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1994 SESSION

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SB 480 Accident and sickness insurance; cost sharing provisions.

Introduced by: Clarence A. Holland | all patrons    ...    notes | add to my profiles

SUMMARY:

Accident and sickness insurance; cost sharing provisions. Requires insurers, health services plans and health maintenance organizations to calculate the amount payable by an insured, subscriber or enrollee (when such person is required to pay a specified percentage of the cost of covered services) based upon the total amount actually paid or payable to the provider for the services provided. The bill ensures that an insured's payment would be based upon a percentage of the "discounted" amount as agreed to by the insurer, plan or HMO and the provider. Knowing and willful violations of this provision are subject to the penalties and restitution payments provisions of § 38.2-218. The bill also requires insurers, health services plans and HMOs to file with the SCC for approval explanation of benefits forms which are to clearly and accurately explain the amounts covered under a policy or plan or show the amounts payable by a covered person to a health care provider.


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