                                 CODE OF VIRGINIA

INTEREST ON CLAIM PROCEEDS (§ 38.2-4306.1)

A. If an action to recover the claim proceeds due under a health care plan
results in a judgment against a health maintenance organization, interest on the
judgment at the legal rate of interest shall be paid from the date of
presentation to the health maintenance organization of proof of loss to the date
judgment is entered.

B. If no action is brought, interest upon the claim proceeds paid to the
subscriber, claimant, or assignee entitled thereto shall be computed daily at
the legal rate of interest from the date of thirty calendar days from the health
maintenance organization&#8217;s receipt of proof of loss to the date of claim
payment.

C. This section shall not apply to individual contracts issued prior to July 1,
1990, but shall apply to any renewals or reissues of group contracts occurring
after that date.

D. This section shall not apply to claims for which payment has been or will be
made directly to health care providers pursuant to a negotiated reimbursement
arrangement requiring uniform or periodic interim payments to be applied against
the health maintenance organization&#8217;s obligation on such claims.

E. For purposes of this section, &#8220;proof of loss&#8221; means all necessary
documentation reasonably required by the health maintenance organization to make
a determination of benefit coverage.

HISTORY: 1992, c. 23; 1996, c. 75.