A. Each group accident and sickness insurance policy and health care planshall contain a provision which provides that the insurer, upon request,shall provide a policyholder that employed an average of at least 100individuals who were insureds, subscribers, or enrollees on business daysduring the preceding 12-month period with a complete record of thepolicyholder's medical claims experience or medical costs incurred under thegroup policy, contract or plan. This record shall include all claims incurredfor the lesser of (i) the period of time since the policy, contract or planwas issued or issued for delivery or (ii) the period of time since thepolicy, contract, or plan was last renewed, reissued or extended, if alreadyissued. This record shall be made available promptly to the policyholder uponrequest made not less than 30 days prior to the date upon which the premiumsor contractual terms of the policy, contract or plan may be amended. Nothingin this section shall require the disclosure of personal or privilegedinformation about an individual that is protected from disclosure underChapter 6 (§ 38.2-600 et seq.) of this title, or under any other applicablefederal or state law or regulation. No policyholder shall be required to payfor information requested pursuant to this section.
B. A policyholder that employed an average of at least 100 individuals whowere insureds, subscribers or enrollees on business days during the preceding12-month period shall receive from its insurer, upon request, at the timethat the insurer provides a record of medical claims experience or medicalcosts under subsection A of this section (i) a summary of medical claimscharges or medical costs incurred and the amount paid with respect to thoseclaims for the most recently available 24-month period; (ii) a listing of thenumber of insured, subscribers or enrollees for whom combined medical claimspayments or medical costs exceed $100,000 for the most recently available12-month period, and for the preceding 12 months if not previously provided,with information as to whether these enrollees from the most recentlyavailable 12-month period remain enrolled under the policy, and provided thata policyholder and insurer may agree by contract to provide the listing foramounts less than $100,000; and (iii) total enrollment in each membershiptype as of the end of the most recently available 12-month period. Thisrecord shall be made available to the policyholder within 20 business daysupon written request made not less than 45 days prior to the date upon whichthe premiums or contractual terms of the policy may be amended. Nothing inthis section shall require the disclosure of personal or privilegedinformation about an individual that is protected from disclosure underChapter 6 (§ 38.2-600 et seq.) of this title, or under any other applicablefederal or state law or regulation. No policyholder shall be required to payfor information requested pursuant to this section.
C. With respect to group accident and sickness insurance policies, therequirements of this section shall apply to all policies, contracts, andplans delivered, issued for delivery, reissued or extended on and after July1, 2003, or at any time after the effective date hereof when any term of anysuch policy, contract or plan is changed or any premium adjustment is made.With respect to health care plans, the requirements of this section shallapply to all contracts delivered, issued for delivery, reissued or extendedon and after January 1, 2005, or at any time after the effective date hereofwhen any term of any such contract or plan is changed or any premiumadjustment is made.
(1992, c. 800; 1999, c. 116; 2003, c. 654; 2004, c. 772.)
A. Each group accident and sickness insurance policy and health care planshall contain a provision which provides that the insurer, upon request,shall provide a policyholder that employed an average of at least 100individuals who were insureds, subscribers, or enrollees on business daysduring the preceding 12-month period with a complete record of thepolicyholder's medical claims experience or medical costs incurred under thegroup policy, contract or plan. This record shall include all claims incurredfor the lesser of (i) the period of time since the policy, contract or planwas issued or issued for delivery or (ii) the period of time since thepolicy, contract, or plan was last renewed, reissued or extended, if alreadyissued. This record shall be made available promptly to the policyholder uponrequest made not less than 30 days prior to the date upon which the premiumsor contractual terms of the policy, contract or plan may be amended. Nothingin this section shall require the disclosure of personal or privilegedinformation about an individual that is protected from disclosure underChapter 6 (§ 38.2-600 et seq.) of this title, or under any other applicablefederal or state law or regulation. No policyholder shall be required to payfor information requested pursuant to this section.
