Health insurance; federal market reforms. (HB1958)

Introduced By

Del. Tom Rust (R-Herndon)

Description

Health insurance; market reforms.  Conforms inconsistent and conflicting requirements of Virginia's health insurance laws to corresponding provisions of the federal Patient Protection and Affordable Care Act that became effective on September 23, 2010. The provisions of the federal act that are implemented by these amendments include (i) requiring employers that offer dependent coverage to provide coverage for dependents of employees who do not have access to other employer-based health care coverage until they reach age 26; (ii) limiting the ability of insurers to impose annual and lifetime dollar limits on essential benefits; (iii) limiting rescission of health insurance policies to cases of fraud or misrepresentation; (iv) requiring nongrandfathered plans to cover preventive health and wellness services without out-of-pocket cost-sharing for the insured; (v) requiring nongrandfathered plans to permit covered persons to designate any participating primary health care professional who is available to accept the covered person and prohibits such plans from requiring authorization or referral for obstetrical or gynecological care by in-network health care professionals specializing in obstetrics or gynecology; (vi) prohibiting nongrandfathered plans from imposing preexisting condition exclusions for enrollees who are under 19 years of age; and (vii) prohibiting nongrandfathered plans from charging higher cost-sharing for emergency services that are obtained out of a plan's network or from requiring preauthorization for emergency services. The measure also requires managed care health insurance plans (MCHIPs) to provide notice of the alleged fraudulent act, practice, or omission, or intentional misrepresentation, and related information, in advance of a rescission of coverage. The length of time that such plans are required to maintain certain records is increased from five to six years. The existing adverse decision procedures applicable to MCHIPs are revised to apply to adverse determinations, which are determinations by a health carrier or its utilization review organization that a health care service does not meet the health carrier's requirement for necessity, appropriateness, health care setting, level of care, or effectiveness, and the requested service or payment of the service is therefore denied, reduced, or terminated. Read the Bill »

Outcome

History