{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3541.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3541.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3541.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3541.html"}],"law_id":55325,"edition_id":1,"section_id":55325,"structure_id":13628,"section_number":"38.2-3541","catch_line":"Continuation on termination of eligibility","history":"1979, c. 97, \u00a7 38.1-348.11; 1982, c. 625; 1984, c. 300; 1986, c. 562; 1988, c. 551; 2010, c. 503; 2014, c. 814; 2018, c. 471.","full_text":"A\n\nEach group hospital policy, group medical and surgical policy, or group major medical policy delivered or issued for delivery in the Commonwealth or renewed, reissued, or extended if already issued, shall contain a provision for continuation of coverage under the group policy if the insurance on a person covered under such a policy ceases because of the termination of the person’s eligibility for coverage, prior to that person becoming eligible for Medicare or Medicaid benefits. This provision shall not be applicable if the group policyholder is required by federal law to provide for continuation of coverage under its group health plan pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).B\n\nThe insured’s present coverage shall continue under the policy for a period of 12 months immediately following the date of the termination of the person’s eligibility, without evidence of insurability, subject to the following requirements:1\n\nThe application and payment for the extended coverage is made to the group policyholder within 31 days after issuance of the written notice required in subsection C, but in no event beyond the 60-day period following the date of the termination of the person’s eligibility;2\n\nEach premium for such extended coverage is timely paid to the group policyholder on a monthly basis during the 12-month period;3\n\nThe premium for continuing the group coverage shall be at the insurer’s current rate applicable to the group policy plus any applicable administrative fee not to exceed two percent of the current rate;4\n\nContinuation shall only be available to an employee or member who has been continuously insured under the group policy during the entire three-month period immediately preceding termination of eligibility; and5\n\nContinuation shall not be available to an individual whose eligibility for coverage under the group policy ceased because the individual was discharged from employment by the group policyholder for gross misconduct. As used in this subdivision, “gross misconduct” means any conduct connected with the individual’s work that would constitute misconduct under § 60.2-618, including deliberately and willfully engaging in conduct evincing a complete disregard for the employer’s workplace standards and policies.C\n\nThe group policyholder shall provide each employee or other person covered under such a policy written notice of the availability of continuation of coverage and the procedures and timeframes for obtaining continuation of the group policy. Such notice shall be provided within 14 days of the policyholder’s knowledge of the employee’s or other covered person’s loss of eligibility under the policy.","order_by":null,"text":{"0":{"id":202882,"text":"Each group hospital policy, group medical and surgical policy, or group major medical policy delivered or issued for delivery in the Commonwealth or renewed, reissued, or extended if already issued, shall contain a provision for continuation of coverage under the group policy if the insurance on a person covered under such a policy ceases because of the termination of the person’s eligibility for coverage, prior to that person becoming eligible for Medicare or Medicaid benefits. This provision shall not be applicable if the group policyholder is required by federal law to provide for continuation of coverage under its group health plan pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":202883,"text":"The insured’s present coverage shall continue under the policy for a period of 12 months immediately following the date of the termination of the person’s eligibility, without evidence of insurability, subject to the following requirements:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"B1"},"2":{"id":202884,"text":"The application and payment for the extended coverage is made to the group policyholder within 31 days after issuance of the written notice required in subsection C, but in no event beyond the 60-day period following the date of the termination of the person’s eligibility;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"3":{"id":202885,"text":"Each premium for such extended coverage is timely paid to the group policyholder on a monthly basis during the 12-month period;","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"4":{"id":202886,"text":"The premium for continuing the group coverage shall be at the insurer’s current