{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3445.06.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3445.06.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3445.06.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3445.06.html"}],"law_id":66467,"edition_id":1,"section_id":66467,"structure_id":13819,"section_number":"38.2-3445.06","catch_line":"Applicability of certain sections","history":"2020, cc. 1080, 1081.","full_text":"A\n\nExcept as provided in this section, the provisions of §§ 38.2-3445 through 38.2-3445.05 shall not apply to an entity providing or administering an employee welfare benefit plan, as defined in § 3(1) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002(1), that is self-insured or self-funded with respect to such plan. Such an entity may elect to be subject to the provisions of §§ 38.2-3445 through 38.2-3445.06 in the same manner as applied to a health carrier by providing notice to the Commission annually, in a form and manner prescribed by the Commission, attesting to the plan’s participation and agreeing to be bound by the provisions of §§ 38.2-3445 through 38.2-3445.06. Such entity shall amend the plan, policies, contracts, and other documents to reflect such election. In addition, the entity that elects to opt in pursuant to this section shall file current plan documentation confirming that the plan accepts the obligations of §§ 38.2-3445 through 38.2-3445.06 and attests that any amended plan documents will be filed with the Commission before the effective date of such amendments. The Commission shall post on its website a list of entities, including relevant plan information, that have elected to be subject to the provisions of §§ 38.2-3445 through 38.2-3445.06. The Commission shall update such list at least once per quarter.B\n\nThe provisions of §§ 38.2-3445.01 and 38.2-3445.02 shall not apply to services when the provider’s fees are subject to schedules or other monetary limitations under any other law, including the Virginia Workers’ Compensation Act, and such sections shall not preempt any such law.C\n\nThe provisions of §§ 38.2-3445 through 38.2-3445.05 shall apply to health coverage insurance offered to state employees pursuant to § 2.2-2818 and may apply to health insurance coverage offered to employees of local governments, local officers, teachers, and retirees, and the dependents of such employees, officers, teachers, and retirees pursuant to § 2.2-1204.D\n\nExcept for its facilitation of arbitration pursuant to § 38.2-3445.02 and its role in any appeals process established pursuant to subsection J of § 38.2-3445.02, the Commission shall have no jurisdiction to resolve disputes arising out of § 38.2-3445.01.E\n\nExcept for in a provider contract between a carrier and an in-network provider, no person shall waive, be required to waive, or require another person to waive the provisions of §§ 38.2-3445 through 38.2-3445.05.","order_by":null,"text":{"0":{"id":241224,"text":"Except as provided in this section, the provisions of §§ 38.2-3445 through 38.2-3445.05 shall not apply to an entity providing or administering an employee welfare benefit plan, as defined in § 3(1) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002(1), that is self-insured or self-funded with respect to such plan. Such an entity may elect to be subject to the provisions of §§ 38.2-3445 through 38.2-3445.06 in the same manner as applied to a health carrier by providing notice to the Commission annually, in a form and manner prescribed by the Commission, attesting to the plan’s participation and agreeing to be bound by the provisions of §§ 38.2-3445 through 38.2-3445.06. Such entity shall amend the plan, policies, contracts, and other documents to reflect such election. In addition, the entity that elects to opt in pursuant to this section shall file current plan documentation confirming that the plan accepts the obligations of §§ 38.2-3445 through 38.2-3445.06 and attests that any amended plan documents will be filed with the Commission before the effective date of such amendments. The Commission shall post on its website a list of entities, including relevant plan information, that have elected to be subject to the provisions of §§ 38.2-3445 through 38.2-3445.06. The Commission shall update such list at least once per quarter.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":241225,"text":"The provisions of §§ 38.2-3445.01 and 38.2-3445.02 shall not apply to services when the provider’s fees are subject to schedules or other monetary limitations under any other law, including the Virginia Workers’ Compensation Act, and such sections shall not preempt any such law.