{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-4303.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-4303.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-4303.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-4303.html"}],"law_id":73205,"edition_id":1,"section_id":73205,"structure_id":12833,"section_number":"38.2-4303","catch_line":"Powers","history":"1980, c. 720, \u00a7 38.1-866; 1986, c. 562; 1990, c. 224; 1992, c. 481; 2003, cc. 752, 767; 2008, c. 214.","full_text":"A\n\nThe powers of a health maintenance organization shall include, but shall not be limited to, the following, provided that the activities comply with all applicable state statutes and regulations:1\n\nThe purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical or other health care facilities, and their ancillary equipment and other property reasonably required for its principal office or for other purposes necessary in the transaction of the business of the organization;2\n\nThe making of loans to (i) health care providers under contract with it in advancement of its health care plan or (ii) any corporation under its control for the purpose of acquiring or constructing medical or other health care facilities and hospitals or in advancement of its health care plan providing health care services to enrollees;3\n\nThe furnishing of health care services through providers that are under contract with or employed by the health maintenance organization;4\n\nThe contracting with any person for the performance on its behalf of certain functions including, but not limited to, marketing, enrollment and administration;5\n\nThe contracting with an insurer or with a health services plan licensed in this Commonwealth, for the provision of insurance, indemnity, or reimbursement for the cost of health care services provided by the health maintenance organization;6\n\nThe offering, in addition to basic health care services, of:\n\t\t\t\ta. Additional health care services;\n\t\t\t\tb. Indemnity benefits covering out-of-area services; and\n\t\t\t\tc. Indemnity benefits, in addition to those relating to out-of-area services, provided through insurers or health services plans;7\n\nThe offering of health care plans for limited health care services; and8\n\nThe requirement for the enrollee to pay a deductible or copayment, or both, for any health care services offered pursuant to this chapter.B\n\n1. A health maintenance organization shall file notice with the Commission within 30 days after the exercise of any power granted in subdivision 1 or 2 of subsection A of this section that exceeds one percent of the admitted assets of the organization or five percent of net worth, whichever is less. A health maintenance organization shall file notice, with adequate supporting information, with the Commission prior to the exercise of any power granted in subdivision 1 or 2 of subsection A of this section that exceeds five percent of the admitted assets of the organization or 25 percent of net worth, whichever is less. Any series of transactions occurring within a 12-month period that are sufficiently similar in nature to be reasonably construed as a single transaction shall be subject to the limitations set forth in this section. The Commission shall disapprove the exercise of power if the Commission believes such exercise of power would substantially and adversely affect the financial soundness of the health maintenance organization and endanger the health maintenance organization’s ability to meet its obligations. If the Commission does not disapprove the exercise of power within 30 days of the filing, it shall be deemed approved.2\n\nUpon application by the health maintenance organization, the Commission may exempt from the filing requirement of subdivision 1 of subsection B of this section those activities having a minimal effect.","order_by":null,"text":{"0":{"id":263527,"text":"The powers of a health maintenance organization shall include, but shall not be limited to, the following, provided that the activities comply with all applicable state statutes and regulations:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":263528,"text":"The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical or other health care facilities, and their ancillary equipment and other property reasonably required for its principal office or for other purposes necessary in the transaction of the business of the organization;","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":263529,"text":"The making of loans to (i) health care providers under contract with it in advancement of its health care plan or (ii) any corporation under its control for the purpose of acquiring or constructing medical or other health care facilities and hospitals or in advancement of its health care plan providing health care services to enrollees;","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":263530,"text":"The