{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3420.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3420.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3420.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3420.html"}],"law_id":64087,"edition_id":1,"section_id":64087,"structure_id":16142,"section_number":"38.2-3420","catch_line":"Authority and jurisdiction of Commission; exception","history":"1983, c. 417, \u00a7 38.1-43.7; 1986, c. 562; 1990, c. 477; 2004, c. 236; 2011, c. 329; 2012, c. 589; 2022, cc. 404, 405.","full_text":"A\n\nExcept as provided in subsection C, any person offering or providing coverage in the Commonwealth for health care services, whether the coverage is by direct payment, reimbursement, or otherwise, shall be presumed to be subject to the jurisdiction of the Commission to the extent the person is not regulated by another agency of the Commonwealth, any subdivision of the Commonwealth, or the federal government relating to the offering or providing of coverage for health care services.B\n\nAs used in this subsection:\n\t\t\t“Health benefit plan” has the same meaning as described in \u00a7 38.2-3431.\n\t\t\t“Self-funded multiple employer welfare arrangement” or “self-funded MEWA” means any multiple employer welfare arrangement that is not fully insured by a licensed insurance company. This term includes a benefit consortium established under Chapter 55 (\u00a7 59.1-589 et seq.) of Title 59.1.1\n\nNo self-funded multiple employer welfare arrangement shall issue health benefit plans in the Commonwealth until it has obtained a license pursuant to regulations promulgated by the Commission. No provision of this subsection shall authorize a self-funded MEWA domiciled outside of the Commonwealth to operate in the Commonwealth without obtaining a license pursuant to the regulations promulgated by the Commission.2\n\nNotwithstanding any other section of this title or Chapter 55 (§ 59.1-589 et seq.) of Title 59.1 to the contrary, all financial and solvency requirements imposed by provisions of this title upon domestic insurers shall apply to domestic self-funded MEWAs unless domestic self-funded MEWAs are otherwise specifically exempted. For the purposes of handling the rehabilitation, liquidation, or conservation of a domestic self-funded MEWA, the provisions of Chapter 15 (§ 38.2-1500 et seq.) shall apply.3\n\nNotwithstanding any other section of this title or Chapter 55 (§ 59.1-589 et seq.) of Title 59.1 to the contrary, any health benefit plan issued by a self-funded MEWA, including a trust, benefits consortium, or other arrangement, that covers one or more employees of one or more small employers shall (i) provide essential health benefits and cost-sharing requirements as set forth in § 38.2-3451; (ii) offer a minimum level of coverage designed to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided under the plan; (iii) not limit or exclude coverage for an individual by imposing a preexisting condition exclusion on that individual pursuant to § 38.2-3444; (iv) not establish discriminatory rules based on health status related to eligibility or premium or contribution requirements as imposed on health carriers pursuant to § 38.2-3432.2; (v) meet the renewability standards set forth for health insurance issuers in § 38.2-3432.1; (vi) establish base rates formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims; and (vii) utilize each employer member’s specific risk profile to determine premiums by actuarially adjusting above or below established base rates, and utilize either pooling or reinsurance of individual large claimants to reduce the adverse impact on any specific employer member’s premiums.4\n\nThe Commission shall have authority to adopt regulations applicable to self-funded MEWAs, whether domiciled inside or outside of the Commonwealth, including regulations addressing the self-funded MEWA’s financial condition, solvency requirements, and insolvency plan and its exclusion, pursuant to § 59.1-592, from the Virginia Life, Accident and Sickness Insurance Guaranty Association established under Chapter 17 (§ 38.2-1700 et seq.).C\n\nNeither the provisions of this section nor any other provision of this title shall be construed to affect or apply to a multiple employer welfare arrangement (MEWA) composed only of banks together with their plan-sponsoring organization, and their respective employees, provided the multiple employer welfare arrangement (i) is duly licensed as a MEWA by the insurance regulatory agency of a state contiguous to the Commonwealth, (ii) files with the Commission a copy of its certificate of authority or other proper license from the contiguous state, (iii) has no more than 500 Virginia residents who are employees of its member banks enrolled in or receiving accident and sickness benefits as insureds, members, enrollees, or subscribers of the MEWA, and (iv) is subject to solvency examination authority and reserve adequacy requirements determined by sound actuarial principles by such domiciliary contiguous state. For purposes of this subsection:\n\t\t\t“Bank” means an institution that has or is eligible for insurance of deposits by the Federal Deposit Insurance Corporation.