§ 38.2-3430.7. Renewability of individual health insurance coverage.
A. Except as provided in this section, a health insurance issuer thatprovides individual health insurance coverage shall renew or continue inforce such coverage at the option of the individual.
B. A health insurance issuer may nonrenew or discontinue health insurancecoverage of an individual in the individual market based on one or more ofthe following:
1. The individual has failed to pay premiums or contributions in accordancewith the terms of the health insurance coverage or the issuer has notreceived timely premium payments;
2. The individual has performed an act or practice that constitutes fraud ormade an intentional misrepresentation of material fact under the terms of thecoverage;
3. The issuer is ceasing to offer coverage in the individual market inaccordance with subsection C and applicable state law;
4. In the case of a health insurance issuer that offers health insurancecoverage in the individual market through a network plan, the individual nolonger resides, lives, or works in the service area, or in an area for whichthe health insurance issuer is authorized to do business but only if suchcoverage is terminated under this section uniformly without regard to anyhealth status-related factor of covered individuals; or
5. In the case of health insurance coverage that is made available in theindividual market only through one or more bona fide associations, themembership of the individual in the association (on the basis of which thecoverage is provided) ceases but only if such coverage is terminated underthis section uniformly without regard to any health status-related factor ofcovered individuals.
C. Requirements for uniform termination of coverage.
1. In any case in which a health insurance issuer decides to discontinueoffering a particular type of health insurance coverage offered in theindividual market, coverage of such type may be discontinued by the healthinsurance issuer only if:
a. The health insurance issuer provides notice to each covered individualprovided coverage of this type in such market of such discontinuation atleast ninety days prior to the date of the discontinuation of such coverage;
b. The health insurance issuer offers to each individual in the individualmarket provided coverage of this type, the option to purchase any otherindividual health insurance coverage currently being offered by the healthinsurance issuer for individuals in such market; and
c. In exercising the option to discontinue coverage of this type and inoffering the option of coverage under subdivision 1 b of this subsection, thehealth insurance issuer acts uniformly without regard to any healthstatus-related factor of enrolled individuals or individuals who may becomeeligible for such coverage.
2. Discontinuance of all coverage.
a. Subject to subdivision 1 c of this subsection, in any case in which ahealth insurance issuer elects to discontinue offering all health insurancecoverage in the individual market in the Commonwealth, health insurancecoverage may be discontinued by the health insurance issuer only if: (i) thehealth insurance issuer provides notice to the Commission and to eachindividual of such discontinuation at least 180 days prior to the date of theexpiration of such coverage, and (ii) all health insurance issued ordelivered for issuance in this Commonwealth in such market is discontinuedand coverage under such health insurance coverage in such market is notrenewed.
b. In the case of discontinuation under subdivision 2 a of this subsection inthe individual market, the health insurance issuer may not provide for theissuance of any health insurance coverage in the individual market in thisCommonwealth during the five-year period beginning on the date of thediscontinuation of the last health insurance coverage not so renewed.
D. At the time of coverage renewal, a health insurance issuer may modify thehealth insurance coverage for a policy form offered to individuals in theindividual market so long as such modification is consistent with the laws ofthis Commonwealth and effective on a uniform basis among all individuals withthat policy form.
E. In applying this section in the case of health insurance coverage that ismade available by health insurance issuers in the individual market toindividuals only through one or more associations, a reference to an"individual" is deemed to include a reference to such an association ofwhich the individual is a member.
§ 38.2-3430.7. Renewability of individual health insurance coverage.
A. Except as provided in this section, a health insurance issuer thatprovides individual health insurance coverage shall renew or continue inforce such coverage at the option of the individual.
B. A health insurance issuer may nonrenew or discontinue health insurancecoverage of an individual in the individual market based on one or more ofthe following:
1. The individual has failed to pay premiums or contributions in accordancewith the terms of the health insurance coverage or the issuer has notreceived timely premium payments;
2. The individual has performed an act or practice that constitutes fraud ormade an intentional misrepresentation of material fact under the terms of thecoverage;
3. The issuer is ceasing to offer coverage in the individual market inaccordance with subsection C and applicable state law;
4. In the case of a health insurance issuer that offers health insurancecoverage in the individual market through a network plan, the individual nolonger resides, lives, or works in the service area, or in an area for whichthe health insurance issuer is authorized to do business but only if suchcoverage is terminated under this section uniformly without regard to anyhealth status-related factor of covered individuals; or
5. In the case of health insurance coverage that is made available in theindividual market only through one or more bona fide associations, themembership of the individual in the association (on the basis of which thecoverage is provided) ceases but only if such coverage is terminated underthis section uniformly without regard to any health status-related factor ofcovered individuals.
C. Requirements for uniform termination of coverage.
1. In any case in which a health insurance issuer decides to discontinueoffering a particular type of health insurance coverage offered in theindividual market, coverage of such type may be discontinued by the healthinsurance issuer only if:
a. The health insurance issuer provides notice to each covered individualprovided coverage of this type in such market of such discontinuation atleast ninety days prior to the date of the discontinuation of such coverage;
b. The health insurance issuer offers to each individual in the individualmarket provided coverage of this type, the option to purchase any otherindividual health insurance coverage currently being offered by the healthinsurance issuer for individuals in such market; and
c. In exercising the option to discontinue coverage of this type and inoffering the option of coverage under subdivision 1 b of this subsection, thehealth insurance issuer acts uniformly without regard to any healthstatus-related factor of enrolled individuals or individuals who may becomeeligible for such coverage.
