§ 38.2-3541. Continuation on termination of eligibility.
Each group hospital policy, group medical and surgical policy or group majormedical policy delivered or issued for delivery in this Commonwealth orrenewed, reissued or extended if already issued, shall contain, subject tothe policyholder's selection, one of the options set forth in this section.Option 1 shall apply if the insurance on a person covered under such a policyceases because of the termination of the person's eligibility for coverage,prior to that person becoming eligible for Medicare or Medicaid benefitsunless such termination is due to termination of the group policy undercircumstances in which the insured person is insurable under otherreplacement group coverage or health care plan without waiting periods orpreexisting conditions under the replacement coverage or plan. Option 2 shallapply if the insurance on a person covered under such a policy that remainsin force ceases because of the termination of the person's eligibility forcoverage prior to that person becoming eligible for Medicare or Medicaidbenefits. Option 2 shall not be applicable if the group policyholder isrequired by federal law to provide for continuation of coverage under itsgroup health plan pursuant to the Consolidated Omnibus Budget ReconciliationAct of 1985 (COBRA).
1. Option 1: To have the insurer issue him, without evidence of insurability,an individual accident and sickness insurance policy in the event that theinsurer is not exempt under § 38.2-3416 and offers such policy, subject tothe following requirements:
a. The application for the policy shall be made, and the first premium paidto the insurer within thirty-one days after issuance of the written noticerequired in subdivision 3, but in no event beyond the 60 day period followingthe date of the termination of the person's eligibility;
b. The premium on the policy shall be at the insurer's then customary rateapplicable: (i) to such policies, (ii) to the class of risk to which theperson then belongs, and (iii) to his or her age on the effective date of thepolicy;
c. The policy will not result in over-insurance on the basis of the insurer'sunderwriting standards at the time of issue;
d. The benefits under the policy shall not duplicate any benefits paid forthe same injury or same sickness under the prior policy;
e. The policy shall extend coverage to the same family members that wereinsured under the group policy; and
f. Coverage under this option shall be effected in such a way as to result incontinuous coverage from the date of the insured's termination of eligibilityfor such insured if requested and paid for by the insured.
2. Option 2: To have his present coverage under the policy continued for aperiod of 12 months immediately following the date of the termination of theperson's eligibility, without evidence of insurability, subject to thefollowing requirements:
a. The application and payment for the extended coverage is made to the grouppolicyholder within 31 days after issuance of the written notice required insubdivision 3, but in no event beyond the 60 day period following the date ofthe termination of the person's eligibility;
b. Each premium for such extended coverage is timely paid to the grouppolicyholder on a monthly basis during the twelve-month period;
c. The premium for continuing the group coverage shall be at the insurer'scurrent rate applicable to the group policy plus any applicableadministrative fee not to exceed two percent of the current rate; and
d. Continuation shall only be available to an employee or member who has beencontinuously insured under the group policy during the entire three months'period immediately preceding termination of eligibility.
3. The group policyholder shall provide each employee or other person coveredunder such a policy written notice of the availability of the option chosenand the procedures and timeframes for obtaining continuation or conversion ofthe group policy. Such notice shall be provided within 14 days of thepolicyholder's knowledge of the employee's or other covered person's loss ofeligibility under the policy.
(1979, c. 97, § 38.1-348.11; 1982, c. 625; 1984, c. 300; 1986, c. 562; 1988,c. 551; 2010, c. 503.)
§ 38.2-3541. Continuation on termination of eligibility.
Each group hospital policy, group medical and surgical policy or group majormedical policy delivered or issued for delivery in this Commonwealth orrenewed, reissued or extended if already issued, shall contain, subject tothe policyholder's selection, one of the options set forth in this section.Option 1 shall apply if the insurance on a person covered under such a policyceases because of the termination of the person's eligibility for coverage,prior to that person becoming eligible for Medicare or Medicaid benefitsunless such termination is due to termination of the group policy undercircumstances in which the insured person is insurable under otherreplacement group coverage or health care plan without waiting periods orpreexisting conditions under the replacement coverage or plan. Option 2 shallapply if the insurance on a person covered under such a policy that remainsin force ceases because of the termination of the person's eligibility forcoverage prior to that person becoming eligible for Medicare or Medicaidbenefits. Option 2 shall not be applicable if the group policyholder isrequired by federal law to provide for continuation of coverage under itsgroup health plan pursuant to the Consolidated Omnibus Budget ReconciliationAct of 1985 (COBRA).
1. Option 1: To have the insurer issue him, without evidence of insurability,an individual accident and sickness insurance policy in the event that theinsurer is not exempt under § 38.2-3416 and offers such policy, subject tothe following requirements:
a. The application for the policy shall be made, and the first premium paidto the insurer within thirty-one days after issuance of the written noticerequired in subdivision 3, but in no event beyond the 60 day period followingthe date of the termination of the person's eligibility;
b. The premium on the policy shall be at the insurer's then customary rateapplicable: (i) to such policies, (ii) to the class of risk to which theperson then belongs, and (iii) to his or her age on the effective date of thepolicy;
c. The policy will not result in over-insurance on the basis of the insurer'sunderwriting standards at the time of issue;
d. The benefits under the policy shall not duplicate any benefits paid forthe same injury or same sickness under the prior policy;
e. The policy shall extend coverage to the same family members that wereinsured under the group policy; and
f. Coverage under this option shall be effected in such a way as to result incontinuous coverage from the date of the insured's termination of eligibilityfor such insured if requested and paid for by the insured.