\n\t\t\t“Plan-sponsoring organization” means an association that (i) sponsors a MEWA composed only of banks; (ii) has been actively in existence for at least five years; (iii) has been formed and maintained in good faith for purposes other than obtaining insurance; (iv) does not condition membership in the association on any health status-related factor relating to an individual, including an employee of an employer or a dependent of an employee; (v) makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to such members or individuals eligible for coverage through a member; (vi) does not make health insurance coverage offered through the association available other than in connection with a member of the association; and (vii) meets such additional requirements as may be imposed under the laws of the Commonwealth, and includes any subsidiary of such an association.","order_by":null,"text":{"0":{"id":233348,"text":"Except as provided in subsection C, any person offering or providing coverage in the Commonwealth for health care services, whether the coverage is by direct payment, reimbursement, or otherwise, shall be presumed to be subject to the jurisdiction of the Commission to the extent the person is not regulated by another agency of the Commonwealth, any subdivision of the Commonwealth, or the federal government relating to the offering or providing of coverage for health care services.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":233349,"text":"As used in this subsection:\n\t\t\t“Health benefit plan” has the same meaning as described in \u00a7 38.2-3431.\n\t\t\t“Self-funded multiple employer welfare arrangement” or “self-funded MEWA” means any multiple employer welfare arrangement that is not fully insured by a licensed insurance company. This term includes a benefit consortium established under Chapter 55 (\u00a7 59.1-589 et seq.) of Title 59.1.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"B1"},"2":{"id":233350,"text":"No self-funded multiple employer welfare arrangement shall issue health benefit plans in the Commonwealth until it has obtained a license pursuant to regulations promulgated by the Commission. No provision of this subsection shall authorize a self-funded MEWA domiciled outside of the Commonwealth to operate in the Commonwealth without obtaining a license pursuant to the regulations promulgated by the Commission.","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"3":{"id":233351,"text":"Notwithstanding any other section of this title or Chapter 55 (§ 59.1-589 et seq.) of Title 59.1 to the contrary, all financial and solvency requirements imposed by provisions of this title upon domestic insurers shall apply to domestic self-funded MEWAs unless domestic self-funded MEWAs are otherwise specifically exempted. For the purposes of handling the rehabilitation, liquidation, or conservation of a domestic self-funded MEWA, the provisions of Chapter 15 (§ 38.2-1500 et seq.) shall apply.","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"4":{"id":233352,"text":"Notwithstanding any other section of this title or Chapter 55 (§ 59.1-589 et seq.) of Title 59.1 to the contrary, any health benefit plan issued by a self-funded MEWA, including a trust, benefits consortium, or other arrangement, that covers one or more employees of one or more small employers shall (i) provide essential health benefits and cost-sharing requirements as set forth in § 38.2-3451; (ii) offer a minimum level of coverage designed to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided under the plan; (iii) not limit or exclude coverage for an individual by imposing a preexisting condition exclusion on that individual pursuant to § 38.2-3444; (iv) not establish discriminatory rules based on health status related to eligibility or premium or contribution requirements as imposed on health carriers pursuant to § 38.2-3432.2; (v) meet the renewability standards set forth for health insurance issuers in § 38.2-3432.1; (vi) establish base rates formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims; and (vii) utilize each employer member’s specific risk profile to determine premiums by actuarially adjusting above or below established base rates, and utilize either pooling or reinsurance of individual large claimants to reduce the adverse impact on any specific employer member’s premiums.","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B4"},"5":{"id":233353,"text":"The Commission shall have authority to adopt regulations applicable to self-funded MEWAs, whether domiciled inside or outside of the Commonwealth, including