the legal representative has previously obtained a review of the dismissed claim by the Commission. Such review can only be filed for live births and cannot be filed for claims dismissed as caused by genetic or congenital abnormalities, degenerative neurological diseases, or maternal substance abuse. The full Commission will review the evidence and make a determination on the petition as though the definition in effect on July 1, 1990, had been in effect on the date of the child's birth and no previous review or dismissal had occurred. The statute of limitations on filing of claims is modified to allow for applications for review in these narrow circumstances to be filed by July 1, 2000, for any infant whose birth occurred more than ten years prior to the application, if the dismissed claim upon which the application is filed was filed before the infant's tenth birthday. This retroactive provision could result in two or more dismissed claims being reconsidered.

Patron - Marye

P SB1102

Insurance; motor vehicle rental contract enrollers. Authorizes motor vehicle rental contract enrollers to effect insurance in connection with motor vehicle rentals. A motor vehicle rental contract enroller is defined as an unlicensed hourly or salaried employee of a motor vehicle rental company. Enrollers are further defined as individuals who receive no direct or indirect commission from the insurer, renter or vehicle rental company. Motor vehicle rental companies are described in this definition as being in the business of providing primarily private motor vehicles to the public under a rental agreement for a period of less than six months.

Patron - Colgan

P SB1176

Patron - Saslaw

P SB1217

Health insurance; small employer market provisions. Allows health insurance issuers, who are registered as a health insurance issuer in the small group market and have offered small employer group insurance to the employer as required by law, to offer individual health insurance coverage to small employers that differ from the small employer market provisions, so long as the employer does not (i) permit payroll deductions for covered employees and (ii) pay any portion of the premium charged for such coverage. Under current law, the small employer market provisions are applicable to any health insurance issuer who (i) permits payroll deductions for covered employees or (ii) pays any portion of the premiums charged for such coverage.

Patron - Bolling

P SB1235

Contracts between health insurance plans and health care providers are prohibited from containing provisions which require a provider or provider group to deny medical services that are medically necessary and appropriate. Health insurance plans, as well as the state employees' health plan, are also required to have personnel available to provide authorization at all times that preauthorization prior to receiving medical treatment is required. Health insurance plans are required to provide written notice to covered persons at least 60 days in advance prior to increasing premiums more than 35%. Additionally, any benefit reductions must be provided to covered persons at least 60 days prior to such benefit reductions becoming effective. Health insurance plans and the state employees' health plan may develop closed prescription drug formularies only after consultation with a pharmacy and therapeutics committee. This pharmacy and therapeutics committee will have a majority of its members who are physicians, pharmacists, and other health care providers. Additionally, these health plans must allow a covered person to obtain, without additional cost-sharing beyond that provided for formulary prescription drugs within the covered benefits, a specific medically necessary nonformulary prescription drug if, after reasonable investigation and consultation with the prescribing physician, the formulary drug is determined to be an inappropriate therapy for the medical condition of the enrollee. The insurer, corporation, or health maintenance organization must act on such requests within one business day of receipt of the request.

Health insurance plans and the state employees' health plan must provide access to specialists for those individuals with ongoing special conditions. Once such covered individual is referred to the specialist, the specialist may begin treating the individual in the same manner as the individual's primary care provider would otherwise be permitted, including the ability to authorize tests, procedures, referrals, and other medical services. Additionally, procedures must be developed whereby a covered person with an ongoing special condition may receive a standing referral to a specialist. These health plans may require a specialist to provide written notification to the individual's primary care physician, including a description of the services rendered. Health insurance plans and the state employees' health plan must provide 90 days notice to enrollees prior to terminating providers, and must allow enrollees to continue using a terminated provider for 90 days. Pregnant women may continue receiving treatment from a terminated provider through delivery, and the terminally ill may continue receiving treatment from such a provider until death. Health insurance plans and the state employees' health plan are required to provide coverage for patient costs associated with clinical trials for treatment studies on cancer, including ovarian cancer. Patient costs covered include the costs of medically necessary health care services required in conjunction with the clinical trials. Costs not covered include the costs of research management or the cost of an investigational drug or device. The clinical trials must be approved by the National Cancer Institute, the Department of Veteran's Affairs, the Food and Drug Administration or the other specified organizations. Phases II, III and IV cancer trials would be covered. Coverage of Phase I trials would be on a case-by-case basis. Women covered under a health insurance plan or the state health plan will receive a minimum hospital stay of 23 hours when undergoing a laparoscopy-assisted vaginal hysterectomy, and a minimum stay of 48 hours for a vaginal hysterectomy, unless the attending physician, in consultation with the patient, decides that a shorter period of hospital stay is appropriate. Health insurance plans and the state employees' health plan may not refuse to accept or make reimbursement pursuant to an assignment of benefits made to a dentist or oral surgeon by a covered person. An "assignment of benefits" means the transfer of dental care coverage reimbursement benefits or other rights under an insurance policy, subscription contract or dental services plan by a covered person. Such covered person must notify the insured, subscriber or enrollee in writing of the assignment. Finally, the bill 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. This specific provision must be reenacted by the 2000 General Assembly prior to becoming effective.