furnishing of health care services through providers that are under contract with or employed by the health maintenance organization;","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"A4"},"4":{"id":263531,"text":"The contracting with any person for the performance on its behalf of certain functions including, but not limited to, marketing, enrollment and administration;","type":"section","prefixes":["A","4"],"prefix":"4","entire_prefix":"A4","prefix_anchor":"A4","level":2,"prior_prefix":"A3","next_prefix":"A5"},"5":{"id":263532,"text":"The contracting with an insurer or with a health services plan licensed in this Commonwealth, for the provision of insurance, indemnity, or reimbursement for the cost of health care services provided by the health maintenance organization;","type":"section","prefixes":["A","5"],"prefix":"5","entire_prefix":"A5","prefix_anchor":"A5","level":2,"prior_prefix":"A4","next_prefix":"A6"},"6":{"id":263533,"text":"The offering, in addition to basic health care services, of:\n\t\t\t\ta. Additional health care services;\n\t\t\t\tb. Indemnity benefits covering out-of-area services; and\n\t\t\t\tc. Indemnity benefits, in addition to those relating to out-of-area services, provided through insurers or health services plans;","type":"section","prefixes":["A","6"],"prefix":"6","entire_prefix":"A6","prefix_anchor":"A6","level":2,"prior_prefix":"A5","next_prefix":"A7"},"7":{"id":263534,"text":"The offering of health care plans for limited health care services; and","type":"section","prefixes":["A","7"],"prefix":"7","entire_prefix":"A7","prefix_anchor":"A7","level":2,"prior_prefix":"A6","next_prefix":"A8"},"8":{"id":263535,"text":"The requirement for the enrollee to pay a deductible or copayment, or both, for any health care services offered pursuant to this chapter.","type":"section","prefixes":["A","8"],"prefix":"8","entire_prefix":"A8","prefix_anchor":"A8","level":2,"prior_prefix":"A7","next_prefix":"B"},"9":{"id":263536,"text":"1. A health maintenance organization shall file notice with the Commission within 30 days after the exercise of any power granted in subdivision 1 or 2 of subsection A of this section that exceeds one percent of the admitted assets of the organization or five percent of net worth, whichever is less. A health maintenance organization shall file notice, with adequate supporting information, with the Commission prior to the exercise of any power granted in subdivision 1 or 2 of subsection A of this section that exceeds five percent of the admitted assets of the organization or 25 percent of net worth, whichever is less. Any series of transactions occurring within a 12-month period that are sufficiently similar in nature to be reasonably construed as a single transaction shall be subject to the limitations set forth in this section. The Commission shall disapprove the exercise of power if the Commission believes such exercise of power would substantially and adversely affect the financial soundness of the health maintenance organization and endanger the health maintenance organization’s ability to meet its obligations. If the Commission does not disapprove the exercise of power within 30 days of the filing, it shall be deemed approved.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A8","next_prefix":"B2"},"10":{"id":263537,"text":"Upon application by the health maintenance organization, the Commission may exempt from the filing requirement of subdivision 1 of subsection B of this section those activities having a minimal effect.","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B"}},"ancestry":[{"id":12833,"edition_id":1,"name":"Health Maintenance Organizations","identifier":"43","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:43:55","date_modified":"2026-06-26 03:43:55","permalink":{"id":216835,"object_type":"structure","relational_id":12833,"identifier":"43","token":"38.2\/43","url":"\/38.2\/43\/","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":72005,"structure_id":12833,"section_number":"38.2-4300","catch_line":"Definitions","url":"\/38.2-4300\/","token":"38.2\/43\/38.2-4300","metadata":false},{"id":80882,"structure_id":12833,"section_number":"38.2-4301","catch_line":"Establishment of health maintenance organizations","url":"\/38.2-4301\/","token":"38.2\/43\/38.2-4301","metadata":false},{"id":64417,"structure_id":12833,"section_number":"38.2-4302","catch_line":"Issuance of license; fee; minimum net worth; impairment","url":"\/38.2-4302\/","token":"38.2\/43\/38.2-4302","metadata":false},{"id":73205,"structure_id":12833,"section_number":"38.2-4303","catch_line":"Powers","url":"\/38.2-4303\/","token":"38.2\/43\/38.2-4303","metadata":false},{"id":68216,"structure_id":12833,"section_number":"38.2-4304","catch_line":"Governing body","url":"\/38.2-4304\/","token":"38.2\/43\/38.2-4304","metadata":false},{"id":54130,"structure_id":12833,"section_number":"38.2-4305","catch_line":"Fiduciary