regulations addressing the self-funded MEWA’s financial condition, solvency requirements, and insolvency plan and its exclusion, pursuant to § 59.1-592, from the Virginia Life, Accident and Sickness Insurance Guaranty Association established under Chapter 17 (§ 38.2-1700 et seq.).","type":"section","prefixes":["B","4"],"prefix":"4","entire_prefix":"B4","prefix_anchor":"B4","level":2,"prior_prefix":"B3","next_prefix":"C"},"6":{"id":233354,"text":"Neither the provisions of this section nor any other provision of this title shall be construed to affect or apply to a multiple employer welfare arrangement (MEWA) composed only of banks together with their plan-sponsoring organization, and their respective employees, provided the multiple employer welfare arrangement (i) is duly licensed as a MEWA by the insurance regulatory agency of a state contiguous to the Commonwealth, (ii) files with the Commission a copy of its certificate of authority or other proper license from the contiguous state, (iii) has no more than 500 Virginia residents who are employees of its member banks enrolled in or receiving accident and sickness benefits as insureds, members, enrollees, or subscribers of the MEWA, and (iv) is subject to solvency examination authority and reserve adequacy requirements determined by sound actuarial principles by such domiciliary contiguous state. For purposes of this subsection:\n\t\t\t“Bank” means an institution that has or is eligible for insurance of deposits by the Federal Deposit Insurance Corporation.\n\t\t\t“Plan-sponsoring organization” means an association that (i) sponsors a MEWA composed only of banks; (ii) has been actively in existence for at least five years; (iii) has been formed and maintained in good faith for purposes other than obtaining insurance; (iv) does not condition membership in the association on any health status-related factor relating to an individual, including an employee of an employer or a dependent of an employee; (v) makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to such members or individuals eligible for coverage through a member; (vi) does not make health insurance coverage offered through the association available other than in connection with a member of the association; and (vii) meets such additional requirements as may be imposed under the laws of the Commonwealth, and includes any subsidiary of such an association.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B4"}},"ancestry":[{"id":16142,"edition_id":1,"name":"Jurisdiction over Providers of Health Care Services","identifier":"3","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 04:07:21","date_modified":"2026-06-26 04:07:21","permalink":{"id":215333,"object_type":"structure","relational_id":16142,"identifier":"3","token":"38.2\/34\/3","url":"\/38.2\/34\/3\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12993,"edition_id":1,"name":"Provisions Relating to Accident and Sickness Insurance","identifier":"34","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214887,"object_type":"structure","relational_id":12993,"identifier":"34","token":"38.2\/34","url":"\/38.2\/34\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":64087,"structure_id":16142,"section_number":"38.2-3420","catch_line":"Authority and jurisdiction of Commission; exception","url":"\/38.2-3420\/","token":"38.2\/34\/3\/38.2-3420","metadata":false},{"id":70633,"structure_id":16142,"section_number":"38.2-3421","catch_line":"How to show jurisdiction of other state agency or federal government","url":"\/38.2-3421\/","token":"38.2\/34\/3\/38.2-3421","metadata":false},{"id":77260,"structure_id":16142,"section_number":"38.2-3422","catch_line":"Examination","url":"\/38.2-3422\/","token":"38.2\/34\/3\/38.2-3422","metadata":false},{"id":86693,"structure_id":16142,"section_number":"38.2-3423","catch_line":"When subject to this title","url":"\/38.2-3423\/","token":"38.2\/34\/3\/38.2-3423","metadata":false},{"id":64092,"structure_id":16142,"section_number":"38.2-3424","catch_line":"Disclosure of extent and elements of coverage","url":"\/38.2-3424\/","token":"38.2\/34\/3\/38.2-3424","metadata":false},{"id":79837,"structure_id":16142,"section_number":"38.2-3424.1","catch_line":"Applicability","url":"\/38.2-3424.1\/","token":"38.2\/34\/3\/38.2-3424.1","metadata":false}],"next_section":{"id":70633,"structure_id":16142,"section_number":"38.2-3421","catch_line":"How to show jurisdiction of other state agency or federal government","url":"\/38.2-3421\/","token":"38.2\/34\/3\/38.2-3421","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3420\/","history_text":"

