{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3430.4.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3430.4.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3430.4.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3430.4.html"}],"law_id":85161,"edition_id":1,"section_id":85161,"structure_id":14047,"section_number":"38.2-3430.4","catch_line":"Special rules for network plans","history":"1997, cc. 807, 913; 1998, c. 24.","full_text":"A health insurance issuer that offers health insurance coverage in the individual market may:\n\n1\n\nLimit the eligible individuals who may be enrolled under such coverage to those who live, reside, or work within the service area for such network plan;2\n\nWithin the service area of such plan, deny such coverage to such individuals if the health insurance issuer has demonstrated to the Commission that: (i) it will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders, enrollees and enrollees covered under individual contracts; and (ii) it is applying this section uniformly to individuals without regard to any health status-related factor of such individuals and without regard to whether the individuals are eligible individuals;3\n\nA health insurance issuer, upon denying health insurance coverage in any service area in accordance with subdivision 2, may not offer coverage in the individual market within such service area for a period of 180 days after such coverage is denied.","order_by":null,"text":{"0":{"id":305155,"text":"A health insurance issuer that offers health insurance coverage in the individual market may:","type":"section","prefixes":[""],"prefix":"","entire_prefix":"","prefix_anchor":"","level":1,"next_prefix":"1"},"1":{"id":305156,"text":"Limit the eligible individuals who may be enrolled under such coverage to those who live, reside, or work within the service area for such network plan;","type":"section","prefixes":["1"],"prefix":"1","entire_prefix":"1","prefix_anchor":"1","level":1,"prior_prefix":"","next_prefix":"2"},"2":{"id":305157,"text":"Within the service area of such plan, deny such coverage to such individuals if the health insurance issuer has demonstrated to the Commission that: (i) it will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders, enrollees and enrollees covered under individual contracts; and (ii) it is applying this section uniformly to individuals without regard to any health status-related factor of such individuals and without regard to whether the individuals are eligible individuals;","type":"section","prefixes":["2"],"prefix":"2","entire_prefix":"2","prefix_anchor":"2","level":1,"prior_prefix":"1","next_prefix":"3"},"3":{"id":305158,"text":"A health insurance issuer, upon denying health insurance coverage in any service area in accordance with subdivision 2, may not offer coverage in the individual market within such service area for a period of 180 days after such coverage is denied.","type":"section","prefixes":["3"],"prefix":"3","entire_prefix":"3","prefix_anchor":"3","level":1,"prior_prefix":"2"}},"ancestry":[{"id":14047,"edition_id":1,"name":"Individual Health Insurance Coverage","identifier":"4.1","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:46:41","date_modified":"2026-06-26 03:46:41","permalink":{"id":215365,"object_type":"structure","relational_id":14047,"identifier":"4.1","token":"38.2\/34\/4.1","url":"\/38.2\/34\/4.1\/","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":77688,"structure_id":14047,"section_number":"38.2-3430.1","catch_line":"Application of article","url":"\/38.2-3430.1\/","token":"38.2\/34\/4.1\/38.2-3430.1","metadata":false},{"id":70426,"structure_id":14047,"section_number":"38.2-3430.10","catch_line":"Effective date","url":"\/38.2-3430.10\/","token":"38.2\/34\/4.1\/38.2-3430.10","metadata":false},{"id":55143,"structure_id":14047,"section_number":"38.2-3430.1:1","catch_line":"Health insurance coverage not required","url":"\/38.2-3430.1_1\/","token":"38.2\/34\/4.1\/38.2-3430.1_1","metadata":false},{"id":60829,"structure_id":14047,"section_number":"38.2-3430.2","catch_line":"Definitions","url":"\/38.2-3430.2\/","token":"38.2\/34\/4.1\/38.2-3430.2","metadata":false},{"id":86672,"structure_id":14047,"section_number":"38.2-3430.3","catch_line":"Guaranteed availability of individual health insurance coverage to certain individuals with prior group coverage","url":"\/38.2-3430.3\/","token":"38.2\/34\/4.1\/38.2-3430.3","metadata":false},{"id":69767,"structure_id":14047,"section_number":"38.2-3430.3:1","catch_line":"Expired","url":"\/38.2-3430.3_1\/","token":"38.2\/34\/4.1\/38.2-3430.3_1","metadata":false},{"id":85161,"structure_id":14047,"section_number":"38.2-3430.4","catch_line":"Special rules for network