{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3431.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3431.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3431.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3431.html"}],"law_id":86404,"edition_id":1,"section_id":86404,"structure_id":15009,"section_number":"38.2-3431","catch_line":"Application of article; definitions","history":"1992, c. 800; 1993, cc. 148, 960; 1994, c. 303; 1996, c. 262; 1997, cc. 415, 807, 913; 1998, cc. 24, 26; 1999, cc. 789, 815, 1004; 2003, c. 645; 2013, cc. 709, 751; 2016, c. 1; 2018, c. 782; 2019, cc. 383, 450; 2022, cc. 404, 405.","full_text":"A\n\nThis article applies to group health plans and to health insurance issuers offering group health insurance coverage, and individual policies offered to employees of small employers.\n\t\t\tEach insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis, each corporation providing individual or group accident and sickness subscription contracts, and each health maintenance organization or multiple employer welfare arrangement providing health care plans for health care services that offers individual or group coverage to the small employer market in the Commonwealth shall be subject to the provisions of this article. Any issuer of individual coverage to employees of a small employer shall be subject to the provisions of this article if any of the following conditions are met:1\n\nAny portion of the premiums or benefits is paid by or on behalf of the employer;2\n\nThe eligible employee or dependent is reimbursed, whether through wage adjustments or otherwise, by or on behalf of the employer for any portion of the premium;3\n\nThe employer has permitted payroll deduction for the covered individual and any portion of the premium is paid by the employer, provided that the health insurance issuer providing individual coverage under such circumstances shall be registered as a health insurance issuer in the small group market under this article, and shall have offered small employer group insurance to the employer in the manner required under this article; or4\n\nThe health benefit plan is treated by the employer or any of the covered individuals as part of a plan or program for the purpose of § 106, 125, or 162 of the United States Internal Revenue Code.B\n\nFor the purposes of this article:\n\t\t\t“Actuarial certification” means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the Commission that a health insurance issuer is in compliance with the provisions of this article based upon the person’s examination, including a review of the appropriate records and of the actuarial assumptions and methods used by the health insurance issuer in establishing premium rates for applicable insurance coverage.\n\t\t\t“Affiliation period” means a period which, under the terms of the health insurance coverage offered by a health maintenance organization, must expire before the health insurance coverage becomes effective. The health maintenance organization is not required to provide health care services or benefits during such period and no premium shall be charged to the participant or beneficiary for any coverage during the period.1\n\nSuch period shall begin on the enrollment date.2\n\nAn affiliation period under a plan shall run concurrently with any waiting period under the plan.\n\t\t\t\t“Beneficiary” has the meaning given such term under section 3(8) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (8)).\n\t\t\t\t“Bona fide association” means, with respect to health insurance coverage offered in the Commonwealth, an association which:1\n\nHas been actively in existence for at least five years;2\n\nHas been formed and maintained in good faith for purposes other than obtaining insurance;3\n\nDoes 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);4\n\nMakes 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);5\n\nDoes not make health insurance coverage offered through the association available other than in connection with a member of the association; and6\n\nMeets such additional requirements as may be imposed under the laws of the Commonwealth.\n\t\t\t\t“Certification” means a written certification of the period of creditable coverage of an individual under a group health plan and coverage provided by a health insurance issuer offering group health insurance coverage and the coverage if any under such COBRA continuation provision, and the waiting period if any and affiliation period if applicable imposed with respect to the individual for any coverage under such plan.\n\t\t\t\t“Church plan” has the meaning given such term under section 3(33) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (33)).\n\t\t\t\t“COBRA continuation provision” means any of the following:1\n\nSection 4980B of the Internal Revenue Code of 1986 (26 U.S.C. § 4980B), other than subsection (f)(1) of such section insofar as it relates to pediatric vaccines;2\n\nPart 6 of subtitle B of Title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1161 et seq.), other than section 609 of such Act; or3\n\nTitle XXII of P.L. 104-191.\n\t\t\t\t“Creditable coverage” means with respect to an individual, coverage of the individual under any of the following:1\n\nA group health plan;2\n\nHealth insurance coverage;3\n\nPart A or B of Title XVIII of the Social Security Act (42 U.S.C. § 1395c or § 1395);4\n\nTitle XIX of the Social Security Act (42 U.S.C. § 1396 et seq.), other than coverage consisting solely of benefits under section 1928;5\n\nChapter 55 of Title 10, United States Code (10 U.S.C. § 1071 et seq.);6\n\nA medical care program of the Indian Health Service or of a tribal organization;7\n\nA state health benefits risk pool;8\n\nA health plan offered under Chapter 89 of Title 5, United States Code (5 U.S.C. § 8901 et seq.);9\n\nA public health plan (as defined in federal regulations);10\n\nA health benefit plan under section 5 (e) of the Peace Corps Act (22 U.S.C. § 2504(e)); or11\n\nIndividual health insurance coverage.\n\t\t\t\tSuch term does not include coverage consisting solely of coverage of excepted benefits.\n\t\t\t\t“Dependent” means the spouse or child of an eligible employee, subject to the applicable terms of the policy, contract or plan covering the eligible employee.\n\t\t\t\t“Eligible employee” means an employee who works for a small group employer on a full-time basis, has a normal work week of 30 or more hours, has satisfied applicable waiting period requirements, and is not a part-time, temporary or substitute employee. At the employer’s sole discretion, the eligibility criterion may be broadened to include part-time employees.\n\t\t\t\t“Eligible individual” means such an individual in relation to the employer as shall be determined:1\n\nIn accordance with the terms of such plan;2\n\nAs provided by the health insurance issuer under rules of the health insurance issuer which are uniformly applicable to employers in the group market; and3\n\nIn accordance with all applicable law of the Commonwealth governing such issuer and such market.\n\t\t\t\t“Employee” has the meaning given such term under section 3(6) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (6)).\n\t\t\t\t“Employer” has the meaning given such term under section 3(5) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (5)), except that such term shall include only employers of two or more employees.\n\t\t\t\t“Enrollment date” means, with respect to an eligible individual covered under a group health plan or health insurance coverage, the date of enrollment of the eligible individual in the plan or coverage or, if earlier, the first day of the waiting period for such enrollment.\n\t\t\t\t“Excepted benefits” means benefits under one or more (or any combination thereof) of the following:1\n\nBenefits not subject to requirements of this article:\n\t\t\t\ta. Coverage only for accident, or disability income insurance, or any combination thereof;\n\t\t\t\tb. Coverage issued as a supplement to liability insurance;\n\t\t\t\tc. Liability insurance, including general liability insurance and automobile liability insurance;\n\t\t\t\td. Workers’ compensation or similar insurance;\n\t\t\t\te. Medical expense and loss of income benefits;\n\t\t\t\tf. Credit-only insurance;\n\t\t\t\tg. Coverage for on-site medical clinics; and\n\t\t\t\th. Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.2\n\nBenefits not subject to requirements of this article if offered separately:\n\t\t\t\ta. Limited scope dental or vision benefits;\n\t\t\t\tb. Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; and\n\t\t\t\tc. Such other similar, limited benefits as are specified in regulations.3\n\nBenefits not subject to requirements of this article if offered as independent, noncoordinated benefits:\n\t\t\t\ta. Coverage only for a specified disease or illness; and\n\t\t\t\tb. Hospital indemnity or other fixed indemnity insurance.4\n\nBenefits not subject to requirements of this article if offered as separate insurance policy:\n\t\t\t\ta. Medicare supplemental health insurance (as defined under section 1882 (g)(1) of the Social Security Act (42 U.S.C. § 1395ss (g)(1));\n\t\t\t\tb. Coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code (10 U.S.C. § 1071 et seq.); and\n\t\t\t\tc. Similar supplemental coverage provided to coverage under a group health plan.\n\t\t\t\t“Federal governmental plan” means a governmental plan established or maintained for its employees by the government of the United States or by an agency or instrumentality of such government.\n\t\t\t\t“Governmental plan” has the meaning given such term under section 3(32) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (32)) and any federal governmental plan.\n\t\t\t\t“Group health insurance coverage” means in connection with a group health plan, health insurance coverage offered in connection with such plan.\n\t\t\t\t“Group health plan” means an employee welfare benefit plan (as defined in section 3 (1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (1)), to the extent that the plan provides medical care and including items and services paid for as medical care to employees or their dependents (as defined under the terms of the plan) directly or through insurance, reimbursement, or otherwise.\n\t\t\t\t“Health benefit plan” means any accident and health insurance policy or certificate, health services plan contract, health maintenance organization subscriber contract, plan provided by a MEWA or plan provided by another benefit arrangement. “Health benefit plan” does not mean accident only, credit, or disability insurance; coverage of Medicare services or federal employee health plans, pursuant to contracts with the United States government; Medicare supplement or long-term care insurance; Medicaid coverage; dental only or vision only insurance; specified disease insurance; hospital confinement indemnity coverage; limited benefit health coverage; coverage issued as a supplement to liability insurance; insurance arising out of a workers’ compensation or similar law; automobile medical payment insurance; medical expense and loss of income benefits; or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.\n\t\t\t\t“Health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer.\n\t\t\t\t“Health insurance issuer” means an insurance company, or insurance organization (including a health maintenance organization) which is licensed to engage in the business of insurance in the Commonwealth and which is subject to the laws of the Commonwealth which regulate insurance within the meaning of section 514 (b)(2) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1144 (b)(2)). Such term does not include a group health plan.\n\t\t\t\t“Health maintenance organization” means:1\n\nA federally qualified health maintenance organization;2\n\nAn organization recognized under the laws of the Commonwealth as a health maintenance organization; or3\n\nA similar organization regulated under the laws of the Commonwealth for solvency in the same manner and to the same extent as such a health maintenance organization.\n\t\t\t\t“Health status-related factor” means the following in relation to the individual or a dependent eligible for coverage under a group health plan or health insurance coverage offered by a health insurance issuer:1\n\nHealth status;2\n\nMedical condition (including both physical and mental illnesses);3\n\nClaims experience;4\n\nReceipt of health care;5\n\nMedical history;6\n\nGenetic information;7\n\nEvidence of insurability (including conditions arising out of acts of domestic violence); or8\n\nDisability.