A. A nonstock corporation licensed under this chapter shall make available tocitizens of the Commonwealth an open enrollment program under the terms setforth in this section.
B. As used in this section, the term:
"Comprehensive accident and sickness contracts" means contracts conformingto the requirements of subsection E which are issued to provide basichospital and medical-surgical coverage.
"Open enrollment contracts" means comprehensive accident and sicknesscontracts issued pursuant to an open enrollment program by a nonstockcorporation licensed pursuant to this chapter providing coverage toindividuals.
C. Each nonstock corporation's open enrollment program shall provide for theissuance of open enrollment contracts without imposition by the nonstockcorporation of underwriting criteria whereby coverage is denied or subject tocancellation or nonrenewal, in whole or in part because of any individual'sage, health or medical history, or employment status or, if employed,industry or job classification. The open enrollment program shall make openenrollment contracts available to any individual residing in the nonstockcorporation's service area within the Commonwealth; however, this subsectionshall not require, and no person shall otherwise indicate, that openenrollment contracts are available to any individual who is an employee of anemployer which provides, in whole or in part, hospitalization or other healthcoverage to its employees. Each nonstock corporation's open enrollmentprogram shall make open enrollment contracts available on a year-round basis.The subscription charge for contracts issued pursuant to an open enrollmentprogram shall be reasonable in relation to the benefits and deductiblesprovided, as determined by the Commission.
D. Each nonstock corporation must prominently advertise the availability ofits open enrollment contracts at least twelve times annually in a newspaperor newspapers of general circulation throughout its service area in Virginia.The content and format of such advertising shall be generally approved by theCommission.
E. The Commission may prescribe minimum standards to govern the contents ofcomprehensive accident and sickness contracts issued pursuant to thissection. Such minimum standards shall ensure that such contracts providehealth benefit coverage for a comprehensive range of health care needswithout qualifying exclusions that fail to protect the subscriber undernormal circumstances. Such standards shall ensure that the option ofobtaining comprehensive major medical coverage is made available to allindividuals included within the definition of "open enrollment contracts"and shall allow for reasonable co-payment provisions, a range of deductiblesand a range of coverages available to the consumer. Preexisting conditionsmay not be excluded from coverage under such contracts; however, waitingperiods of up to twelve months for coverage of preexisting conditions shallbe allowed. In addition, the Commission may prescribe reasonable minimumstandards in order to govern the contents of policies issued to individualswho have converted from group comprehensive accident and sickness contractsto individual coverage because of termination of the individual's eligibilityfor group coverage.
F. If a nonstock corporation licensed under this chapter elects todiscontinue its open enrollment program provided under this section, it maydo so only after giving written notice to the Commission of at leasttwenty-four months in advance of the effective date of termination. Upontermination of the program, the nonstock corporation shall be subject to thelicense tax provisions of subdivision 1 of subsection A of § 58.1-2501.
G. In addition, a nonstock corporation licensed under this chapter shallprovide other public services to the community including health-relatededucational support and training for those subscribers who, based upon sucheducational support and training, may experience a lesser need forhealth-related care and expense.
(1987, cc. 565, 655; 1988, c. 185; 1997, cc. 807, 913.)
A. A nonstock corporation licensed under this chapter shall make available tocitizens of the Commonwealth an open enrollment program under the terms setforth in this section.
B. As used in this section, the term:
"Comprehensive accident and sickness contracts" means contracts conformingto the requirements of subsection E which are issued to provide basichospital and medical-surgical coverage.
"Open enrollment contracts" means comprehensive accident and sicknesscontracts issued pursuant to an open enrollment program by a nonstockcorporation licensed pursuant to this chapter providing coverage toindividuals.
C. Each nonstock corporation's open enrollment program shall provide for theissuance of open enrollment contracts without imposition by the nonstockcorporation of underwriting criteria whereby coverage is denied or subject tocancellation or nonrenewal, in whole or in part because of any individual'sage, health or medical history, or employment status or, if employed,industry or job classification. The open enrollment program shall make openenrollment contracts available to any individual residing in the nonstockcorporation's service area within the Commonwealth; however, this subsectionshall not require, and no person shall otherwise indicate, that openenrollment contracts are available to any individual who is an employee of anemployer which provides, in whole or in part, hospitalization or other healthcoverage to its employees. Each nonstock corporation's open enrollmentprogram shall make open enrollment contracts available on a year-round basis.The subscription charge for contracts issued pursuant to an open enrollmentprogram shall be reasonable in relation to the benefits and deductiblesprovided, as determined by the Commission.
D. Each nonstock corporation must prominently advertise the availability ofits open enrollment contracts at least twelve times annually in a newspaperor newspapers of general circulation throughout its service area in Virginia.The content and format of such advertising shall be generally approved by theCommission.
