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 Virginia Administrative Code (Last Updated: January 10, 2017)
 Title 14. Insurance
 Agency 5. State Corporation Commission, Bureau of Insurance
 Chapter 190. Rules Governing the Reporting of Cost and Utilization Data Relating to Mandatedbenefits and Mandated Providers

  Section 30. Definitions  

Latest version.

  • For the purposes of this regulation:

    "Applicable policy" or "contract" means any accident and sickness insurance policy providing hospital, medical and surgical or major medical coverage on an expense incurred basis or any accident and sickness subscription contract or any health care plan provided by a health maintenance organization issued or issued for delivery in the Commonwealth of Virginia.

    "Earned premiums" means the aggregate of the earned premium on all policies during a given period. The figure is calculated by adding the premiums written to the unearned premiums as of the beginning of the period and subtracting the unearned premiums as of the end of the period.

    "Incurred claims" means the total losses sustained whether paid or unpaid.

    "Insurer" means any association, aggregate of individuals, business, corporation, individual, joint-stock company, Lloyds type of organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society engaged in the business of making contracts of insurance, as set forth in § 38.2-100 of the Code of Virginia.

    "Mandated benefits" means those benefits that must be included or offered in policies delivered or issued for delivery in the Commonwealth as required by §§ 38.2-3409 through 38.2-3419 of the Code of Virginia.

    "Mandated providers" means those practitioners that are listed in §§ 38.2-3408 and 38.2-4221 of the Code of Virginia.

    "Paid claims" means the aggregate of loss payments, less deductions for all credits, except that no deduction is made for reinsurance recoveries, during a given period.

    "Reporting period" means the calendar year immediately preceding the May 1 reporting date.

    "Written premiums" means gross premiums written minus premiums on policies cancelled and all returned premiums during a given period. Premiums paid to reinsurance carriers on reinsurance ceded are not deducted.

Historical Notes

Derived from Regulation 38, Case No. INS910044, § 3, eff. October 1, 1991; amended, Case No. INS940147, Volume 11, Issue 08, eff. December 7, 1994.

Statutory Authority

§§ 12.1-13, 38.2-223 and 38.2-3419.1 of the Code of Virginia.