\n\t\t\t\t“Individual health insurance coverage” means health insurance coverage offered to individuals in the individual market, but does not include coverage defined as excepted benefits. Individual health insurance coverage does not include short-term limited duration coverage.\n\t\t\t\t“Individual market” means the market for health insurance coverage offered to individuals other than in connection with a group health plan.\n\t\t\t\t“Large employer” means, in connection with a group health plan or health insurance coverage with respect to a calendar year and a plan year, an employer who employed an average of at least 51 employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year.\n\t\t\t\t“Large group market” means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a large employer.\n\t\t\t\t“Late enrollee” means, with respect to coverage under a group health plan or health insurance coverage provided by a health insurance issuer, a participant or beneficiary who enrolls under the plan other than during:1\n\nThe first period in which the individual is eligible to enroll under the plan; or2\n\nA special enrollment period as required pursuant to subsections J through M of § 38.2-3432.3.\n\t\t\t\t“Medical care” means amounts paid for:1\n\nThe diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body;2\n\nTransportation primarily for and essential to medical care referred to in subdivision 1; and3\n\nInsurance covering medical care referred to in subdivisions 1 and 2.\n\t\t\t\t“Network plan” means health insurance coverage of a health insurance issuer under which the financing and delivery of medical care (including items and services paid for as medical care) are provided, in whole or in part, through a defined set of providers under contract with the health insurance issuer.\n\t\t\t\t“Nonfederal governmental plan” means a governmental plan that is not a federal governmental plan.\n\t\t\t\t“Participant” has the meaning given such term under section 3(7) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (7)).\n\t\t\t\t“Placed for adoption,” or “placement” or “being placed” for adoption, in connection with any placement for adoption of a child with any person, means the assumption and retention by such person of a legal obligation for total or partial support of such child in anticipation of adoption of such child. The child’s placement with such person terminates upon the termination of such legal obligation.\n\t\t\t\t“Plan sponsor” has the meaning given such term under section 3(16)(B) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (16)(B)).\n\t\t\t\t“Preexisting condition exclusion” means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date. Genetic information shall not be treated as a preexisting condition in the absence of a diagnosis of the condition related to such information.\n\t\t\t\t“Premium” means all moneys paid by an employer and eligible employees as a condition of coverage from a health insurance issuer, including fees and other contributions associated with the health benefit plan.\n\t\t\t\t“Rating period” means the 12-month period for which premium rates are determined by a health insurance issuer and are assumed to be in effect.\n\t\t\t\t“Self-employed individual” means an individual who derives a substantial portion of his income from a trade or business (i) operated by the individual as a sole proprietor, (ii) through which the individual has attempted to earn taxable income, and (iii) for which he has filed the appropriate Internal Revenue Service Form 1040, Schedule C or F, for the previous taxable year.\n\t\t\t\t“Service area” means a broad geographic area of the Commonwealth in which a health insurance issuer sells or has sold insurance policies on or before January 1994, or upon its subsequent authorization to do business in Virginia.\n\t\t\t\t“Small employer” means in connection with a group health plan or health insurance coverage with respect to a calendar year and a plan year, an employer who employed an average of at least one but not more than 50 employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year. In determining whether a corporation or limited liability company employed an average of at least one individual during the preceding calendar year and employed at least one employee on the first day of the plan year, an individual who performed any service for remuneration under a contract of hire, written or oral, express or implied, for a (i) corporation of which the individual is a shareholder or an immediate family member of a shareholder or (ii) a limited liability company of which the individual is a member shall be deemed to be an employee of the corporation or the limited liability company, respectively. However, a health insurance issuer shall not be required to issue more than one group health plan for each employer identification number issued by the Internal Revenue Service for a business entity, without regard to the number of shareholders or members of such business entity. “Small employer” includes a self-employed individual.\n\t\t\t\t“Small group market” means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a small employer.\n\t\t\t\t“Sponsoring association” means a nonstock corporation formed under the Virginia Nonstock Corporation Act (§ 13.1-801 et seq.) that:1\n\nHas been formed and maintained in good faith for purposes other than obtaining or providing health benefits;2\n\nDoes not condition membership in the sponsoring association on any factor relating to the health status of an individual, including an employee of an employer member of the sponsoring association or a dependent of such an employee;3\n\nMakes any health benefit plan available to all members regardless of any factor relating to the health status of such members or individuals eligible for coverage through another member;4\n\nDoes not make any health benefit plan available to any person who is not a member of the association;5\n\nMakes available health plans or health benefit plans that meet the requirements for health benefit plans set forth in subdivision B 3 of § 38.2-3420;6\n\nOperates as a nonprofit entity under § 501(c)(5) or 501(c)(6) of the Internal Revenue Code;7\n\nHas been in active existence for at least five years; and8\n\nMeets such additional requirements as may be imposed under the laws of the Commonwealth.\n\t\t\t\t“Sponsoring association” includes any wholly owned subsidiary of a sponsoring association.\n\t\t\t\t“State” means each of the several states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.\n\t\t\t\t“Waiting period” means, with respect to a group health plan or health insurance coverage provided by a health insurance issuer and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan. If an employee or dependent enrolls during a special enrollment period pursuant to subsections J through M of § 38.2-3432.3 or as a late enrollee, any period before such enrollment is not a waiting period.C\n\nThe provisions of this section shall not apply in any instance in which the provisions of this section are inconsistent or in conflict with a provision of Article 6 (§ 38.2-3438 et seq.) of Chapter 34.","order_by":null,"text":{"0":{"id":309450,"text":"This article applies to group health plans and to health insurance issuers offering group health insurance coverage, and individual policies offered to employees of small employers.\n\t\t\tEach insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis, each corporation providing individual or group accident and sickness subscription contracts, and each health maintenance organization or multiple employer welfare arrangement providing health care plans for health care services that offers individual or group coverage to the small employer market in the Commonwealth shall be subject to the provisions of this article. Any issuer of individual coverage to employees of a small employer shall be subject to the provisions of this article if any of the following conditions are met:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":309451,"text":"Any portion of the premiums or benefits is paid by or on behalf of the employer;","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":309452,"text":"The eligible employee or dependent is reimbursed, whether through wage adjustments or otherwise, by or on behalf of the employer for any portion of the premium;","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":309453,"text":"The employer has permitted payroll deduction for the covered individual and any portion of the premium is paid by the employer, provided that the health insurance issuer providing individual coverage under such circumstances shall be registered as a health insurance issuer in the small group market under this article, and shall have offered small employer group insurance to the employer in the manner required under this article; or","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"A4"},"4":{"id":309454,"text":"The health benefit plan is treated by the employer or any of the covered individuals as part of a plan or program for the purpose of § 106, 125, or 162 of the United States Internal Revenue Code.","type":"section","prefixes":["A","4"],"prefix":"4","entire_prefix":"A4","prefix_anchor":"A4","level":2,"prior_prefix":"A3","next_prefix":"B"},"5":{"id":309455,"text":"For the purposes of this article:\n\t\t\t“Actuarial certification” means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the Commission that a health insurance issuer is in compliance with the provisions of this article based upon the person’s examination, including a review of the appropriate records and of the actuarial assumptions and methods used by the health insurance issuer in establishing premium rates for applicable insurance coverage.\n\t\t\t“Affiliation period” means a period which, under the terms of the health insurance coverage offered by a health maintenance organization, must expire before the health insurance coverage becomes effective. The health maintenance organization is not required to provide health care services or benefits during such period and no premium shall be charged to the participant or beneficiary for any coverage during the period.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A4","next_prefix":"B1"},"6":{"id":309456,"text":"Such period shall begin on the enrollment date.","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"7":{"id":309457,"text":"An affiliation period under a plan shall run concurrently with any waiting period under the plan.\n\t\t\t\t“Beneficiary” has the meaning given such term under section 3(8) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (8)).\n\t\t\t\t“Bona fide association” means, with respect to health insurance coverage offered in the Commonwealth, an association which:","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B1"},"8":{"id":309458,"text":"Has been actively in existence for at least five years;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B2","next_prefix":"B2"},"9":{"id":309459,"text":"Has been formed and maintained in good faith for purposes other than obtaining insurance;","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"10":{"id":309460,"text":"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);","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B4"},"11":{"id":309461,"text":"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);","type":"section","prefixes":["B","4"],"prefix":"4","entire_prefix":"B4","prefix_anchor":"B4","level":2,"prior_prefix":"B3","next_prefix":"B5"},"12":{"id":309462,"text":"Does not make health insurance coverage offered through the association available other than in connection with a member of the association; and","type":"section","prefixes":["B","5"],"prefix":"5","entire_prefix":"B5","prefix_anchor":"B5","level":2,"prior_prefix":"B4","next_prefix":"B6"},"13":{"id":309463,"text":"Meets such additional requirements as may be imposed under the laws of the Commonwealth.\n\t\t\t\t“Certification” means a written certification of the period of creditable coverage of an individual under a group health plan and coverage provided by a health insurance issuer offering group health insurance coverage and the coverage if any under such COBRA continuation provision, and the waiting period if any and affiliation period if applicable imposed with respect to the individual for any coverage under such plan.