Final Text
Part III
Other Procedures
14VAC10-10-160. Insurance.
A. Because the Virginia Birth-Related Neurological Injury
Compensation Program (Program) generally is a payer of last resort, it
each admitted claimant's parent or legal guardian must purchase private health
insurance to provide coverage for the actual medically necessary and reasonable
expenses as described in ยง 38.2-5009 A 1 of the Code of Virginia that were, or
are, incurred as a result of the admitted claimant's birth-related neurological
injury and for the admitted claimant's benefit. The admitted claimant's parent
or legal guardian may request the [ Program facilitator's ]
assistance [ of the Program facilitator ] in
obtaining a suitable health insurance policy for the admitted claimant if he
[ or she ] has no [ pre-existing
preexisting ] coverage for the admitted claimant upon the admitted
claimant's admission into the Program. The Program will reimburse, upon receipt
of proof of payment, solely the portion of the premiums that is attributable to
the admitted claimant's post-admission coverage and paid for by the admitted
claimant's parent or legal guardian. The Program must be provided with a
copy of the applicable health insurance policy, if one exists, or a complete
description of applicable coverage, before benefits are paid by the
Program. It is the responsibility of the parents or guardians to seek benefits
for which an admitted claimant is eligible by submitting requests to the
[ Program's Third-Party Administrator Program third-party
administrator ] or other appropriate staff person, as indicated on
the Program's website. In addition, the parents or guardians of the
admitted claimant must identify a primary care physician.
B. Claimants must utilize the primary insurer's in-network providers and facilities unless otherwise authorized by the Program. Utilizing non-network or nonparticipating providers or facilities may result in reduced payment, nonpayment, or nonreimbursement of incurred expenses.