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":241226,"text":"The provisions of §§ 38.2-3445 through 38.2-3445.05 shall apply to health coverage insurance offered to state employees pursuant to § 2.2-2818 and may apply to health insurance coverage offered to employees of local governments, local officers, teachers, and retirees, and the dependents of such employees, officers, teachers, and retirees pursuant to § 2.2-1204.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":241227,"text":"Except for its facilitation of arbitration pursuant to § 38.2-3445.02 and its role in any appeals process established pursuant to subsection J of § 38.2-3445.02, the Commission shall have no jurisdiction to resolve disputes arising out of § 38.2-3445.01.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":241228,"text":"Except for in a provider contract between a carrier and an in-network provider, no person shall waive, be required to waive, or require another person to waive the provisions of §§ 38.2-3445 through 38.2-3445.05.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D"}},"ancestry":[{"id":13819,"edition_id":1,"name":"Federal Market Reforms","identifier":"6","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:45:59","date_modified":"2026-06-26 03:45:59","permalink":{"id":215457,"object_type":"structure","relational_id":13819,"identifier":"6","token":"38.2\/34\/6","url":"\/38.2\/34\/6\/","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":57210,"structure_id":13819,"section_number":"38.2-3438","catch_line":"Definitions","url":"\/38.2-3438\/","token":"38.2\/34\/6\/38.2-3438","metadata":false},{"id":55902,"structure_id":13819,"section_number":"38.2-3439","catch_line":"Dependent coverage for individuals to age 26","url":"\/38.2-3439\/","token":"38.2\/34\/6\/38.2-3439","metadata":false},{"id":59514,"structure_id":13819,"section_number":"38.2-3440","catch_line":"Lifetime and annual limits","url":"\/38.2-3440\/","token":"38.2\/34\/6\/38.2-3440","metadata":false},{"id":74720,"structure_id":13819,"section_number":"38.2-3441","catch_line":"Rescissions","url":"\/38.2-3441\/","token":"38.2\/34\/6\/38.2-3441","metadata":false},{"id":81548,"structure_id":13819,"section_number":"38.2-3442","catch_line":"Preventive services","url":"\/38.2-3442\/","token":"38.2\/34\/6\/38.2-3442","metadata":false},{"id":54833,"structure_id":13819,"section_number":"38.2-3443","catch_line":"Choice of a health care professional","url":"\/38.2-3443\/","token":"38.2\/34\/6\/38.2-3443","metadata":false},{"id":68187,"structure_id":13819,"section_number":"38.2-3444","catch_line":"Preexisting condition exclusions","url":"\/38.2-3444\/","token":"38.2\/34\/6\/38.2-3444","metadata":false},{"id":60836,"structure_id":13819,"section_number":"38.2-3445","catch_line":"Patient access to emergency services","url":"\/38.2-3445\/","token":"38.2\/34\/6\/38.2-3445","metadata":false},{"id":57195,"structure_id":13819,"section_number":"38.2-3445.01","catch_line":"Balance billing for certain services; prohibited","url":"\/38.2-3445.01\/","token":"38.2\/34\/6\/38.2-3445.01","metadata":false},{"id":74656,"structure_id":13819,"section_number":"38.2-3445.02","catch_line":"Arbitration","url":"\/38.2-3445.02\/","token":"38.2\/34\/6\/38.2-3445.02","metadata":false},{"id":57491,"structure_id":13819,"section_number":"38.2-3445.03","catch_line":"Data sets for determining commercially reasonable payments","url":"\/38.2-3445.03\/","token":"38.2\/34\/6\/38.2-3445.03","metadata":false},{"id":55717,"structure_id":13819,"section_number":"38.2-3445.04","catch_line":"Transparency","url":"\/38.2-3445.04\/","token":"38.2\/34\/6\/38.2-3445.04","metadata":false},{"id":67926,"structure_id":13819,"section_number":"38.2-3445.05","catch_line":"Enforcement","url":"\/38.2-3445.05\/","token":"38.2\/34\/6\/38.2-3445.05","metadata":false},{"id":66467,"structure_id":13819,"section_number":"38.2-3445.06","catch_line":"Applicability of certain sections","url":"\/38.2-3445.06\/","token":"38.2\/34\/6\/38.2-3445.06","metadata":false},{"id":72898,"structure_id":13819,"section_number":"38.2-3445.07","catch_line":"Rules and regulations","url":"\/38.2-3445.07\/","token":"38.2\/34\/6\/38.2-3445.07","metadata":false},{"id":68114,"structure_id":13819,"section_number":"38.2-3445.1","catch_line":"Repealed","url":"\/38.2-3445.1\/","token":"38.2\/34\/6\/38.2-3445.1","metadata":false},{"id":63588,"structure_id":13819,"section_number":"38.2-3445.2","catch_line":"Out-of-network claims; reporting requirements","url":"\/38.2-3445.2\/","token":"38.2\/34\/6\/38.2-3445.2","metadata":false},{"id":86937,"structure_id":13819,"section_number":"38.2-3446","catch_line":"Applicability of federal law","url":"\/38.2-3446\/","token":"38.2\/34\/6\/38.2-3446","metadata":false},{"id":66501,"structure_id":13819,"section_number":"38.2-3447","catch_line":"(Effective January 1, 2026) Restrictions relating to premium