{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-137.1.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-137.1.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-137.1.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-137.1.html"}],"law_id":61229,"edition_id":1,"section_id":61229,"structure_id":15832,"section_number":"32.1-137.1","catch_line":"Definitions","history":"1998, c. 891.","full_text":"As used in this and the following article, unless the context indicates otherwise:\n\t\t“Agent” or “insurance agent,” when used without qualification, means an individual, partnership, limited liability company, or corporation that solicits, negotiates, procures or effects contracts of insurance or annuity in this Commonwealth.\n\t\t“Bureau of Insurance” means the State Corporation Commission acting pursuant to Title 38.2.\n\t\t“Complaint” means any written communication from a covered person primarily expressing a grievance.\n\t\t“Covered person” means an individual residing in the Commonwealth, whether a policyholder, subscriber, enrollee, or member of a managed care health insurance plan, who is entitled to health care services or benefits provided, arranged for, paid for or reimbursed pursuant to a managed care health insurance plan under Title 38.2.\n\t\t“Managed care health insurance plan” means an arrangement for the delivery of health care in which a health carrier as defined in \u00a7 38.2-5800 undertakes to provide, arrange for, pay for, or reimburse any of the costs of health care services for a covered person on a prepaid or insured basis which (i) contains one or more incentive arrangements, including any credentialing requirements intended to influence the cost or level of health care services between the health carrier and one or more providers with respect to the delivery of health care services; and (ii) requires or creates benefit payment differential incentives for covered persons to use providers that are directly or indirectly managed, owned, under contract with or employed by the health carrier. Any health maintenance organization as defined in \u00a7 38.2-4300 or health carrier that offers preferred provider contracts or policies as defined in \u00a7 38.2-3407 or preferred provider subscription contracts as defined in \u00a7 38.2-4209 shall be deemed to be offering one or more managed care health insurance plans. For the purposes of this definition, the prohibition of balance billing by a provider shall not be deemed a benefit payment differential incentive for covered persons to use providers who are directly or indirectly managed, owned, under contract with or employed by the health carrier. A single managed care health insurance plan may encompass multiple products and multiple types of benefit payment differentials; however, a single managed care health insurance plan shall encompass only one provider network or set of provider networks.\n\t\t“Managed care health insurance plan licensee” means a health carrier subject to licensure by the Bureau of Insurance under Title 38.2 who is responsible for a managed care health insurance plan in accordance with Chapter 58 (\u00a7 38.2-5801 et seq.) of Title 38.2.\n\t\t“Person” means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds type of organization, other organization, partnership, receiver, reciprocal or inter-insurance exchange, trustee or society.","order_by":null,"text":{"0":{"id":223734,"text":"As used in this and the following article, unless the context indicates otherwise:\n\t\t“Agent” or “insurance agent,” when used without qualification, means an individual, partnership, limited liability company, or corporation that solicits, negotiates, procures or effects contracts of insurance or annuity in this Commonwealth.\n\t\t“Bureau of Insurance” means the State Corporation Commission acting pursuant to Title 38.2.\n\t\t“Complaint” means any written communication from a covered person primarily expressing a grievance.\n\t\t“Covered person” means an individual residing in the Commonwealth, whether a policyholder, subscriber, enrollee, or member of a managed care health insurance plan, who is entitled to health care services or benefits provided, arranged for, paid for or reimbursed pursuant to a managed care health insurance plan under Title 38.2.\n\t\t“Managed care health insurance plan” means an arrangement for the delivery of health care in which a health carrier as defined in \u00a7 38.2-5800 undertakes to provide, arrange for, pay for, or reimburse any of the costs of health care services for a covered person on a prepaid or insured basis which (i) contains one or more incentive arrangements, including any credentialing requirements intended to influence the cost or level of health care services between the health carrier and one or more providers with respect to the delivery of health care services; and (ii) requires or creates benefit payment differential incentives for covered persons to use providers that are directly or indirectly managed, owned, under contract with or employed by the health carrier. Any health maintenance organization as defined in \u00a7 38.2-4300 or health carrier that offers preferred provider contracts or policies as defined in \u00a7 38.2-3407 or preferred provider subscription contracts as defined in \u00a7 38.2-4209 shall be deemed to be offering one or more managed care health insurance plans. For the purposes of this definition, the prohibition of balance billing by a provider shall not be deemed a benefit payment differential incentive for covered persons to use providers who are directly or indirectly managed, owned, under contract with or employed by the health carrier. A single managed care health insurance plan may encompass multiple products and multiple types of benefit payment differentials; however, a single managed care health insurance plan shall encompass only one provider network or set of provider networks.