HD12 - The Financial Impact of Mandated Health Insurance Benefits and Providers Pursuant to Section 38.2-3419.1 of the Code of Virginia: 1998 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.) require every insurer, health services plan, and health maintenance organization (HMO) from which a report is deemed necessary to report 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. The Commission is required to prepare a consolidation of these reports, as represented by this document, for submission to the General Assembly. This document constitutes the Commission's report for the 1998 calendar year reporting period.

Of the 906 companies licensed to issue accident and sickness, or subscription contracts in Virginia, or licensed as HMOs in Virginia in 1998, 66 were required to file full reports for the 1998 reporting period. Information presented in this report reflects data reported by 44 insurers and 21 HMOs that provided credible data. Of the 44 insurers, 9 issued only individual, 23 issued only group, and 12 issued both individual contracts and group health insurance certificates or subscription contracts in Virginia in 1998. This report reflects data reported by companies representing 43.79% of the Virginia accident and sickness insurance market and 580,639 units of coverage (single and family individual contracts and group certificates) subject to Virginia's mandated benefit and provider requirements. The credible reports of 21 HMOs, representing an additional 35.02% of the Virginia accident and sickness market and 486,402 contracts or certificates (units of coverage), were also used in the preparation of this report. Because HMOs are not subject to many of the mandated benefit 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.) 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.