Patron - Williams

P SB1299

Accident and sickness insurance; standing referral for cancer pain management. Requires each (i) insurer proposing to issue 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 policies, contracts or plans, including any certificate or evidence of coverage issued in connection with such policies, contracts or plans to permit any individual covered thereunder who has been diagnosed with cancer to have a standing referral to a board certified specialist in pain management or an oncologist who is authorized to provide services under such policy, contract or plan and has been selected by the cancer patient. The board-certified specialist in pain management or oncologist must consult on a regular basis as required under the terms of the policy, contract or plan, by telephone or through written communication, with the primary care physician and any oncologist providing care to the patient concerning the plan for pain management for the patient. The cancer pain management specialist is not be authorized to direct the patient to other health care services. Nothing contained in this provision will prohibit an insurer, corporation, or health maintenance organization from requiring a participating cancer pain specialist to provide written notification to the cancer patient's primary care physician of any visit to him, which may include a description of the health care services rendered at the time of the visit. Insurers and health maintenance organizations subject to these provisions must inform subscribers in writing. These requirements of this section will apply to all insurance policies, contracts, and plans delivered, issued for delivery, reissued, renewed, or extended or at any time when any term of any such policy, contract, or plan is changed or any premium adjustment is made and will not apply to short-term travel or accident-only policies, or to short-term nonrenewable policies of not more than six months' duration.

Patron - Mims

P SB1300

Accident and sickness insurance; utilization review and coverage of cancer pain medications. Requires utilization review agencies to make all decisions on prescriptions for the alleviation of cancer pain within 24 hours. The bill also provides that any individual or group accident and sickness insurance policy providing hospital, medical and surgical or major medical coverage on an expense-incurred basis, any corporation providing individual or group accident and sickness subscription contracts, and any 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, whether on an inpatient or outpatient basis, or both, must provide in each such policy, contract, plan, certificate, and evidence of coverage that such benefits will not be denied for any drug approved by the United States Food and Drug Administration for use in the treatment of cancer pain on the basis that the dosage is in excess of the recommended dosage of the pain-relieving agent, if the prescription in excess of the recommended dosage has been prescribed in compliance with §§ 54.1-2971.01 and 54.1-3408.1 for a patient with intractable cancer pain. These provisions will not apply to short-term travel, or accident-only policies, or to short-term nonrenewable policies of not more than six months' duration and are applicable to contracts, policies or plans delivered, issued for delivery or renewed in this Commonwealth on and after July 1, 1999.

Patron - Mims

F Failed

F HB1537

Credit life and accident insurance; experience reports and adjustment of prima facie rates; nonrefundable origination fee. Permits credit life and credit accident and sickness insurers to impose a nonrefundable origination fee of $7.00 per transaction. This fee would not be included in any calculations of prima facie rates.

Patron - Robinson

F HB1720

Insurance agents; licensees exempt from continuing education requirements. Exempts from Virginia's insurance agent continuing education requirements those agents who will have attained the age of 65 by the end of a biennium with respect to any license that they have held for an aggregate period of 20 years, either in Virginia or in any other state or other jurisdiction in the United States, or any combination thereof. Under current law, insurance agents who have attained the age of 65 by the end of any applicable biennium are exempt from continuing education requirements with respect to any Virginia-issued license they have held for at least 20 years. The provisions of this bill are applicable to continuing education requirements in the 1999-200 biennium, and thereafter.

