14 Va. Admin. Code § 5-130-65
A. Benefits shall be deemed reasonable in relation to premiums provided the anticipated loss ratio of the policy form, including riders and endorsements, is at least as great as specified in this subsection:
1. If the expected average annual premium is at least $200 but less than $1,000:
| Type of Coverage | Renewal Clause | ||||
| OR | CR | GR | NC | Other | |
| Hospital Confinement Indemnity | n/a | n/a | 55% | 50% | n/a |
| Disability Income Protection, Accident Only, Specified Disease and Other, whether paid on an expense incurred or indemnity basis | 60% | 55% | 50% | 45% | 60% |
| Short-term Limited Duration | n/a | n/a | n/a | n/a | 60% |
Definitions of renewal clause:
OR - Optionally renewable: individual policy renewal is at the option of the insurance company.
CR - Conditionally renewable: renewal can be declined by the insurance company only for stated reasons other than deterioration of health or renewal can be declined on a geographic territory basis.
GR - Guaranteed renewable: renewal cannot be declined by the insurance company for any reason, but the insurance company can revise rates on a class basis.
NC - Noncancellable: renewal cannot be declined nor can rates be revised by the insurance company.
Other - Any other renewal or nonrenewal clauses.
7. Notwithstanding subdivisions 1 through 4 of this subsection, all small employer group health insurance coverage shall be originally priced to meet a minimum 75% loss ratio and shall be guaranteed renewable or noncancellable.
The above anticipated loss ratio standards do not apply to a type of coverage where such standards are in conflict with specific statutes or regulations.
§§ 12.1-13 and 38.2-223 of the Code of Virginia.
Derived from Virginia Register Volume 29, Issue 20, eff. July 1, 2013; amended, Virginia Register Volume 32, Issue 9, eff. January 1, 2016; Volume 36, Issue 5, eff. January 1, 2020.