38.2-4306.1 - Interest on claim proceeds. - Virginia Statutes

§ 38.2-4306.1. Interest on claim proceeds.

A. If an action to recover the claim proceeds due under a health care planresults in a judgment against a health maintenance organization, interest onthe judgment at the legal rate of interest shall be paid from the date ofpresentation to the health maintenance organization of proof of loss to thedate judgment is entered.

B. If no action is brought, interest upon the claim proceeds paid to thesubscriber, claimant, or assignee entitled thereto shall be computed daily atthe legal rate of interest from the date of thirty calendar days from thehealth maintenance organization's receipt of proof of loss to the date ofclaim payment.

C. This section shall not apply to individual contracts issued prior to July1, 1990, but shall apply to any renewals or reissues of group contractsoccurring after that date.

D. This section shall not apply to claims for which payment has been or willbe made directly to health care providers pursuant to a negotiatedreimbursement arrangement requiring uniform or periodic interim payments tobe applied against the health maintenance organization's obligation on suchclaims.

E. For purposes of this section, "proof of loss" means all necessarydocumentation reasonably required by the health maintenance organization tomake a determination of benefit coverage.

(1992, c. 23; 1996, c. 75.)