{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3541.2.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3541.2.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3541.2.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3541.2.html"}],"law_id":63267,"edition_id":1,"section_id":63267,"structure_id":13628,"section_number":"38.2-3541.2","catch_line":"Enrollment following change in eligibility status under assistance programs","history":"2010, c. 504.","full_text":"A\n\nAs used in this section, “assistance program” means the Commonwealth’s medical assistance services program, established pursuant to § 32.1-325, or the Family Access to Medical Insurance Security Plan, established pursuant to § 32.1-351, including under any waiver or demonstration project conducted under or in relation thereto.B\n\nAny employer providing health insurance coverage for his employees under a group accident and sickness insurance policy, or subscription contract, or other evidence of coverage shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the policy, contract or plan, or a dependent of such an employee, if the dependent is eligible but not enrolled, for coverage under such terms, to enroll for coverage under the terms of the policy, contract or plan, if either of the following conditions is met:1\n\nThe employee or dependent has received health insurance coverage under an assistance program, coverage of the employee or dependent under the assistance program is terminated as a result of loss of eligibility for such coverage, and the employee requests coverage under the group policy, contract or plan not later than 60 days after the date of termination of coverage under the assistance program; or2\n\nThe employee or dependent becomes eligible under an assistance program for premium assistance for the purchase of coverage under the group policy, contract or plan, including contributions to the cost of employer-sponsored health insurance pursuant to subsection C of § 32.1-351.1, and the employee requests coverage under the group policy, contract or plan not later than 60 days after the date the employee or dependent is determined to be eligible for such premium assistance.C\n\nAny employer providing health insurance coverage for his employees under a group accident and sickness insurance policy, or subscription contract, or other evidence of coverage within the Commonwealth, shall provide to each employee a written notice informing the employee of premium assistance opportunities currently available for the employee or the employee’s dependents through the Commonwealth’s assistance programs. For purposes of compliance with this subsection, for employees residing within the Commonwealth, the employer may use a Virginia-specific model notice developed in accordance with section 701(f)(3)(B)(i)(II) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1181 (f)(3)(B)(i)(II)). An employer may provide the Virginia-specific model notice concurrent with (i) the furnishing of materials notifying the employee of health plan eligibility; (ii) materials provided to the employee in connection with an open season or election process conducted under the plan; or (iii) the furnishing of the summary plan description as provided in section 104(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1024).D\n\nIf an employee or the employee’s dependents are covered under an assistance program and potentially eligible for premium assistance for the purchase of coverage under the employer’s group health plan, the plan administrator of the group health plan shall disclose to the Department of Medical Assistance Services, upon request, information about the benefits available under the group health plan in sufficient specificity, as determined under regulations of the Secretary of Health and Human Services in consultation with the Secretary, that require use of the model coverage coordination disclosure form developed under § 311(b)(1)(C) of the Children’s Health Insurance Program Reauthorization Act of 2009, so as to permit the Department of Medical Assistance Services to make a determination concerning the cost-effectiveness of the provision by the Commonwealth of contributions to the cost of employer-sponsored health insurance, through premium assistance for the purchase of coverage under such group health plan, and in order for the Department of Medical Assistance Services to provide any required supplemental benefits under an assistance program.","order_by":null,"text":{"0":{"id":230592,"text":"As used in this section, “assistance program” means the Commonwealth’s medical assistance services program, established pursuant to § 32.1-325, or the Family Access to Medical Insurance Security Plan, established pursuant to § 32.1-351, including under any waiver or demonstration project conducted under or in relation thereto.