38.2-3522.1 - Limits of group accident and sickness insurance.
§ 38.2-3522.1. Limits of group accident and sickness insurance.
Group accident and sickness insurance offered to a resident of thisCommonwealth under a group accident and sickness insurance policy issued to agroup other than one described in § 38.2-3521.1 shall be subject to thefollowing requirements:
A. No such group accident and sickness insurance policy shall be delivered inthis Commonwealth unless the Commission finds that:
1. The issuance of such group policy is not contrary to Virginia's publicpolicy and is in the best interest of the citizens of this Commonwealth;
2. The issuance of the group policy would result in economies of acquisitionor administration; and
3. The benefits are reasonable in relation to the premiums charged.
Insurers filing policy forms seeking approval under the provisions of thissubsection shall accompany the forms with a certification, signed by theofficer of the company with the responsibility for forms compliance, in whichthe company certifies that each such policy form will be issued only wherethe requirements set forth in subdivisions 1 through 3 of this subsectionhave been met.
B. No such group accident and sickness insurance coverage may be offered inthis Commonwealth by an insurer under a policy issued in another state unlessthis Commonwealth or another state having requirements substantially similarto those contained in subdivisions 1, 2, and 3 of subsection A has made adetermination that such requirements have been met.
1. An insurer offering group accident and sickness insurance coverage in thisCommonwealth under this subsection shall file a certification, signed by theofficer of the company having responsibility for forms compliance, in whichthe company certifies that all group insurance coverage marketed to residentsof this Commonwealth under policies which have not been approved by thisCommonwealth will comply with the provisions of § 38.2-3521.1 or have met therequirements set forth in subdivisions A 1 through A 3 of this section, andwhich clearly demonstrates that the substantially similar requirements of thestate in which the contract will be issued have been met. The certificationshall be accompanied by documentation from such state, evidencing thedetermination that such requirements have been met.
2. An insurer offering group accident and sickness insurance in thisCommonwealth under this subsection that is unable to provide thedocumentation required in subdivision 1 of this subsection shall be requiredto file policy forms consistent with requirements in § 38.2-316 which areimposed on policies issued in Virginia. The policy shall be required to beapproved as meeting all requirements of this title prior to its being offeredto residents of this Commonwealth.
C. The premium for the policy shall be paid either from the policyholder'sfunds or from funds contributed by the covered persons, or from both.
D. An insurer may exclude or limit the coverage on any person as to whomevidence of individual insurability is not satisfactory to the insurer,except as otherwise prohibited in this title.
(1998, c. 154.)