Patron - Wilkins

F HB2007

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, 1999. 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

F HB2192

Health insurance; assignment of benefits. Prohibits (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, and (iii) dental services plan offering or administering prepaid dental services from refusing to accept or make reimbursement pursuant to an assignment of benefits made to a dentist or oral surgeon by an insured, subscriber or plan enrollee. An "assignment of benefits" means the transfer of dental care coverage reimbursement benefits or other rights under an insurance policy, subscription contract or dental services plan by an insured, subscriber or plan enrollee. Such insured, subscriber or enrollee must notify the insured, subscriber or enrollee in writing of the assignment. This bill has been incorporated into HB 871.

Patron - Tate

F HB2197

Coverage for certain low protein foods for individuals diagnosed with inborn errors of amino acid metabolism. 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 foods which are prescribed for the treatment of inborn errors of amino acid metabolism 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 an inborn error of amino acid metabolism will be deemed to be prescription drugs; however, commercial food products which are naturally 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 the treatment of an inborn error of amino acid metabolism 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 foods for the treatment of inborn errors of amino acid metabolism. 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, 1999. Diseases classified as inborn errors of amino acid metabolism include phenylketonuria, maple syrup urine disease and homocystinuria-all of which can be diagnosed at birth or soon after and will cause mental retardation in the absence of treatment.

Patron - McDonnell

F HB2199

Coverage for certain medical formulas for individuals diagnosed with an inborn error of metabolism. 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 medical formulas prescribed for the treatment of inborn errors of metabolism, including phenylketonuria, maple syrup urine disease or homocystinuria, and approved by the United States Food and Drug Administration for such treatment. The term "prescription drug" shall include metabolic or medical formulas classified by the United States Food and Drug Administration as a medical food and defined as foods which are formulated to be consumed or administered entirely under the supervision of a physician and which are intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluation. Medical formulas shall not include commercial products which may be low in protein but have not been developed for the treatment of an inborn error of metabolism. This new section will not require coverage for experimental drugs for the treatment of an inborn error of metabolism 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 medical 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, 1999. Diseases classified as inborn errors of metabolism include phenylketonuria, maple syrup urine disease and homocystinuria, all of which can be diagnosed at birth or soon after and will cause severe mental retardation in the absence of treatment.

Patron - McDonnell

F HB2234

Insurance; change to domestic insurer; date of authorization. Provides that a foreign insurer who redomesticates in Virginia is recognized as having been initially licensed in Virginia as of the date of the insurer's initial licensure in its original domiciliary state.

Patron - Howell

F HB2325

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 - Melvin

F HB2353

Review of adverse utilization review decisions; review of claims appeal by an independent external panel; penalty. Establishes, within the State Corporation Commission's Bureau of Insurance, a process of independent external review for individuals denied a course of treatment by their managed care health insurance plan. If the person seeking review is determined by the Bureau of Insurance (i) to have coverage by the health plan, (ii) to be seeking a treatment that appears to be covered by the plan, (iii) to have exhausted all available utilization review complaint and appeals procedures and (iv) to have provided all information necessary to begin review, an impartial appeals panel comprised of one representative from a licensee operating a managed care health insurance plan not involved in the complaint, one health care practitioner (selected by the individual who submitted the appeal from a list of three practitioners compiled by the Board of Medicine and selected by the State Corporation Commission) and the Commissioner of Insurance or his designee.. Each individual seeking such review will pay a filing fee of $50, which is returned if the covered person prevails as a result of the review. Insurers writing accident and sickness insurance in Virginia will pay an assessment not to exceed 0.01 percent of the direct gross premium income during the preceding year to fund such appeals. The State Corporation Commission will also promulgate regulations implementing the provisions of this bill, including establishing provisions for expedited consideration of appeals involving emergency health care. Any managed care health insurance plan that does not comply within 10 working days after receipt of notification of a decision by the External Appeals Panel shall be subject to, in addition to other penalties currently in Title 38.2, an additional penalty of $500 per day noncompliance with the decision of the External Appeals Panel. Managed care health insurance plans are required to include information about the External Appeals Panel in their complaint procedures, as well as to provide information about this process anytime an adverse utilization review decision is communicated to a covered person. The bill's provisions become effective on July 1, 1999; however, the appeals process set forth in the bill does not take effect until the earlier of (i) 90 days following the promulgation of regulations by the State Corporation Commission or (ii) July 1, 2000. This bill has been incorporated into HB 2594.