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":230593,"text":"Any employer providing health insurance coverage for his employees under a group accident and sickness insurance policy, or subscription contract, or other evidence of coverage shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the policy, contract or plan, or a dependent of such an employee, if the dependent is eligible but not enrolled, for coverage under such terms, to enroll for coverage under the terms of the policy, contract or plan, if either of the following conditions is met:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"B1"},"2":{"id":230594,"text":"The employee or dependent has received health insurance coverage under an assistance program, coverage of the employee or dependent under the assistance program is terminated as a result of loss of eligibility for such coverage, and the employee requests coverage under the group policy, contract or plan not later than 60 days after the date of termination of coverage under the assistance program; or","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"3":{"id":230595,"text":"The employee or dependent becomes eligible under an assistance program for premium assistance for the purchase of coverage under the group policy, contract or plan, including contributions to the cost of employer-sponsored health insurance pursuant to subsection C of § 32.1-351.1, and the employee requests coverage under the group policy, contract or plan not later than 60 days after the date the employee or dependent is determined to be eligible for such premium assistance.","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"C"},"4":{"id":230596,"text":"Any employer providing health insurance coverage for his employees under a group accident and sickness insurance policy, or subscription contract, or other evidence of coverage within the Commonwealth, shall provide to each employee a written notice informing the employee of premium assistance opportunities currently available for the employee or the employee’s dependents through the Commonwealth’s assistance programs. For purposes of compliance with this subsection, for employees residing within the Commonwealth, the employer may use a Virginia-specific model notice developed in accordance with section 701(f)(3)(B)(i)(II) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1181 (f)(3)(B)(i)(II)). An employer may provide the Virginia-specific model notice concurrent with (i) the furnishing of materials notifying the employee of health plan eligibility; (ii) materials provided to the employee in connection with an open season or election process conducted under the plan; or (iii) the furnishing of the summary plan description as provided in section 104(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1024).","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B2","next_prefix":"D"},"5":{"id":230597,"text":"If an employee or the employee’s dependents are covered under an assistance program and potentially eligible for premium assistance for the purchase of coverage under the employer’s group health plan, the plan administrator of the group health plan shall disclose to the Department of Medical Assistance Services, upon request, information about the benefits available under the group health plan in sufficient specificity, as determined under regulations of the Secretary of Health and Human Services in consultation with the Secretary, that require use of the model coverage coordination disclosure form developed under § 311(b)(1)(C) of the Children’s Health Insurance Program Reauthorization Act of 2009, so as to permit the Department of Medical Assistance Services to make a determination concerning the cost-effectiveness of the provision by the Commonwealth of contributions to the cost of employer-sponsored health insurance, through premium assistance for the purchase of coverage under such group health plan, and in order for the Department of Medical Assistance Services to provide any required supplemental benefits under an assistance program.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C"}},"ancestry":[{"id":13628,"edition_id":1,"name":"Group Accident and Sickness Insurance Policies","identifier":"3","label":"article","depth":3,"order_by":1,"parent_id":13348,"metadata":{},"date_created":"2026-06-26 03:45:25","date_modified":"2026-06-26 03:45:25","permalink":{"id":215739,"object_type":"structure","relational_id":13628,"identifier":"3","token":"38.2\/35\/3","url":"\/38.2\/35\/3\/","edition_id":1,"permalink":0,"preferred":1}},{"id":13348,"edition_id":1,"name":"Accident and Sickness Insurance Policies","identifier":"35","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:41","date_modified":"2026-06-26 03:44:41","permalink":{"id":215641,"object_type":"structure","relational_id":13348,"identifier":"35","token":"38.2\/35","url":"\/38.2\/35\/","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":82746,"structure_id":13628,"section_number":"38.2-3521","catch_line":"Repealed","url":"\/38.2-3521\/","token":"38.2\/35\/3\/38.2-3521","metadata":false},{"id":83222,"structure_id":13628,"section_number":"38.2-3521.1","catch_line":"Group accident and sickness insurance definitions","url":"\/38.2-3521.1\/","token":"38.2\/35\/3\/38.2-3521.1","metadata":false},{"id":62206,"structure_id":13628,"section_number":"38.2-3521.2","catch_line":"Blanket accident and sickness 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failure to remit funds","url":"\/38.2-3542\/","token":"38.2\/35\/3\/38.2-3542","metadata":false},{"id":81170,"structure_id":13628,"section_number":"38.2-3543","catch_line":"Provisions required by other jurisdictions","url":"\/38.2-3543\/","token":"38.2\/35\/3\/38.2-3543","metadata":false},{"id":83285,"structure_id":13628,"section_number":"38.2-3543.1","catch_line":"Regulations","url":"\/38.2-3543.1\/","token":"38.2\/35\/3\/38.2-3543.1","metadata":false},{"id":65251,"structure_id":13628,"section_number":"38.2-3543.2","catch_line":"Applicability