\n\t\t\t\t“Church plan” has the meaning given such term under section 3(33) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (33)).\n\t\t\t\t“COBRA continuation provision” means any of the following:","type":"section","prefixes":["B","6"],"prefix":"6","entire_prefix":"B6","prefix_anchor":"B6","level":2,"prior_prefix":"B5","next_prefix":"B1"},"14":{"id":309464,"text":"Section 4980B of the Internal Revenue Code of 1986 (26 U.S.C. § 4980B), other than subsection (f)(1) of such section insofar as it relates to pediatric vaccines;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B6","next_prefix":"B2"},"15":{"id":309465,"text":"Part 6 of subtitle B of Title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1161 et seq.), other than section 609 of such Act; or","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"16":{"id":309466,"text":"Title XXII of P.L. 104-191.\n\t\t\t\t“Creditable coverage” means with respect to an individual, coverage of the individual under any of the following:","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B1"},"17":{"id":309467,"text":"A group health plan;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B3","next_prefix":"B2"},"18":{"id":309468,"text":"Health insurance coverage;","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"19":{"id":309469,"text":"Part A or B of Title XVIII of the Social Security Act (42 U.S.C. § 1395c or § 1395);","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B4"},"20":{"id":309470,"text":"Title XIX of the Social Security Act (42 U.S.C. § 1396 et seq.), other than coverage consisting solely of benefits under section 1928;","type":"section","prefixes":["B","4"],"prefix":"4","entire_prefix":"B4","prefix_anchor":"B4","level":2,"prior_prefix":"B3","next_prefix":"B5"},"21":{"id":309471,"text":"Chapter 55 of Title 10, United States Code (10 U.S.C. § 1071 et seq.);","type":"section","prefixes":["B","5"],"prefix":"5","entire_prefix":"B5","prefix_anchor":"B5","level":2,"prior_prefix":"B4","next_prefix":"B6"},"22":{"id":309472,"text":"A medical care program of the Indian Health Service or of a tribal organization;","type":"section","prefixes":["B","6"],"prefix":"6","entire_prefix":"B6","prefix_anchor":"B6","level":2,"prior_prefix":"B5","next_prefix":"B7"},"23":{"id":309473,"text":"A state health benefits risk pool;","type":"section","prefixes":["B","7"],"prefix":"7","entire_prefix":"B7","prefix_anchor":"B7","level":2,"prior_prefix":"B6","next_prefix":"B8"},"24":{"id":309474,"text":"A health plan offered under Chapter 89 of Title 5, United States Code (5 U.S.C. § 8901 et seq.);","type":"section","prefixes":["B","8"],"prefix":"8","entire_prefix":"B8","prefix_anchor":"B8","level":2,"prior_prefix":"B7","next_prefix":"B9"},"25":{"id":309475,"text":"A public health plan (as defined in federal regulations);","type":"section","prefixes":["B","9"],"prefix":"9","entire_prefix":"B9","prefix_anchor":"B9","level":2,"prior_prefix":"B8","next_prefix":"B10"},"26":{"id":309476,"text":"A health benefit plan under section 5 (e) of the Peace Corps Act (22 U.S.C. § 2504(e)); or","type":"section","prefixes":["B","10"],"prefix":"10","entire_prefix":"B10","prefix_anchor":"B10","level":2,"prior_prefix":"B9","next_prefix":"B11"},"27":{"id":309477,"text":"Individual health insurance coverage.\n\t\t\t\tSuch term does not include coverage consisting solely of coverage of excepted benefits.\n\t\t\t\t“Dependent” means the spouse or child of an eligible employee, subject to the applicable terms of the policy, contract or plan covering the eligible employee.\n\t\t\t\t“Eligible employee” means an employee who works for a small group employer on a full-time basis, has a normal work week of 30 or more hours, has satisfied applicable waiting period requirements, and is not a part-time, temporary or substitute employee. At the employer’s sole discretion, the eligibility criterion may be broadened to include part-time employees.\n\t\t\t\t“Eligible individual” means such an individual in relation to the employer as shall be determined:","type":"section","prefixes":["B","11"],"prefix":"11","entire_prefix":"B11","prefix_anchor":"B11","level":2,"prior_prefix":"B10","next_prefix":"B1"},"28":{"id":309478,"text":"In accordance with the terms of such plan;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B11","next_prefix":"B2"},"29":{"id":309479,"text":"As provided by the health insurance issuer under rules of the health insurance issuer which are uniformly applicable to employers in the group market; and","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"30":{"id":309480,"text":"In accordance with all applicable law of the Commonwealth governing such issuer and such market.\n\t\t\t\t“Employee” has the meaning given such term under section 3(6) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (6)).\n\t\t\t\t“Employer” has the meaning given such term under section 3(5) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (5)), except that such term shall include only employers of two or more employees.\n\t\t\t\t“Enrollment date” means, with respect to an eligible individual covered under a group health plan or health insurance coverage, the date of enrollment of the eligible individual in the plan or coverage or, if earlier, the first day of the waiting period for such enrollment.\n\t\t\t\t“Excepted benefits” means benefits under one or more (or any combination thereof) of the following:","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B1"},"31":{"id":309481,"text":"Benefits not subject to requirements of this article:\n\t\t\t\ta. Coverage only for accident, or disability income insurance, or any combination thereof;\n\t\t\t\tb. Coverage issued as a supplement to liability insurance;\n\t\t\t\tc. Liability insurance, including general liability insurance and automobile liability insurance;\n\t\t\t\td. Workers’ compensation or similar insurance;\n\t\t\t\te. Medical expense and loss of income benefits;\n\t\t\t\tf. Credit-only insurance;\n\t\t\t\tg. Coverage for on-site medical clinics; and\n\t\t\t\th. Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B3","next_prefix":"B2"},"32":{"id":309482,"text":"Benefits not subject to requirements of this article if offered separately:\n\t\t\t\ta. Limited scope dental or vision benefits;\n\t\t\t\tb. Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; and\n\t\t\t\tc. Such other similar, limited benefits as are specified in regulations.","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"33":{"id":309483,"text":"Benefits not subject to requirements of this article if offered as independent, noncoordinated benefits:\n\t\t\t\ta. Coverage only for a specified disease or illness; and\n\t\t\t\tb. Hospital indemnity or other fixed indemnity insurance.","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B4"},"34":{"id":309484,"text":"Benefits not subject to requirements of this article if offered as separate insurance policy:\n\t\t\t\ta. Medicare supplemental health insurance (as defined under section 1882 (g)(1) of the Social Security Act (42 U.S.C. § 1395ss (g)(1));\n\t\t\t\tb. Coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code (10 U.S.C. § 1071 et seq.); and\n\t\t\t\tc. Similar supplemental coverage provided to coverage under a group health plan.\n\t\t\t\t“Federal governmental plan” means a governmental plan established or maintained for its employees by the government of the United States or by an agency or instrumentality of such government.\n\t\t\t\t“Governmental plan” has the meaning given such term under section 3(32) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (32)) and any federal governmental plan.\n\t\t\t\t“Group health insurance coverage” means in connection with a group health plan, health insurance coverage offered in connection with such plan.\n\t\t\t\t“Group health plan” means an employee welfare benefit plan (as defined in section 3 (1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (1)), to the extent that the plan provides medical care and including items and services paid for as medical care to employees or their dependents (as defined under the terms of the plan) directly or through insurance, reimbursement, or otherwise.\n\t\t\t\t“Health benefit plan” means any accident and health insurance policy or certificate, health services plan contract, health maintenance organization subscriber contract, plan provided by a MEWA or plan provided by another benefit arrangement. “Health benefit plan” does not mean accident only, credit, or disability insurance; coverage of Medicare services or federal employee health plans, pursuant to contracts with the United States government; Medicare supplement or long-term care insurance; Medicaid coverage; dental only or vision only insurance; specified disease insurance; hospital confinement indemnity coverage; limited benefit health coverage; coverage issued as a supplement to liability insurance; insurance arising out of a workers’ compensation or similar law; automobile medical payment insurance; medical expense and loss of income benefits; or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.\n\t\t\t\t“Health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer.\n\t\t\t\t“Health insurance issuer” means an insurance company, or insurance organization (including a health maintenance organization) which is licensed to engage in the business of insurance in the Commonwealth and which is subject to the laws of the Commonwealth which regulate insurance within the meaning of section 514 (b)(2) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1144 (b)(2)). Such term does not include a group health plan.\n\t\t\t\t“Health maintenance organization” means:","type":"section","prefixes":["B","4"],"prefix":"4","entire_prefix":"B4","prefix_anchor":"B4","level":2,"prior_prefix":"B3","next_prefix":"B1"},"35":{"id":309485,"text":"A federally qualified health maintenance organization;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B4","next_prefix":"B2"},"36":{"id":309486,"text":"An organization recognized under the laws of the Commonwealth as a health maintenance organization; or","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"37":{"id":309487,"text":"A similar organization regulated under the laws of the Commonwealth for solvency in the same manner and to the same extent as such a health maintenance organization.\n\t\t\t\t“Health status-related factor” means the following in relation to the individual or a dependent eligible for coverage under a group health plan or health insurance coverage offered by a health insurance issuer:","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B1"},"38":{"id":309488,"text":"Health status;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B3","next_prefix":"B2"},"39":{"id":309489,"text":"Medical condition (including both physical and mental illnesses);","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"40":{"id":309490,"text":"Claims experience;","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B4"},"41":{"id":309491,"text":"Receipt of health care;","type":"section","prefixes":["B","4"],"prefix":"4","entire_prefix":"B4","prefix_anchor":"B4","level":2,"prior_prefix":"B3","next_prefix":"B5"},"42":{"id":309492,"text":"Medical history;","type":"section","prefixes":["B","5"],"prefix":"5","entire_prefix":"B5","prefix_anchor":"B5","level":2,"prior_prefix":"B4","next_prefix":"B6"},"43":{"id":309493,"text":"Genetic information;","type":"section","prefixes":["B","6"],"prefix":"6","entire_prefix":"B6","prefix_anchor":"B6","level":2,"prior_prefix":"B5","next_prefix":"B7"},"44":{"id":309494,"text":"Evidence of insurability (including conditions arising out of acts of domestic violence); or","type":"section","prefixes":["B","7"],"prefix":"7","entire_prefix":"B7","prefix_anchor":"B7","level":2,"prior_prefix":"B6","next_prefix":"B8"},"45":{"id":309495,"text":"Disability.\n\t\t\t\t“Individual health insurance coverage” means health insurance coverage offered to individuals in the individual market, but does not include coverage defined as excepted benefits. Individual health insurance coverage does not include short-term limited duration coverage.\n\t\t\t\t“Individual market” means the market for health insurance coverage offered to individuals other than in connection with a group health plan.\n\t\t\t\t“Large employer” means, in connection with a group health plan or health insurance coverage with respect to a calendar year and a plan year, an employer who employed an average of at least 51 employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year.