Patron - Davies

F HB2380

Accident and sickness insurance; health maintenance organizations; optional coverage for obstetrical services. Requires insurers issuing individual health insurance policies, corporations issuing individual major medical subscription contracts and health maintenance organizations to provide, as an option to the policyholder, subscriber, or member, coverage for obstetrical services. The coverage for obstetrical services must have durational limits, deductibles, coinsurance factors, and copayments that are no less favorable than for physical illness generally. The provisions of this bill apply to all insurance policies, contracts, and plans delivered, issued for delivery, reissued, renewed or extended or at any time when such policies, contracts, or plans are changed or the premium is adjusted after July 1, 2000.

Patron - Keating

F HB2389

Health care; Office of the State Managed Care Consumer Advocate. Creates the Office of the State Managed Care Consumer Advocate. Such Office will be established by the Virginia State Corporation Commission's Commissioner of Insurance via contract with a nonprofit entity. The Office will assist health insurance consumers with (i) health plan selection (ii) individual health care coverage complaints, and (iii) other information and advocacy concerning managed health care plans. The Office will be funded through an annual assessment of up to 0.01 percent of the net direct premiums of Virginia-licensed health insurers, health service plans, and health maintenance organizations. The Office will submit an annual report of its activities to the Governor and the General Assembly. Additionally, the Office will make an annual report to the Virginia Joint Commission on Health Care concerning (i) the implementation of this managed care consumer advocacy program and (ii) the Office's coordination of its activities with other health care and information programs within Virginia.

Patron - Brink

F HB2395

Prohibited incentives. Prohibits health insurance, health services plans, and health maintenance organization contracts from containing provisions which include an incentive or specific payment made directly, in any form, to a health care provider as an inducement to deny services that the provider or group knows to be medically necessary and appropriate that are provided with respect to a specific enrollee or group of enrollees with similar medical conditions. This bill does not prohibit the use of capitation as a method of payment, nor does it prohibit the inclusion of incentives or payments that reward providers or provider groups for providing services in a cost effective manner or that promote the quality initiative established under a managed care health insurance plan. This bill has been incorporated into HB 871.

Patron - Barlow

F HB2403

Accident and sickness insurance; coverage for the treatment of infertility. 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, 1999. 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 - Barlow

F HB2404

Accident and sickness insurance; coverage for clinical trials for life-threatening diseases. Requires health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for patient costs associated with clinical trials for treatment studies on cancer, including ovarian cancer. Patient costs covered include the costs of medically necessary health care services required in conjunction with the clinical trials. Costs not covered include the costs of research management or the cost of an investigational drug or device. The clinical trials must be approved by the National Cancer Institute, the Department of Veteran's Affairs, the Food and Drug Administration or the other specified organizations. Phases II, III and IV cancer trials would be covered. Coverage of Phase I trials would be on a case-by-case basis. The bill's provisions are applicable to policies, plans and contracts delivered, issued for delivery or renewed on and after July 1, 1999. 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 has been incorporated into HB 871.

Patron - Keating

F HB2456

Health care provider panels; preauthorization. Provides that any health insurers, nonstock corporations providing health services plans, and health maintenance organizations requiring preauthorization before providing medical treatment must have someone available to give authorization at all times when such preauthorization is required. The bill provisions are also applicable to the state health care plan. This bill has been incorporated into HB 871.

Patron - Williams

F HB2457

Health care provider panels; notice of benefit restrictions. Requires carriers to furnish group policyholders written notice of any new benefit restrictions at least 60 days before such restrictions become effective. Group policyholders, in turn, are required by the bill to give corresponding notice to affected enrollees at least 30 days before such restrictions become effective. This bill has been incorporated into HB 871.

Patron - Williams

F HB2469

Medical Injury Insurance Coverage Act; claims of medical malpractice. Establishes the Medical Injury Insurance Coverage Act and increases the statutory cap on medical malpractice awards from $1 million to $1.25 million. Injured patients electing to stay with the $1 million cap may also be entitled to receive, in addition to any settlement or judgment, reimbursement for medical expenses over $300,000, paid as incurred up to a lifetime limit of $2.5 million. Medical damages are to be based on the actual payments received by the health care provider, rather than the initial charge rendered. The bill also excludes medical malpractice actions from existing restrictions on the right of a health care provider to confer with a lawyer representing a party to the action.