\n\t\t“Managed care health insurance plan licensee” means a health carrier subject to licensure by the Bureau of Insurance under Title 38.2 who is responsible for a managed care health insurance plan in accordance with Chapter 58 (\u00a7 38.2-5801 et seq.) of Title 38.2.\n\t\t“Person” means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds type of organization, other organization, partnership, receiver, reciprocal or inter-insurance exchange, trustee or society.","type":"section","prefixes":[""],"prefix":"","entire_prefix":"","prefix_anchor":"","level":1}},"ancestry":[{"id":15832,"edition_id":1,"name":"Certificate of Quality Assurance of Managed Care Health Insurance Plan Licensees","identifier":"1.1","label":"article","depth":3,"order_by":1,"parent_id":12728,"metadata":{},"date_created":"2026-06-26 04:00:17","date_modified":"2026-06-26 04:00:17","permalink":{"id":203095,"object_type":"structure","relational_id":15832,"identifier":"1.1","token":"32.1\/5\/1.1","url":"\/32.1\/5\/1.1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12728,"edition_id":1,"name":"Regulation of Medical Care Facilities and Services","identifier":"5","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":202855,"object_type":"structure","relational_id":12728,"identifier":"5","token":"32.1\/5","url":"\/32.1\/5\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":61229,"structure_id":15832,"section_number":"32.1-137.1","catch_line":"Definitions","url":"\/32.1-137.1\/","token":"32.1\/5\/1.1\/32.1-137.1","metadata":false},{"id":80679,"structure_id":15832,"section_number":"32.1-137.2","catch_line":"Certification of quality assurance; application; issuance; denial; renewal","url":"\/32.1-137.2\/","token":"32.1\/5\/1.1\/32.1-137.2","metadata":false},{"id":84080,"structure_id":15832,"section_number":"32.1-137.3","catch_line":"Regulations","url":"\/32.1-137.3\/","token":"32.1\/5\/1.1\/32.1-137.3","metadata":false},{"id":80091,"structure_id":15832,"section_number":"32.1-137.4","catch_line":"Examination, review or investigation","url":"\/32.1-137.4\/","token":"32.1\/5\/1.1\/32.1-137.4","metadata":false},{"id":61098,"structure_id":15832,"section_number":"32.1-137.5","catch_line":"Civil penalties; probation; suspension; restriction or prohibition of new enrollments to managed care health insurance plan licensee; revocation or nonrenewal of certificate of quality assurance; appeal process; correction","url":"\/32.1-137.5\/","token":"32.1\/5\/1.1\/32.1-137.5","metadata":false},{"id":74118,"structure_id":15832,"section_number":"32.1-137.6","catch_line":"Complaint system","url":"\/32.1-137.6\/","token":"32.1\/5\/1.1\/32.1-137.6","metadata":false}],"next_section":{"id":80679,"structure_id":15832,"section_number":"32.1-137.2","catch_line":"Certification of quality assurance; application; issuance; denial; renewal","url":"\/32.1-137.2\/","token":"32.1\/5\/1.1\/32.1-137.2","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-137.1\/","history_text":"

This law was first created in 1998. The record of its establishment is cataloged in chapter 891<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year.<\/p>","references":[{"id":74476,"section_number":"32.1-137.16","catch_line":"Records","order_by":null,"url":"\/32.1-137.16\/"},{"id":63869,"section_number":"38.2-5807","catch_line":"Access to care","order_by":null,"url":"\/38.2-5807\/"},{"id":75727,"section_number":"38.2-5809","catch_line":"Suspension or revocation of license","order_by":null,"url":"\/38.2-5809\/"}],"refers_to":[{"id":76321,"section_number":"38.2-3407","catch_line":"Health benefit programs","order_by":null,"url":"\/38.2-3407\/"},{"id":80669,"section_number":"38.2-4209","catch_line":"Preferred provider subscription contracts","order_by":null,"url":"\/38.2-4209\/"},{"id":72005,"section_number":"38.2-4300","catch_line":"Definitions","order_by":null,"url":"\/38.2-4300\/"},{"id":77304,"section_number":"38.2-5800","catch_line":"Definitions","order_by":null,"url":"\/38.2-5800\/"},{"id":64894,"section_number":"38.2-5801","catch_line":"General provisions","order_by":null,"url":"\/38.2-5801\/"}],"permalink":{"id":203097,"object_type":"law","relational_id":61229,"identifier":"32.1-137.1","token":"32.1\/5\/1.1\/32.1-137.1","url":"\/32.1-137.1\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-137.1\/","token":"32.1\/5\/1.1\/32.1-137.1","dublin_core":{"Title":"Definitions","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-137.1","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

