TITLE 14. INSURANCE
TITLE 14. INSURANCE
STATE CORPORATION COMMISSION
Forms
REGISTRAR'S NOTICE: Forms used in administering the regulation have been filed by the agency. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of a form with a hyperlink to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, 900 East Main Street, 11th Floor, Richmond, Virginia 23219.
Title of Regulation: 14VAC5-405. Rules Governing Balance Billing for Out-of-Network Health Care Services.
Agency Contact: Jackie Myers, Chief Insurance Market Examiner, Bureau of Insurance, State Corporation Commission, P.O. Box 1157, Richmond, VA 23218, telephone (804) 371-9630, or email jackie.myers@scc.virginia.gov.
FORMS (14VAC5-405)
Notice of Consumer Rights, Form 405-A (eff. 1/2021)
Notice of Consumer Rights, Form 405-A (rev. 9/2022)
Elective Group Health Plan Opt-In, Form 405-B (rev. 3/2021)
Elective Group Health Plan Change/Termination, Form 405-C (rev. 3/2021)
Notice of Intent to Arbitrate, Form 405-D (rev. 3/2021)
Notice of Intent to Arbitrate, Form 405-D (rev. 9/2022)
Arbitrator Application, Form 405-E (rev. 3/2021)
VA.R. Doc. No. R23-7366; Filed September 16, 2022