State RegulationsVA specificDifficulty 2/5
A Virginia health services plan contracts with a limited panel of physicians and pharmacies. What obligation does the plan still owe its enrollees regarding access to care?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Virginia's health services plan provisions, which begin with the definitions at Va. Code § 38.2-4201 and extend through Va. Code § 38.2-4205 and related sections, address qualified providers and the enrollee's choice of provider and pharmacy. A plan that limits its network to a panel must still give enrollees a meaningful choice among the qualified providers and pharmacies on that panel. The practical consequence is that panel contracting is permitted, but Virginia law does not allow a plan to reduce that arrangement to a single take-it-or-leave-it channel of care.
Why the other options are wrong
- A) Virginia's health services plan provisions do not require equal cost-sharing for any provider an enrollee picks; the choice obligation runs within the plan's qualified panel.
- C) Cash refunds for going outside the panel are not the access mechanism Virginia contemplates; the requirement concerns choice of qualified providers and pharmacies under the plan.
- D) Enrollees do not redesign provider panels; the plan selects its qualified providers and pharmacies subject to the requirements of the health services plan provisions.
Memory hook
Panel yes, take-it-or-leave-it no — enrollees choose within the panel.