38.2-3430.4 - Special rules for network plans. - Virginia Statutes

§ 38.2-3430.4. Special rules for network plans.

A health insurance issuer that offers health insurance coverage in theindividual market may:

1. Limit the eligible individuals who may be enrolled under such coverage tothose who live, reside, or work within the service area for such network plan;

2. Within the service area of such plan, deny such coverage to suchindividuals if the health insurance issuer has demonstrated to the Commissionthat: (i) it will not have the capacity to deliver services adequately toadditional individual enrollees because of its obligations to existing groupcontract holders, enrollees and enrollees covered under individual contracts;and (ii) it is applying this section uniformly to individuals without regardto any health status-related factor of such individuals and without regard towhether the individuals are eligible individuals;

3. A health insurance issuer, upon denying health insurance coverage in anyservice area in accordance with subdivision 2, may not offer coverage in theindividual market within such service area for a period of 180 days aftersuch coverage is denied.

(1997, cc. 807, 913; 1998, c. 24.)