2006 Code of Virginia § 38.2-3407.4:2 - Requirements for prescription benefit cards

38.2-3407.4:2. Requirements for prescription benefit cards.

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

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

2. The insured's, subscriber's, or enrollee's name and identification number;

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

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

B. The prescription benefit card, health insurance benefit card, or othertechnology shall be issued to each insured, subscriber or enrollee, and shallupon any changes in the required data elements set forth in subsection A,either reissue the card or provide the insured, subscriber or enrollee suchcorrective information as may be required to electronically process aprescription claim. Notwithstanding the requirements of 38.2-4300 andsubdivision A 2 of 38.2-4306, a prescription benefit card, health benefitcard or other technology issued pursuant to this section shall not beconsidered part of the evidence of coverage and shall not be required to befiled with or approved by the Commission.

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

D. Compliance with any federal law or regulation that requires theprescription benefit data elements on a prescription benefit card or healthinsurance benefit card pursuant to subsection A shall be deemed to becompliance 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 morethan six months' duration, (iii) such an insurer, corporation, or healthmaintenance organization that does not include coverage for prescriptiondrugs; or (iv) any health maintenance organization that operates or maintainsits own pharmacies and dispenses, on an annual basis, over ninety-fivepercent of prescription drugs or devices to its enrollees at its ownpharmacies.

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

(2001, c. 334.)