rate applicable to the group policy plus any applicable administrative fee not to exceed two percent of the current rate;","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B4"},"5":{"id":202887,"text":"Continuation shall only be available to an employee or member who has been continuously insured under the group policy during the entire three-month period immediately preceding termination of eligibility; and","type":"section","prefixes":["B","4"],"prefix":"4","entire_prefix":"B4","prefix_anchor":"B4","level":2,"prior_prefix":"B3","next_prefix":"B5"},"6":{"id":202888,"text":"Continuation shall not be available to an individual whose eligibility for coverage under the group policy ceased because the individual was discharged from employment by the group policyholder for gross misconduct. As used in this subdivision, “gross misconduct” means any conduct connected with the individual’s work that would constitute misconduct under § 60.2-618, including deliberately and willfully engaging in conduct evincing a complete disregard for the employer’s workplace standards and policies.","type":"section","prefixes":["B","5"],"prefix":"5","entire_prefix":"B5","prefix_anchor":"B5","level":2,"prior_prefix":"B4","next_prefix":"C"},"7":{"id":202889,"text":"The group policyholder shall provide each employee or other person covered under such a policy written notice of the availability of continuation of coverage and the procedures and timeframes for obtaining continuation of the group policy. Such notice shall be provided within 14 days of the policyholder’s knowledge of the employee’s or other covered person’s loss of eligibility under the policy.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B5"}},"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 insurance","url":"\/38.2-3521.2\/","token":"38.2\/35\/3\/38.2-3521.2","metadata":false},{"id":61357,"structure_id":13628,"section_number":"38.2-3522","catch_line":"Repealed","url":"\/38.2-3522\/","token":"38.2\/35\/3\/38.2-3522","metadata":false},{"id":67462,"structure_id":13628,"section_number":"38.2-3522.1","catch_line":"Limits of group accident and sickness insurance","url":"\/38.2-3522.1\/","token":"38.2\/35\/3\/38.2-3522.1","metadata":false},{"id":57697,"structure_id":13628,"section_number":"38.2-3523","catch_line":"Repealed","url":"\/38.2-3523\/","token":"38.2\/35\/3\/38.2-3523","metadata":false},{"id":71976,"structure_id":13628,"section_number":"38.2-3523.1","catch_line":"Review of records","url":"\/38.2-3523.1\/","token":"38.2\/35\/3\/38.2-3523.1","metadata":false},{"id":61669,"structure_id":13628,"section_number":"38.2-3523.2","catch_line":"Policies issued outside of the Commonwealth of Virginia","url":"\/38.2-3523.2\/","token":"38.2\/35\/3\/38.2-3523.2","metadata":false},{"id":59982,"structure_id":13628,"section_number":"38.2-3523.3","catch_line":"Requirements for those marketing group accident and sickness insurance","url":"\/38.2-3523.3\/","token":"38.2\/35\/3\/38.2-3523.3","metadata":false},{"id":84584,"structure_id":13628,"section_number":"38.2-3523.4","catch_line":"Minimum number of persons covered","url":"\/38.2-3523.4\/","token":"38.2\/35\/3\/38.2-3523.4","metadata":false},{"id":54597,"structure_id":13628,"section_number":"38.2-3524","catch_line":"Repealed","url":"\/38.2-3524\/","token":"38.2\/35\/3\/38.2-3524","metadata":false},{"id":78059,"structure_id":13628,"section_number":"38.2-3525","catch_line":"Group accident and sickness insurance coverages of spouses, dependent children or other persons","url":"\/38.2-3525\/","token":"38.2\/35\/3\/38.2-3525","metadata":false},{"id":70591,"structure_id":13628,"section_number":"38.2-3526","catch_line":"Standard provisions required; exceptions","url":"\/38.2-3526\/","token":"38.2\/35\/3\/38.2-3526","metadata":false},{"id":66611,"structure_id":13628,"section_number":"38.2-3527","catch_line":"Grace period","url":"\/38.2-3527\/","token":"38.2\/35\/3\/38.2-3527","metadata":false},{"id":71054,"structure_id":13628,"section_number":"38.2-3528","catch_line":"Incontestability","url":"\/38.2-3528\/","token":"38.2\/35\/3\/38.2-3528","metadata":false},{"id":80053,"structure_id":13628,"section_number":"38.2-3529","catch_line":"Entire contract; statements deemed representations","url":"\/38.2-3529\/","token":"38.2\/35\/3\/38.2-3529","metadata":false},{"id":59015,"structure_id":13628,"section_number":"38.2-3530","catch_line":"Evidence of individual insurability","url":"\/38.2-3530\/","token":"38.2\/35\/3\/38.2-3530","metadata":false},{"id":57577,"structure_id":13628,"section_number":"38.2-3531","catch_line":"Additional exclusions and limitations","url":"\/38.2-3531\/","token":"38.2\/35\/3\/38.2-3531","metadata":false},{"id":66450,"structure_id":13628,"section_number":"38.2-3532","catch_line":"Misstatement of age","url":"\/38.2-3532\/","token":"38.2\/35\/3\/38.2-3532","metadata":false},{"id":85603,"structure_id":13628,"section_number":"38.2-3533","catch_line":"Individual