HD15 - The Financial Impact of Mandated Health Insurance Benefits and Providers Pursuant to Section 38.2-3419.1 of the Code of Virginia: 1995 Reporting Period


Executive Summary:
Section 38.2-3419.1 of the Code of Virginia and the State Corporation Commission's Rules Governing the Reporting of Cost and Utilization Data Relating to Mandated Benefits and Mandated Providers (14 VAC 5-190-10 et seq., formerly Insurance Regulation No. 38) require every insurer, health services plan, and health maintenance organization from which a report is deemed necessary to report annually to the Commission cost and utilization information for each of the mandated benefits and mandated providers identified in §§ 38.2-3408 through 38.2-3419 ,and 38.2-4221 of the Code of Virginia. This document is the Commission's consolidation of reports submitted by affected companies for the 1995 calendar year reporting period.

Of the 903 companies licensed to issue accident and sickness policies or subscription contracts in Virginia, or licensed as health maintenance organizations in Virginia in 1995, 76 were required to file full reports for the 1995 reporting period. Information presented in this report reflects data reported by 52 insurers, exclusive of health maintenance organizations, that provided credible data. Of these companies, 9 issued only individual, 27 issued only group, and 16 issued both individual and group health insurance policies or subscription contracts in Virginia in 1995. This report reflects data reported by companies representing 54.9% of the Virginia accident and sickness insurance market and 691,247 units of coverage (single and family individual policies and group certificates) subject to Virginia's mandated benefit and provider requirements. The credible reports of 22 health maintenance organizations (HMOs) representing an additional 25.3% of the Virginia accident and sickness market and 617,434 contracts or certificates (units of coverage) were also used in the preparation of this report. Because HMOs are not subject to most of the mandated benefit and mandated provider requirements of Title 38.2 of the Code of Virginia and are regulated by the Commission's Rules Governing Health Maintenance Organizations (14 VAC 5-210-10 et seq., formerly Insurance Regulation No. 28) with regard to the services they must provide, the data reported by these companies has been analyzed separately from data reported by insurers and health services plans.

The data presented in this report varies from the Commission's reports for earlier reporting periods to the extent that figures representing overall averages of benefit and provider categories are reported, both for claims and for premiums. Previous reports displayed subtotals and totals of the percentages attributed to mandated benefits, mandated offers and mandated providers. Because of this difference in the presentation of information, the average overall percentages cannot be compared to the totals and subtotals presented in earlier reports. The overall averages, however, are a more accurate representation of total utilization of providers and services.