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A. As used in this section:
"Health insurance coverage" means benefits consisting of coverage for costs of medical care, whether directly, through insurance or reimbursement, or otherwise, and including items and services paid for as medical care under a group policy of accident and sickness insurance, hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract, which coverage is subject to this title or is provided under a plan regulated under the Employee Retirement Income Security Act of 1974.
"Health insurer" means any insurance company that issues accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis or a corporation that provides accident and sickness subscription contracts, that is licensed to engage in such business in the Commonwealth, and that is subject to the laws of the Commonwealth that regulate insurance within the meaning of § 514 (b) (2) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1144 (b) (2)).
"Qualified small employer" means a small employer that has not offered health insurance coverage to its employees during the six months prior to the date a policy under this section becomes effective.
"Small employer" means, with respect to a calendar year and a plan year, an employer located in the Commonwealth that employed at least two but not more than 50 employees on business days during the preceding calendar year and who employs at least two employees on the date a policy under this section becomes effective.
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(A) The term "insurer" means an entity subject to the laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange, pay for or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits, or healthcare services. An insurance company, insurance service, or insurance organization, including a health maintenance organization, which is licensed in the business of insurance in this state and which is subject to state law that regulates insurance.
(B) The terms "small employer" and "employer" mean a business that, during the most recent calendar year, employed at least 2 and not more than 50 employees who are eligible for coverage under a health benefit plan on at least 50 percent of that business' working days.
(C) The term "employee welfare benefit plan" has the same meaning as that term is given by the Employee Retirement Income Security Act of 1974 (29 USC Section 1001 et seq.).
(D) The terms "health benefit plan" and "plan" mean any employee welfare benefit plan that is issued by an insurer and that provides medical, surgical, or hospital care or benefits to employees of a small employer and their dependents. The terms shall exclude any individual major medical policy that is renewable at the option of the insured except for reasons set forth in paragraphs 3(A) or 3(C) of this Act or if the insurer non-renews all policies issued on the same policy form in this state. These terms also exclude any policy of group insurance that is not designed, administered, or marketed as a health benefit plan to be provided by an employer for its employees.
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"State-mandated health benefit" means coverage required under this title or other laws of the Commonwealth to be provided in a policy of accident and sickness insurance or a contract for a health-related condition that (i) includes coverage for specific health care services or benefits; (ii) places limitations or restrictions on deductibles, coinsurance, copayments, or any annual or lifetime maximum benefit amounts; or (iii) includes a specific category of licensed health care practitioners from whom an insured is entitled to receive care. "State-mandated health benefit" includes, without limitation, any coverage, or the offering of coverage, of a benefit or provider pursuant to §§ 38.2-3407.5through 38.2-3407.6:1, 38.2-3407.9:01, 38.2-3407.9:02, 38.2-3407.11 through 38.2-3407.11:3, 38.2-3407.16, 38.2-3408, 38.2-3411 through 38.2-3414.1, 38.2-3418 through 38.2-3418.14, or § 38.2-4221. For purposes of this article, "state-mandated health benefit" does not include a benefit that is mandated by federal law.
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B. Notwithstanding any provision of this title to the contrary, a group accident and sickness insurance policy providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis, and a group accident and sickness subscription contract, that is offered, sold, or issued by a health insurer to a qualified small employer:
1. Shall not be required to include coverage, or the offer of coverage, for any state-mandated health benefit; and
2. May include any, or none, of the state-mandated health benefits as the health insurer and the qualified small employer shall agree.
C. A health insurer offering an insurance policy or subscription contract to a qualified small employer shall inform the employer that a policy or contract is not required to provide state-mandated health benefits.
D. A health insurer selling or issuing an insurance policy or subscription contract to a qualified small employer that does not include all state-mandated health benefits shall provide to the qualified small employer and to each participant a written disclosure statement that lists any state-mandated health benefits that the policy or subscription contract does not provide.
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Section 6. {No Mandated Benefits.} No statute or regulation that mandates the provision of specified health insurance benefits or that prohibits or limits the use of managed care shall be construed to apply to any small employer health benefit plan or any conversion policy provided in accordance with Section 5 of this Act.
