38.2-3407.13:2 - Claims paid to insureds for services from nonparticipating physicians - Virginia Statutes

§ 38.2-3407.13:2. Claims paid to insureds for services from nonparticipatingphysicians.

When an insurer, health services plan or health maintenance organizationfollows a policy of sending its payment to the insured, subscriber orenrollee for a claim for services received from a nonparticipating physicianor osteopath, the insurer, health services plan or health maintenanceorganization shall: (i) include language in the certificate or evidence ofcoverage of the insured, subscriber or enrollee that notifies the insured,subscriber or enrollee of the responsibility to apply the plan payment to theclaim from such nonparticipating provider, (ii) include this language withany such payment sent to the insured, subscriber or enrollee, and (iii)include the name and any last known address of the nonparticipating provideron the explanation of benefits statement.

(2005, c. 739.)