38.2-3436 - Eligibility to enroll. - Virginia Statutes

§ 38.2-3436. Eligibility to enroll.

A. A health insurance issuer offering group health insurance coverage, maynot establish rules for eligibility (including continued eligibility) of anyindividual to enroll under the terms of the plan based on any of the healthstatus-related factors.

B. The provisions of this section shall not be construed:

1. To require a group health insurance coverage to provide particularbenefits other than those provided under the terms of such plan or coverage;or

2. To prevent a health insurance issuer offering group health insurancecoverage from establishing limitations or restrictions on the amount, level,extent or nature of the benefits or coverage for similarly situatedindividuals enrolled in the plan or coverage rules for eligibility to enrollunder a plan which includes rules defining any applicable waiting periods forsuch enrollment.

C. A health insurance issuer offering group health insurance coverage, maynot require an individual (as a condition of enrollment or continuedenrollment under the plan) to pay a premium or contribution which is greaterthan such premium or contribution for a similarly situated individualenrolled in the plan on the basis of any health status related factor inrelation to the individual or to an individual enrolled under the plan as adependent of the individual.

D. Nothing in subsection C shall be construed:

1. To restrict the amount that an employee may be charged for coverage undera group health plan or group health insurance coverage; or

2. To prevent a health insurance issuer offering group health insurancecoverage, from establishing premium discounts or rebates or modifyingotherwise applicable copayments or deductibles in return for adherence toprograms of health promotion and disease prevention.

(1997, cc. 807, 913.)