38.2-3407.4 - Explanation of benefits. - Virginia Statutes

§ 38.2-3407.4. Explanation of benefits.

A. Each insurer issuing an accident and sickness insurance policy, acorporation issuing subscription contracts, and each health maintenanceorganization shall file for approval explanation of benefits forms. Theseexplanation of benefit forms shall be subject to the requirements of §38.2-316 or § 38.2-4306 as applicable.

B. The explanation of benefits shall accurately and clearly set forth thebenefits payable under the contract.

C. The Commission may issue regulations to establish standards for theaccuracy and clarity of the information presented in an explanation ofbenefits.

D. The term "explanation of benefits" as used in this section shall includeany form provided by an insurer, health services plan or health maintenanceorganization which explains the amounts covered under a policy or plan orshows the amounts payable by a covered person to a health care provider.

(1994, c. 320.)