certificates","url":"\/38.2-3533\/","token":"38.2\/35\/3\/38.2-3533","metadata":false},{"id":72638,"structure_id":13628,"section_number":"38.2-3534","catch_line":"Notice of claim","url":"\/38.2-3534\/","token":"38.2\/35\/3\/38.2-3534","metadata":false},{"id":65149,"structure_id":13628,"section_number":"38.2-3535","catch_line":"Claim forms","url":"\/38.2-3535\/","token":"38.2\/35\/3\/38.2-3535","metadata":false},{"id":79101,"structure_id":13628,"section_number":"38.2-3536","catch_line":"Proofs of loss","url":"\/38.2-3536\/","token":"38.2\/35\/3\/38.2-3536","metadata":false},{"id":72065,"structure_id":13628,"section_number":"38.2-3537","catch_line":"Time of payment of claims","url":"\/38.2-3537\/","token":"38.2\/35\/3\/38.2-3537","metadata":false},{"id":65230,"structure_id":13628,"section_number":"38.2-3538","catch_line":"Payment of benefits","url":"\/38.2-3538\/","token":"38.2\/35\/3\/38.2-3538","metadata":false},{"id":69184,"structure_id":13628,"section_number":"38.2-3539","catch_line":"Physical examinations and autopsy","url":"\/38.2-3539\/","token":"38.2\/35\/3\/38.2-3539","metadata":false},{"id":77451,"structure_id":13628,"section_number":"38.2-3540","catch_line":"Legal actions","url":"\/38.2-3540\/","token":"38.2\/35\/3\/38.2-3540","metadata":false},{"id":58127,"structure_id":13628,"section_number":"38.2-3540.1","catch_line":"Claims experience","url":"\/38.2-3540.1\/","token":"38.2\/35\/3\/38.2-3540.1","metadata":false},{"id":82316,"structure_id":13628,"section_number":"38.2-3540.2","catch_line":"Employee wellness program","url":"\/38.2-3540.2\/","token":"38.2\/35\/3\/38.2-3540.2","metadata":false},{"id":55325,"structure_id":13628,"section_number":"38.2-3541","catch_line":"Continuation on termination of eligibility","url":"\/38.2-3541\/","token":"38.2\/35\/3\/38.2-3541","metadata":false},{"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},{"id":63267,"structure_id":13628,"section_number":"38.2-3541.2","catch_line":"Enrollment following change in eligibility status under assistance programs","url":"\/38.2-3541.2\/","token":"38.2\/35\/3\/38.2-3541.2","metadata":false},{"id":75709,"structure_id":13628,"section_number":"38.2-3542","catch_line":"Notice to employees upon termination of coverage; penalty for 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":82316,"structure_id":13628,"section_number":"38.2-3540.2","catch_line":"Employee wellness program","url":"\/38.2-3540.2\/","token":"38.2\/35\/3\/38.2-3540.2","metadata":false},"next_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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3541\/","history_text":"

This law was first created in 1979. The record of its establishment is cataloged in chapter 97 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 1979 \u201cActs\u201d aren\u2019t available online. It has been modified 7 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 1982, chapter 625; in 1984, chapter 300; in 1986, chapter 562; in 1988, chapter 551; in 2010, chapter 503<\/a>; in 2014, chapter 814<\/a>; in 2018, chapter 471<\/a>.<\/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":62548,"section_number":"38.2-4509","catch_line":"Application of certain laws","order_by":null,"url":"\/38.2-4509\/"}],"refers_to":[{"id":61574,"section_number":"60.2-618","catch_line":"Disqualification for benefits","order_by":null,"url":"\/60.2-618\/"}],"permalink":{"id":215857,"object_type":"law","relational_id":55325,"identifier":"38.2-3541","token":"38.2\/35\/3\/38.2-3541","url":"\/38.2-3541\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3541\/","token":"38.2\/35\/3\/38.2-3541","dublin_core":{"Title":"Continuation on termination of eligibility","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3541","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Each group hospital policy, group medical and surgical policy, or group major medical policy delivered or issued for delivery in the Commonwealth or renewed, reissued, or extended if already issued, shall contain a provision for continuation of coverage under the group policy if the insurance<\/span> on a person<\/span> covered under such a policy ceases because of the termination of the person<\/span>’s eligibility for coverage, prior to that person<\/span> becoming eligible for Medicare<\/span> or Medicaid benefits. This provision shall not be applicable if the group policyholder is required by federal law<\/span> to provide for continuation of coverage under its group health plan pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The insured’s present coverage shall continue under the policy for a period of 12 months immediately following the date of the termination of the person<\/span>’s eligibility, without evidence<\/span> of insurability, subject to the following requirements: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The application and payment for the extended coverage is made to the group policyholder within 31 days after issuance of the written notice required in subsection C, but