This law was first created in 1983. The record of its establishment is cataloged in chapter 417 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. Unfortunately, the 1983 \u201cActs\u201d aren\u2019t available online. It has been modified 6 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1986, chapter 562; in 1990, chapter 477; in 2004, chapter 236<\/a>; in 2011, chapter 329<\/a>; in 2012, chapter 589<\/a>; in 2022, chapters 404<\/a> and 405<\/a>.<\/p>","references":[{"id":70633,"section_number":"38.2-3421","catch_line":"How to show jurisdiction of other state agency or federal government","order_by":null,"url":"\/38.2-3421\/"},{"id":86404,"section_number":"38.2-3431","catch_line":"Application of article; definitions","order_by":null,"url":"\/38.2-3431\/"},{"id":78302,"section_number":"38.2-3552","catch_line":"Small employer health group cooperatives","order_by":null,"url":"\/38.2-3552\/"},{"id":64894,"section_number":"38.2-5801","catch_line":"General provisions","order_by":null,"url":"\/38.2-5801\/"},{"id":85968,"section_number":"59.1-589","catch_line":"Definitions","order_by":null,"url":"\/59.1-589\/"}],"refers_to":[{"id":66658,"section_number":"38.2-1500","catch_line":"Scope of chapter","order_by":null,"url":"\/38.2-1500\/"},{"id":85176,"section_number":"38.2-1700","catch_line":"Purpose and applicability of chapter","order_by":null,"url":"\/38.2-1700\/"},{"id":86404,"section_number":"38.2-3431","catch_line":"Application of article; definitions","order_by":null,"url":"\/38.2-3431\/"},{"id":79618,"section_number":"38.2-3432.1","catch_line":"Renewability","order_by":null,"url":"\/38.2-3432.1\/"},{"id":85868,"section_number":"38.2-3432.2","catch_line":"Availability","order_by":null,"url":"\/38.2-3432.2\/"},{"id":68187,"section_number":"38.2-3444","catch_line":"Preexisting condition exclusions","order_by":null,"url":"\/38.2-3444\/"},{"id":83154,"section_number":"38.2-3451","catch_line":"Essential health benefits","order_by":null,"url":"\/38.2-3451\/"},{"id":85968,"section_number":"59.1-589","catch_line":"Definitions","order_by":null,"url":"\/59.1-589\/"},{"id":75925,"section_number":"59.1-592","catch_line":"Exemptions; license tax","order_by":null,"url":"\/59.1-592\/"}],"permalink":{"id":215335,"object_type":"law","relational_id":64087,"identifier":"38.2-3420","token":"38.2\/34\/3\/38.2-3420","url":"\/38.2-3420\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3420\/","token":"38.2\/34\/3\/38.2-3420","dublin_core":{"Title":"Authority and jurisdiction of Commission; exception","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3420","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Except as provided in subsection C, any person<\/span> offering or providing coverage in the Commonwealth for health care services, whether the coverage is by direct payment, reimbursement, or otherwise, shall be presumed to be subject to the jurisdiction<\/span> of the Commission<\/span> to the extent the person<\/span> is not regulated by another agency of the Commonwealth, any subdivision of the Commonwealth, or the federal government relating to the offering or providing of coverage for health care services. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> As used in this subsection:\n\t\t\t“Health benefit plan<\/span>” has the same meaning as described in \u00a7 38.2-3431<\/a>.\n\t\t\t“Self-funded multiple employer welfare arrangement<\/span>” or “self-funded MEWA<\/span>” means any multiple employer welfare arrangement that is not fully insured by a licensed insurance company<\/span>. This term includes a benefit consortium established under Chapter 55 (\u00a7 59.1-589<\/a> et seq.) of Title 59.1. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> No self-funded multiple employer welfare arrangement<\/span> shall issue<\/span> health benefit plans<\/span> in the Commonwealth until it has obtained a license pursuant to regulations promulgated by the Commission<\/span>. No provision of this subsection shall authorize a self-funded MEWA<\/span> domiciled outside of the Commonwealth to operate in the Commonwealth without obtaining a license pursuant to the regulations promulgated by the Commission<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Notwithstanding any other section of this title or Chapter 55 (§ 59.1-589<\/a> et seq.) of Title 59.1 to the contrary, all financial and solvency requirements imposed by provisions of this title upon domestic insurers<\/span> shall apply to domestic self-funded MEWAs<\/span> unless domestic self-funded MEWAs<\/span> are otherwise specifically exempted. For the purposes of handling the rehabilitation, liquidation<\/span>, or conservation of a domestic self-funded MEWA<\/span>, the provisions of Chapter 15 (§ 38.2-1500<\/a> et seq.) shall apply. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Notwithstanding any other section of this title or Chapter 55 (§ 59.1-589<\/a> et seq.) of Title 59.1 to the contrary, any health benefit plan<\/span> issued by a self-funded MEWA<\/span>, including a trust, benefits consortium, or other arrangement, that covers one or more employees of one or more small employers shall (i) provide essential health benefits and cost-sharing requirements as set forth in § 38.2-3451<\/a>; (ii) offer a minimum level of coverage designed to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided under the plan; (iii) not limit or exclude coverage for an individual by imposing a preexisting condition exclusion on that individual pursuant to § 38.2-3444<\/a>; (iv) not establish discriminatory rules based on health status related to eligibility or premium or contribution requirements as imposed on health carriers pursuant to § 38.2-3432.2<\/a>; (v) meet the renewability standards set forth for health insurance issuers in § 38.2-3432.1<\/a>; (vi) establish base rates<\/span><\/span> formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims; and (vii) utilize each employer member’s specific risk profile to determine premiums by actuarially adjusting above or below established base rates<\/span><\/span>, and utilize either pooling or reinsurance of individual large claimants to reduce the adverse impact on any specific employer member’s premiums. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> The Commission<\/span> shall have authority to adopt regulations applicable to self-funded MEWAs<\/span>, whether domiciled inside or outside of the Commonwealth, including regulations addressing the self-funded MEWA<\/span>’s financial condition, solvency requirements, and insolvency plan and its exclusion, pursuant to § 59.1-592<\/a>, from the Virginia Life, Accident and Sickness Insurance Guaranty Association established under Chapter 17 (§ 38.2-1700<\/a> et seq.). <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> Neither the provisions of this section nor any other provision of this title shall be construed to affect or apply to a multiple employer welfare arrangement (MEWA) composed only of banks<\/span> together with their plan-sponsoring organization<\/span>, and their respective employees, provided the multiple employer welfare arrangement (i) is duly licensed as a MEWA by the insurance regulatory agency of a state<\/span> contiguous to the Commonwealth, (ii) files with the Commission<\/span> a copy of its certificate of authority or other proper license from the contiguous state<\/span>, (iii) has no more than 500 Virginia residents who are employees of its member banks<\/span> enrolled in or receiving accident and sickness benefits as insureds, members, enrollees, or subscribers of the MEWA, and (iv) is subject to solvency examination authority and reserve adequacy requirements determined by sound actuarial principles by such domiciliary contiguous state<\/span>. For purposes of this subsection:\n\t\t\t“Bank<\/span>” means an institution that has or is eligible for insurance of deposits by the Federal Deposit Insurance Corporation.\n\t\t\t“Plan-sponsoring organization<\/span>” means an association that (i) sponsors a MEWA composed only of banks<\/span>; (ii) has been actively in existence for at least five years; (iii) has been formed and maintained in good faith for purposes other than obtaining insurance; (iv) does not condition membership in the association on any health status-related factor relating to an individual, including an employee of an employer or a dependent of an employee; (v) makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to such members or individuals eligible for coverage through a member; (vi) does not make health insurance coverage offered through the association available other than in connection with a member of the association; and (vii) meets such additional requirements as may be imposed under the laws<\/span> of the Commonwealth, and includes any subsidiary of such an association. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nAUTHORITY AND JURISDICTION OF COMMISSION; EXCEPTION (\u00a7 38.2-3420)\n\nA. Except as provided in subsection C, any person offering or providing coverage\nin the Commonwealth for health care services, whether the coverage is by direct\npayment, reimbursement, or otherwise, shall be presumed to be subject to the\njurisdiction of the Commission to the extent the person is not regulated by\nanother agency of the Commonwealth, any subdivision of the Commonwealth, or the\nfederal government relating to the offering or providing of coverage for health\ncare services.\n\nB. As used in this subsection:\n\t\t\t“Health benefit plan” has the same meaning as described in \u00a7\n38.2-3431.\n\t\t\t“Self-funded multiple employer welfare arrangement” or\n“self-funded MEWA” means any multiple employer welfare arrangement\nthat is not fully insured by a licensed insurance company. This term includes a\nbenefit consortium established under Chapter 55 (\u00a7 59.1-589 et seq.) of Title\n59.1.\n\n 1. No self-funded multiple employer welfare arrangement shall issue health\n benefit plans in the Commonwealth until it has obtained a license pursuant to\n regulations promulgated by the Commission. No provision of this subsection\n shall authorize a self-funded MEWA domiciled outside of the Commonwealth to\n operate in the Commonwealth without obtaining a license pursuant to the\n regulations promulgated by the Commission.