                                 CODE OF VIRGINIA

DISCLOSURES AND REPRESENTATIONS TO ENROLLEES (§ 38.2-5803)

A. The following shall be provided to the MCHIP&#8217;s covered persons at the
time of enrollment or at the time the contract or evidence of coverage is issued
and shall be made available upon request or at least annually:

   1. A list of the names and locations of all affiliated providers. Such list
   may be made available in a form other than a printed document, provided the
   purchaser or existing enrollee is given the means to request and receive a
   printed copy of such list.

   2. A description of the service area or areas within which the MCHIP shall
   provide health care services.

   3. A description of the method of resolving complaints of covered persons,
   including a description of any arbitration procedure if complaints may be
   resolved through a specified arbitration agreement.

   4. Notice that the MCHIP is subject to regulation in the Commonwealth by both
   the State Corporation Commission Bureau of Insurance pursuant to Title 38.2
   and the Virginia Department of Health pursuant to Title 32.1.

   5. A prominent notice included within the evidence of coverage, providing
   substantially the following: &#8220;If you have any questions regarding an
   appeal or grievance concerning the health care services that you have been
   provided that have not been satisfactorily addressed by your plan, you may
   contact the Office of the Managed Care Ombudsman for assistance.&#8221; Such
   notice shall also provide the toll-free telephone number, mailing address, and
   electronic mail address of the Office of the Managed Care Ombudsman. This
   section shall not apply to evidences of coverage for enrollees in the plans
   administered by the Department of Medical Assistance Services that provide
   benefits pursuant to Title XIX or Title XXI of the Social Security Act, as
   amended.

B. The following shall apply to MCHIPs that require a covered person to select a
primary care physician with respect to the offer of basic health care services
by the MCHIP:

   1. At the time of enrollment each covered person shall have the right to
   select a primary care physician from among the health carrier&#8217;s
   affiliated primary care physicians for the MCHIP, subject to availability.

   2. Any covered person who is dissatisfied with his primary care physician
   shall have the right to select another primary care physician from among the
   affiliated primary care physicians, subject to availability. The health
   carrier may impose a reasonable waiting period for this transfer.

HISTORY: 1998, c. 891; 2000, c. 922; 2004, c. 715; 2006, c. 866.