in no event beyond the 60-day period following the date of the termination of the person<\/span>’s eligibility; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Each premium for such extended coverage is timely paid to the group policyholder on a monthly basis during the 12-month period; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> The premium for continuing the group coverage shall be at the insurer<\/span>’s current rate<\/span> applicable to the group policy plus any applicable administrative fee not to exceed two percent of the current rate<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Continuation shall only be available to an employee or member who has been continuously insured under the group policy during the entire three-month period immediately preceding termination of eligibility; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> Continuation shall not be available to an individual whose eligibility for coverage under the group policy ceased because the individual was discharged from employment by the group policyholder for gross misconduct<\/span>. As used in this subdivision, “gross misconduct<\/span>” means any conduct connected with the individual’s work that would constitute misconduct under § 60.2-618<\/a>, including deliberately and willfully engaging in conduct evincing a complete disregard for the employer’s workplace standards and policies. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> The group policyholder shall provide each employee or other person<\/span> covered under such a policy written notice of the availability of continuation of coverage and the procedures and timeframes for obtaining continuation of the group policy. Such notice shall be provided within 14 days of the policyholder’s knowledge of the employee’s or other covered person<\/span>’s loss of eligibility under the policy. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nCONTINUATION ON TERMINATION OF ELIGIBILITY (\u00a7 38.2-3541)\n\nA. Each group hospital policy, group medical and surgical policy, or group major\nmedical policy delivered or issued for delivery in the Commonwealth or renewed,\nreissued, or extended if already issued, shall contain a provision for\ncontinuation of coverage under the group policy if the insurance on a person\ncovered under such a policy ceases because of the termination of the\nperson’s eligibility for coverage, prior to that person becoming eligible\nfor Medicare or Medicaid benefits. This provision shall not be applicable if the\ngroup policyholder is required by federal law to provide for continuation of\ncoverage under its group health plan pursuant to the Consolidated Omnibus Budget\nReconciliation Act of 1985 (COBRA).\n\nB. The insured’s present coverage shall continue under the policy for a\nperiod of 12 months immediately following the date of the termination of the\nperson’s eligibility, without evidence of insurability, subject to the\nfollowing requirements:\n\n 1. The application and payment for the extended coverage is made to the group\n policyholder within 31 days after issuance of the written notice required in\n subsection C, but in no event beyond the 60-day period following the date of\n the termination of the person’s eligibility;\n\n 2. Each premium for such extended coverage is timely paid to the group\n policyholder on a monthly basis during the 12-month period;\n\n 3. The premium for continuing the group coverage shall be at the\n insurer’s current rate applicable to the group policy plus any\n applicable administrative fee not to exceed two percent of the current rate;\n\n 4. Continuation shall only be available to an employee or member who has been\n continuously insured under the group policy during the entire three-month\n period immediately preceding termination of eligibility; and\n\n 5. Continuation shall not be available to an individual whose eligibility for\n coverage under the group policy ceased because the individual was discharged\n from employment by the group policyholder for gross misconduct. As used in\n this subdivision, “gross misconduct” means any conduct connected\n with the individual’s work that would constitute misconduct under §\n 60.2-618, including deliberately and willfully engaging in conduct evincing a\n complete disregard for the employer’s workplace standards and policies.\n\nC. The group policyholder shall provide each employee or other person covered\nunder such a policy written notice of the availability of continuation of\ncoverage and the procedures and timeframes for obtaining continuation of the\ngroup policy. Such notice shall be provided within 14 days of the\npolicyholder’s knowledge of the employee’s or other covered\nperson’s loss of eligibility under the policy.\n\nHISTORY: 1979, c. 97, \u00a7 38.1-348.11; 1982, c. 625; 1984, c. 300; 1986, c. 562;\n1988, c. 551; 2010, c. 503; 2014, c. 814; 2018, c. 471.","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}}