§ 38.2-508.5. Re-underwriting individual under existing group or individualaccident and sickness insurance policy prohibited; exceptions.
A. No premium increase, including a reduced premium increase in the form of adiscount, may be implemented for an insured individual under existingindividual health insurance coverage as defined in subsection B of §38.2-3431 subsequent to the initial effective date of coverage under suchpolicy or certificate to the extent that such premium increase is determinedbased upon: (i) a change in a health-status-related factor of the individualinsured as defined in subsection B of § 38.2-3431 or (ii) the past orprospective claim experience of the individual insured.
B. No reduction in benefits may be implemented for an insured individualunder existing individual health insurance coverage as defined in subsectionB of § 38.2-3431 subsequent to the initial effective date of coverage undersuch policy or certificate to the extent that such reduction in benefits isdetermined based upon: (i) a change in a health-status-related factor of theindividual insured as defined in subsection B of § 38.2-3431 or (ii) the pastor prospective claim experience of the individual insured.
C. No modifications to contractual terms and conditions may be implementedfor an insured individual under existing individual health insurance coverageas defined in subsection B of § 38.2-3431 subsequent to the initial effectivedate of coverage under such policy or certificate to the extent that suchmodifications to contractual terms and conditions are determined based upon:(i) a change in a health-status-related factor of the individual insured asdefined in subsection B of § 38.2-3431 or (ii) the past or prospective claimexperience of the individual insured.
D. This section shall not prohibit adjustments to premium, rescission of, oramendments to the insurance contract in the following circumstances:
1. When an insurer learns of information subsequent to issuing the policy orcertificate that was not disclosed in the underwriting process and that, hadit been known, would have resulted in a higher premium level or denial ofcoverage. Any adjustment to premium or rescission of coverage made for thisreason may be made only to extent that it would have been made had theinformation been disclosed in the application process, and shall not beimposed beyond any period of incontestability, or beyond any time periodproscribing an insurer from asserting defenses based upon misstatements inapplications, as otherwise may be provided by applicable law. Any suchrescission shall be consistent with § 38.2-3430.3 regarding guaranteedavailability.
2. When an insurer provides a lifestyle-based good health discount based uponan individual's adherence to a healthy lifestyle and this discount is notbased upon a specific health condition or diagnosis.
3. When an insurer removes waivers or riders attached to the policy at issuethat limit coverage for specific named pre-existing medical conditions.
E. For purposes of this section, re-underwriting means the reevaluation ofany health-status-related factor of an individual for purposes of adjustingpremiums, benefits or contractual terms as provided in subsections A, B and Cof this section.
F. The provisions of this section shall not apply to individual healthinsurance coverage issued to members of a bona fide association, as definedin subsection B of § 38.2-3431, where coverage is available to all members ofthe association and eligible dependents of such members without regard to anyhealth-status-related factor.
§ 38.2-508.5. Re-underwriting individual under existing group or individualaccident and sickness insurance policy prohibited; exceptions.
A. No premium increase, including a reduced premium increase in the form of adiscount, may be implemented for an insured individual under existingindividual health insurance coverage as defined in subsection B of §38.2-3431 subsequent to the initial effective date of coverage under suchpolicy or certificate to the extent that such premium increase is determinedbased upon: (i) a change in a health-status-related factor of the individualinsured as defined in subsection B of § 38.2-3431 or (ii) the past orprospective claim experience of the individual insured.
B. No reduction in benefits may be implemented for an insured individualunder existing individual health insurance coverage as defined in subsectionB of § 38.2-3431 subsequent to the initial effective date of coverage undersuch policy or certificate to the extent that such reduction in benefits isdetermined based upon: (i) a change in a health-status-related factor of theindividual insured as defined in subsection B of § 38.2-3431 or (ii) the pastor prospective claim experience of the individual insured.
C. No modifications to contractual terms and conditions may be implementedfor an insured individual under existing individual health insurance coverageas defined in subsection B of § 38.2-3431 subsequent to the initial effectivedate of coverage under such policy or certificate to the extent that suchmodifications to contractual terms and conditions are determined based upon:(i) a change in a health-status-related factor of the individual insured asdefined in subsection B of § 38.2-3431 or (ii) the past or prospective claimexperience of the individual insured.