Patron - Howell

F HB2538

Purchase and sale of structured settlement payments. Provides disclosure provisions for persons entering into (i) a structured settlement agreement or (ii) an agreement to transfer the right to receive all or any portion of future payments under a structured settlement agreement. The bill also requires persons entering into or transferring the rights to receive a structured settlement to have (i) a five-day absolute right of rescission, (ii) independent legal representation, and (iii) approval of the court, if such settlement was originally approved by a court.

Patron - Croshaw

F HB2565

Access to specialists. Requires each (i) insurer proposing to issue 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 provide access to specialists for those individuals with ongoing special conditions. Once such covered individual is referred to the specialist, the specialist may begin treating the individual in the same manner as the individual's primary care provider would otherwise be permitted, including the ability to authorize tests, procedures, referrals, and other medical services. Each insurer, corporation or health maintenance organization is required to develop procedures whereby a covered individual with an ongoing special condition may receive a standing referral to a specialist. Insurers, corporations, and health maintenance organizations may require a specialist to provide written notification to the individual's primary care physician, including a description of the services rendered. This bill has been incorporated into HB 871.

Patron - Orrock

F HB2578

Prescription drug formularies. Requires any prescription drug formulary applied by any (i) insurer proposing to issue 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 be developed only after consultation and approval by a pharmacy and therapeutics committee. This pharmacy and therapeutics committee will have a majority of its members who are physicians and must also include at least one licensed pharmacist. Additionally, each insurer, corporation, or health maintenance organization maintaining a prescription drug formulary must allow an enrollee to obtain, without additional cost-sharing beyond that provided for formulary prescription drugs within the covered benefits, a specific medically necessary nonformulary prescription drug if, after reasonable investigation and consultation with the prescribing physician, the formulary drug is determined to be an inappropriate therapy for the medical condition of the enrollee. The insurer, corporation, or health maintenance organization must act on such requests within 40 hours of receipt of the request. This bill has been incorporated into HB 871.

Patron - Baskerville

F HB2594

Review of adverse utilization review decisions; review of claims appeal by an independent external panel. Establishes, within the State Corporation Commission's Bureau of Insurance, a process of independent external review for individuals denied a course of treatment by their managed care health insurance plan. If the person seeking review is determined by the Bureau of Insurance to (i) have coverage by the health plan, (ii) be seeking a treatment that appears to be covered by the plan, (iii) have exhausted all available utilization review complaint and appeals procedures and (iv) have provided all information necessary to begin review, an impartial health entity shall review the final adverse decision to determine whether the decision is objective clinically valid, compatible with established principles of health care, and contractually appropriate. Each individual seeking such review will pay a filing fee of $50, which is nonrefundable. Insurers writing accident and sickness insurance in Virginia will pay an assessment not to exceed 0.015 percent of the direct gross premium income during the preceding year to fund such appeals process. The impartial health entity will issue a written recommendation within sixty days of the acceptance of the appeal by the Bureau of Insurance, and the State Corporation Commission will issue a binding order carrying out the recommendation of the impartial health entity. These appeals provisions become effective either (i) 90 days following the promulgation of regulations by the State Corporation Commission or (ii) July 1, 2000. The bill also establishes an Office of Managed Care Ombudsman within the Bureau of Insurance. The Managed Care Ombudsman is charged with promoting and protecting the interests of covered persons under managed care health insurance plans in Virginia. The duties of the Managed Care Ombudsman include assisting persons in understanding their rights and processes available to them under their managed care plan, developing information on the types of managed health insurance plans available in Virginia, and monitoring and providing information to the General Assembly on managed care issues. This bill has been incorporated into HB 871.

Patron - Purkey

F HB2613

Health care provider panels; continuity of care. Requires health insurance plans and health maintenance organizations to provide 90 days notice to enrollees prior to terminating providers, and to allow enrollees to continue using a terminated provider for 90 days. The bill also allows pregnant women to continue receiving treatment from a terminated provider through delivery, and the terminally ill to continue receiving treatment from such a provider until death. This bill has been incorporated into HB 871.

Patron - Moran

F HB2614

Patron - Baskerville

F HB2619

Prescription drug formularies. Requires any prescription drug formulary applied by any (i) insurer proposing to issue 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 be developed only after consultation and approval by a pharmacy and therapeutics committee made up of a majority of members who are licensed physicians. The bill also requires each insurer, corporation, or health maintenance organization to establish an expeditious process or procedure that allows covered individuals to obtain appropriate nonformulary drugs without prior approval. The covered individual would be responsible for the payment of any costs of the nonformulary prescription drug which exceeds the cost the insurer, corporation, or health maintenance organization would pay for the prescription drug on the formulary which is intended to address the medical condition of the enrollee for which the nonformulary drug is prescribed. This bill has been incorporated into HB 2578.