of laws","url":"\/38.2-3543.2\/","token":"38.2\/35\/3\/38.2-3543.2","metadata":false}],"previous_section":{"id":61422,"structure_id":13628,"section_number":"38.2-3541.1","catch_line":"Repealed","url":"\/38.2-3541.1\/","token":"38.2\/35\/3\/38.2-3541.1","metadata":false},"next_section":{"id":75709,"structure_id":13628,"section_number":"38.2-3542","catch_line":"Notice to employees upon termination of coverage; penalty for failure to remit 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This law was first created in 2010. The record of its establishment is cataloged in chapter 504<\/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":55347,"section_number":"38.2-4214","catch_line":"Application of certain provisions of law","order_by":null,"url":"\/38.2-4214\/"},{"id":67952,"section_number":"38.2-4319","catch_line":"Statutory construction and relationship to other laws","order_by":null,"url":"\/38.2-4319\/"}],"refers_to":[{"id":77747,"section_number":"32.1-325","catch_line":"Board to submit plan for medical assistance services to U.S. Secretary of Health and Human Services pursuant to federal law; administration of plan; contracts with health care providers","order_by":null,"url":"\/32.1-325\/"},{"id":86147,"section_number":"32.1-351","catch_line":"Family Access to Medical Insurance Security Plan established","order_by":null,"url":"\/32.1-351\/"},{"id":59066,"section_number":"32.1-351.1","catch_line":"Assistance with employer-sponsored health insurance","order_by":null,"url":"\/32.1-351.1\/"}],"permalink":{"id":215865,"object_type":"law","relational_id":63267,"identifier":"38.2-3541.2","token":"38.2\/35\/3\/38.2-3541.2","url":"\/38.2-3541.2\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3541.2\/","token":"38.2\/35\/3\/38.2-3541.2","dublin_core":{"Title":"Enrollment following change in eligibility status under assistance programs","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3541.2","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> As used in this section, “assistance program<\/span>” means the Commonwealth’s medical assistance services program, established pursuant to § 32.1-325<\/a>, or the Family Access to Medical Insurance<\/span> Security Plan, established pursuant to § 32.1-351<\/a>, including under any waiver<\/span> or demonstration project conducted under or in relation thereto. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Any employer providing health insurance<\/span> coverage for his employees under a group accident and sickness insurance<\/span> policy, or subscription contract<\/span>, or other evidence<\/span> of coverage shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the policy, contract<\/span> or plan, or a dependent of such an employee, if the dependent is eligible but not enrolled, for coverage under such terms, to enroll for coverage under the terms of the policy, contract<\/span> or plan, if either of the following conditions is met: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The employee or dependent has received health insurance<\/span> coverage under an assistance program<\/span>, coverage of the employee or dependent under the assistance program<\/span> is terminated as a result of loss of eligibility for such coverage, and the employee requests coverage under the group policy, contract<\/span> or plan not later than 60 days after the date of termination of coverage under the assistance program<\/span>; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The employee or dependent becomes eligible under an assistance program<\/span> for premium assistance for the purchase of coverage under the group policy, contract<\/span> or plan, including contributions to the cost of employer-sponsored health insurance<\/span> pursuant to subsection C of § 32.1-351.1<\/a>, and the employee requests coverage under the group policy, contract<\/span> or plan not later than 60 days after the date the employee or dependent is determined to be eligible for such premium assistance. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> Any employer providing health insurance<\/span> coverage for his employees under a group accident and sickness insurance<\/span> policy, or subscription contract<\/span>, or other evidence<\/span> of coverage within the Commonwealth, shall provide to each employee a written notice informing the employee of premium assistance opportunities currently available for the employee or the employee’s dependents through the Commonwealth’s assistance programs<\/span>. For purposes of compliance with this subsection, for employees residing within the Commonwealth, the employer may use a Virginia-specific model notice developed in accordance with section 701(f)(3)(B)(i)(II) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1181 (f)(3)(B)(i)(II)). An employer may provide the Virginia-specific model notice concurrent with (i) the furnishing of materials<\/span> notifying the employee of health plan eligibility; (ii) materials<\/span> provided to the employee in connection with an open season or election process conducted under the plan; or (iii) the furnishing of the summary plan description as provided in section 104(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1024). <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> If an employee or the employee’s dependents are covered under an assistance program<\/span> and potentially eligible for premium assistance for