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ALEC Legislation in Virginia: Health Care
Contents
HB 10, HB 722, HB 576, SB 417, SB 283, and SB 311: Virginia Health Care Freedom Act
This bill prohibits the penalizing residents for failing to obtain health insurance coverage. ALEC touts on its website that this legislation has been introduced in at least 38 states. This legislation has served as the basis for standing in Attorney General Cuccinelli's lawsuit against the federal government over the Affordable Care Act. The U.S. Court of Appeals for the 4th Circuit threw out Cuccinelli's suit, ruling that the Virginia Health Care Freedom Act did not provide him standing to sue. (Sources: ALEC, Washington Post)
HB 10: Virginia's Health Care Freedom Act
ALEC's Freedom of Choice in Health Care Act
No law shall restrict a person's natural right and power of contract to secure the blessings of liberty to choose private health care systems or private plans. No law shall interfere with the right of a person or entity to pay for lawful medical services to preserve life or health, nor shall any law impose a penalty, tax, fee, or fine, of any type, to decline or to contract for health care coverage or to participate in any particular health care system or plan, except as required by a court where an individual or entity is a named party in a judicial dispute. Nothing herein shall be construed to expand, limit or otherwise modify any determination of law regarding what constitutes lawful medical services within the Commonwealth.
The people have the right to enter into private contracts with health care providers for health care services and to purchase private health care coverage. The legislature may not require any person to participate in any health care system or plan, nor may it impose a penalty or fine, of any type, for choosing to obtain or decline health care coverage or for participation in any particular health care system or plan.
Virginia's bills: http://leg1.state.va.us/cgi-bin/legp504.exe?101+sum+HB10
http://lis.virginia.gov/cgi-bin/legp604.exe?101+ful+SB417
http://lis.virginia.gov/cgi-bin/legp604.exe?101+ful+SB283
http://lis.virginia.gov/cgi-bin/legp604.exe?101+ful+SB311
ALEC's model legislation:
http://alecexposed.org/w/ images/3/3b/5U2-FREEDOM_OF_CHOICE _IN_HEALTH_CARE_ACT_Exposed.pdf
HB 720: Health Insurance Choice
This bill would permit the purchase of health insurance across state lines, from an insurer not licensed in the state of Virginia, circumventing the mandated benefits required in all plans sold in the state of Virginia. While the intent behind the bills is the same and each offers similar regulatory proposals, the language is not identical.
Virginia's Health Insurance Choice Act
ALEC's Health Care Choice Act for States
http://leg1.state.va.us/cgi-bin/legp504.exe?101+ful+HB720
http://alecexposed.org/w/ images/c/c3/5U4-Health_Care_Choice _Act_for_States_Exposed.pdf
HB 1512: Health Care Sharing Ministries
This legislation declares that insurance laws do not apply to health care sharing ministries.
Virginia's Health Care Sharing Ministries Act
ALEC's Health Care Sharing Ministries Freedom to Share Act
Definition.
As used in this chapter, "health care sharing ministry" means a health care cost sharing arrangement among individuals of the same religion based on their sincerely held religious beliefs, which arrangement is administered by a non-profit organization that has been granted an exemption from federal income taxation pursuant to § 501(c)(3) of the Internal Revenue Code of 1986 and that:
1. Limits its membership to individuals who are of a similar faith;
2. Acts as an organizational clearinghouse for information about members who have financial or medical needs and matches them with members with the present ability to assist those with financial or medical needs, all in accordance with the organization's criteria;
3. Provides for the financial or medical needs of a member through payments directly from one member to another. The requirements of this subdivision 3 may be satisfied by a trust established solely for the benefit of members, which trust is audited annually by an independent auditing firm;
4. Provides amounts that members/subscribers may contribute with (i) no assumption of risk or promise to pay among the members and (ii) no assumption of risk or promise to pay by the organization to the members;
5. Provides written monthly statements to all members that list the total dollar amount of qualified needs submitted to the organization by members for their contribution; and
6. Provides in substance the following written disclaimer on or accompanying all promotional documents distributed by or on behalf of the organization, including applications and guideline materials:
As used in this Act, the following definition applies:
A. "Health care sharing ministry" means a health care cost sharing arrangement among persons of the same religion based on their sincerely held religious beliefs, administered by a not-for-profit religious organization.
(Drafting Note: The following language may be used as an alternate Paragraph A.)
