{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3554.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3554.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3554.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3554.html"}],"law_id":83599,"edition_id":1,"section_id":83599,"structure_id":16550,"section_number":"38.2-3554","catch_line":"Provisions relating to health insurance issuers","history":"2006, c. 427.","full_text":"A\n\nNo group health policy shall be offered to a small employer group health cooperative that will cover a resident of the Commonwealth unless the Commission finds that:1\n\nThe issuance of such group health policy is not contrary to Virginia’s public policy and is in the best interest of the citizens of the Commonwealth;2\n\nThe issuance of the group health policy would result in economies of acquisition or administration; and3\n\nThe benefits are reasonable in relation to the premiums charged.B\n\nIssuers filing policy forms seeking approval under the provisions of this subsection shall provide with the forms a certification, signed by the officer of the company with the responsibility for forms compliance, in which the company certifies that each such policy form will be issued only when the requirements set forth in subdivisions 1 through 3 of subsection A have been satisfied.C\n\nIf a small employer health group cooperative has elected, under subdivision B 1 a of § 38.2-3552, to be deemed the policyholder of a group health policy covering the eligible employees and eligible dependents of its employer-members within the service area of an issuer and has furnished the authorization required under subdivision B 2 of § 38.2-3552, the issuer of such policy shall deem the small employer health group cooperative to be the policyholder in all respects permissible under applicable state and federal laws and regulations.D\n\nIf a small employer health group cooperative has elected, under subdivision B 1 b of § 38.2-3552, to be deemed only a sponsoring entity facilitating the acquisition of separate group health policies for its employer-members within the service area of an issuer, the issuer shall issue a separate policy to each such employer-member of the cooperative. Each such policy shall conform to the benefit and premium specifications and other policy terms mutually agreed upon by the issuer and the small employer health group cooperative in accordance with subsection B of § 38.2-3552.E\n\nAn issuer providing a group health policy or policies to or through a small employer health group cooperative shall make such policy or policies available to every eligible employee of an employer-member within its service area who applies for such policy or policies, and their eligible dependents, subject to an individual employee’s right to reject coverage in writing. No coverage may be offered only to certain eligible employees or their eligible dependents, and no eligible employees or their eligible dependents may be excluded or charged additional premiums, because of health status-related factors.F\n\nThe premiums for the policy or policies issued to or through a small employer health group cooperative shall be paid from funds contributed by the small employer health group cooperative, its employer-members, or both; or from funds contributed by the covered persons, or from both the covered persons and the employer-members or small employer health group cooperative.","order_by":null,"text":{"0":{"id":299567,"text":"No group health policy shall be offered to a small employer group health cooperative that will cover a resident of the Commonwealth unless the Commission finds that:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":299568,"text":"The issuance of such group health policy is not contrary to Virginia’s public policy and is in the best interest of the citizens of the Commonwealth;","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":299569,"text":"The issuance of the group health policy would result in economies of acquisition or administration; and","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":299570,"text":"The benefits are reasonable in relation to the premiums charged.","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"B"},"4":{"id":299571,"text":"Issuers filing policy forms seeking approval under the provisions of this subsection shall provide with the forms a certification, signed by the officer of the company with the responsibility for forms compliance, in which the company certifies that each such policy form will be issued only when the requirements set forth in subdivisions 1 through 3 of subsection A have been satisfied.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A3","next_prefix":"C"},"5":{"id":299572,"text":"If a small employer health group cooperative has elected, under subdivision B 1 a of § 38.2-3552, to be deemed the policyholder of a group health policy covering the eligible employees and eligible dependents of its employer-members within the service area of an issuer and has furnished the authorization required under subdivision B 2 of § 38.2-3552, the issuer of such policy shall deem the small employer health group cooperative to be the policyholder in all respects permissible under applicable state and federal laws and regulations.