Patron - Jones, S.C.

F HB2622

Patron - Dudley

F HB2643

Accident and sickness claim proceeds; escrow accounts; penalty. Provides that an insurer must, within thirty days of receipt of proof of loss, either pay an accident and sickness claim or place in an interest-bearing escrow account an amount equal to the usual and customary fee charged for the service rendered. All interest earned from the money placed in escrow is to be paid annually to the Virginia Indigent Health Care Trust Fund. Any person who knowingly and willfully fails to pay in a timely manner the contribution owed to the fund may be civilly liable for penalties up to $500 per day.

Patron - Griffith

F HB2645

Accident and sickness insurance; access to specialists; standing referrals. Requires each (i) insurer proposing to issue 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 provide access to specialists for those individuals with ongoing special conditions. Each insurer, corporation or health maintenance organization is required to develop procedures whereby a covered individual with an ongoing special condition may receive a standing referral to a specialist. Insurers, corporations, and health maintenance organizations may require a specialist to provide written notification to the individual's primary care physician, including a description of the services rendered. This bill has been incorporated into HB 871.

Patron - Jones, D.C.

F HB2653

Accident and sickness insurance; coverage for certain ovarian cancer testing. Requires health insurers, health maintenance organizations, and corporations providing accident and sickness subscription contracts to provide coverage to (i) any post-menopausal woman or (ii) any woman who is at high risk of ovarian cancer, according to the most recently published guidelines of the American Cancer Society, for one CA 125 test or, when available, one LPA test, in a 12-month period, all in accordance with American Cancer Society guidelines under any such policy, contract or plan delivered, issued for delivery or renewed in this Commonwealth on and after July 1, 1999. "CA 125 test" is defined as the analysis of a blood sample to determine the presence of the tumor marker, CA 125, which may indicate the existence of ovarian cancer cells. "LPA test" means the analysis of a blood sample to detect elevated levels of lysophosphatidic acid (LPA), a substance which stimulates the growth of ovarian cancer cells. Because the LPA test is not yet marketed, this provision would require coverage if the LPA test is available. The requirements of this bill will not apply 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) policies of 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.

Patron - Katzen

F HB2679

Motor vehicles; motor vehicle insurance; proof of financial responsibility. Declares that whenever any court of competent jurisdiction determines that, in an application made to an insurance carrier for a policy of motor vehicle liability insurance adequate to demonstrate proof of financial responsibility in the future (§ 46.2-707), the applicant knowingly made a misstatement as to a material fact required in such application, (i) any policy of motor vehicle liability insurance issued as the result of such application shall be cancelled forthwith pursuant to subdivision D 4 of § 38.2-2212, and (ii) such person shall, upon such cancellation, be deemed in violation of § 46.2-707 for operating an uninsured motor vehicle. The bill also amends § 38.2-2212 of the insurance code to establish any such misstatements as a basis for cancellation of a motor vehicle liability insurance policy.

Patron - O'Brien

F HB2690

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 - Joannou

F HB2707

Special Advisory Commission on Managed Care Health Insurance Plans; Office of Managed Care Ombudsman. Establishes the Special Advisory Commission on Managed Care Health Insurance Plans, composed of 14 members and two ex officio members. The Special Advisory Commission is charged with (i) developing and maintaining, with the Bureau of Insurance, a system and program of data collection to assess the impact, including costs to employers and insurers, impact of treatment, cost savings in the health care system, number of providers and other data on managed care health insurance plans as may be appropriate, and (ii) advising and assisting the Bureau of Insurance and the Department of Health on matters relating to managed care health insurance plan benefits and provider regulations. The bill also creates, within the office of the Attorney General's Division of Consumer Counsel, an Office of Managed Care Ombudsman. The ombudsman will promote and protect the interests of covered persons under managed care health insurance plans in the Commonwealth, and coordinate with the Special Advisory Commission on Managed Care Health Insurance Plans in studies relating to the enforcement and improvement of managed care health insurance plans and provider regulations.

Patron - Byron

F HB2732

Accident and sickness insurance; access to specialists. Requires each (i) insurer proposing to issue 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 allow covered individuals to designate a specialist as their primary care doctor.