D. This section shall not prohibit adjustments to premium, rescission of, oramendments to the insurance contract in the following circumstances:
1. When an insurer learns of information subsequent to issuing the policy orcertificate that was not disclosed in the underwriting process and that, hadit been known, would have resulted in a higher premium level or denial ofcoverage. Any adjustment to premium or rescission of coverage made for thisreason may be made only to extent that it would have been made had theinformation been disclosed in the application process, and shall not beimposed beyond any period of incontestability, or beyond any time periodproscribing an insurer from asserting defenses based upon misstatements inapplications, as otherwise may be provided by applicable law. Any suchrescission shall be consistent with § 38.2-3430.3 regarding guaranteedavailability.
2. When an insurer provides a lifestyle-based good health discount based uponan individual's adherence to a healthy lifestyle and this discount is notbased upon a specific health condition or diagnosis.
3. When an insurer removes waivers or riders attached to the policy at issuethat limit coverage for specific named pre-existing medical conditions.
E. For purposes of this section, re-underwriting means the reevaluation ofany health-status-related factor of an individual for purposes of adjustingpremiums, benefits or contractual terms as provided in subsections A, B and Cof this section.
F. The provisions of this section shall not apply to individual healthinsurance coverage issued to members of a bona fide association, as definedin subsection B of § 38.2-3431, where coverage is available to all members ofthe association and eligible dependents of such members without regard to anyhealth-status-related factor.
§ 38.2-508.5. Re-underwriting individual under existing group or individualaccident and sickness insurance policy prohibited; exceptions.
A. No premium increase, including a reduced premium increase in the form of adiscount, may be implemented for an insured individual under existingindividual health insurance coverage as defined in subsection B of §38.2-3431 subsequent to the initial effective date of coverage under suchpolicy or certificate to the extent that such premium increase is determinedbased upon: (i) a change in a health-status-related factor of the individualinsured as defined in subsection B of § 38.2-3431 or (ii) the past orprospective claim experience of the individual insured.
B. No reduction in benefits may be implemented for an insured individualunder existing individual health insurance coverage as defined in subsectionB of § 38.2-3431 subsequent to the initial effective date of coverage undersuch policy or certificate to the extent that such reduction in benefits isdetermined based upon: (i) a change in a health-status-related factor of theindividual insured as defined in subsection B of § 38.2-3431 or (ii) the pastor prospective claim experience of the individual insured.
C. No modifications to contractual terms and conditions may be implementedfor an insured individual under existing individual health insurance coverageas defined in subsection B of § 38.2-3431 subsequent to the initial effectivedate of coverage under such policy or certificate to the extent that suchmodifications to contractual terms and conditions are determined based upon:(i) a change in a health-status-related factor of the individual insured asdefined in subsection B of § 38.2-3431 or (ii) the past or prospective claimexperience of the individual insured.
D. This section shall not prohibit adjustments to premium, rescission of, oramendments to the insurance contract in the following circumstances:
1. When an insurer learns of information subsequent to issuing the policy orcertificate that was not disclosed in the underwriting process and that, hadit been known, would have resulted in a higher premium level or denial ofcoverage. Any adjustment to premium or rescission of coverage made for thisreason may be made only to extent that it would have been made had theinformation been disclosed in the application process, and shall not beimposed beyond any period of incontestability, or beyond any time periodproscribing an insurer from asserting defenses based upon misstatements inapplications, as otherwise may be provided by applicable law. Any suchrescission shall be consistent with § 38.2-3430.3 regarding guaranteedavailability.
2. When an insurer provides a lifestyle-based good health discount based uponan individual's adherence to a healthy lifestyle and this discount is notbased upon a specific health condition or diagnosis.
3. When an insurer removes waivers or riders attached to the policy at issuethat limit coverage for specific named pre-existing medical conditions.
E. For purposes of this section, re-underwriting means the reevaluation ofany health-status-related factor of an individual for purposes of adjustingpremiums, benefits or contractual terms as provided in subsections A, B and Cof this section.
F. The provisions of this section shall not apply to individual healthinsurance coverage issued to members of a bona fide association, as definedin subsection B of § 38.2-3431, where coverage is available to all members ofthe association and eligible dependents of such members without regard to anyhealth-status-related factor.