the purchase of coverage under the employer’s group health plan, the plan administrator of the group health plan shall disclose to the Department of Medical Assistance Services, upon request, information about the benefits available under the group health plan in sufficient specificity, as determined under regulations of the Secretary of Health and Human Services in consultation with the Secretary, that require use of the model coverage coordination disclosure form developed under § 311(b)(1)(C) of the Children’s Health Insurance<\/span> Program Reauthorization Act of 2009, so as to permit the Department of Medical Assistance Services to make a determination concerning the cost-effectiveness of the provision by the Commonwealth of contributions to the cost of employer-sponsored health insurance<\/span>, through premium assistance for the purchase of coverage under such group health plan, and in order<\/span> for the Department of Medical Assistance Services to provide any required supplemental benefits under an assistance program<\/span>. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nENROLLMENT FOLLOWING CHANGE IN ELIGIBILITY STATUS UNDER ASSISTANCE PROGRAMS (\u00a7\n38.2-3541.2)\n\nA. As used in this section, “assistance program” means the\nCommonwealth’s medical assistance services program, established pursuant\nto § 32.1-325, or the Family Access to Medical Insurance Security Plan,\nestablished pursuant to § 32.1-351, including under any waiver or\ndemonstration project conducted under or in relation thereto.\n\nB. Any employer providing health insurance coverage for his employees under a\ngroup accident and sickness insurance policy, or subscription contract, or other\nevidence of coverage shall permit an employee who is eligible, but not enrolled,\nfor coverage under the terms of the policy, contract or plan, or a dependent of\nsuch an employee, if the dependent is eligible but not enrolled, for coverage\nunder such terms, to enroll for coverage under the terms of the policy, contract\nor plan, if either of the following conditions is met:\n\n 1. The employee or dependent has received health insurance coverage under an\n assistance program, coverage of the employee or dependent under the assistance\n program is terminated as a result of loss of eligibility for such coverage,\n and the employee requests coverage under the group policy, contract or plan\n not later than 60 days after the date of termination of coverage under the\n assistance program; or\n\n 2. The employee or dependent becomes eligible under an assistance program for\n premium assistance for the purchase of coverage under the group policy,\n contract or plan, including contributions to the cost of employer-sponsored\n health insurance pursuant to subsection C of § 32.1-351.1, and the\n employee requests coverage under the group policy, contract or plan not later\n than 60 days after the date the employee or dependent is determined to be\n eligible for such premium assistance.\n\nC. Any employer providing health insurance coverage for his employees under a\ngroup accident and sickness insurance policy, or subscription contract, or other\nevidence of coverage within the Commonwealth, shall provide to each employee a\nwritten notice informing the employee of premium assistance opportunities\ncurrently available for the employee or the employee’s dependents through\nthe Commonwealth’s assistance programs. For purposes of compliance with\nthis subsection, for employees residing within the Commonwealth, the employer\nmay use a Virginia-specific model notice developed in accordance with section\n701(f)(3)(B)(i)(II) of the Employee Retirement Income Security Act of 1974 (29\nU.S.C. § 1181 (f)(3)(B)(i)(II)). An employer may provide the\nVirginia-specific model notice concurrent with (i) the furnishing of materials\nnotifying the employee of health plan eligibility; (ii) materials provided to\nthe employee in connection with an open season or election process conducted\nunder the plan; or (iii) the furnishing of the summary plan description as\nprovided in section 104(b) of the Employee Retirement Income Security Act of\n1974 (29 U.S.C. § 1024).\n\nD. If an employee or the employee’s dependents are covered under an\nassistance program and potentially eligible for premium assistance for the\npurchase of coverage under the employer’s group health plan, the plan\nadministrator of the group health plan shall disclose to the Department of\nMedical Assistance Services, upon request, information about the benefits\navailable under the group health plan in sufficient specificity, as determined\nunder regulations of the Secretary of Health and Human Services in consultation\nwith the Secretary, that require use of the model coverage coordination\ndisclosure form developed under § 311(b)(1)(C) of the Children’s\nHealth Insurance Program Reauthorization Act of 2009, so as to permit the\nDepartment of Medical Assistance Services to make a determination concerning the\ncost-effectiveness of the provision by the Commonwealth of contributions to the\ncost of employer-sponsored health insurance, through premium assistance for the\npurchase of coverage under such group health plan, and in order for the\nDepartment of Medical Assistance Services to provide any required supplemental\nbenefits under an assistance program.\n\nHISTORY: 2010, c. 504.","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}}