{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3436.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3436.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3436.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3436.html"}],"law_id":77749,"edition_id":1,"section_id":77749,"structure_id":15009,"section_number":"38.2-3436","catch_line":"Eligibility to enroll","history":"1997, cc. 807, 913; 2013, c. 751.","full_text":"A\n\nA health insurance issuer offering group health insurance coverage, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the health status-related factors.B\n\nThe provisions of this section shall not be construed:1\n\nTo require a group health insurance coverage to provide particular benefits other than those provided under the terms of such plan or coverage; or2\n\nTo prevent a health insurance issuer offering group health insurance coverage from establishing limitations or restrictions on the amount, level, extent or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage rules for eligibility to enroll under a plan which includes rules defining any applicable waiting periods for such enrollment.C\n\nA health insurance issuer offering group health insurance coverage, may not require an individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.D\n\nNothing in subsection C shall be construed:1\n\nTo restrict the amount that an employee may be charged for coverage under a group health plan or group health insurance coverage; or2\n\nTo prevent a health insurance issuer offering group health insurance coverage, from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.E\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":278858,"text":"A health insurance issuer offering group health insurance coverage, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the health status-related factors.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":278859,"text":"The provisions of this section shall not be construed:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"B1"},"2":{"id":278860,"text":"To require a group health insurance coverage to provide particular benefits other than those provided under the terms of such plan or coverage; or","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"3":{"id":278861,"text":"To prevent a health insurance issuer offering group health insurance coverage from establishing limitations or restrictions on the amount, level, extent or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage rules for eligibility to enroll under a plan which includes rules defining any applicable waiting periods for such enrollment.","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"C"},"4":{"id":278862,"text":"A health insurance issuer offering group health insurance coverage, may not require an individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B2","next_prefix":"D"},"5":{"id":278863,"text":"Nothing in subsection C shall be construed:","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"D1"},"6":{"id":278864,"text":"To restrict the amount that an employee may be charged for coverage under a group health plan or group health insurance coverage; or","type":"section","prefixes":["D","1"],"prefix":"1","entire_prefix":"D1","prefix_anchor":"D1","level":2,"prior_prefix":"D","next_prefix":"D2"},"7":{"id":278865,"text":"To prevent a health insurance issuer offering group health insurance coverage, from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.","type":"section","prefixes":["D","2"],"prefix":"2","entire_prefix":"D2","prefix_anchor":"D2","level":2,"prior_prefix":"D1","next_prefix":"E"},"8":{"id":278866,"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":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D2"}},"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}],"previous_section":{"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},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3436\/","history_text":"

This law was first created in 1997. The record of its establishment is cataloged in chapters 807<\/a> and 913<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. It has been modified 1 time. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. That modification is as follows: in 2013, chapter 751<\/a>.<\/p>","references":[{"id":81144,"section_number":"38.2-3418.17","catch_line":"Coverage for autism spectrum disorder","order_by":null,"url":"\/38.2-3418.17\/"},{"id":79799,"section_number":"38.2-3448","catch_line":"Guaranteed availability","order_by":null,"url":"\/38.2-3448\/"},{"id":76537,"section_number":"38.2-3452","catch_line":"Waiting periods","order_by":null,"url":"\/38.2-3452\/"}],"refers_to":[{"id":57210,"section_number":"38.2-3438","catch_line":"Definitions","order_by":null,"url":"\/38.2-3438\/"}],"permalink":{"id":215449,"object_type":"law","relational_id":77749,"identifier":"38.2-3436","token":"38.2\/34\/5\/38.2-3436","url":"\/38.2-3436\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3436\/","token":"38.2\/34\/5\/38.2-3436","dublin_core":{"Title":"Eligibility to enroll","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3436","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> A health insurance<\/span> issuer offering group health insurance<\/span> coverage, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the health status-related factors. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The provisions of this section shall not be construed: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> To require a group health insurance<\/span> coverage to provide particular benefits other than those provided under the terms of such plan or coverage; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> To prevent a health insurance<\/span> issuer offering group health insurance<\/span> coverage from establishing limitations or restrictions on the amount, level, extent or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage rules for eligibility to enroll under a plan which includes rules defining any applicable waiting periods for such enrollment. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> A health insurance<\/span> issuer offering group health insurance<\/span> coverage, may not require an individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> Nothing in subsection C shall be construed: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> To restrict the amount that an employee may be charged for coverage under a group health plan or group health insurance<\/span> coverage; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> To prevent a health insurance<\/span> issuer offering group health insurance<\/span> coverage, from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/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\nELIGIBILITY TO ENROLL (\u00a7 38.2-3436)\n\nA. A health insurance issuer offering group health insurance coverage, may not\nestablish rules for eligibility (including continued eligibility) of any\nindividual to enroll under the terms of the plan based on any of the health\nstatus-related factors.\n\nB. The provisions of this section shall not be construed:\n\n 1. To require a group health insurance coverage to provide particular benefits\n other than those provided under the terms of such plan or coverage; or\n\n 2. To prevent a health insurance issuer offering group health insurance\n coverage from establishing limitations or restrictions on the amount, level,\n extent or nature of the benefits or coverage for similarly situated\n individuals enrolled in the plan or coverage rules for eligibility to enroll\n under a plan which includes rules defining any applicable waiting periods for\n such enrollment.\n\nC. A health insurance issuer offering group health insurance coverage, may not\nrequire an individual (as a condition of enrollment or continued enrollment\nunder the plan) to pay a premium or contribution which is greater than such\npremium or contribution for a similarly situated individual enrolled in the plan\non the basis of any health status related factor in relation to the individual\nor to an individual enrolled under the plan as a dependent of the individual.\n\nD. Nothing in subsection C shall be construed:\n\n 1. To restrict the amount that an employee may be charged for coverage under a\n group health plan or group health insurance coverage; or\n\n 2. To prevent a health insurance issuer offering group health insurance\n coverage, from establishing premium discounts or rebates or modifying\n otherwise applicable copayments or deductibles in return for adherence to\n programs of health promotion and disease prevention.\n\nE. 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: 1997, cc. 807, 913; 2013, c. 751.","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}}