\n\t\t\t\t“Large group market” means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a large employer.\n\t\t\t\t“Late enrollee” means, with respect to coverage under a group health plan or health insurance coverage provided by a health insurance issuer, a participant or beneficiary who enrolls under the plan other than during:","type":"section","prefixes":["B","8"],"prefix":"8","entire_prefix":"B8","prefix_anchor":"B8","level":2,"prior_prefix":"B7","next_prefix":"B1"},"46":{"id":309496,"text":"The first period in which the individual is eligible to enroll under the plan; or","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B8","next_prefix":"B2"},"47":{"id":309497,"text":"A special enrollment period as required pursuant to subsections J through M of § 38.2-3432.3.\n\t\t\t\t“Medical care” means amounts paid for:","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B1"},"48":{"id":309498,"text":"The diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B2","next_prefix":"B2"},"49":{"id":309499,"text":"Transportation primarily for and essential to medical care referred to in subdivision 1; and","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"50":{"id":309500,"text":"Insurance covering medical care referred to in subdivisions 1 and 2.\n\t\t\t\t“Network plan” means health insurance coverage of a health insurance issuer under which the financing and delivery of medical care (including items and services paid for as medical care) are provided, in whole or in part, through a defined set of providers under contract with the health insurance issuer.\n\t\t\t\t“Nonfederal governmental plan” means a governmental plan that is not a federal governmental plan.\n\t\t\t\t“Participant” has the meaning given such term under section 3(7) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (7)).\n\t\t\t\t“Placed for adoption,” or “placement” or “being placed” for adoption, in connection with any placement for adoption of a child with any person, means the assumption and retention by such person of a legal obligation for total or partial support of such child in anticipation of adoption of such child. The child’s placement with such person terminates upon the termination of such legal obligation.\n\t\t\t\t“Plan sponsor” has the meaning given such term under section 3(16)(B) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (16)(B)).\n\t\t\t\t“Preexisting condition exclusion” means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date. Genetic information shall not be treated as a preexisting condition in the absence of a diagnosis of the condition related to such information.\n\t\t\t\t“Premium” means all moneys paid by an employer and eligible employees as a condition of coverage from a health insurance issuer, including fees and other contributions associated with the health benefit plan.\n\t\t\t\t“Rating period” means the 12-month period for which premium rates are determined by a health insurance issuer and are assumed to be in effect.\n\t\t\t\t“Self-employed individual” means an individual who derives a substantial portion of his income from a trade or business (i) operated by the individual as a sole proprietor, (ii) through which the individual has attempted to earn taxable income, and (iii) for which he has filed the appropriate Internal Revenue Service Form 1040, Schedule C or F, for the previous taxable year.\n\t\t\t\t“Service area” means a broad geographic area of the Commonwealth in which a health insurance issuer sells or has sold insurance policies on or before January 1994, or upon its subsequent authorization to do business in Virginia.\n\t\t\t\t“Small employer” means in connection with a group health plan or health insurance coverage with respect to a calendar year and a plan year, an employer who employed an average of at least one but not more than 50 employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year. In determining whether a corporation or limited liability company employed an average of at least one individual during the preceding calendar year and employed at least one employee on the first day of the plan year, an individual who performed any service for remuneration under a contract of hire, written or oral, express or implied, for a (i) corporation of which the individual is a shareholder or an immediate family member of a shareholder or (ii) a limited liability company of which the individual is a member shall be deemed to be an employee of the corporation or the limited liability company, respectively. However, a health insurance issuer shall not be required to issue more than one group health plan for each employer identification number issued by the Internal Revenue Service for a business entity, without regard to the number of shareholders or members of such business entity. “Small employer” includes a self-employed individual.\n\t\t\t\t“Small group market” means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a small employer.\n\t\t\t\t“Sponsoring association” means a nonstock corporation formed under the Virginia Nonstock Corporation Act (§ 13.1-801 et seq.) that:","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B1"},"51":{"id":309501,"text":"Has been formed and maintained in good faith for purposes other than obtaining or providing health benefits;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B3","next_prefix":"B2"},"52":{"id":309502,"text":"Does not condition membership in the sponsoring association on any factor relating to the health status of an individual, including an employee of an employer member of the sponsoring association or a dependent of such an employee;","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"53":{"id":309503,"text":"Makes any health benefit plan available to all members regardless of any factor relating to the health status of such members or individuals eligible for coverage through another member;","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B4"},"54":{"id":309504,"text":"Does not make any health benefit plan available to any person who is not a member of the association;","type":"section","prefixes":["B","4"],"prefix":"4","entire_prefix":"B4","prefix_anchor":"B4","level":2,"prior_prefix":"B3","next_prefix":"B5"},"55":{"id":309505,"text":"Makes available health plans or health benefit plans that meet the requirements for health benefit plans set forth in subdivision B 3 of § 38.2-3420;","type":"section","prefixes":["B","5"],"prefix":"5","entire_prefix":"B5","prefix_anchor":"B5","level":2,"prior_prefix":"B4","next_prefix":"B6"},"56":{"id":309506,"text":"Operates as a nonprofit entity under § 501(c)(5) or 501(c)(6) of the Internal Revenue Code;","type":"section","prefixes":["B","6"],"prefix":"6","entire_prefix":"B6","prefix_anchor":"B6","level":2,"prior_prefix":"B5","next_prefix":"B7"},"57":{"id":309507,"text":"Has been in active existence for at least five years; and","type":"section","prefixes":["B","7"],"prefix":"7","entire_prefix":"B7","prefix_anchor":"B7","level":2,"prior_prefix":"B6","next_prefix":"B8"},"58":{"id":309508,"text":"Meets such additional requirements as may be imposed under the laws of the Commonwealth.\n\t\t\t\t“Sponsoring association” includes any wholly owned subsidiary of a sponsoring association.\n\t\t\t\t“State” means each of the several states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.\n\t\t\t\t“Waiting period” means, with respect to a group health plan or health insurance coverage provided by a health insurance issuer and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan. If an employee or dependent enrolls during a special enrollment period pursuant to subsections J through M of § 38.2-3432.3 or as a late enrollee, any period before such enrollment is not a waiting period.","type":"section","prefixes":["B","8"],"prefix":"8","entire_prefix":"B8","prefix_anchor":"B8","level":2,"prior_prefix":"B7","next_prefix":"C"},"59":{"id":309509,"text":"The provisions of this section shall not apply in any instance in which the provisions of this section are inconsistent or in conflict with a provision of Article 6 (§ 38.2-3438 et seq.) of Chapter 34.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B8"}},"ancestry":[{"id":15009,"edition_id":1,"name":"Group Market Reforms and Individual Coverage Offered to Employees of Small Employers","identifier":"5","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:51:28","date_modified":"2026-06-26 03:51:28","permalink":{"id":215415,"object_type":"structure","relational_id":15009,"identifier":"5","token":"38.2\/34\/5","url":"\/38.2\/34\/5\/","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":86404,"structure_id":15009,"section_number":"38.2-3431","catch_line":"Application of article; definitions","url":"\/38.2-3431\/","token":"38.2\/34\/5\/38.2-3431","metadata":false},{"id":83361,"structure_id":15009,"section_number":"38.2-3432","catch_line":"Repealed","url":"\/38.2-3432\/","token":"38.2\/34\/5\/38.2-3432","metadata":false},{"id":79618,"structure_id":15009,"section_number":"38.2-3432.1","catch_line":"Renewability","url":"\/38.2-3432.1\/","token":"38.2\/34\/5\/38.2-3432.1","metadata":false},{"id":85868,"structure_id":15009,"section_number":"38.2-3432.2","catch_line":"Availability","url":"\/38.2-3432.2\/","token":"38.2\/34\/5\/38.2-3432.2","metadata":false},{"id":63783,"structure_id":15009,"section_number":"38.2-3432.3","catch_line":"Limitation on preexisting condition exclusion period","url":"\/38.2-3432.3\/","token":"38.2\/34\/5\/38.2-3432.3","metadata":false},{"id":64415,"structure_id":15009,"section_number":"38.2-3433","catch_line":"Repealed","url":"\/38.2-3433\/","token":"38.2\/34\/5\/38.2-3433","metadata":false},{"id":57232,"structure_id":15009,"section_number":"38.2-3434","catch_line":"Disclosure of information","url":"\/38.2-3434\/","token":"38.2\/34\/5\/38.2-3434","metadata":false},{"id":74752,"structure_id":15009,"section_number":"38.2-3435","catch_line":"Exclusions","url":"\/38.2-3435\/","token":"38.2\/34\/5\/38.2-3435","metadata":false},{"id":77749,"structure_id":15009,"section_number":"38.2-3436","catch_line":"Eligibility to enroll","url":"\/38.2-3436\/","token":"38.2\/34\/5\/38.2-3436","metadata":false},{"id":70799,"structure_id":15009,"section_number":"38.2-3437","catch_line":"Rules used to determine group size","url":"\/38.2-3437\/","token":"38.2\/34\/5\/38.2-3437","metadata":false}],"next_section":{"id":83361,"structure_id":15009,"section_number":"38.2-3432","catch_line":"Repealed","url":"\/38.2-3432\/","token":"38.2\/34\/5\/38.2-3432","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3431\/","history_text":"

