A. This chapter shall apply to all health carriers, except that the provisions of this chapter shall not apply to a policy or certificate that provides coverage only for a specified disease, specified accident or accident-only coverage, credit, disability income, hospital indemnity, long-term care, dental, vision care, or any other limited supplemental benefit or to a Medicare supplement policy of insurance, coverage under a plan through Medicare, Medicaid, or the federal employees health benefits program, self-insured plans, any coverage issued under Chapter 55 of Title 10 of the U.S. Code, and any coverage issued as supplemental to that coverage, any coverage issued as supplemental to liability insurance, workers' compensation or similar insurance, automobile medical payment insurance or any insurance under which benefits are payable with or without regard to fault, whether written on a group blanket or individual basis.
B. Notwithstanding the provisions of this section, self-insured employee welfare benefit plans may request a standard external review from the Commission. "Employee welfare benefit plan" has the meaning set forth in the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002 (1).
2011, c. 788.
Structure Code of Virginia
Chapter 35.1 - Health Carrier Internal Appeal Process and External Review
§ 38.2-3558. Health carrier's internal appeal process
§ 38.2-3559. Notice of right to external review
§ 38.2-3560. Exhaustion of internal appeal process
§ 38.2-3561. Standard external review
§ 38.2-3562. Expedited external review
§ 38.2-3563. External review of experimental or investigational treatment adverse determinations
§ 38.2-3564. Binding nature of external review decision
§ 38.2-3565. Minimum qualifications for independent review organizations
§ 38.2-3566. Approval of independent review organizations
§ 38.2-3567. Independent review organizations to be held harmless
§ 38.2-3568. External review reporting requirements
§ 38.2-3569. Funding of external review