As used in this and the following article, unless the context indicates otherwise:\n\t\t“Agent<\/span>” or “insurance agent<\/span>,” when used without qualification, means an individual, partnership, limited liability company, or corporation that solicits, negotiates, procures or effects contracts<\/span> of insurance or annuity in this Commonwealth.\n\t\t“Bureau of Insurance<\/span>” means the State Corporation Commission acting pursuant to Title 38.2.\n\t\t“Complaint<\/span>” means any written communication from a covered person<\/span> primarily expressing a grievance.\n\t\t“Covered person<\/span>” means an individual residing in the Commonwealth, whether a policyholder, subscriber, enrollee, or member of a managed care health insurance plan<\/span>, who is entitled to health care services or benefits provided, arranged for, paid for or reimbursed pursuant to a managed care health insurance plan<\/span> under Title 38.2.\n\t\t“Managed care health insurance plan<\/span>” means an arrangement for the delivery of health care in which a health carrier as defined in \u00a7 38.2-5800<\/a> undertakes to provide, arrange for, pay for, or reimburse any of the costs of health care services for a covered person<\/span> on a prepaid or insured basis which (i) contains one or more incentive arrangements, including any credentialing requirements intended to influence the cost or level of health care services between the health carrier and one or more providers with respect to the delivery of health care services; and (ii) requires or creates benefit payment differential incentives for covered persons<\/span> to use providers that are directly or indirectly managed, owned, under contract<\/span> with or employed by the health carrier. Any health maintenance organization as defined in \u00a7 38.2-4300<\/a> or health carrier that offers preferred provider contracts<\/span> or policies as defined in \u00a7 38.2-3407<\/a> or preferred provider subscription contracts<\/span> as defined in \u00a7 38.2-4209<\/a> shall be deemed to be offering one or more managed care health insurance plans<\/span>. For the purposes of this definition, the prohibition of balance billing by a provider shall not be deemed a benefit payment differential incentive for covered persons<\/span> to use providers who are directly or indirectly managed, owned, under contract<\/span> with or employed by the health carrier. A single managed care health insurance plan<\/span> may encompass multiple products and multiple types of benefit payment differentials; however, a single managed care health insurance plan<\/span> shall encompass only one provider network or set of provider networks.\n\t\t“Managed care health insurance plan<\/span> licensee<\/span>” means a health carrier subject to licensure by the Bureau of Insurance<\/span> under Title 38.2 who is responsible for a managed care health insurance plan<\/span> in accordance with Chapter 58 (\u00a7 38.2-5801<\/a> et seq.) of Title 38.2.\n\t\t“Person” means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds type of organization, other organization, partnership, receiver, reciprocal or inter-insurance exchange, trustee or society.<\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nDEFINITIONS (\u00a7 32.1-137.1)\n\nAs used in this and the following article, unless the context indicates\notherwise:\n\t\t“Agent” or “insurance agent,” when used without\nqualification, means an individual, partnership, limited liability company, or\ncorporation that solicits, negotiates, procures or effects contracts of\ninsurance or annuity in this Commonwealth.\n\t\t“Bureau of Insurance” means the State Corporation Commission\nacting pursuant to Title 38.2.\n\t\t“Complaint” means any written communication from a covered person\nprimarily expressing a grievance.\n\t\t“Covered person” means an individual residing in the Commonwealth,\nwhether a policyholder, subscriber, enrollee, or member of a managed care health\ninsurance plan, who is entitled to health care services or benefits provided,\narranged for, paid for or reimbursed pursuant to a managed care health insurance\nplan under Title 38.2.\n\t\t“Managed care health insurance plan” means an arrangement for the\ndelivery of health care in which a health carrier as defined in \u00a7 38.2-5800\nundertakes to provide, arrange for, pay for, or reimburse any of the costs of\nhealth care services for a covered person on a prepaid or insured basis which\n(i) contains one or more incentive arrangements, including any credentialing\nrequirements intended to influence the cost or level of health care services\nbetween the health carrier and one or more providers with respect to the\ndelivery of health care services; and (ii) requires or creates benefit payment\ndifferential incentives for covered persons to use providers that are directly\nor indirectly managed, owned, under contract with or employed by the health\ncarrier. Any health maintenance organization as defined in \u00a7 38.2-4300 or\nhealth carrier that offers preferred provider contracts or policies as defined\nin \u00a7 38.2-3407 or preferred provider subscription contracts as defined in \u00a7\n38.2-4209 shall be deemed to be offering one or more managed care health\ninsurance plans. For the purposes of this definition, the prohibition of balance\nbilling by a provider shall not be deemed a benefit payment differential\nincentive for covered persons to use providers who are directly or indirectly\nmanaged, owned, under contract with or employed by the health carrier. A single\nmanaged care health insurance plan may encompass multiple products and multiple\ntypes of benefit payment differentials; however, a single managed care health\ninsurance plan shall encompass only one provider network or set of provider\nnetworks.\n\t\t“Managed care health insurance plan licensee” means a health\ncarrier subject to licensure by the Bureau of Insurance under Title 38.2 who is\nresponsible for a managed care health insurance plan in accordance with Chapter\n58 (\u00a7 38.2-5801 et seq.) of Title 38.2.\n\t\t“Person” means any association, aggregate of individuals,\nbusiness, company, corporation, individual, joint-stock company, Lloyds type of\norganization, other organization, partnership, receiver, reciprocal or\ninter-insurance exchange, trustee or society.\n\nHISTORY: 1998, c. 891.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}