This law was first created in 1992. The record of its establishment is cataloged in chapter 800 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 1992 \u201cActs\u201d aren\u2019t available online. It has been modified 12 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 1993, chapters 148 and 960; in 1994, chapter 303<\/a>; in 1996, chapter 262<\/a>; in 1997, chapters 415<\/a>, 807<\/a>, and 913<\/a>; in 1998, chapters 24<\/a> and 26<\/a>; in 1999, chapters 789<\/a>, 815<\/a>, and 1004<\/a>; in 2003, chapter 645<\/a>; in 2013, chapters 709<\/a> and 751<\/a>; in 2016, chapter 1<\/a>; in 2018, chapter 782<\/a>; in 2019, chapters 383<\/a> and 450<\/a>; in 2022, chapters 404<\/a> and 405<\/a>.<\/p>","references":[{"id":85582,"section_number":"38.2-316.1","catch_line":"Premium rates","order_by":null,"url":"\/38.2-316.1\/"},{"id":84333,"section_number":"38.2-3406.1","catch_line":"Application of requirements that policies offered by small employers include state-mandated health benefits","order_by":null,"url":"\/38.2-3406.1\/"},{"id":85964,"section_number":"38.2-3407.22","catch_line":"Option for rebates to enrollees; protected information","order_by":null,"url":"\/38.2-3407.22\/"},{"id":84153,"section_number":"38.2-3412.1","catch_line":"Coverage for mental health and substance use disorders","order_by":null,"url":"\/38.2-3412.1\/"},{"id":64087,"section_number":"38.2-3420","catch_line":"Authority and jurisdiction of Commission; exception","order_by":null,"url":"\/38.2-3420\/"},{"id":77688,"section_number":"38.2-3430.1","catch_line":"Application of article","order_by":null,"url":"\/38.2-3430.1\/"},{"id":60829,"section_number":"38.2-3430.2","catch_line":"Definitions","order_by":null,"url":"\/38.2-3430.2\/"},{"id":67431,"section_number":"38.2-3430.9","catch_line":"Regulations establishing standards","order_by":null,"url":"\/38.2-3430.9\/"},{"id":57210,"section_number":"38.2-3438","catch_line":"Definitions","order_by":null,"url":"\/38.2-3438\/"},{"id":78815,"section_number":"38.2-3449","catch_line":"Prohibiting discrimination based on health status","order_by":null,"url":"\/38.2-3449\/"},{"id":83999,"section_number":"38.2-3461","catch_line":"Definitions","order_by":null,"url":"\/38.2-3461\/"},{"id":74263,"section_number":"38.2-3514.2","catch_line":"Renewability of coverage","order_by":null,"url":"\/38.2-3514.2\/"},{"id":74003,"section_number":"38.2-3516","catch_line":"Purpose","order_by":null,"url":"\/38.2-3516\/"},{"id":62206,"section_number":"38.2-3521.2","catch_line":"Blanket accident and sickness insurance","order_by":null,"url":"\/38.2-3521.2\/"},{"id":75709,"section_number":"38.2-3542","catch_line":"Notice to employees upon termination of coverage; penalty for failure to remit funds","order_by":null,"url":"\/38.2-3542\/"},{"id":80992,"section_number":"38.2-3610","catch_line":"Medicare supplement policies for persons eligible by reason of disability","order_by":null,"url":"\/38.2-3610\/"},{"id":67952,"section_number":"38.2-4319","catch_line":"Statutory construction and relationship to other laws","order_by":null,"url":"\/38.2-4319\/"},{"id":63129,"section_number":"38.2-4322","catch_line":"Affiliation period","order_by":null,"url":"\/38.2-4322\/"},{"id":77794,"section_number":"38.2-508.5","catch_line":"Re-underwriting individual under existing group or individual accident and sickness insurance policy prohibited; exceptions","order_by":null,"url":"\/38.2-508.5\/"},{"id":70898,"section_number":"38.2-5810","catch_line":"Statutory construction and relationship to other laws","order_by":null,"url":"\/38.2-5810\/"},{"id":68558,"section_number":"58.1-2501","catch_line":"Levy of license tax","order_by":null,"url":"\/58.1-2501\/"},{"id":85968,"section_number":"59.1-589","catch_line":"Definitions","order_by":null,"url":"\/59.1-589\/"}],"refers_to":[{"id":76305,"section_number":"13.1-801","catch_line":"Short title","order_by":null,"url":"\/13.1-801\/"},{"id":64087,"section_number":"38.2-3420","catch_line":"Authority and jurisdiction of Commission; exception","order_by":null,"url":"\/38.2-3420\/"},{"id":63783,"section_number":"38.2-3432.3","catch_line":"Limitation on preexisting condition exclusion period","order_by":null,"url":"\/38.2-3432.3\/"},{"id":57210,"section_number":"38.2-3438","catch_line":"Definitions","order_by":null,"url":"\/38.2-3438\/"}],"permalink":{"id":215417,"object_type":"law","relational_id":86404,"identifier":"38.2-3431","token":"38.2\/34\/5\/38.2-3431","url":"\/38.2-3431\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3431\/","token":"38.2\/34\/5\/38.2-3431","dublin_core":{"Title":"Application of article; definitions","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3431","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> This article applies to group health plans<\/span> and to health insurance issuers<\/span> offering group health insurance coverage<\/span><\/span>, and individual policies offered to employees of small employers<\/span>.\n\t\t\tEach insurer<\/span> proposing to issue<\/span> individual or group accident and sickness insurance policies<\/span> providing hospital, medical and surgical or major medical coverage on an expense incurred basis, each corporation providing individual or group accident and sickness subscription contracts<\/span>, and each health maintenance organization or multiple employer welfare arrangement providing health care plans for health care services that offers individual or group coverage to the small employer<\/span> market in the Commonwealth shall be subject to the provisions of this article. Any issuer of individual coverage to employees of a small employer<\/span> shall be subject to the provisions of this article if any of the following conditions are met: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Any portion of the premiums<\/span> or benefits is paid by or on behalf of the employer; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The eligible employee<\/span> or dependent<\/span> is reimbursed, whether through wage adjustments or otherwise, by or on behalf of the employer for any portion of the premium<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> The employer has permitted payroll deduction for the covered individual and any portion of the premium<\/span> is paid by the employer, provided that the health insurance issuer<\/span> providing individual coverage under such circumstances shall be registered as a health insurance issuer<\/span> in the small group market<\/span> under this article, and shall have offered small employer<\/span> group insurance to the employer in the manner required under this article; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> The health benefit plan<\/span> is treated by the employer or any of the covered individuals as part of a plan or program for the purpose of § 106, 125, or 162 of the United States<\/span> Internal Revenue Code. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> For the purposes of this article:\n\t\t\t“Actuarial certification<\/span>” means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the Commission<\/span> that a health insurance issuer<\/span> is in compliance with the provisions of this article based upon the person<\/span>’s examination, including a review of the appropriate records and of the actuarial assumptions and methods used by the health insurance issuer<\/span> in establishing premium<\/span> rates<\/span><\/span> for applicable insurance coverage.\n\t\t\t“Affiliation period<\/span>” means a period which, under the terms of the health insurance coverage<\/span> offered by a health maintenance organization, must expire before the health insurance coverage<\/span> becomes effective. The health maintenance organization is not required to provide health care services or benefits during such period and no premium<\/span> shall be charged to the participant or beneficiary for any coverage during the period. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Such period shall begin on the enrollment date. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> An affiliation period<\/span> under a plan shall run concurrently with any waiting period under the plan.\n\t\t\t\t“Beneficiary” has the meaning given such term under section 3(8) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (8)).\n\t\t\t\t“Bona fide association” means, with respect to health insurance coverage<\/span> offered in the Commonwealth, an association which: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Has been actively in existence for at least five years; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Has been formed and maintained in good faith for purposes other than obtaining insurance; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Does not condition membership in the association on any health status-related factor<\/span> relating to an individual (including an employee of an employer or a dependent<\/span> of an employee); <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Makes health insurance coverage<\/span> offered through the association available to all members regardless of any health status-related factor<\/span> relating to such members (or individuals eligible for coverage through a member); <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> Does not make health insurance coverage<\/span> offered through the association available other than in connection with a member of the association; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> Meets such additional requirements as may be imposed under the laws<\/span> of the Commonwealth.\n\t\t\t\t“Certification” means a written certification of the period of creditable coverage<\/span> of an individual under a group health plan<\/span> and coverage provided by a health insurance issuer<\/span> offering group health insurance coverage<\/span><\/span> and the coverage if any under such COBRA continuation provision<\/span>, and the waiting period if any and affiliation period<\/span> if applicable imposed with respect to the individual for any coverage under such plan.\n\t\t\t\t“Church plan” has the meaning given such term under section 3(33) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (33)).\n\t\t\t\t“COBRA continuation provision<\/span>” means any of the following: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Section 4980B of the Internal Revenue Code of 1986 (26 U.S.C. § 4980B), other than subsection (f)(1) of such section insofar as it relates to pediatric vaccines; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Part 6 of subtitle B of Title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1161 et seq.), other than section 609 of such Act; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Title XXII of P.L. 104-191.\n\t\t\t\t“Creditable coverage<\/span>” means with respect to an individual, coverage of the individual under any of the following: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> A group health plan<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Health insurance coverage<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Part A or B of Title XVIII of the Social Security Act (42 U.S.C. § 1395c or § 1395); <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Title XIX of the Social Security Act (42 U.S.C. § 1396 et seq.), other than coverage consisting solely of benefits under section 1928; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> Chapter 55 of Title 10, United States<\/span> Code (10 U.S.C. § 1071 et seq.); <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> A medical care<\/span> program of the Indian Health Service or of a tribal organization; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

7.<\/span> A state<\/span> health benefits risk pool; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

8.<\/span> A health plan offered under Chapter 89 of Title 5, United States<\/span> Code (5 U.S.C. § 8901 et seq.); <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

9.<\/span> A public health plan (as defined in federal regulations); <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

10.<\/span> A health benefit plan<\/span> under section 5 (e) of the Peace Corps Act (22 U.S.C. § 2504(e)); or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

11.<\/span> Individual health insurance coverage<\/span><\/span>.\n\t\t\t\tSuch term does not include coverage consisting solely of coverage of excepted benefits<\/span>.\n\t\t\t\t“Dependent<\/span>” means the spouse or child of an eligible employee<\/span>, subject to the applicable terms of the policy, contract<\/span> or plan covering the eligible employee<\/span>.\n\t\t\t\t“Eligible employee<\/span>” means an employee who works for a small group employer on a full-time basis, has a normal work week of 30 or more hours, has satisfied applicable waiting period requirements, and is not a part-time, temporary or substitute employee. At the employer’s sole discretion, the eligibility criterion may be broadened to include part-time employees.\n\t\t\t\t“Eligible individual<\/span>” means such an individual in relation to the employer as shall be determined: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> In accordance with the terms of such plan; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> As provided by the health insurance issuer<\/span> under rules of the health insurance issuer<\/span> which are uniformly applicable to employers in the group market; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> In accordance with all applicable law<\/span> of the Commonwealth governing such issuer and such market.\n\t\t\t\t“Employee” has the meaning given such term under section 3(6) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (6)).\n\t\t\t\t“Employer” has the meaning given such term under section 3(5) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (5)), except that such term shall include only employers of two or more employees.\n\t\t\t\t“Enrollment date” means, with respect to an eligible individual<\/span> covered under a group health plan<\/span> or health insurance coverage<\/span>, the date of enrollment of the eligible individual<\/span> in the plan or coverage or, if earlier, the first day of the waiting period for such enrollment.