A. "Health Care Sharing Ministry" means a faith-based, non-profit organization that is tax exempt under the Internal Revenue Code which:
1. Limits its membership to those who are of a similar faith;
2. Acts as an organizational clearinghouse for information about members/subscribers who have financial, physical or medical needs, matching them with members/subscribers with the present ability to assist those with financial or medical needs, all in accordance with the organization's criteria;
3. Provides for the financial or medical needs of a member/subscriber through payments directly from one member/subscriber to another. The requirements of this Subsection can be satisfied by a trust established solely for the benefit of members/subscribers,
which is audited annually by an independent auditing firm;
4. Provides amounts that members/subscribers may contribute with no assumption of risk or promise to pay among the members/subscribers and no assumption of the risk or promise to pay by such organization to the members/subscribers;
5. Provides a written monthly statement to all members/subscribers, listing the total dollar amount of qualified needs submitted to such organization, as well as the amount actually published or assigned to members/subscribers for their contribution; and
6. Provides in substance the following written disclaimer on or accompanying all promotional documents distributed by or on behalf of the organization, including applications, and guideline materials:
"Notice:
This publication is not insurance, and is not offered through an insurance company. Whether anyone chooses to assist you with your medical bills will be totally voluntary, as no other member will be compelled by law to contribute toward your medical bills. As such, this publication should never be considered to be insurance. Whether you receive any payments for medical expenses and whether or not this publication continues to operate, you are always personally responsible for the payment of your own medical bills."
"Notice:
This publication is not an insurance company nor is it offered through an insurance company. Whether anyone chooses to assist you with your medical bills will be totally voluntary, as no other subscriber or member will be compelled by law to contribute toward your medical bills. As such, this publication should never be considered to be insurance. Whether you receive any payments for medical expenses and whether or not this publication continues to operate, you are always personally responsible for the payment of your own medical bills.
Virginia's bill: http://leg1.state.va.us/cgi-bin/legp504.exe?081+ful+HB1512
ALEC's model legislation: http://alecexposed.org/w/images/ 4/46/5U5-Health_Care_ Sharing_Ministries_Freedom _to_Share_Act_Exposed.pdf
HB 726: Assessing mandated health benefits
This bill would require a periodic review of the benefits Virginia mandates to be covered in health plans sold in the commonwealth. The comparable ALEC legislation would also require a review of proposed new mandated benefits based on financial impact. Virginia already has a similar procedure for reviewing new benefits and therefore this bill only adds a review process for established benefits.
Virginia's Assessment of mandated health benefits
ALEC's Mandated Benefits Review Act
The Commission shall assess the social and financial impact and the medical efficacy of existing mandated benefits and providers and report to the standing committees of the General Assembly having jurisdiction over health insurance matters. The Commission shall submit a schedule of evaluations to the standing committees of the General Assembly having jurisdiction over health insurance matters setting forth the dates by which particular mandates shall be evaluated by the Commission.
The Department of Insurance shall annually review a {insert amount} percentage of existing state mandated benefits, mandated health insurance coverage, and mandated offerings of health benefits in the same manner as prescribed in Sections 2 and 3 of this Act. The Department of Insurance shall report the findings of such review to the chair(s) of the legislative committee(s), the legislative committee(s) having jurisdiction, the Speaker of the House and President of the Senate, and the state budget department, no latter than (insert date.)
Virginia's bill: http://lis.virginia.gov/cgi-bin/legp604.exe?101+ful+HB726
ALEC's model legislation: http://alecexposed.org/w/images/c/c5/5N1-Mandated_Benefits_Review_Act_Exposed.pdf
HB 2024: Unregulated small business health care plans
This bill allows health insurers to offer and sell group health insurance policies or contracts that do not include state mandated health insurance benefits to employers with 50 or fewer employees to provide coverage for employees. A 2011 report by the Virginia Bureau of Insurance showed that the legislation failed to deliver on its goals of increasing inexpensive health care access for small businesses. The Bureau of Insurance surveyed 33 insurers offering plans to small businesses. They found that only four had developed plans under HB 2024. Of those four insurers, only one had actually sold a mandate-less plan and it ended its sales on July 1, 2011. (State Corporate Commission Bureau of Insurance)
Virginia's bill on the availability of basic insurance
ALEC's Health Insurance Reform Act for Small Business Coverage
A. As used in this section:
"Health insurance coverage" means benefits consisting of coverage for costs of medical care, whether directly, through insurance or reimbursement, or otherwise, and including items and services paid for as medical care under a group policy of accident and sickness insurance, hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract, which coverage is subject to this title or is provided under a plan regulated under the Employee Retirement Income Security Act of 1974.
