Virginia Administrative Code
Title 14 - INSURANCE
Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE
Chapter 135 - RULES GOVERNING INDIVIDUAL AND SMALL GROUP MARKET HEALTH BENEFIT PLANS
Section 14VAC5-135-50 - Prohibitions, limitations, and disclosures

Universal Citation: 4 VA Admin Code 5-135-50

Current through Register Vol. 41, No. 3, September 23, 2024

A. A health carrier shall not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, gender expression, sexual orientation, or status as a transgender individual. Nothing in this section shall be construed to prevent a health carrier from appropriately utilizing reasonable medical management techniques including medical necessity.

B. If a health carrier offers an optional benefit to a health benefit plan, the health carrier may file a separate schedule that includes the additional benefit and identify the health benefit plan to which the schedule applies. A different plan identification is necessary to distinguish the health benefit plan with the additional benefit.

C. A health carrier may offer a health benefit plan that does not include pediatric oral health benefits if:

1. The health carrier is reasonably assured that pediatric oral health benefits are available to the purchaser of the health benefit plan in accordance with § 38.2-3451 B of the Code of Virginia, and

2. The plan contains the following statement on the first page of the policy and bold:

"This policy does not provide the ACA-required pediatric oral health benefits."

D. If an individual policy contains a military service exclusion or a provision that suspends coverage during military service, the policy shall provide for a refund of unearned premium upon receipt of written notice of the military service.

E. A policy application shall not contain questions about any health-status related factors other than age and tobacco use.

F. A policy shall only be rated on age, tobacco use, geographic location, plan category, and whether the policy covers dependents in accordance with § 38.2-3447 of the Code of Virginia.

G. No policy shall contain a provision that allows for increase in premium or change in deductible except during renewal.

H. A health benefit plan shall not impose any preexisting condition exclusion.

I. Policy exclusions may be no more restrictive than allowed by the state-selected essential health benefits benchmark plan.

Statutory Authority: §§ 12.1-13 and 38.2-223 of the Code of Virginia.

Disclaimer: These regulations may not be the most recent version. Virginia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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