\n\t\t\t\t“Excepted benefits<\/span>” means benefits under one or more (or any combination thereof) of the following: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Benefits not subject to requirements of this article:\n\t\t\t\ta. Coverage only for accident, or disability income insurance, or any combination thereof;\n\t\t\t\tb. Coverage issued as a supplement to liability insurance;\n\t\t\t\tc. Liability insurance, including general liability insurance and automobile liability insurance;\n\t\t\t\td. Workers’ compensation or similar insurance;\n\t\t\t\te. Medical expense and loss of income benefits;\n\t\t\t\tf. Credit-only insurance;\n\t\t\t\tg. Coverage for on-site medical clinics; and\n\t\t\t\th. Other similar insurance coverage, specified in regulations, under which benefits for medical care<\/span> are secondary or incidental to other insurance benefits. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Benefits not subject to requirements of this article if offered separately:\n\t\t\t\ta. Limited scope dental or vision benefits;\n\t\t\t\tb. Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; and\n\t\t\t\tc. Such other similar, limited benefits as are specified in regulations. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Benefits not subject to requirements of this article if offered as independent, noncoordinated benefits:\n\t\t\t\ta. Coverage only for a specified disease or illness; and\n\t\t\t\tb. Hospital indemnity or other fixed indemnity insurance. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Benefits not subject to requirements of this article if offered as separate insurance policy:\n\t\t\t\ta. Medicare<\/span> supplemental health insurance (as defined under section 1882 (g)(1) of the Social Security Act (42 U.S.C. § 1395ss (g)(1));\n\t\t\t\tb. Coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States<\/span> Code (10 U.S.C. § 1071 et seq.); and\n\t\t\t\tc. Similar supplemental coverage provided to coverage under a group health plan<\/span>.\n\t\t\t\t“Federal governmental plan<\/span>” means a governmental plan established or maintained for its employees by the government of the United States<\/span> or by an agency or instrumentality of such government.\n\t\t\t\t“Governmental plan” has the meaning given such term under section 3(32) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (32)) and any federal governmental plan<\/span>.\n\t\t\t\t“Group health insurance coverage<\/span><\/span>” means in connection with a group health plan<\/span>, health insurance coverage<\/span> offered in connection with such plan.\n\t\t\t\t“Group health plan<\/span>” means an employee welfare benefit plan (as defined in section 3 (1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (1)), to the extent that the plan provides medical care<\/span> and including items and services paid for as medical care<\/span> to employees or their dependents<\/span> (as defined under the terms of the plan) directly or through insurance, reimbursement, or otherwise.\n\t\t\t\t“Health benefit plan<\/span>” means any accident and health insurance policy or certificate, health services plan<\/span> contract<\/span>, health maintenance organization subscriber contract<\/span>, plan provided by a MEWA or plan provided by another benefit arrangement. “Health benefit plan<\/span>” does not mean accident only, credit, or disability insurance; coverage of Medicare<\/span> services or federal employee health plans, pursuant to contracts<\/span> with the United States<\/span> government; Medicare<\/span> supplement or long-term care insurance; Medicaid coverage; dental only or vision only insurance; specified disease insurance; hospital confinement indemnity coverage; limited benefit health coverage; coverage issued as a supplement to liability insurance; insurance arising out of a workers’ compensation or similar law<\/span>; automobile medical payment insurance; medical expense and loss of income benefits; or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.\n\t\t\t\t“Health insurance coverage<\/span>” means benefits consisting of medical care<\/span> (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care<\/span>) under any hospital or medical service policy or certificate, hospital or medical service plan contract<\/span>, or health maintenance organization contract<\/span> offered by a health insurance issuer<\/span>.\n\t\t\t\t“Health insurance issuer<\/span>” means an insurance company<\/span>, or insurance organization (including a health maintenance organization) which is licensed to engage in the business of insurance in the Commonwealth and which is subject to the laws<\/span> of the Commonwealth which regulate insurance within the meaning of section 514 (b)(2) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1144 (b)(2)). Such term does not include a group health plan<\/span>.\n\t\t\t\t“Health maintenance organization” means: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> A federally qualified health maintenance organization; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> An organization recognized under the laws<\/span> of the Commonwealth as a health maintenance organization; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> A similar organization regulated under the laws<\/span> of the Commonwealth for solvency in the same manner and to the same extent as such a health maintenance organization.\n\t\t\t\t“Health status-related factor<\/span>” means the following in relation to the individual or a dependent<\/span> eligible for coverage under a group health plan<\/span> or health insurance coverage<\/span> offered by a health insurance issuer<\/span>: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Health status; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Medical condition (including both physical and mental illnesses); <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Claims experience; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Receipt of health care; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> Medical history; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> Genetic information; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

7.<\/span> Evidence<\/span> of insurability (including conditions arising out of acts of domestic violence); or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

8.<\/span> Disability.\n\t\t\t\t“Individual health insurance coverage<\/span><\/span>” means health insurance coverage<\/span> offered to individuals in the individual market<\/span>, but does not include coverage defined as excepted benefits<\/span>. Individual health insurance coverage<\/span><\/span> does not include short-term limited duration coverage.\n\t\t\t\t“Individual market<\/span>” means the market for health insurance coverage<\/span> offered to individuals other than in connection with a group health plan<\/span>.\n\t\t\t\t“Large employer” means, in connection with a group health plan<\/span> or health insurance coverage<\/span> with respect to a calendar year and a plan year, an employer who employed an average of at least 51 employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year.\n\t\t\t\t“Large group market<\/span>” means the health insurance market under which individuals obtain health insurance coverage<\/span> (directly or through any arrangement) on behalf of themselves (and their dependents<\/span>) through a group health plan<\/span> maintained by a large employer.\n\t\t\t\t“Late enrollee” means, with respect to coverage under a group health plan<\/span> or health insurance coverage<\/span> provided by a health insurance issuer<\/span>, a participant or beneficiary who enrolls under the plan other than during: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The first period in which the individual is eligible to enroll under the plan; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> A special enrollment period as required pursuant to subsections J through M of § 38.2-3432.3<\/a>.\n\t\t\t\t“Medical care<\/span>” means amounts paid for: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Transportation primarily for and essential to medical care<\/span> referred to in subdivision 1; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Insurance covering medical care<\/span> referred to in subdivisions 1 and 2.\n\t\t\t\t“Network plan<\/span>” means health insurance coverage<\/span> of a health insurance issuer<\/span> under which the financing and delivery of medical care<\/span> (including items and services paid for as medical care<\/span>) are provided, in whole or in part, through a defined set of providers under contract<\/span> with the health insurance issuer<\/span>.\n\t\t\t\t“Nonfederal governmental plan<\/span>” means a governmental plan that is not a federal governmental plan<\/span>.\n\t\t\t\t“Participant” has the meaning given such term under section 3(7) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (7)).\n\t\t\t\t“Placed for adoption,” or “placement<\/span>” or “being placed<\/span>” for adoption, in connection with any placement<\/span> for adoption of a child with any person<\/span>, means the assumption and retention by such person<\/span> of a legal obligation for total or partial support of such child in anticipation of adoption of such child. The child’s placement<\/span> with such person<\/span> terminates upon the termination of such legal obligation.\n\t\t\t\t“Plan sponsor” has the meaning given such term under section 3(16)(B) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002 (16)(B)).\n\t\t\t\t“Preexisting condition exclusion” means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact<\/span> that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date. Genetic information shall not be treated as a preexisting condition in the absence of a diagnosis of the condition related to such information.\n\t\t\t\t“Premium<\/span>” means all moneys paid by an employer and eligible employees<\/span> as a condition of coverage from a health insurance issuer<\/span>, including fees and other contributions associated with the health benefit plan<\/span>.\n\t\t\t\t“Rating period<\/span>” means the 12-month period for which premium<\/span> rates<\/span><\/span> are determined by a health insurance issuer<\/span> and are assumed to be in effect.\n\t\t\t\t“Self-employed individual<\/span>” means an individual who derives a substantial portion of his income from a trade or business (i) operated by the individual as a sole proprietor, (ii) through which the individual has attempted to earn taxable income, and (iii) for which he has filed the appropriate Internal Revenue Service Form 1040, Schedule C or F, for the previous taxable year.\n\t\t\t\t“Service area<\/span>” means a broad geographic area of the Commonwealth in which a health insurance issuer<\/span> sells or has sold insurance policies<\/span> on or before January 1994, or upon its subsequent authorization to do business in Virginia.\n\t\t\t\t“Small employer<\/span>” means in connection with a group health plan<\/span> or health insurance coverage<\/span> with respect to a calendar year and a plan year, an employer who employed an average of at least one but not more than 50 employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year. In determining whether a corporation or limited liability company employed an average of at least one individual during the preceding calendar year and employed at least one employee on the first day of the plan year, an individual who performed any service for remuneration under a contract<\/span> of hire, written or oral, express or implied, for a (i) corporation of which the individual is a shareholder or an immediate family member of a shareholder or (ii) a limited liability company of which the individual is a member shall be deemed to be an employee of the corporation or the limited liability company, respectively. However, a health insurance issuer<\/span> shall not be required to issue<\/span> more than one group health plan<\/span> for each employer identification number issued by the Internal Revenue Service for a business entity, without regard to the number of shareholders or members of such business entity. “Small employer<\/span>” includes a self-employed individual<\/span>.\n\t\t\t\t“Small group market<\/span>” means the health insurance market under which individuals obtain health insurance coverage<\/span> (directly or through any arrangement) on behalf of themselves (and their dependents<\/span>) through a group health plan<\/span> maintained by a small employer<\/span>.\n\t\t\t\t“Sponsoring association<\/span>” means a nonstock corporation formed under the Virginia Nonstock Corporation Act (§ 13.1-801<\/a> et seq.) that: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Has been formed and maintained in good faith for purposes other than obtaining or providing health benefits; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Does not condition membership in the sponsoring association<\/span> on any factor relating to the health status of an individual, including an employee of an employer member of the sponsoring association<\/span> or a dependent<\/span> of such an employee; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Makes any health benefit plan<\/span> available to all members regardless of any factor relating to the health status of such members or individuals eligible for coverage through another member; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Does not make any health benefit plan<\/span> available to any person<\/span> who is not a member of the association; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> Makes available health plans or health benefit plans<\/span> that meet the requirements for health benefit plans<\/span> set forth in subdivision B 3 of § 38.2-3420<\/a>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> Operates as a nonprofit entity under § 501(c)(5) or 501(c)(6) of the Internal Revenue Code; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