"Health insurer" means any insurance company that issues accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis or a corporation that provides accident and sickness subscription contracts, that is licensed to engage in such business in the Commonwealth, and that is subject to the laws of the Commonwealth that regulate insurance within the meaning of § 514 (b) (2) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1144 (b) (2)).
"Qualified small employer" means a small employer that has not offered health insurance coverage to its employees during the six months prior to the date a policy under this section becomes effective.
"Small employer" means, with respect to a calendar year and a plan year, an employer located in the Commonwealth that employed at least two but not more than 50 employees on business days during the preceding calendar year and who employs at least two employees on the date a policy under this section becomes effective.
(A) The term "insurer" means an entity subject to the laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange, pay for or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits, or healthcare services. An insurance company, insurance service, or insurance organization, including a health maintenance organization, which is licensed in the business of insurance in this state and which is subject to state law that regulates insurance.
(B) The terms "small employer" and "employer" mean a business that, during the most recent calendar year, employed at least 2 and not more than 50 employees who are eligible for coverage under a health benefit plan on at least 50 percent of that business' working days.
(C) The term "employee welfare benefit plan" has the same meaning as that term is given by the Employee Retirement Income Security Act of 1974 (29 USC Section 1001 et seq.).
(D) The terms "health benefit plan" and "plan" mean any employee welfare benefit plan that is issued by an insurer and that provides medical, surgical, or hospital care or benefits to employees of a small employer and their dependents. The terms shall exclude any individual major medical policy that is renewable at the option of the insured except for reasons set forth in paragraphs 3(A) or 3(C) of this Act or if the insurer non-renews all policies issued on the same policy form in this state. These terms also exclude any policy of group insurance that is not designed, administered, or marketed as a health benefit plan to be provided by an employer for its employees.
"State-mandated health benefit" means coverage required under this title or other laws of the Commonwealth to be provided in a policy of accident and sickness insurance or a contract for a health-related condition that (i) includes coverage for specific health care services or benefits; (ii) places limitations or restrictions on deductibles, coinsurance, copayments, or any annual or lifetime maximum benefit amounts; or (iii) includes a specific category of licensed health care practitioners from whom an insured is entitled to receive care. "State-mandated health benefit" includes, without limitation, any coverage, or the offering of coverage, of a benefit or provider pursuant to §§ 38.2-3407.5through 38.2-3407.6:1, 38.2-3407.9:01, 38.2-3407.9:02, 38.2-3407.11 through 38.2-3407.11:3, 38.2-3407.16, 38.2-3408, 38.2-3411 through 38.2-3414.1, 38.2-3418 through 38.2-3418.14, or § 38.2-4221. For purposes of this article, "state-mandated health benefit" does not include a benefit that is mandated by federal law.
B. Notwithstanding any provision of this title to the contrary, a group accident and sickness insurance policy providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis, and a group accident and sickness subscription contract, that is offered, sold, or issued by a health insurer to a qualified small employer:
1. Shall not be required to include coverage, or the offer of coverage, for any state-mandated health benefit; and
2. May include any, or none, of the state-mandated health benefits as the health insurer and the qualified small employer shall agree.
C. A health insurer offering an insurance policy or subscription contract to a qualified small employer shall inform the employer that a policy or contract is not required to provide state-mandated health benefits.
D. A health insurer selling or issuing an insurance policy or subscription contract to a qualified small employer that does not include all state-mandated health benefits shall provide to the qualified small employer and to each participant a written disclosure statement that lists any state-mandated health benefits that the policy or subscription contract does not provide.
Section 6. {No Mandated Benefits.} No statute or regulation that mandates the provision of specified health insurance benefits or that prohibits or limits the use of managed care shall be construed to apply to any small employer health benefit plan or any conversion policy provided in accordance with Section 5 of this Act.
E. The Commission shall adopt any regulations necessary to implement this section.
§ 38.2-3406.2. Capped benefits under insurance policies and contracts.
Nothing in this chapter or Chapters 35 (§ 38.2-3500 et seq.) or 42 (§ 38.2-4200 et seq.) shall prohibit the offering, sale, or issuance of accident and sickness insurance policies or subscription contracts that cap or limit the total annual or lifetime benefits provided under an accident and sickness insurance policy or subscription contracts at specified dollar amounts.
Virginia's bill: http://leg1.state.va.us/cgi-bin/legp504.exe?091+ful+HB2024
ALEC's model legislation: http://alecexposed.org/w/images/ f/f5/5U7-Health_Insurance_Reform_Act _for_Small_Business_ Coverage_Exposed.pdf