B. A policyholder that employed an average of at least 100 individuals whowere insureds, subscribers or enrollees on business days during the preceding12-month period shall receive from its insurer, upon request, at the timethat the insurer provides a record of medical claims experience or medicalcosts under subsection A of this section (i) a summary of medical claimscharges or medical costs incurred and the amount paid with respect to thoseclaims for the most recently available 24-month period; (ii) a listing of thenumber of insured, subscribers or enrollees for whom combined medical claimspayments or medical costs exceed $100,000 for the most recently available12-month period, and for the preceding 12 months if not previously provided,with information as to whether these enrollees from the most recentlyavailable 12-month period remain enrolled under the policy, and provided thata policyholder and insurer may agree by contract to provide the listing foramounts less than $100,000; and (iii) total enrollment in each membershiptype as of the end of the most recently available 12-month period. Thisrecord shall be made available to the policyholder within 20 business daysupon written request made not less than 45 days prior to the date upon whichthe premiums or contractual terms of the policy may be amended. Nothing inthis section shall require the disclosure of personal or privilegedinformation about an individual that is protected from disclosure underChapter 6 (§ 38.2-600 et seq.) of this title, or under any other applicablefederal or state law or regulation. No policyholder shall be required to payfor information requested pursuant to this section.
C. With respect to group accident and sickness insurance policies, therequirements of this section shall apply to all policies, contracts, andplans delivered, issued for delivery, reissued or extended on and after July1, 2003, or at any time after the effective date hereof when any term of anysuch policy, contract or plan is changed or any premium adjustment is made.With respect to health care plans, the requirements of this section shallapply to all contracts delivered, issued for delivery, reissued or extendedon and after January 1, 2005, or at any time after the effective date hereofwhen any term of any such contract or plan is changed or any premiumadjustment is made.
(1992, c. 800; 1999, c. 116; 2003, c. 654; 2004, c. 772.)
A. Each group accident and sickness insurance policy and health care planshall contain a provision which provides that the insurer, upon request,shall provide a policyholder that employed an average of at least 100individuals who were insureds, subscribers, or enrollees on business daysduring the preceding 12-month period with a complete record of thepolicyholder's medical claims experience or medical costs incurred under thegroup policy, contract or plan. This record shall include all claims incurredfor the lesser of (i) the period of time since the policy, contract or planwas issued or issued for delivery or (ii) the period of time since thepolicy, contract, or plan was last renewed, reissued or extended, if alreadyissued. This record shall be made available promptly to the policyholder uponrequest made not less than 30 days prior to the date upon which the premiumsor contractual terms of the policy, contract or plan may be amended. Nothingin this section shall require the disclosure of personal or privilegedinformation about an individual that is protected from disclosure underChapter 6 (§ 38.2-600 et seq.) of this title, or under any other applicablefederal or state law or regulation. No policyholder shall be required to payfor information requested pursuant to this section.
B. A policyholder that employed an average of at least 100 individuals whowere insureds, subscribers or enrollees on business days during the preceding12-month period shall receive from its insurer, upon request, at the timethat the insurer provides a record of medical claims experience or medicalcosts under subsection A of this section (i) a summary of medical claimscharges or medical costs incurred and the amount paid with respect to thoseclaims for the most recently available 24-month period; (ii) a listing of thenumber of insured, subscribers or enrollees for whom combined medical claimspayments or medical costs exceed $100,000 for the most recently available12-month period, and for the preceding 12 months if not previously provided,with information as to whether these enrollees from the most recentlyavailable 12-month period remain enrolled under the policy, and provided thata policyholder and insurer may agree by contract to provide the listing foramounts less than $100,000; and (iii) total enrollment in each membershiptype as of the end of the most recently available 12-month period. Thisrecord shall be made available to the policyholder within 20 business daysupon written request made not less than 45 days prior to the date upon whichthe premiums or contractual terms of the policy may be amended. Nothing inthis section shall require the disclosure of personal or privilegedinformation about an individual that is protected from disclosure underChapter 6 (§ 38.2-600 et seq.) of this title, or under any other applicablefederal or state law or regulation. No policyholder shall be required to payfor information requested pursuant to this section.
C. With respect to group accident and sickness insurance policies, therequirements of this section shall apply to all policies, contracts, andplans delivered, issued for delivery, reissued or extended on and after July1, 2003, or at any time after the effective date hereof when any term of anysuch policy, contract or plan is changed or any premium adjustment is made.With respect to health care plans, the requirements of this section shallapply to all contracts delivered, issued for delivery, reissued or extendedon and after January 1, 2005, or at any time after the effective date hereofwhen any term of any such contract or plan is changed or any premiumadjustment is made.
(1992, c. 800; 1999, c. 116; 2003, c. 654; 2004, c. 772.)