7.<\/span> Has been in active existence for at least five years; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

8.<\/span> Meets such additional requirements as may be imposed under the laws<\/span> of the Commonwealth.\n\t\t\t\t“Sponsoring association<\/span>” includes any wholly owned subsidiary of a sponsoring association<\/span>.\n\t\t\t\t“State<\/span>” means each of the several states<\/span>, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.\n\t\t\t\t“Waiting period” means, with respect to a group health plan<\/span> or health insurance coverage<\/span> provided by a health insurance issuer<\/span> and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan. If an employee or dependent<\/span> enrolls during a special enrollment period pursuant to subsections J through M of § 38.2-3432.3<\/a> or as a late enrollee, any period before such enrollment is not a waiting period. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> The provisions of this section shall not apply in any instance in which the provisions of this section are inconsistent or in conflict with a provision of Article 6 (§ 38.2-3438<\/a> et seq.) of Chapter 34. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nAPPLICATION OF ARTICLE; DEFINITIONS (\u00a7 38.2-3431)\n\nA. This article applies to group health plans and to health insurance issuers\noffering group health insurance coverage, and individual policies offered to\nemployees of small employers.\n\t\t\tEach insurer proposing to issue individual or group accident and sickness\ninsurance policies providing hospital, medical and surgical or major medical\ncoverage on an expense incurred basis, each corporation providing individual or\ngroup accident and sickness subscription contracts, and each health maintenance\norganization or multiple employer welfare arrangement providing health care\nplans for health care services that offers individual or group coverage to the\nsmall employer market in the Commonwealth shall be subject to the provisions of\nthis article. Any issuer of individual coverage to employees of a small employer\nshall be subject to the provisions of this article if any of the following\nconditions are met:\n\n 1. Any portion of the premiums or benefits is paid by or on behalf of the\n employer;\n\n 2. The eligible employee or dependent is reimbursed, whether through wage\n adjustments or otherwise, by or on behalf of the employer for any portion of\n the premium;\n\n 3. The employer has permitted payroll deduction for the covered individual and\n any portion of the premium is paid by the employer, provided that the health\n insurance issuer providing individual coverage under such circumstances shall\n be registered as a health insurance issuer in the small group market under\n this article, and shall have offered small employer group insurance to the\n employer in the manner required under this article; or\n\n 4. The health benefit plan is treated by the employer or any of the covered\n individuals as part of a plan or program for the purpose of § 106, 125,\n or 162 of the United States Internal Revenue Code.\n\nB. For the purposes of this article:\n\t\t\t“Actuarial certification” means a written statement by a member\nof the American Academy of Actuaries or other individual acceptable to the\nCommission that a health insurance issuer is in compliance with the provisions\nof this article based upon the person’s examination, including a review of\nthe appropriate records and of the actuarial assumptions and methods used by the\nhealth insurance issuer in establishing premium rates for applicable insurance\ncoverage.\n\t\t\t“Affiliation period” means a period which, under the terms of the\nhealth insurance coverage offered by a health maintenance organization, must\nexpire before the health insurance coverage becomes effective. The health\nmaintenance organization is not required to provide health care services or\nbenefits during such period and no premium shall be charged to the participant\nor beneficiary for any coverage during the period.\n\n 1. Such period shall begin on the enrollment date.\n\n 2. An affiliation period under a plan shall run concurrently with any waiting\n period under the plan.\n \t\t\t\t“Beneficiary” has the meaning given such term under section\n 3(8) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. §\n 1002 (8)).\n \t\t\t\t“Bona fide association” means, with respect to health\n insurance coverage offered in the Commonwealth, an association which:\n\n 1. Has been actively in existence for at least five years;\n\n 2. Has been formed and maintained in good faith for purposes other than\n obtaining insurance;\n\n 3. Does not condition membership in the association on any health\n status-related factor relating to an individual (including an employee of an\n employer or a dependent of an employee);\n\n 4. Makes health insurance coverage offered through the association available\n to all members regardless of any health status-related factor relating to such\n members (or individuals eligible for coverage through a member);\n\n 5. Does not make health insurance coverage offered through the association\n available other than in connection with a member of the association; and\n\n 6. Meets such additional requirements as may be imposed under the laws of the\n Commonwealth.\n \t\t\t\t“Certification” means a written certification of the period of\n creditable coverage of an individual under a group health plan and coverage\n provided by a health insurance issuer offering group health insurance coverage\n and the coverage if any under such COBRA continuation provision, and the\n waiting period if any and affiliation period if applicable imposed with\n respect to the individual for any coverage under such plan.\n \t\t\t\t“Church plan” has the meaning given such term under section\n 3(33) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. §\n 1002 (33)).\n \t\t\t\t“COBRA continuation provision” means any of the following:\n\n 1. Section 4980B of the Internal Revenue Code of 1986 (26 U.S.C. §\n 4980B), other than subsection (f)(1) of such section insofar as it relates to\n pediatric vaccines;\n\n 2. Part 6 of subtitle B of Title I of the Employee Retirement Income Security\n Act of 1974 (29 U.S.C. § 1161 et seq.), other than section 609 of such\n Act; or\n\n 3. Title XXII of P.L. 104-191.\n \t\t\t\t“Creditable coverage” means with respect to an individual,\n coverage of the individual under any of the following:\n\n 1. A group health plan;\n\n 2. Health insurance coverage;\n\n 3. Part A or B of Title XVIII of the Social Security Act (42 U.S.C. §\n 1395c or § 1395);\n\n 4. Title XIX of the Social Security Act (42 U.S.C. § 1396 et seq.), other\n than coverage consisting solely of benefits under section 1928;\n\n 5. Chapter 55 of Title 10, United States Code (10 U.S.C. § 1071 et seq.);\n\n 6. A medical care program of the Indian Health Service or of a tribal\n organization;\n\n 7. A state health benefits risk pool;\n\n 8. A health plan offered under Chapter 89 of Title 5, United States Code (5\n U.S.C. § 8901 et seq.);\n\n 9. A public health plan (as defined in federal regulations);\n\n 10. A health benefit plan under section 5 (e) of the Peace Corps Act (22\n U.S.C. § 2504(e)); or\n\n 11. Individual health insurance coverage.\n \t\t\t\tSuch term does not include coverage consisting solely of coverage of\n excepted benefits.\n \t\t\t\t“Dependent” means the spouse or child of an eligible employee,\n subject to the applicable terms of the policy, contract or plan covering the\n eligible employee.\n \t\t\t\t“Eligible employee” means an employee who works for a small\n group employer on a full-time basis, has a normal work week of 30 or more\n hours, has satisfied applicable waiting period requirements, and is not a\n part-time, temporary or substitute employee. At the employer’s sole\n discretion, the eligibility criterion may be broadened to include part-time\n employees.\n \t\t\t\t“Eligible individual” means such an individual in relation to\n the employer as shall be determined:\n\n 1. In accordance with the terms of such plan;\n\n 2. As provided by the health insurance issuer under rules of the health\n insurance issuer which are uniformly applicable to employers in the group\n market; and\n\n 3. In accordance with all applicable law of the Commonwealth governing such\n issuer and such market.\n \t\t\t\t“Employee” has the meaning given such term under section 3(6)\n of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002\n (6)).\n \t\t\t\t“Employer” has the meaning given such term under section 3(5)\n of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1002\n (5)), except that such term shall include only employers of two or more\n employees.\n \t\t\t\t“Enrollment date” means, with respect to an eligible\n individual covered under a group health plan or health insurance coverage, the\n date of enrollment of the eligible individual in the plan or coverage or, if\n earlier, the first day of the waiting period for such enrollment.\n \t\t\t\t“Excepted benefits” means benefits under one or more (or any\n combination thereof) of the following:\n\n 1. Benefits not subject to requirements of this article:\n \t\t\t\ta. Coverage only for accident, or disability income insurance, or any\n combination thereof;\n \t\t\t\tb. Coverage issued as a supplement to liability insurance;\n \t\t\t\tc. Liability insurance, including general liability insurance and\n automobile liability insurance;\n \t\t\t\td. Workers’ compensation or similar insurance;\n \t\t\t\te. Medical expense and loss of income benefits;\n \t\t\t\tf. Credit-only insurance;\n \t\t\t\tg. Coverage for on-site medical clinics; and\n \t\t\t\th. Other similar insurance coverage, specified in regulations, under which\n benefits for medical care are secondary or incidental to other insurance\n benefits.\n\n 2. Benefits not subject to requirements of this article if offered separately:\n \t\t\t\ta. Limited scope dental or vision benefits;\n \t\t\t\tb. Benefits for long-term care, nursing home care, home health care,\n community-based care, or any combination thereof; and\n \t\t\t\tc. Such other similar, limited benefits as are specified in regulations.\n\n 3. Benefits not subject to requirements of this article if offered as\n independent, noncoordinated benefits:\n \t\t\t\ta. Coverage only for a specified disease or illness; and\n \t\t\t\tb. Hospital indemnity or other fixed indemnity insurance.\n\n 4. Benefits not subject to requirements of this article if offered as separate\n insurance policy:\n \t\t\t\ta. Medicare supplemental health insurance (as defined under section 1882\n (g)(1) of the Social Security Act (42 U.S.C. § 1395ss (g)(1));\n \t\t\t\tb. Coverage supplemental to the coverage provided under Chapter 55 of\n Title 10, United States Code (10 U.S.C. § 1071 et seq.); and\n \t\t\t\tc. Similar supplemental coverage provided to coverage under a group health\n plan.\n \t\t\t\t“Federal governmental plan” means a governmental plan\n established or maintained for its employees by the government of the United\n States or by an agency or instrumentality of such government.