\n\n 2. Notwithstanding any other section of this title or Chapter 55 (§\n 59.1-589 et seq.) of Title 59.1 to the contrary, all financial and solvency\n requirements imposed by provisions of this title upon domestic insurers shall\n apply to domestic self-funded MEWAs unless domestic self-funded MEWAs are\n otherwise specifically exempted. For the purposes of handling the\n rehabilitation, liquidation, or conservation of a domestic self-funded MEWA,\n the provisions of Chapter 15 (§ 38.2-1500 et seq.) shall apply.\n\n 3. Notwithstanding any other section of this title or Chapter 55 (§\n 59.1-589 et seq.) of Title 59.1 to the contrary, any health benefit plan\n issued by a self-funded MEWA, including a trust, benefits consortium, or other\n arrangement, that covers one or more employees of one or more small employers\n shall (i) provide essential health benefits and cost-sharing requirements as\n set forth in § 38.2-3451; (ii) offer a minimum level of coverage designed\n to provide benefits that are actuarially equivalent to 60 percent of the full\n actuarial value of the benefits provided under the plan; (iii) not limit or\n exclude coverage for an individual by imposing a preexisting condition\n exclusion on that individual pursuant to § 38.2-3444; (iv) not establish\n discriminatory rules based on health status related to eligibility or premium\n or contribution requirements as imposed on health carriers pursuant to §\n 38.2-3432.2; (v) meet the renewability standards set forth for health\n insurance issuers in § 38.2-3432.1; (vi) establish base rates formed on\n an actuarially sound, modified community rating methodology that considers the\n pooling of all participant claims; and (vii) utilize each employer\n member’s specific risk profile to determine premiums by actuarially\n adjusting above or below established base rates, and utilize either pooling or\n reinsurance of individual large claimants to reduce the adverse impact on any\n specific employer member’s premiums.\n\n 4. The Commission shall have authority to adopt regulations applicable to\n self-funded MEWAs, whether domiciled inside or outside of the Commonwealth,\n including regulations addressing the self-funded MEWA’s financial\n condition, solvency requirements, and insolvency plan and its exclusion,\n pursuant to § 59.1-592, from the Virginia Life, Accident and Sickness\n Insurance Guaranty Association established under Chapter 17 (§ 38.2-1700\n et seq.).\n\nC. Neither the provisions of this section nor any other provision of this title\nshall be construed to affect or apply to a multiple employer welfare arrangement\n(MEWA) composed only of banks together with their plan-sponsoring organization,\nand their respective employees, provided the multiple employer welfare\narrangement (i) is duly licensed as a MEWA by the insurance regulatory agency of\na state contiguous to the Commonwealth, (ii) files with the Commission a copy of\nits certificate of authority or other proper license from the contiguous state,\n(iii) has no more than 500 Virginia residents who are employees of its member\nbanks enrolled in or receiving accident and sickness benefits as insureds,\nmembers, enrollees, or subscribers of the MEWA, and (iv) is subject to solvency\nexamination authority and reserve adequacy requirements determined by sound\nactuarial principles by such domiciliary contiguous state. For purposes of this\nsubsection:\n\t\t\t“Bank” means an institution that has or is eligible for insurance\nof deposits by the Federal Deposit Insurance Corporation.\n\t\t\t“Plan-sponsoring organization” means an association that (i)\nsponsors a MEWA composed only of banks; (ii) has been actively in existence for\nat least five years; (iii) has been formed and maintained in good faith for\npurposes other than obtaining insurance; (iv) does not condition membership in\nthe association on any health status-related factor relating to an individual,\nincluding an employee of an employer or a dependent of an employee; (v) makes\nhealth insurance coverage offered through the association available to all\nmembers regardless of any health status-related factor relating to such members\nor individuals eligible for coverage through a member; (vi) does not make health\ninsurance coverage offered through the association available other than in\nconnection with a member of the association; and (vii) meets such additional\nrequirements as may be imposed under the laws of the Commonwealth, and includes\nany subsidiary of such an association.\n\nHISTORY: 1983, c. 417, \u00a7 38.1-43.7; 1986, c. 562; 1990, c. 477; 2004, c. 236;\n2011, c. 329; 2012, c. 589; 2022, cc. 404, 405.","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}}