rates","url":"\/38.2-3447\/","token":"38.2\/34\/6\/38.2-3447","metadata":false},{"id":79799,"structure_id":13819,"section_number":"38.2-3448","catch_line":"Guaranteed availability","url":"\/38.2-3448\/","token":"38.2\/34\/6\/38.2-3448","metadata":false},{"id":78815,"structure_id":13819,"section_number":"38.2-3449","catch_line":"Prohibiting discrimination based on health status","url":"\/38.2-3449\/","token":"38.2\/34\/6\/38.2-3449","metadata":false},{"id":67706,"structure_id":13819,"section_number":"38.2-3449.1","catch_line":"Prohibited discrimination based on gender identity or status as a transgender individual","url":"\/38.2-3449.1\/","token":"38.2\/34\/6\/38.2-3449.1","metadata":false},{"id":64622,"structure_id":13819,"section_number":"38.2-3450","catch_line":"Genetic information and testing","url":"\/38.2-3450\/","token":"38.2\/34\/6\/38.2-3450","metadata":false},{"id":83154,"structure_id":13819,"section_number":"38.2-3451","catch_line":"Essential health benefits","url":"\/38.2-3451\/","token":"38.2\/34\/6\/38.2-3451","metadata":false},{"id":76537,"structure_id":13819,"section_number":"38.2-3452","catch_line":"Waiting periods","url":"\/38.2-3452\/","token":"38.2\/34\/6\/38.2-3452","metadata":false},{"id":86395,"structure_id":13819,"section_number":"38.2-3453","catch_line":"Clinical trials","url":"\/38.2-3453\/","token":"38.2\/34\/6\/38.2-3453","metadata":false},{"id":81951,"structure_id":13819,"section_number":"38.2-3454","catch_line":"Wellness programs","url":"\/38.2-3454\/","token":"38.2\/34\/6\/38.2-3454","metadata":false},{"id":84250,"structure_id":13819,"section_number":"38.2-3454.1","catch_line":"Renewal of health benefit plans; special exception","url":"\/38.2-3454.1\/","token":"38.2\/34\/6\/38.2-3454.1","metadata":false}],"previous_section":{"id":67926,"structure_id":13819,"section_number":"38.2-3445.05","catch_line":"Enforcement","url":"\/38.2-3445.05\/","token":"38.2\/34\/6\/38.2-3445.05","metadata":false},"next_section":{"id":72898,"structure_id":13819,"section_number":"38.2-3445.07","catch_line":"Rules and regulations","url":"\/38.2-3445.07\/","token":"38.2\/34\/6\/38.2-3445.07","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3445.06\/","history_text":"

This law was first created in 2020. The record of its establishment is cataloged in chapters 1080<\/a> and 1081<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year.<\/p>","references":[{"id":66467,"section_number":"38.2-3445.06","catch_line":"Applicability of certain sections","order_by":null,"url":"\/38.2-3445.06\/"},{"id":72898,"section_number":"38.2-3445.07","catch_line":"Rules and regulations","order_by":null,"url":"\/38.2-3445.07\/"}],"refers_to":[{"id":68317,"section_number":"2.2-2818","catch_line":"Health and related insurance for state employees","order_by":null,"url":"\/2.2-2818\/"},{"id":60836,"section_number":"38.2-3445","catch_line":"Patient access to emergency services","order_by":null,"url":"\/38.2-3445\/"},{"id":57195,"section_number":"38.2-3445.01","catch_line":"Balance billing for certain services; prohibited","order_by":null,"url":"\/38.2-3445.01\/"},{"id":74656,"section_number":"38.2-3445.02","catch_line":"Arbitration","order_by":null,"url":"\/38.2-3445.02\/"},{"id":67926,"section_number":"38.2-3445.05","catch_line":"Enforcement","order_by":null,"url":"\/38.2-3445.05\/"},{"id":66467,"section_number":"38.2-3445.06","catch_line":"Applicability of certain sections","order_by":null,"url":"\/38.2-3445.06\/"}],"permalink":{"id":215511,"object_type":"law","relational_id":66467,"identifier":"38.2-3445.06","token":"38.2\/34\/6\/38.2-3445.06","url":"\/38.2-3445.06\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3445.06\/","token":"38.2\/34\/6\/38.2-3445.06","dublin_core":{"Title":"Applicability of certain sections","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3445.06","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Except as provided in this section, the provisions of §§ 38.2-3445<\/a> through 38.2-3445.05<\/a> shall not apply to an entity providing or administering an employee welfare benefit plan, as defined in § 3(1) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002(1), that is self-insured or self-funded with respect to such plan. Such an entity may elect to be subject to the provisions of §§ 38.2-3445<\/a> through 38.2-3445.06<\/a> in the same manner as applied to a health carrier by providing notice to the Commission<\/span> annually, in a form and manner prescribed by the Commission<\/span>, attesting to the plan’s participation and agreeing to be bound by the provisions of §§ 38.2-3445<\/a> through 38.2-3445.06<\/a>. Such entity shall amend<\/span> the plan, policies, contracts<\/span>, and other documents to reflect such election. In addition, the entity that elects to opt in pursuant to this section shall file current plan documentation confirming that the plan accepts the obligations of §§ 38.2-3445<\/a> through 38.2-3445.06<\/a> and attests that any amended plan documents will be filed with the Commission<\/span> before the effective date of such amendments. The Commission<\/span> shall post on its website a list of entities, including relevant plan information, that have elected to be subject to the provisions of §§ 38.2-3445<\/a> through 38.2-3445.06<\/a>. The Commission<\/span> shall update such list at least once per quarter. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The provisions of §§ 38.2-3445.01<\/a> and 38.2-3445.02<\/a> shall not apply to services when the provider’s fees are subject to schedules<\/span> or other monetary limitations under any other law<\/span>, including the Virginia Workers’ Compensation Act, and such sections shall not preempt any such law<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> The provisions of §§ 38.2-3445<\/a> through 38.2-3445.05<\/a> shall apply to health coverage insurance<\/span> offered to state<\/span> employees pursuant to § 2.2-2818<\/a> and may apply to health insurance<\/span> coverage offered to employees of local governments, local officers, teachers, and retirees, and the dependents of such employees, officers, teachers, and retirees pursuant to § 2.2-1204<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> Except for its facilitation of arbitration pursuant to § 38.2-3445.02<\/a> and its role in any appeals<\/span> process established pursuant to subsection J of § 38.2-3445.02<\/a>, the Commission<\/span> shall have no jurisdiction<\/span> to resolve disputes arising out of § 38.2-3445.01<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> Except for in a provider contract<\/span> between a carrier and an in-network provider, no person<\/span> shall waive<\/span>, be required to waive<\/span>, or require another person<\/span> to waive<\/span> the provisions of §§ 38.2-3445<\/a> through 38.2-3445.05<\/a>. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nAPPLICABILITY OF CERTAIN SECTIONS (\u00a7 38.2-3445.06)\n\nA. Except as provided in this section, the provisions of §§ 38.2-3445\nthrough 38.2-3445.05 shall not apply to an entity providing or administering an\nemployee welfare benefit plan, as defined in § 3(1) of the Employee\nRetirement Income Security Act of 1974, 29 U.S.C. § 1002(1), that is\nself-insured or self-funded with respect to such plan. Such an entity may elect\nto be subject to the provisions of §§ 38.2-3445 through 38.2-3445.06\nin the same manner as applied to a health carrier by providing notice to the\nCommission annually, in a form and manner prescribed by the Commission,\nattesting to the plan’s participation and agreeing to be bound by the\nprovisions of §§ 38.2-3445 through 38.2-3445.06. Such entity shall\namend the plan, policies, contracts, and other documents to reflect such\nelection. In addition, the entity that elects to opt in pursuant to this section\nshall file current plan documentation confirming that the plan accepts the\nobligations of §§ 38.2-3445 through 38.2-3445.06 and attests that any\namended plan documents will be filed with the Commission before the effective\ndate of such amendments. The Commission shall post on its website a list of\nentities, including relevant plan information, that have elected to be subject\nto the provisions of §§ 38.2-3445 through 38.2-3445.06. The Commission\nshall update such list at least once per quarter.\n\nB. The provisions of §§ 38.2-3445.01 and 38.2-3445.02 shall not apply\nto services when the provider’s fees are subject to schedules or other\nmonetary limitations under any other law, including the Virginia Workers’\nCompensation Act, and such sections shall not preempt any such law.\n\nC. The provisions of §§ 38.2-3445 through 38.2-3445.05 shall apply to\nhealth coverage insurance offered to state employees pursuant to § 2.2-2818\nand may apply to health insurance coverage offered to employees of local\ngovernments, local officers, teachers, and retirees, and the dependents of such\nemployees, officers, teachers, and retirees pursuant to § 2.2-1204.\n\nD. Except for its facilitation of arbitration pursuant to § 38.2-3445.02\nand its role in any appeals process established pursuant to subsection J of\n§ 38.2-3445.02, the Commission shall have no jurisdiction to resolve\ndisputes arising out of § 38.2-3445.01.\n\nE. Except for in a provider contract between a carrier and an in-network\nprovider, no person shall waive, be required to waive, or require another person\nto waive the provisions of §§ 38.2-3445 through 38.2-3445.05.\n\nHISTORY: 2020, cc. 1080, 1081.","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}}