\n \t\t\t\t“Governmental plan” has the meaning given such term under\n section 3(32) of the Employee Retirement Income Security Act of 1974 (29\n U.S.C. § 1002 (32)) and any federal governmental plan.\n \t\t\t\t“Group health insurance coverage” means in connection with a\n group health plan, health insurance coverage offered in connection with such\n plan.\n \t\t\t\t“Group health plan” means an employee welfare benefit plan (as\n defined in section 3 (1) of the Employee Retirement Income Security Act of\n 1974 (29 U.S.C. § 1002 (1)), to the extent that the plan provides medical\n care and including items and services paid for as medical care to employees or\n their dependents (as defined under the terms of the plan) directly or through\n insurance, reimbursement, or otherwise.\n \t\t\t\t“Health benefit plan” means any accident and health insurance\n policy or certificate, health services plan contract, health maintenance\n organization subscriber contract, plan provided by a MEWA or plan provided by\n another benefit arrangement. “Health benefit plan” does not mean\n accident only, credit, or disability insurance; coverage of Medicare services\n or federal employee health plans, pursuant to contracts with the United States\n government; Medicare supplement or long-term care insurance; Medicaid\n coverage; dental only or vision only insurance; specified disease insurance;\n hospital confinement indemnity coverage; limited benefit health coverage;\n coverage issued as a supplement to liability insurance; insurance arising out\n of a workers’ compensation or similar law; automobile medical payment\n insurance; medical expense and loss of income benefits; or insurance under\n which benefits are payable with or without regard to fault and that is\n statutorily required to be contained in any liability insurance policy or\n equivalent self-insurance.\n \t\t\t\t“Health insurance coverage” means benefits consisting of\n medical care (provided directly, through insurance or reimbursement, or\n otherwise and including items and services paid for as medical care) under any\n hospital or medical service policy or certificate, hospital or medical service\n plan contract, or health maintenance organization contract offered by a health\n insurance issuer.\n \t\t\t\t“Health insurance issuer” means an insurance company, or\n insurance organization (including a health maintenance organization) which is\n licensed to engage in the business of insurance in the Commonwealth and which\n is subject to the laws of the Commonwealth which regulate insurance within the\n meaning of section 514 (b)(2) of the Employee Retirement Income Security Act\n of 1974 (29 U.S.C. § 1144 (b)(2)). Such term does not include a group\n health plan.\n \t\t\t\t“Health maintenance organization” means:\n\n 1. A federally qualified health maintenance organization;\n\n 2. An organization recognized under the laws of the Commonwealth as a health\n maintenance organization; or\n\n 3. A similar organization regulated under the laws of the Commonwealth for\n solvency in the same manner and to the same extent as such a health\n maintenance organization.\n \t\t\t\t“Health status-related factor” means the following in relation\n to the individual or a dependent eligible for coverage under a group health\n plan or health insurance coverage offered by a health insurance issuer:\n\n 1. Health status;\n\n 2. Medical condition (including both physical and mental illnesses);\n\n 3. Claims experience;\n\n 4. Receipt of health care;\n\n 5. Medical history;\n\n 6. Genetic information;\n\n 7. Evidence of insurability (including conditions arising out of acts of\n domestic violence); or\n\n 8. Disability.\n \t\t\t\t“Individual health insurance coverage” means health insurance\n coverage offered to individuals in the individual market, but does not include\n coverage defined as excepted benefits. Individual health insurance coverage\n does not include short-term limited duration coverage.\n \t\t\t\t“Individual market” means the market for health insurance\n coverage offered to individuals other than in connection with a group health\n plan.\n \t\t\t\t“Large employer” means, in connection with a group health plan\n or health insurance coverage with respect to a calendar year and a plan year,\n an employer who employed an average of at least 51 employees on business days\n during the preceding calendar year and who employs at least one employee on\n the first day of the plan year.\n \t\t\t\t“Large group market” means the health insurance market under\n which individuals obtain health insurance coverage (directly or through any\n arrangement) on behalf of themselves (and their dependents) through a group\n health plan maintained by a large employer.\n \t\t\t\t“Late enrollee” means, with respect to coverage under a group\n health plan or health insurance coverage provided by a health insurance\n issuer, a participant or beneficiary who enrolls under the plan other than\n during:\n\n 1. The first period in which the individual is eligible to enroll under the\n plan; or\n\n 2. A special enrollment period as required pursuant to subsections J through M\n of § 38.2-3432.3.\n \t\t\t\t“Medical care” means amounts paid for:\n\n 1. The diagnosis, cure, mitigation, treatment, or prevention of disease, or\n amounts paid for the purpose of affecting any structure or function of the\n body;\n\n 2. Transportation primarily for and essential to medical care referred to in\n subdivision 1; and\n\n 3. Insurance covering medical care referred to in subdivisions 1 and 2.\n \t\t\t\t“Network plan” means health insurance coverage of a health\n insurance issuer under which the financing and delivery of medical care\n (including items and services paid for as medical care) are provided, in whole\n or in part, through a defined set of providers under contract with the health\n insurance issuer.\n \t\t\t\t“Nonfederal governmental plan” means a governmental plan that\n is not a federal governmental plan.\n \t\t\t\t“Participant” has the meaning given such term under section\n 3(7) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. §\n 1002 (7)).\n \t\t\t\t“Placed for adoption,” or “placement” or\n “being placed” for adoption, in connection with any placement for\n adoption of a child with any person, means the assumption and retention by\n such person of a legal obligation for total or partial support of such child\n in anticipation of adoption of such child. The child’s placement with\n such person terminates upon the termination of such legal obligation.\n \t\t\t\t“Plan sponsor” has the meaning given such term under section\n 3(16)(B) of the Employee Retirement Income Security Act of 1974 (29 U.S.C.\n § 1002 (16)(B)).\n \t\t\t\t“Preexisting condition exclusion” means, with respect to\n coverage, a limitation or exclusion of benefits relating to a condition based\n on the fact that the condition was present before the date of enrollment for\n such coverage, whether or not any medical advice, diagnosis, care, or\n treatment was recommended or received before such date. Genetic information\n shall not be treated as a preexisting condition in the absence of a diagnosis\n of the condition related to such information.\n \t\t\t\t“Premium” means all moneys paid by an employer and eligible\n employees as a condition of coverage from a health insurance issuer, including\n fees and other contributions associated with the health benefit plan.\n \t\t\t\t“Rating period” means the 12-month period for which premium\n rates are determined by a health insurance issuer and are assumed to be in\n effect.\n \t\t\t\t“Self-employed individual” means an individual who derives a\n substantial portion of his income from a trade or business (i) operated by the\n individual as a sole proprietor, (ii) through which the individual has\n attempted to earn taxable income, and (iii) for which he has filed the\n appropriate Internal Revenue Service Form 1040, Schedule C or F, for the\n previous taxable year.\n \t\t\t\t“Service area” means a broad geographic area of the\n Commonwealth in which a health insurance issuer sells or has sold insurance\n policies on or before January 1994, or upon its subsequent authorization to do\n business in Virginia.\n \t\t\t\t“Small employer” means in connection with a group health plan\n or health insurance coverage with respect to a calendar year and a plan year,\n an employer who employed an average of at least one but not more than 50\n employees on business days during the preceding calendar year and who employs\n at least one employee on the first day of the plan year. In determining\n whether a corporation or limited liability company employed an average of at\n least one individual during the preceding calendar year and employed at least\n one employee on the first day of the plan year, an individual who performed\n any service for remuneration under a contract of hire, written or oral,\n express or implied, for a (i) corporation of which the individual is a\n shareholder or an immediate family member of a shareholder or (ii) a limited\n liability company of which the individual is a member shall be deemed to be an\n employee of the corporation or the limited liability company, respectively.\n However, a health insurance issuer shall not be required to issue more than\n one group health plan for each employer identification number issued by the\n Internal Revenue Service for a business entity, without regard to the number\n of shareholders or members of such business entity. “Small\n employer” includes a self-employed individual.\n \t\t\t\t“Small group market” means the health insurance market under\n which individuals obtain health insurance coverage (directly or through any\n arrangement) on behalf of themselves (and their dependents) through a group\n health plan maintained by a small employer.\n \t\t\t\t“Sponsoring association” means a nonstock corporation formed\n under the Virginia Nonstock Corporation Act (§ 13.1-801 et seq.) that:\n\n 1. Has been formed and maintained in good faith for purposes other than\n obtaining or providing health benefits;\n\n 2. Does not condition membership in the sponsoring association on any factor\n relating to the health status of an individual, including an employee of an\n employer member of the sponsoring association or a dependent of such an\n employee;\n\n 3. Makes any health benefit plan available to all members regardless of any\n factor relating to the health status of such members or individuals eligible\n for coverage through another member;\n\n 4. Does not make any health benefit plan available to any person who is not a\n member of the association;\n\n 5. Makes available health plans or health benefit plans that meet the\n requirements for health benefit plans set forth in subdivision B 3 of §\n 38.2-3420;\n\n 6. Operates as a nonprofit entity under § 501(c)(5) or 501(c)(6) of the\n Internal Revenue Code;\n\n 7. Has been in active existence for at least five years; and\n\n 8. Meets such additional requirements as may be imposed under the laws of the\n Commonwealth.\n \t\t\t\t“Sponsoring association” includes any wholly owned subsidiary\n of a sponsoring association.\n \t\t\t\t“State” means each of the several states, the District of\n Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the\n Northern Mariana Islands.\n \t\t\t\t“Waiting period” means, with respect to a group health plan or\n health insurance coverage provided by a health insurance issuer and an\n individual who is a potential participant or beneficiary in the plan, the\n period that must pass with respect to the individual before the individual is\n eligible to be covered for benefits under the terms of the plan. If an\n employee or dependent enrolls during a special enrollment period pursuant to\n subsections J through M of § 38.2-3432.3 or as a late enrollee, any\n period before such enrollment is not a waiting period.\n\nC. The provisions of this section shall not apply in any instance in which the\nprovisions of this section are inconsistent or in conflict with a provision of\nArticle 6 (§ 38.2-3438 et seq.) of Chapter 34.\n\nHISTORY: 1992, c. 800; 1993, cc. 148, 960; 1994, c. 303; 1996, c. 262; 1997, cc.\n415, 807, 913; 1998, cc. 24, 26; 1999, cc. 789, 815, 1004; 2003, c. 645; 2013,\ncc. 709, 751; 2016, c. 1; 2018, c. 782; 2019, cc. 383, 450; 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}}