Virginia HB 101: Group health benefit plans; sponsoring associations, formation of benefits consortium.

Bill Text

2022SESSION
INTRODUCED
22102793D
1 HOUSEBILLNO.101
2 OfferedJanuary12,2022
3 PrefiledJanuary6,2022
4 A BILL to amend and reenact §§ 38.2-508.5, 38.2-3420, 38.2-3431, 38.2-3432.1, 38.2-3432.2,
5 38.2-3432.3, and 38.2-3521.1 of the Code of Virginia and to amend the Code of Virginia by adding
6 in Title 59.1 a chapter numbered 55, consisting of sections numbered 59.1-589 through 59.1-592,
7 relating to group health benefit plans; sponsoring associations; formation of benefits consortium.
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Patron––Head
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10 ReferredtoCommitteeonCommerceandEnergy
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12 Be it enacted by the General Assembly of Virginia:
13 1. That §§ 38.2-508.5, 38.2-3420, 38.2-3431, 38.2-3432.1, 38.2-3432.2, 38.2-3432.3, and 38.2-3521.1 of
14 the Code of Virginia are amended and reenacted and that the Code of Virginia is amended by
15 adding in Title 59.1 a chapter numbered 55, consisting of sections numbered 59.1-589 through
16 59.1-592, as follows:
17 § 38.2-508.5. Re-underwriting individual under existing group or individual accident and
18 sickness insurance policy prohibited; exceptions.
19 A. No premium increase, including a reduced premium increase in the form of a discount, may be
20 implemented for an insured individual under existing individual health insurance coverage as defined in
21 subsection B of § 38.2-3431 subsequent to the initial effective date of coverage under such policy or
22 certificate to the extent that such premium increase is determined based upon: (i) a change in a
23 health-status-related factor of the individual insured as defined in subsection B of § 38.2-3431 or (ii) the
24 past or prospective claim experience of the individual insured.
25 B. No reduction in benefits may be implemented for an insured individual under existing individual
26 health insurance coverage as defined in subsection B of § 38.2-3431 subsequent to the initial effective
27 date of coverage under such policy or certificate to the extent that such reduction in benefits is
28 determined based upon: (i) a change in a health-status-related factor of the individual insured as defined
29 in subsection B of §38.2-3431 or (ii) the past or prospective claim experience of the individual insured.
30 C. No modifications to contractual terms and conditions may be implemented for an insured
31 individual under existing individual health insurance coverage as defined in subsection B of § 38.2-3431
32 subsequent to the initial effective date of coverage under such policy or certificate to the extent that
33 such modifications to contractual terms and conditions are determined based upon: (i) a change in a
34 health-status-related factor of the individual insured as defined in subsection B of § 38.2-3431 or (ii) the
35 past or prospective claim experience of the individual insured.
36 D. This section shall not prohibit adjustments to premium, rescission of, or amendments to the
37 insurance contract in the following circumstances:
38 1. When an insurer learns of information subsequent to issuing the policy or certificate that was not
39 disclosed in the underwriting process and that, had it been known, would have resulted in a higher
40 premium level or denial of coverage. Any adjustment to premium or rescission of coverage made for
41 this reason may be made only to extent that it would have been made had the information been
42 disclosed in the application process, and shall not be imposed beyond any period of incontestability, or
43 beyond any time period proscribing an insurer from asserting defenses based upon misstatements in
44 applications, as otherwise may be provided by applicable law. Any such rescission shall be consistent
45 with §38.2-3430.3 regarding guaranteed availability.
46 2. When an insurer provides a lifestyle-based good health discount based upon an individual's
47 adherence to a healthy lifestyle and this discount is not based upon a specific health condition or
48 diagnosis.
49 3. When an insurer removes waivers or riders attached to the policy at issue that limit coverage for
50 specific named pre-existing medical conditions.
51 E. For purposes of this section, re-underwriting means the reevaluation of any health-status-related
52 factor of an individual for purposes of adjusting premiums, benefits or contractual terms as provided in
53 subsections A, B, and C.
54 F. The provisions of this section shall not apply to individual health insurance coverage issued to
55 members of a bona fide sponsoring association, as defined in subsection B of § 38.2-3431, where
56 coverage is available to all members of the association and eligible dependents of such members without
57 regard to any health-status-related factor.
58 G. The provisions of this section shall not apply in any instance in which the provisions of this
INTRODUCED
HB101
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HB101 2of15
59 section are inconsistent or in conflict with a provision of Article 6 (§38.2-3438 et seq.) of Chapter 34.
60 §38.2-3420. Authority and jurisdiction