RD110 - Annual Report on the Financial Impact of Mandated Health Insurance Benefits and Providers Pursuant to Section 38.2-3419.1 of the Code of Virginia: 2003 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 State Corporation Commission (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 Governor and the General Assembly. This document constitutes the Commission's report for the 2003 calendar year reporting period.

Of the 830 companies licensed to issue accident and sickness or subscription contracts in Virginia or licensed as HMOs in Virginia in 2003, 48 were required to file full reports (30 insurers and 18 HMOs). Of the 30 insurers, 7 issued only individual contracts, 15 issued only group certificates or subscription contracts, and 8 issued both individual contracts and group certificates or subscription contracts in Virginia in 2003. This report reflects data provided by 30 companies representing 45.81% of the Virginia accident and sickness insurance market and 721,810 units of coverage (single and family individual contracts and group certificates) subject to Virginia's mandated benefit and provider requirements. The data of 18 HMOs, representing an additional 35.15% of the Virginia accident and sickness market and 687,667 contracts or certificates (units of coverage), was also used in the preparation of this report. Because HMOs are not subject to all 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 HMOs has been analyzed separately from data reported by insurers and health services plans.