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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>73640</law_id><section_number>38.2-4306.1</section_number><catch_line>Interest on claim proceeds</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>38.2-3407.15</reference></referred_to_by><structure><unit label="title" level="1" order_by="1" identifier="38.2">Insurance</unit><unit label="chapter" level="2" order_by="1" identifier="43">Health Maintenance Organizations</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> If an action to recover the claim proceeds due under a <span class="dictionary">health care plan</span> results in a <span class="dictionary">judgment</span> against a <span class="dictionary">health maintenance organization</span>, interest on the <span class="dictionary">judgment</span> at the legal <span class="dictionary">rate</span> of interest shall be paid from the date of presentation to the <span class="dictionary">health maintenance organization</span> of <span class="dictionary">proof of loss</span> to the date <span class="dictionary">judgment</span> is entered. <a id="paragraph-264844" class="section-permalink" href="https://vacode.org/38.2-4306.1/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> If no action is brought, interest upon the claim proceeds paid to the <span class="dictionary">subscriber</span>, claimant, or assignee entitled thereto shall be computed daily at the legal <span class="dictionary">rate</span> of interest from the date of thirty calendar days from the <span class="dictionary">health maintenance organization</span>&#x2019;s receipt of <span class="dictionary">proof of loss</span> to the date of claim payment. <a id="paragraph-264845" class="section-permalink" href="https://vacode.org/38.2-4306.1/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> This section shall not apply to individual <span class="dictionary">contracts</span> issued prior to July 1, 1990, but shall apply to any renewals or reissues of group <span class="dictionary">contracts</span> occurring after that date. <a id="paragraph-264846" class="section-permalink" href="https://vacode.org/38.2-4306.1/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> This section shall not apply to claims for which payment has been or will be made directly to <span class="dictionary">health care providers</span> pursuant to a negotiated reimbursement arrangement requiring uniform or periodic interim payments to be applied against the <span class="dictionary">health maintenance organization</span>&#x2019;s obligation on such claims. <a id="paragraph-264847" class="section-permalink" href="https://vacode.org/38.2-4306.1/#D"><i class="fa fa-link"/></a></p></section>
						<section id="E"><p><span class="prefix-number">E.</span> For purposes of this section, &#x201C;<span class="dictionary">proof of loss</span>&#x201D; means all necessary documentation reasonably required by the <span class="dictionary">health maintenance organization</span> to make a determination of benefit coverage. <a id="paragraph-264848" class="section-permalink" href="https://vacode.org/38.2-4306.1/#E"><i class="fa fa-link"/></a></p></section></text><history>1992, c. 23; 1996, c. 75.</history><metadata></metadata></law>