Patron - Tate

F SB766

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 extend 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 - Edwards

F SB770

Accident and sickness insurance; coverage for the treatment of morbid obesity. Requires health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for the treatment of morbid obesity. The bill's provisions are applicable to policies, plans and contracts delivered, issued for delivery or renewed on and after July 1, 1999. 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 - Lambert

F SB928

Health care coverage; renewal; notice of proposed premium increases. Requires health insurers, health services plans and HMOs, in connection with proposed renewals of coverage, to furnish prior written notice of intent to increase annual premium charged for such coverage by 40 percent or more. The notice must be provided to the policyholder, contract holder or subscriber, as appropriate, at least 60 days prior to the proposed renewal date of the policy, contract, or plan.

Patron - Woods

F SB948

Explanation of benefits forms. Requires explanation of benefits forms to provide the consumer with timely notice of the action on the claim and to be designed to avoid confusing and redundant multiple notices to the consumer. The State Corporation Commission (SCC) is authorized to issue regulations to establish standards for the accuracy, clarity, and timeliness of the information and to avoid the receipt by the consumer of confusing and redundant multiple explanation of benefits notices. The Administrator of Consumer Affairs is required to advise the SCC concerning consumer complaints about confusing and redundant explanation of benefits forms.

Patron - Marye

F SB954

Medical savings accounts; group self-insurance pools; study. 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 condition 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, 2000. 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 2000 Session of the General Assembly.

Patron - Quayle

F SB1025

Motor vehicle insurance; uninsured motorist coverage; named exclusion. Allows an insured to exclude a person from coverage who would be otherwise covered under a motor vehicle insurance policy. Such exclusion may only be made with the permission of the named insured and the person to be excluded.

Patron - Bolling

F SB1033

Accident and sickness insurance; coverage for clinical trials for life-threatening diseases. Requires health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for clinical trials for life-threatening diseases. Such clinical trials must be approved by the National Institutes of Health ("NIH"), an NIH-sponsored cooperative group, the Department of Veteran's Affairs, or the Food and Drug Administration. Patient care will be insured for trials of either treatment or palliative care. Phase 1 to Phase IV cancer trials would be covered. For other life-threatening conditions, Phase II to Phase IV clinical trials would be covered, and coverage of Phase I trials would be on a case-by-case basis. The bill's provisions are applicable to policies, plans and contracts delivered, issued for delivery or renewed on and after July 1, 1999. 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 - Couric

F SB1043

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

F SB1081

Health care coverage; preexisting conditions. Limits 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. The bill's provisions stipulate that limitations for preexisting conditions exclusions for health insurance coverage offered by a health insurance issuer in the individual market must be the same as that offered by a health insurance issuer in connection with a group plan in the small or large group market. The bill also reduces the preexisting conditions exclusion period from 12 to six months, and from 18 to 12 months for a late enrollee. Finally, the bill redefines an "eligible individual" to reduce the aggregate of the periods of creditable coverage from 18 or more months to 12 or more months. It also includes individual health insurance coverage in the list of health insurance coverages that will be considered the most recent prior creditable coverage.

Patron - Edwards

F SB1104

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. 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 are applicable to accident and sickness insurance policies and plans issued on and after July 1, 1999.

Patron - Colgan

F SB1151

Patron - Lucas

F SB1156

Patron - Colgan

F SB1169

Patron - Ticer

F SB1181

Medical malpractice limit. Raises the amount recoverable from $1 million to $1.5 million, exclusive of interest. The $1 million limit will increase by $50,000 annually until July 1, 2009. The annual increase will apply only to causes of action arising after July 1 of that year. This bill has been incorporated into SB 1230.

Patron - Reynolds

F SB1183

Patron - Couric

F SB1185

Managed care health insurance plans. Implements comprehensive reforms in managed health care by providing for (i) external independent review of adverse utilization review decisions, (ii) an ombudsman to intervene in health care coverage disputes, (iii) civil liability for adverse health treatment decisions made by managed care entities, (iv) mandated coverage for the treatment of diabetes, (v) mandated coverage for participation in clinical trials, (vi) parity in benefits for the treatment of mental illnesses, (vii) required patient notification of changes in benefits, (viii) required and extended continuation of care for a covered person by a provider who is no longer a participating provider, (ix) standing referrals to specialists, (x) specialists to serve as primary care physicians in certain situations, (xi) prohibitions in provider contracts that allow incentives for refusing health care, (xii) accessibility to nonformulary prescription drugs, (xiii) the ability to use out-of-network providers, and (xiv) 24-hour availability of personnel to authorize medical treatments.