plans","url":"\/38.2-3430.4\/","token":"38.2\/34\/4.1\/38.2-3430.4","metadata":false},{"id":83348,"structure_id":14047,"section_number":"38.2-3430.5","catch_line":"Application of financial capacity limits","url":"\/38.2-3430.5\/","token":"38.2\/34\/4.1\/38.2-3430.5","metadata":false},{"id":64965,"structure_id":14047,"section_number":"38.2-3430.6","catch_line":"Market requirements","url":"\/38.2-3430.6\/","token":"38.2\/34\/4.1\/38.2-3430.6","metadata":false},{"id":68860,"structure_id":14047,"section_number":"38.2-3430.7","catch_line":"Renewability of individual health insurance coverage","url":"\/38.2-3430.7\/","token":"38.2\/34\/4.1\/38.2-3430.7","metadata":false},{"id":63144,"structure_id":14047,"section_number":"38.2-3430.8","catch_line":"Certification of coverage","url":"\/38.2-3430.8\/","token":"38.2\/34\/4.1\/38.2-3430.8","metadata":false},{"id":67431,"structure_id":14047,"section_number":"38.2-3430.9","catch_line":"Regulations establishing standards","url":"\/38.2-3430.9\/","token":"38.2\/34\/4.1\/38.2-3430.9","metadata":false}],"previous_section":{"id":69767,"structure_id":14047,"section_number":"38.2-3430.3:1","catch_line":"Expired","url":"\/38.2-3430.3_1\/","token":"38.2\/34\/4.1\/38.2-3430.3_1","metadata":false},"next_section":{"id":83348,"structure_id":14047,"section_number":"38.2-3430.5","catch_line":"Application of financial capacity limits","url":"\/38.2-3430.5\/","token":"38.2\/34\/4.1\/38.2-3430.5","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3430.4\/","history_text":"

This law was first created in 1997. The record of its establishment is cataloged in chapters 807<\/a> and 913<\/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. It has been modified 1 time. 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. That modification is as follows: in 1998, chapter 24<\/a>.<\/p>","references":false,"refers_to":false,"permalink":{"id":215391,"object_type":"law","relational_id":85161,"identifier":"38.2-3430.4","token":"38.2\/34\/4.1\/38.2-3430.4","url":"\/38.2-3430.4\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3430.4\/","token":"38.2\/34\/4.1\/38.2-3430.4","dublin_core":{"Title":"Special rules for network plans","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3430.4","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A health insurance<\/span> issuer that offers health insurance<\/span> coverage in the individual market may:<\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Limit the eligible individuals who may be enrolled under such coverage to those who live, reside, or work within the service area for such network plan; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Within the service area of such plan, deny such coverage to such individuals if the health insurance<\/span> issuer has demonstrated to the Commission<\/span> that: (i) it will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract<\/span> holders, enrollees and enrollees covered under individual contracts<\/span>; and (ii) it is applying this section uniformly to individuals without regard to any health status-related factor of such individuals and without regard to whether the individuals are eligible individuals; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> A health insurance<\/span> issuer, upon denying health insurance<\/span> coverage in any service area in accordance with subdivision 2, may not offer coverage in the individual market within such service area for a period of 180 days after such coverage is denied. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nSPECIAL RULES FOR NETWORK PLANS (\u00a7 38.2-3430.4)\n\nA health insurance issuer that offers health insurance coverage in the\nindividual market may:\n\n1. Limit the eligible individuals who may be enrolled under such coverage to\nthose who live, reside, or work within the service area for such network plan;\n\n2. Within the service area of such plan, deny such coverage to such individuals\nif the health insurance issuer has demonstrated to the Commission that: (i) it\nwill not have the capacity to deliver services adequately to additional\nindividual enrollees because of its obligations to existing group contract\nholders, enrollees and enrollees covered under individual contracts; and (ii) it\nis applying this section uniformly to individuals without regard to any health\nstatus-related factor of such individuals and without regard to whether the\nindividuals are eligible individuals;\n\n3. A health insurance issuer, upon denying health insurance coverage in any\nservice area in accordance with subdivision 2, may not offer coverage in the\nindividual market within such service area for a period of 180 days after such\ncoverage is denied.\n\nHISTORY: 1997, cc. 807, 913; 1998, c. 24.","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}}