2. Discontinuance of all coverage.
a. Subject to subdivision 1 c of this subsection, in any case in which ahealth insurance issuer elects to discontinue offering all health insurancecoverage in the individual market in the Commonwealth, health insurancecoverage may be discontinued by the health insurance issuer only if: (i) thehealth insurance issuer provides notice to the Commission and to eachindividual of such discontinuation at least 180 days prior to the date of theexpiration of such coverage, and (ii) all health insurance issued ordelivered for issuance in this Commonwealth in such market is discontinuedand coverage under such health insurance coverage in such market is notrenewed.
b. In the case of discontinuation under subdivision 2 a of this subsection inthe individual market, the health insurance issuer may not provide for theissuance of any health insurance coverage in the individual market in thisCommonwealth during the five-year period beginning on the date of thediscontinuation of the last health insurance coverage not so renewed.
D. At the time of coverage renewal, a health insurance issuer may modify thehealth insurance coverage for a policy form offered to individuals in theindividual market so long as such modification is consistent with the laws ofthis Commonwealth and effective on a uniform basis among all individuals withthat policy form.
E. In applying this section in the case of health insurance coverage that ismade available by health insurance issuers in the individual market toindividuals only through one or more associations, a reference to an"individual" is deemed to include a reference to such an association ofwhich the individual is a member.
§ 38.2-3430.7. Renewability of individual health insurance coverage.
A. Except as provided in this section, a health insurance issuer thatprovides individual health insurance coverage shall renew or continue inforce such coverage at the option of the individual.
B. A health insurance issuer may nonrenew or discontinue health insurancecoverage of an individual in the individual market based on one or more ofthe following:
1. The individual has failed to pay premiums or contributions in accordancewith the terms of the health insurance coverage or the issuer has notreceived timely premium payments;
2. The individual has performed an act or practice that constitutes fraud ormade an intentional misrepresentation of material fact under the terms of thecoverage;
3. The issuer is ceasing to offer coverage in the individual market inaccordance with subsection C and applicable state law;
4. In the case of a health insurance issuer that offers health insurancecoverage in the individual market through a network plan, the individual nolonger resides, lives, or works in the service area, or in an area for whichthe health insurance issuer is authorized to do business but only if suchcoverage is terminated under this section uniformly without regard to anyhealth status-related factor of covered individuals; or
5. In the case of health insurance coverage that is made available in theindividual market only through one or more bona fide associations, themembership of the individual in the association (on the basis of which thecoverage is provided) ceases but only if such coverage is terminated underthis section uniformly without regard to any health status-related factor ofcovered individuals.
C. Requirements for uniform termination of coverage.
1. In any case in which a health insurance issuer decides to discontinueoffering a particular type of health insurance coverage offered in theindividual market, coverage of such type may be discontinued by the healthinsurance issuer only if:
a. The health insurance issuer provides notice to each covered individualprovided coverage of this type in such market of such discontinuation atleast ninety days prior to the date of the discontinuation of such coverage;
b. The health insurance issuer offers to each individual in the individualmarket provided coverage of this type, the option to purchase any otherindividual health insurance coverage currently being offered by the healthinsurance issuer for individuals in such market; and
c. In exercising the option to discontinue coverage of this type and inoffering the option of coverage under subdivision 1 b of this subsection, thehealth insurance issuer acts uniformly without regard to any healthstatus-related factor of enrolled individuals or individuals who may becomeeligible for such coverage.
2. Discontinuance of all coverage.
a. Subject to subdivision 1 c of this subsection, in any case in which ahealth insurance issuer elects to discontinue offering all health insurancecoverage in the individual market in the Commonwealth, health insurancecoverage may be discontinued by the health insurance issuer only if: (i) thehealth insurance issuer provides notice to the Commission and to eachindividual of such discontinuation at least 180 days prior to the date of theexpiration of such coverage, and (ii) all health insurance issued ordelivered for issuance in this Commonwealth in such market is discontinuedand coverage under such health insurance coverage in such market is notrenewed.
b. In the case of discontinuation under subdivision 2 a of this subsection inthe individual market, the health insurance issuer may not provide for theissuance of any health insurance coverage in the individual market in thisCommonwealth during the five-year period beginning on the date of thediscontinuation of the last health insurance coverage not so renewed.
D. At the time of coverage renewal, a health insurance issuer may modify thehealth insurance coverage for a policy form offered to individuals in theindividual market so long as such modification is consistent with the laws ofthis Commonwealth and effective on a uniform basis among all individuals withthat policy form.
E. In applying this section in the case of health insurance coverage that ismade available by health insurance issuers in the individual market toindividuals only through one or more associations, a reference to an"individual" is deemed to include a reference to such an association ofwhich the individual is a member.