2. Option 2: To have his present coverage under the policy continued for aperiod of 12 months immediately following the date of the termination of theperson's eligibility, without evidence of insurability, subject to thefollowing requirements:
a. The application and payment for the extended coverage is made to the grouppolicyholder within 31 days after issuance of the written notice required insubdivision 3, but in no event beyond the 60 day period following the date ofthe termination of the person's eligibility;
b. Each premium for such extended coverage is timely paid to the grouppolicyholder on a monthly basis during the twelve-month period;
c. The premium for continuing the group coverage shall be at the insurer'scurrent rate applicable to the group policy plus any applicableadministrative fee not to exceed two percent of the current rate; and
d. Continuation shall only be available to an employee or member who has beencontinuously insured under the group policy during the entire three months'period immediately preceding termination of eligibility.
3. The group policyholder shall provide each employee or other person coveredunder such a policy written notice of the availability of the option chosenand the procedures and timeframes for obtaining continuation or conversion ofthe group policy. Such notice shall be provided within 14 days of thepolicyholder's knowledge of the employee's or other covered person's loss ofeligibility under the policy.
(1979, c. 97, § 38.1-348.11; 1982, c. 625; 1984, c. 300; 1986, c. 562; 1988,c. 551; 2010, c. 503.)
§ 38.2-3541. Continuation on termination of eligibility.
Each group hospital policy, group medical and surgical policy or group majormedical policy delivered or issued for delivery in this Commonwealth orrenewed, reissued or extended if already issued, shall contain, subject tothe policyholder's selection, one of the options set forth in this section.Option 1 shall apply if the insurance on a person covered under such a policyceases because of the termination of the person's eligibility for coverage,prior to that person becoming eligible for Medicare or Medicaid benefitsunless such termination is due to termination of the group policy undercircumstances in which the insured person is insurable under otherreplacement group coverage or health care plan without waiting periods orpreexisting conditions under the replacement coverage or plan. Option 2 shallapply if the insurance on a person covered under such a policy that remainsin force ceases because of the termination of the person's eligibility forcoverage prior to that person becoming eligible for Medicare or Medicaidbenefits. Option 2 shall not be applicable if the group policyholder isrequired by federal law to provide for continuation of coverage under itsgroup health plan pursuant to the Consolidated Omnibus Budget ReconciliationAct of 1985 (COBRA).
1. Option 1: To have the insurer issue him, without evidence of insurability,an individual accident and sickness insurance policy in the event that theinsurer is not exempt under § 38.2-3416 and offers such policy, subject tothe following requirements:
a. The application for the policy shall be made, and the first premium paidto the insurer within thirty-one days after issuance of the written noticerequired in subdivision 3, but in no event beyond the 60 day period followingthe date of the termination of the person's eligibility;
b. The premium on the policy shall be at the insurer's then customary rateapplicable: (i) to such policies, (ii) to the class of risk to which theperson then belongs, and (iii) to his or her age on the effective date of thepolicy;
c. The policy will not result in over-insurance on the basis of the insurer'sunderwriting standards at the time of issue;
d. The benefits under the policy shall not duplicate any benefits paid forthe same injury or same sickness under the prior policy;
e. The policy shall extend coverage to the same family members that wereinsured under the group policy; and
f. Coverage under this option shall be effected in such a way as to result incontinuous coverage from the date of the insured's termination of eligibilityfor such insured if requested and paid for by the insured.
2. Option 2: To have his present coverage under the policy continued for aperiod of 12 months immediately following the date of the termination of theperson's eligibility, without evidence of insurability, subject to thefollowing requirements:
a. The application and payment for the extended coverage is made to the grouppolicyholder within 31 days after issuance of the written notice required insubdivision 3, but in no event beyond the 60 day period following the date ofthe termination of the person's eligibility;
b. Each premium for such extended coverage is timely paid to the grouppolicyholder on a monthly basis during the twelve-month period;
c. The premium for continuing the group coverage shall be at the insurer'scurrent rate applicable to the group policy plus any applicableadministrative fee not to exceed two percent of the current rate; and
d. Continuation shall only be available to an employee or member who has beencontinuously insured under the group policy during the entire three months'period immediately preceding termination of eligibility.
3. The group policyholder shall provide each employee or other person coveredunder such a policy written notice of the availability of the option chosenand the procedures and timeframes for obtaining continuation or conversion ofthe group policy. Such notice shall be provided within 14 days of thepolicyholder's knowledge of the employee's or other covered person's loss ofeligibility under the policy.
(1979, c. 97, § 38.1-348.11; 1982, c. 625; 1984, c. 300; 1986, c. 562; 1988,c. 551; 2010, c. 503.)
