Current through Register Vol. 41, No. 3, September 23, 2024
A. Hospital indemnity or other fixed
indemnity insurance means a policy that provides supplementary benefits that
are paid to the insured in a single lump sum or a fixed dollar amount per
specified event, per day, or per other period of hospitalization or illness
regardless of the amount of expenses incurred. The policy shall not be a
substitute for major medical coverage.
B. Hospital indemnity or other fixed
indemnity insurance that is offered in the individual market shall meet the
following criteria:
1. Benefits shall be
provided under a separate policy, certificate, or contract of
insurance;
2. Benefits paid may be
a single lump sum or a fixed dollar amount per service, per specified event,
per day, or per other period of time. Benefits shall be determined based on the
category of services and not the billed amount. Dollar amounts shall be
expressed in the policy;
3. There
is no coordination between the provision of benefits and an exclusion of
benefits under any other health coverage;
4. A pregnancy that exists on the effective
date of coverage may be considered a preexisting condition;
5. No waiting period shall be applied to loss
due to accidental injury; and
6. In
addition to the notice required in
14VAC5-141-30 A, the following
notice shall be displayed prominently on the face of the policy: "THIS IS A
SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL
COVERAGE."
C. Hospital
indemnity or other fixed indemnity insurance offered in the group market shall
meet the following criteria:
1. There is no
coordination between the provision of the benefits and an exclusion of benefits
under any group health plan maintained by the same plan sponsor;
2. The benefits are paid with respect to an
event without regard to whether benefits are provided with respect to the event
under any group health plan maintained by the same plan sponsor; and
3. Benefits shall be paid in a single lump
sum or a fixed dollar amount per day or other period of hospitalization or
illness regardless of the amount of expenses incurred. Benefits shall not be
determined based on the billed amount. Dollar amounts shall be expressed in the
policy.
Statutory Authority: §§ 12.1-13 and 38.2-223 of
the Code of Virginia.