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"6":{"id":299573,"text":"If a small employer health group cooperative has elected, under subdivision B 1 b of § 38.2-3552, to be deemed only a sponsoring entity facilitating the acquisition of separate group health policies for its employer-members within the service area of an issuer, the issuer shall issue a separate policy to each such employer-member of the cooperative. Each such policy shall conform to the benefit and premium specifications and other policy terms mutually agreed upon by the issuer and the small employer health group cooperative in accordance with subsection B of § 38.2-3552.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"7":{"id":299574,"text":"An issuer providing a group health policy or policies to or through a small employer health group cooperative shall make such policy or policies available to every eligible employee of an employer-member within its service area who applies for such policy or policies, and their eligible dependents, subject to an individual employee’s right to reject coverage in writing. No coverage may be offered only to certain eligible employees or their eligible dependents, and no eligible employees or their eligible dependents may be excluded or charged additional premiums, because of health status-related factors.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"F"},"8":{"id":299575,"text":"The premiums for the policy or policies issued to or through a small employer health group cooperative shall be paid from funds contributed by the small employer health group cooperative, its employer-members, or both; or from funds contributed by the covered persons, or from both the covered persons and the employer-members or small employer health group cooperative.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E"}},"ancestry":[{"id":16550,"edition_id":1,"name":"Small Employer Health Insurance Pooling","identifier":"5","label":"article","depth":3,"order_by":1,"parent_id":13348,"metadata":{},"date_created":"2026-06-26 04:23:49","date_modified":"2026-06-26 04:23:49","permalink":{"id":215915,"object_type":"structure","relational_id":16550,"identifier":"5","token":"38.2\/35\/5","url":"\/38.2\/35\/5\/","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":76670,"structure_id":16550,"section_number":"38.2-3551","catch_line":"Definitions","url":"\/38.2-3551\/","token":"38.2\/35\/5\/38.2-3551","metadata":false},{"id":78302,"structure_id":16550,"section_number":"38.2-3552","catch_line":"Small employer health group cooperatives","url":"\/38.2-3552\/","token":"38.2\/35\/5\/38.2-3552","metadata":false},{"id":71043,"structure_id":16550,"section_number":"38.2-3553","catch_line":"Membership in a small employer health group cooperative","url":"\/38.2-3553\/","token":"38.2\/35\/5\/38.2-3553","metadata":false},{"id":83599,"structure_id":16550,"section_number":"38.2-3554","catch_line":"Provisions relating to health insurance issuers","url":"\/38.2-3554\/","token":"38.2\/35\/5\/38.2-3554","metadata":false},{"id":80804,"structure_id":16550,"section_number":"38.2-3555","catch_line":"Authority of the Commission","url":"\/38.2-3555\/","token":"38.2\/35\/5\/38.2-3555","metadata":false}],"previous_section":{"id":71043,"structure_id":16550,"section_number":"38.2-3553","catch_line":"Membership in a small employer health group cooperative","url":"\/38.2-3553\/","token":"38.2\/35\/5\/38.2-3553","metadata":false},"next_section":{"id":80804,"structure_id":16550,"section_number":"38.2-3555","catch_line":"Authority of the Commission","url":"\/38.2-3555\/","token":"38.2\/35\/5\/38.2-3555","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3554\/","history_text":"

This law was first created in 2006. The record of its establishment is cataloged in chapter 427<\/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":false,"refers_to":[{"id":78302,"section_number":"38.2-3552","catch_line":"Small employer health group cooperatives","order_by":null,"url":"\/38.2-3552\/"}],"permalink":{"id":215929,"object_type":"law","relational_id":83599,"identifier":"38.2-3554","token":"38.2\/35\/5\/38.2-3554","url":"\/38.2-3554\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3554\/","token":"38.2\/35\/5\/38.2-3554","dublin_core":{"Title":"Provisions relating to health insurance issuers","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3554","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> No group health policy shall be offered to a small employer group health cooperative that will cover a resident of the Commonwealth unless the Commission<\/span> finds that: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The issuance of such group health policy is not contrary to Virginia’s public policy and is in the best interest of the citizens of the Commonwealth; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The issuance of the group health policy would result in economies of acquisition or administration; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> The benefits are reasonable in relation to the premiums charged. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Issuers filing policy forms seeking approval under the provisions of this subsection shall provide with the forms a certification, signed by the officer of the company<\/span> with the responsibility for forms compliance, in which the company<\/span> certifies that each such policy form will be issued only when the requirements set forth in subdivisions 1 through 3 of subsection A have been satisfied. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> If a small employer health group cooperative has elected, under subdivision B 1 a of § 38.2-3552<\/a>, to be deemed the policyholder of a group health policy covering the eligible employees and eligible dependents of its employer-members within the service area of an issuer and has furnished the authorization required under subdivision B 2 of § 38.2-3552<\/a>, the issuer of such policy shall deem the small employer health group cooperative to be the policyholder in all respects permissible under applicable state<\/span> and federal laws<\/span> and regulations. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> If a small employer health group cooperative has elected, under subdivision B 1 b of § 38.2-3552<\/a>, to be deemed only a sponsoring entity facilitating the acquisition of separate group health policies for its employer-members within the service area of an issuer, the issuer shall issue<\/span> a separate policy to each such employer-member of the cooperative. Each such policy shall conform to the benefit and premium specifications and other policy terms mutually agreed upon by the issuer and the small employer health group cooperative in accordance with subsection B of § 38.2-3552<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> An issuer providing a group health policy or policies to or through a small employer health group cooperative shall make such policy or policies available to every eligible employee of an employer-member within its service area who applies for such policy or policies, and their eligible dependents, subject to an individual employee’s right to reject coverage in writing. No coverage may be offered only to certain eligible employees or their eligible dependents, and no eligible employees or their eligible dependents may be excluded or charged additional premiums, because of health status-related factors. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> The premiums for the policy or policies issued to or through a small employer health group cooperative shall be paid from funds contributed by the small employer health group cooperative, its employer-members, or both; or from funds contributed by the covered persons<\/span>, or from both the covered persons<\/span> and the employer-members or small employer health group cooperative. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nPROVISIONS RELATING TO HEALTH INSURANCE ISSUERS (\u00a7 38.2-3554)\n\nA. No group health policy shall be offered to a small employer group health\ncooperative that will cover a resident of the Commonwealth unless the Commission\nfinds that:\n\n 1. The issuance of such group health policy is not contrary to\n Virginia’s public policy and is in the best interest of the citizens of\n the Commonwealth;\n\n 2. The issuance of the group health policy would result in economies of\n acquisition or administration; and\n\n 3. The benefits are reasonable in relation to the premiums charged.\n\nB. Issuers filing policy forms seeking approval under the provisions of this\nsubsection shall provide with the forms a certification, signed by the officer\nof the company with the responsibility for forms compliance, in which the\ncompany certifies that each such policy form will be issued only when the\nrequirements set forth in subdivisions 1 through 3 of subsection A have been\nsatisfied.\n\nC. If a small employer health group cooperative has elected, under subdivision B\n1 a of § 38.2-3552, to be deemed the policyholder of a group health policy\ncovering the eligible employees and eligible dependents of its employer-members\nwithin the service area of an issuer and has furnished the authorization\nrequired under subdivision B 2 of § 38.2-3552, the issuer of such policy\nshall deem the small employer health group cooperative to be the policyholder in\nall respects permissible under applicable state and federal laws and\nregulations.\n\nD. If a small employer health group cooperative has elected, under subdivision B\n1 b of § 38.2-3552, to be deemed only a sponsoring entity facilitating the\nacquisition of separate group health policies for its employer-members within\nthe service area of an issuer, the issuer shall issue a separate policy to each\nsuch employer-member of the cooperative. Each such policy shall conform to the\nbenefit and premium specifications and other policy terms mutually agreed upon\nby the issuer and the small employer health group cooperative in accordance with\nsubsection B of § 38.2-3552.\n\nE. An issuer providing a group health policy or policies to or through a small\nemployer health group cooperative shall make such policy or policies available\nto every eligible employee of an employer-member within its service area who\napplies for such policy or policies, and their eligible dependents, subject to\nan individual employee’s right to reject coverage in writing. No coverage\nmay be offered only to certain eligible employees or their eligible dependents,\nand no eligible employees or their eligible dependents may be excluded or\ncharged additional premiums, because of health status-related factors.\n\nF. The premiums for the policy or policies issued to or through a small employer\nhealth group cooperative shall be paid from funds contributed by the small\nemployer health group cooperative, its employer-members, or both; or from funds\ncontributed by the covered persons, or from both the covered persons and the\nemployer-members or small employer health group cooperative.\n\nHISTORY: 2006, c. 427.","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}}