E. The Commission may prescribe minimum standards to govern the contents ofcomprehensive accident and sickness contracts issued pursuant to thissection. Such minimum standards shall ensure that such contracts providehealth benefit coverage for a comprehensive range of health care needswithout qualifying exclusions that fail to protect the subscriber undernormal circumstances. Such standards shall ensure that the option ofobtaining comprehensive major medical coverage is made available to allindividuals included within the definition of "open enrollment contracts"and shall allow for reasonable co-payment provisions, a range of deductiblesand a range of coverages available to the consumer. Preexisting conditionsmay not be excluded from coverage under such contracts; however, waitingperiods of up to twelve months for coverage of preexisting conditions shallbe allowed. In addition, the Commission may prescribe reasonable minimumstandards in order to govern the contents of policies issued to individualswho have converted from group comprehensive accident and sickness contractsto individual coverage because of termination of the individual's eligibilityfor group coverage.
F. If a nonstock corporation licensed under this chapter elects todiscontinue its open enrollment program provided under this section, it maydo so only after giving written notice to the Commission of at leasttwenty-four months in advance of the effective date of termination. Upontermination of the program, the nonstock corporation shall be subject to thelicense tax provisions of subdivision 1 of subsection A of § 58.1-2501.
G. In addition, a nonstock corporation licensed under this chapter shallprovide other public services to the community including health-relatededucational support and training for those subscribers who, based upon sucheducational support and training, may experience a lesser need forhealth-related care and expense.
(1987, cc. 565, 655; 1988, c. 185; 1997, cc. 807, 913.)
A. A nonstock corporation licensed under this chapter shall make available tocitizens of the Commonwealth an open enrollment program under the terms setforth in this section.
B. As used in this section, the term:
"Comprehensive accident and sickness contracts" means contracts conformingto the requirements of subsection E which are issued to provide basichospital and medical-surgical coverage.
"Open enrollment contracts" means comprehensive accident and sicknesscontracts issued pursuant to an open enrollment program by a nonstockcorporation licensed pursuant to this chapter providing coverage toindividuals.
C. Each nonstock corporation's open enrollment program shall provide for theissuance of open enrollment contracts without imposition by the nonstockcorporation of underwriting criteria whereby coverage is denied or subject tocancellation or nonrenewal, in whole or in part because of any individual'sage, health or medical history, or employment status or, if employed,industry or job classification. The open enrollment program shall make openenrollment contracts available to any individual residing in the nonstockcorporation's service area within the Commonwealth; however, this subsectionshall not require, and no person shall otherwise indicate, that openenrollment contracts are available to any individual who is an employee of anemployer which provides, in whole or in part, hospitalization or other healthcoverage to its employees. Each nonstock corporation's open enrollmentprogram shall make open enrollment contracts available on a year-round basis.The subscription charge for contracts issued pursuant to an open enrollmentprogram shall be reasonable in relation to the benefits and deductiblesprovided, as determined by the Commission.
D. Each nonstock corporation must prominently advertise the availability ofits open enrollment contracts at least twelve times annually in a newspaperor newspapers of general circulation throughout its service area in Virginia.The content and format of such advertising shall be generally approved by theCommission.
E. The Commission may prescribe minimum standards to govern the contents ofcomprehensive accident and sickness contracts issued pursuant to thissection. Such minimum standards shall ensure that such contracts providehealth benefit coverage for a comprehensive range of health care needswithout qualifying exclusions that fail to protect the subscriber undernormal circumstances. Such standards shall ensure that the option ofobtaining comprehensive major medical coverage is made available to allindividuals included within the definition of "open enrollment contracts"and shall allow for reasonable co-payment provisions, a range of deductiblesand a range of coverages available to the consumer. Preexisting conditionsmay not be excluded from coverage under such contracts; however, waitingperiods of up to twelve months for coverage of preexisting conditions shallbe allowed. In addition, the Commission may prescribe reasonable minimumstandards in order to govern the contents of policies issued to individualswho have converted from group comprehensive accident and sickness contractsto individual coverage because of termination of the individual's eligibilityfor group coverage.
F. If a nonstock corporation licensed under this chapter elects todiscontinue its open enrollment program provided under this section, it maydo so only after giving written notice to the Commission of at leasttwenty-four months in advance of the effective date of termination. Upontermination of the program, the nonstock corporation shall be subject to thelicense tax provisions of subdivision 1 of subsection A of § 58.1-2501.
G. In addition, a nonstock corporation licensed under this chapter shallprovide other public services to the community including health-relatededucational support and training for those subscribers who, based upon sucheducational support and training, may experience a lesser need forhealth-related care and expense.
(1987, cc. 565, 655; 1988, c. 185; 1997, cc. 807, 913.)