Patron - Walker

F SB1213

Health insurance; assignment of benefits; dentists. Permits health care coverage plan providers to accept assignments of benefits executed by covered individuals in favor of dentists. 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 plans offering or administering prepaid dental services. Such assignment is permitted so long as the dentist obtaining the assignment of benefits accepts the reimbursement under the assignment as payment in full and does not charge the insured, subscriber, or plan enrollee any further amount except for the amount of any applicable deductible, copayment, or coinsurance. "Assignment of benefits" means 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 dentist.

Patron - Martin

F SB1270

Patron - Lucas

F SB1271

Health care provider panels; continuity of care. Requires health insurance plans and health maintenance organizations to provide 90 days' notice to enrollees prior to terminating providers, and to allow enrollees to continue using a terminated provider for 90 days. The bill also allows pregnant women to continue receiving treatment from a terminated provider through delivery, and the terminally ill to continue receiving treatment from such a provider until death.

Patron - Lambert

F SB1272

Patron - Whipple

F SB1281

Coverage of certain cancer treatments. Requires the state employees health insurance plan and any insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense-incurred basis, any corporation providing individual or group accident and sickness subscription contracts, and any health maintenance organization providing a health care plan for health care services, whose policy contract or plan covers prescription drugs, surgical procedures, radiation, other therapy or supportive care for the treatment of cancer to cover any drug, surgical procedure, radiation, other therapy or supportive care prescribed for the treatment of cancer if (i) the drug, surgical procedure, radiation, other therapy or supportive care has been recognized as safe and effective for treatment of that specific type of cancer in any of the standard reference compendia or (ii) the drug, surgical procedure, radiation, other therapy or supportive care has been approved for clinical use for the treatment of cancer by one of the National Institutes of Health, regardless of whether approved by the United States Food and Drug Administration for the treatment of any disease or condition or for any cancer. Present law mandates coverage for off-label use of cancer drugs if the drug has been recognized as safe and effective for treatment of that specific type of cancer in any of the standard reference compendia.

Patron - Woods

F SB1285

Accident and sickness insurance; coverage for colorectal cancer screening. Requires health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide colorectal cancer screening coverage. The screening mandated encompasses colonoscopy, flexible sigmoidoscopy, fecal occult blood testing, and stool hemoccults. The frequency of covered testing is linked to age and to family medical history. For example, persons age 50 and over are to receive coverage for screening with flexible sigmoidoscopy once every five years, and annual fecal occult blood tests. Persons aged 40 with moderate risks are covered for annual stool hemoccults and flexible sigmoidoscopy once every five years. The bill's provisions also establish a coverage regimen for persons less than 65 who are not covered by Medicare and who are deemed at high risk for colon cancer. The provisions of this bill do not apply to short-term travel, accident only, limited or specified disease policies other than cancer policies, or to short-term nonrenewable policies of not more than six months duration.

Patron - Couric

F SB1291

Accident and sickness insurance; access to specialists; standing referrals. Requires each (i) insurer proposing to issue 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 provide access to specialists for those individuals with ongoing special conditions. Each insurer, corporation or health maintenance organization is required to develop procedures whereby a covered individual with an ongoing special condition may receive a standing referral to a specialist. Insurers, corporations, and health maintenance organizations may require a specialist to provide written notification to the individual's primary care physician, including a description of the services rendered.

Patron - Miller, Y.B.

F SB1294

Patron - Puckett

F SB1321

Insurance underwriting; unfair discrimination; credit information. Prohibits an insurer from declining to issue or renew homeowners or automobile insurance policies solely because of credit information contained in a consumer report.

Patron - Miller, Y.B.

F SB1324

Health care provider panels; notice of benefit restrictions. Requires carriers to provide to all enrollees and providers written notice of any new benefit restrictions at least 90 days before such restrictions become effective.

Patron - Gartlan

F SB1325

Health care provider panels, preauthorization. Provides that any health insurers, nonstock corporations providing health services plans, and health maintenance organizations requiring preauthorization before providing medical treatment must have someone available to give authorization at all times.

Patron - Reynolds

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P Passed

F Failed