§ 38.2-3417. Deductibles and coinsurance options required.
A. An insurer issuing accident and sickness insurance or a corporationissuing subscription contracts on an expense incurred basis shall makeavailable in offering such coverage or contract to the potential insured orcontract holder one or more of the following options under which theindividual insured or group certificate holder pays for:
1. The first $100 of the cost of the services covered or benefits payable bythe policy or contract during a 12-month period;
2. Twenty percent of the first $1,000 of the cost of the services covered orbenefits payable by the policy or contract during a 12-month period;
3. The first $100 and 20 percent of the next $1,000 of the cost of theservices covered or benefits payable by the policy or contract during a12-month period; or
4. Any other option containing a greater deductible, coinsurance, orcost-sharing provision. However, the option shall not be inconsistent withstandards established with respect to deductibles, coinsurance, orcost-sharing pursuant to § 38.2-3519.
B. As used in this section, "make available" means that the insurer orcorporation shall disseminate information concerning the option or optionsand make a policy or contract containing the option or options available topotential insureds or contract holders at the same time and in the samemanner as the insurer or corporation disseminates information concerningother policies or contracts and coverage options and makes other policies orcontracts and coverage options available.
C. This section shall not apply to short-term travel, accident only, limitedor specified disease, or individual conversion policies or contracts, nor topolicies or contracts designed for issuance to persons eligible for coverageunder Title XVIII of the Social Security Act, known as Medicare, or any othersimilar coverage under state or federal governmental plans.
§ 38.2-3417. Deductibles and coinsurance options required.
A. An insurer issuing accident and sickness insurance or a corporationissuing subscription contracts on an expense incurred basis shall makeavailable in offering such coverage or contract to the potential insured orcontract holder one or more of the following options under which theindividual insured or group certificate holder pays for:
1. The first $100 of the cost of the services covered or benefits payable bythe policy or contract during a 12-month period;
2. Twenty percent of the first $1,000 of the cost of the services covered orbenefits payable by the policy or contract during a 12-month period;
3. The first $100 and 20 percent of the next $1,000 of the cost of theservices covered or benefits payable by the policy or contract during a12-month period; or
4. Any other option containing a greater deductible, coinsurance, orcost-sharing provision. However, the option shall not be inconsistent withstandards established with respect to deductibles, coinsurance, orcost-sharing pursuant to § 38.2-3519.
B. As used in this section, "make available" means that the insurer orcorporation shall disseminate information concerning the option or optionsand make a policy or contract containing the option or options available topotential insureds or contract holders at the same time and in the samemanner as the insurer or corporation disseminates information concerningother policies or contracts and coverage options and makes other policies orcontracts and coverage options available.
C. This section shall not apply to short-term travel, accident only, limitedor specified disease, or individual conversion policies or contracts, nor topolicies or contracts designed for issuance to persons eligible for coverageunder Title XVIII of the Social Security Act, known as Medicare, or any othersimilar coverage under state or federal governmental plans.
§ 38.2-3417. Deductibles and coinsurance options required.
A. An insurer issuing accident and sickness insurance or a corporationissuing subscription contracts on an expense incurred basis shall makeavailable in offering such coverage or contract to the potential insured orcontract holder one or more of the following options under which theindividual insured or group certificate holder pays for:
1. The first $100 of the cost of the services covered or benefits payable bythe policy or contract during a 12-month period;
2. Twenty percent of the first $1,000 of the cost of the services covered orbenefits payable by the policy or contract during a 12-month period;
3. The first $100 and 20 percent of the next $1,000 of the cost of theservices covered or benefits payable by the policy or contract during a12-month period; or
4. Any other option containing a greater deductible, coinsurance, orcost-sharing provision. However, the option shall not be inconsistent withstandards established with respect to deductibles, coinsurance, orcost-sharing pursuant to § 38.2-3519.
B. As used in this section, "make available" means that the insurer orcorporation shall disseminate information concerning the option or optionsand make a policy or contract containing the option or options available topotential insureds or contract holders at the same time and in the samemanner as the insurer or corporation disseminates information concerningother policies or contracts and coverage options and makes other policies orcontracts and coverage options available.
C. This section shall not apply to short-term travel, accident only, limitedor specified disease, or individual conversion policies or contracts, nor topolicies or contracts designed for issuance to persons eligible for coverageunder Title XVIII of the Social Security Act, known as Medicare, or any othersimilar coverage under state or federal governmental plans.
