An applicant is deciding whether to enroll in a Virginia health services plan. Under the disclosure duties of the health services plan provisions, what must the plan do?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
The disclosure requirements of Virginia's health services plan provisions, including Va. Code § 38.2-4219 and the related sections, require plans to furnish enrollees with information describing benefits, limitations, and how to access services under the plan. The purpose is an informed enrollment decision: an applicant should be able to see what the plan covers, what it excludes, and how care is obtained before committing. Hiding limitations until after premium payment or disclosing only to providers defeats the duty and exposes the plan to regulatory action by the Virginia Bureau of Insurance.
Why the other options are wrong
- A) The disclosure duty exists precisely so limitations are visible before enrollment; withholding them until premium payment violates the provisions.
- B) The audience for disclosure is the enrollee; provider-only disclosure leaves the consumer in the dark and fails the requirement.
- D) Periodic audits do not substitute for ongoing disclosure to enrollees of benefits, limitations, and access to services.
Memory hook
Show the shopper the plan — benefits, limits, and how to get care.