                                 CODE OF VIRGINIA

REQUIREMENTS FOR PRESCRIPTION BENEFIT CARDS (§ 38.2-3407.4:2)

A. Each (i) insurer proposing to issue individual or group accident and sickness
insurance policies providing hospital, medical and surgical or major medical
coverage on an expense incurred basis, (ii) corporation providing individual or
group accident and sickness subscription contracts, and (iii) health maintenance
organization providing a health care plan for health care services, whose
policy, contract or plan, including any certificate or evidence of coverage
issued in connection with such policy, contract or plan, includes coverage for
prescription drugs on an outpatient basis, shall provide its insureds,
subscribers or enrollees a prescription benefit card, health insurance benefit
card or other technology that complies with the National Council for
Prescription Drug Programs Pharmacy ID Card Implementation Guide in effect at
the time of card issuance or includes, at a minimum, the following data
elements:

   1. The name or identifying trademark of the insurer, corporation, or health
   maintenance organization or, if another entity administers the prescription
   benefit, the name or identifying trademark of the benefit administrator;

   2. The insured&#8217;s, subscriber&#8217;s, or enrollee&#8217;s name and
   identification number;

   3. The telephone number that providers may call for pharmacy benefit
   assistance; and

   4. The electronic transaction routing information and other numbers required
   by the insurer, corporation, health maintenance organization or benefit
   administrator to electronically process a prescription claim.

B. The prescription benefit card, health insurance benefit card, or other
technology shall be issued to each insured, subscriber or enrollee, and shall
upon any changes in the required data elements set forth in subsection A, either
reissue the card or provide the insured, subscriber or enrollee such corrective
information as may be required to electronically process a prescription claim.
Notwithstanding the requirements of &#xA7; 38.2-4300 and subdivision A 2 of
&#xA7; 38.2-4306, a prescription benefit card, health benefit card or other
technology issued pursuant to this section shall not be considered part of the
evidence of coverage and shall not be required to be filed with or approved by
the Commission.

C. An insurer, corporation, or health maintenance organization may comply with
this section by issuing to each insured, subscriber or enrollee a health
insurance benefit card that contains data elements related to both prescription
and non-prescription health insurance benefits.

D. Compliance with any federal law or regulation that requires the prescription
benefit data elements on a prescription benefit card or health insurance benefit
card pursuant to subsection A shall be deemed to be compliance with this
section.

E. The provisions of this section shall not apply to (i) short-term travel, or
accident-only, policies, (ii) short-term nonrenewable policies of not more than
six months&#8217; duration, (iii) such an insurer, corporation, or health
maintenance organization that does not include coverage for prescription drugs;
or (iv) any health maintenance organization that operates or maintains its own
pharmacies and dispenses, on an annual basis, over ninety-five percent of
prescription drugs or devices to its enrollees at its own pharmacies.

F. The provisions of this section shall apply to contracts, policies or plans
delivered, issued for delivery or renewed in this Commonwealth on and after July
1, 2002.

HISTORY: 2001, c. 334.