{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3557.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3557.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3557.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3557.html"}],"law_id":56086,"edition_id":1,"section_id":56086,"structure_id":14588,"section_number":"38.2-3557","catch_line":"Scope of chapter","history":"2011, c. 788.","full_text":"A\n\nThis chapter shall apply to all health carriers, except that the provisions of this chapter shall not apply to a policy or certificate that provides coverage only for a specified disease, specified accident or accident-only coverage, credit, disability income, hospital indemnity, long-term care, dental, vision care, or any other limited supplemental benefit or to a Medicare supplement policy of insurance, coverage under a plan through Medicare, Medicaid, or the federal employees health benefits program, self-insured plans, any coverage issued under Chapter 55 of Title 10 of the U.S. Code, and any coverage issued as supplemental to that coverage, any coverage issued as supplemental to liability insurance, workers’ compensation or similar insurance, automobile medical payment insurance or any insurance under which benefits are payable with or without regard to fault, whether written on a group blanket or individual basis.B\n\nNotwithstanding the provisions of this section, self-insured employee welfare benefit plans may request a standard external review from the Commission. “Employee welfare benefit plan” has the meaning set forth in the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002 (1).","order_by":null,"text":{"0":{"id":205581,"text":"This chapter shall apply to all health carriers, except that the provisions of this chapter shall not apply to a policy or certificate that provides coverage only for a specified disease, specified accident or accident-only coverage, credit, disability income, hospital indemnity, long-term care, dental, vision care, or any other limited supplemental benefit or to a Medicare supplement policy of insurance, coverage under a plan through Medicare, Medicaid, or the federal employees health benefits program, self-insured plans, any coverage issued under Chapter 55 of Title 10 of the U.S. Code, and any coverage issued as supplemental to that coverage, any coverage issued as supplemental to liability insurance, workers’ compensation or similar insurance, automobile medical payment insurance or any insurance under which benefits are payable with or without regard to fault, whether written on a group blanket or individual basis.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":205582,"text":"Notwithstanding the provisions of this section, self-insured employee welfare benefit plans may request a standard external review from the Commission. “Employee welfare benefit plan” has the meaning set forth in the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002 (1).","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A"}},"ancestry":[{"id":14588,"edition_id":1,"name":"Health Carrier Internal Appeal Process and External Review","identifier":"35.1","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:48:47","date_modified":"2026-06-26 03:48:47","permalink":{"id":215937,"object_type":"structure","relational_id":14588,"identifier":"35.1","token":"38.2\/35.1","url":"\/38.2\/35.1\/","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":58140,"structure_id":14588,"section_number":"38.2-3556","catch_line":"Definitions","url":"\/38.2-3556\/","token":"38.2\/35.1\/38.2-3556","metadata":false},{"id":56086,"structure_id":14588,"section_number":"38.2-3557","catch_line":"Scope of chapter","url":"\/38.2-3557\/","token":"38.2\/35.1\/38.2-3557","metadata":false},{"id":56843,"structure_id":14588,"section_number":"38.2-3558","catch_line":"Health carrier's internal appeal process","url":"\/38.2-3558\/","token":"38.2\/35.1\/38.2-3558","metadata":false},{"id":77920,"structure_id":14588,"section_number":"38.2-3559","catch_line":"Notice of right to external review","url":"\/38.2-3559\/","token":"38.2\/35.1\/38.2-3559","metadata":false},{"id":65207,"structure_id":14588,"section_number":"38.2-3560","catch_line":"Exhaustion of internal appeal process","url":"\/38.2-3560\/","token":"38.2\/35.1\/38.2-3560","metadata":false},{"id":66856,"structure_id":14588,"section_number":"38.2-3561","catch_line":"Standard external review","url":"\/38.2-3561\/","token":"38.2\/35.1\/38.2-3561","metadata":false},{"id":83961,"structure_id":14588,"section_number":"38.2-3562","catch_line":"Expedited external review","url":"\/38.2-3562\/","token":"38.2\/35.1\/38.2-3562","metadata":false},{"id":63745,"structure_id":14588,"section_number":"38.2-3563","catch_line":"External review of experimental or investigational treatment adverse determinations","url":"\/38.2-3563\/","token":"38.2\/35.1\/38.2-3563","metadata":false},{"id":78633,"structure_id":14588,"section_number":"38.2-3564","catch_line":"Binding nature of external review decision","url":"\/38.2-3564\/","token":"38.2\/35.1\/38.2-3564","metadata":false},{"id":63044,"structure_id":14588,"section_number":"38.2-3565","catch_line":"Minimum qualifications for independent review 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This law was first created in 2011. The record of its establishment is cataloged in chapter 788<\/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":58140,"section_number":"38.2-3556","catch_line":"Definitions","order_by":null,"url":"\/38.2-3556\/"}],"refers_to":false,"permalink":{"id":215943,"object_type":"law","relational_id":56086,"identifier":"38.2-3557","token":"38.2\/35.1\/38.2-3557","url":"\/38.2-3557\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3557\/","token":"38.2\/35.1\/38.2-3557","dublin_core":{"Title":"Scope of chapter","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3557","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> This chapter shall apply to all health carriers<\/span>, except that the provisions of this chapter shall not apply to a policy or certificate that provides coverage only for a specified disease, specified accident or accident-only coverage, credit, disability income, hospital indemnity, long-term care, dental, vision care, or any other limited supplemental benefit or to a Medicare<\/span> supplement policy of insurance<\/span>, coverage under a plan through Medicare<\/span>, Medicaid, or the federal employees health benefits<\/span> program, self-insured plans, any coverage issued under Chapter 55 of Title 10 of the U.S. Code, and any coverage issued as supplemental to that coverage, any coverage issued as supplemental to liability insurance<\/span>, workers’ compensation or similar insurance<\/span>, automobile medical payment insurance<\/span> or any insurance<\/span> under which benefits<\/span> are payable with or without regard to fault, whether written on a group blanket or individual basis. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Notwithstanding the provisions of this section, self-insured employee welfare benefit plans may request a standard external review from the Commission<\/span>. “Employee welfare benefit plan” has the meaning set forth in the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002 (1). <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nSCOPE OF CHAPTER (\u00a7 38.2-3557)\n\nA. This chapter shall apply to all health carriers, except that the provisions\nof this chapter shall not apply to a policy or certificate that provides\ncoverage only for a specified disease, specified accident or accident-only\ncoverage, credit, disability income, hospital indemnity, long-term care, dental,\nvision care, or any other limited supplemental benefit or to a Medicare\nsupplement policy of insurance, coverage under a plan through Medicare,\nMedicaid, or the federal employees health benefits program, self-insured plans,\nany coverage issued under Chapter 55 of Title 10 of the U.S. Code, and any\ncoverage issued as supplemental to that coverage, any coverage issued as\nsupplemental to liability insurance, workers’ compensation or similar\ninsurance, automobile medical payment insurance or any insurance under which\nbenefits are payable with or without regard to fault, whether written on a group\nblanket or individual basis.\n\nB. Notwithstanding the provisions of this section, self-insured employee welfare\nbenefit plans may request a standard external review from the Commission.\n“Employee welfare benefit plan” has the meaning set forth in the\nEmployee Retirement Income Security Act of 1974, 29 U.S.C. § 1002 (1).\n\nHISTORY: 2011, c. 788.","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}}