responsibilities","url":"\/38.2-4305\/","token":"38.2\/43\/38.2-4305","metadata":false},{"id":81322,"structure_id":12833,"section_number":"38.2-4306","catch_line":"Evidence of coverage and charges for health care services","url":"\/38.2-4306\/","token":"38.2\/43\/38.2-4306","metadata":false},{"id":73640,"structure_id":12833,"section_number":"38.2-4306.1","catch_line":"Interest on claim proceeds","url":"\/38.2-4306.1\/","token":"38.2\/43\/38.2-4306.1","metadata":false},{"id":65829,"structure_id":12833,"section_number":"38.2-4307","catch_line":"Annual statement","url":"\/38.2-4307\/","token":"38.2\/43\/38.2-4307","metadata":false},{"id":85130,"structure_id":12833,"section_number":"38.2-4307.1","catch_line":"Additional reports","url":"\/38.2-4307.1\/","token":"38.2\/43\/38.2-4307.1","metadata":false},{"id":77610,"structure_id":12833,"section_number":"38.2-4308","catch_line":"Repealed","url":"\/38.2-4308\/","token":"38.2\/43\/38.2-4308","metadata":false},{"id":80159,"structure_id":12833,"section_number":"38.2-4309","catch_line":"Investments","url":"\/38.2-4309\/","token":"38.2\/43\/38.2-4309","metadata":false},{"id":84555,"structure_id":12833,"section_number":"38.2-4310","catch_line":"Protection against insolvency","url":"\/38.2-4310\/","token":"38.2\/43\/38.2-4310","metadata":false},{"id":59833,"structure_id":12833,"section_number":"38.2-4310.1","catch_line":"Deposits","url":"\/38.2-4310.1\/","token":"38.2\/43\/38.2-4310.1","metadata":false},{"id":53983,"structure_id":12833,"section_number":"38.2-4311","catch_line":"Repealed","url":"\/38.2-4311\/","token":"38.2\/43\/38.2-4311","metadata":false},{"id":62703,"structure_id":12833,"section_number":"38.2-4312","catch_line":"Prohibited practices","url":"\/38.2-4312\/","token":"38.2\/43\/38.2-4312","metadata":false},{"id":82617,"structure_id":12833,"section_number":"38.2-4312.1","catch_line":"Pharmacies; freedom of choice","url":"\/38.2-4312.1\/","token":"38.2\/43\/38.2-4312.1","metadata":false},{"id":71246,"structure_id":12833,"section_number":"38.2-4312.2","catch_line":"Repealed","url":"\/38.2-4312.2\/","token":"38.2\/43\/38.2-4312.2","metadata":false},{"id":79585,"structure_id":12833,"section_number":"38.2-4312.3","catch_line":"Patient access to emergency services","url":"\/38.2-4312.3\/","token":"38.2\/43\/38.2-4312.3","metadata":false},{"id":70762,"structure_id":12833,"section_number":"38.2-4313","catch_line":"Licensing of agents","url":"\/38.2-4313\/","token":"38.2\/43\/38.2-4313","metadata":false},{"id":73994,"structure_id":12833,"section_number":"38.2-4314","catch_line":"Powers of insurers and health services plans","url":"\/38.2-4314\/","token":"38.2\/43\/38.2-4314","metadata":false},{"id":60856,"structure_id":12833,"section_number":"38.2-4315","catch_line":"Examinations","url":"\/38.2-4315\/","token":"38.2\/43\/38.2-4315","metadata":false},{"id":61029,"structure_id":12833,"section_number":"38.2-4316","catch_line":"Suspension or revocation of license","url":"\/38.2-4316\/","token":"38.2\/43\/38.2-4316","metadata":false},{"id":82370,"structure_id":12833,"section_number":"38.2-4317","catch_line":"Repealed","url":"\/38.2-4317\/","token":"38.2\/43\/38.2-4317","metadata":false},{"id":84618,"structure_id":12833,"section_number":"38.2-4318","catch_line":"License renewals","url":"\/38.2-4318\/","token":"38.2\/43\/38.2-4318","metadata":false},{"id":67952,"structure_id":12833,"section_number":"38.2-4319","catch_line":"Statutory construction and relationship to other laws","url":"\/38.2-4319\/","token":"38.2\/43\/38.2-4319","metadata":false},{"id":74856,"structure_id":12833,"section_number":"38.2-4320","catch_line":"Authority of Commonwealth to contract with health maintenance organizations","url":"\/38.2-4320\/","token":"38.2\/43\/38.2-4320","metadata":false},{"id":74357,"structure_id":12833,"section_number":"38.2-4320.1","catch_line":"Explanation of benefits for health maintenance organization enrollees who are recipients of medical assistance services or covered by the Family Access to Medical Insurance Security (FAMIS) Plan","url":"\/38.2-4320.1\/","token":"38.2\/43\/38.2-4320.1","metadata":false},{"id":74331,"structure_id":12833,"section_number":"38.2-4321","catch_line":"Health maintenance organization affected by chapter","url":"\/38.2-4321\/","token":"38.2\/43\/38.2-4321","metadata":false},{"id":63129,"structure_id":12833,"section_number":"38.2-4322","catch_line":"Affiliation period","url":"\/38.2-4322\/","token":"38.2\/43\/38.2-4322","metadata":false},{"id":67176,"structure_id":12833,"section_number":"38.2-4323","catch_line":"Alternative methods","url":"\/38.2-4323\/","token":"38.2\/43\/38.2-4323","metadata":false}],"previous_section":{"id":64417,"structure_id":12833,"section_number":"38.2-4302","catch_line":"Issuance of license; fee; minimum net worth; impairment","url":"\/38.2-4302\/","token":"38.2\/43\/38.2-4302","metadata":false},"next_section":{"id":68216,"structure_id":12833,"section_number":"38.2-4304","catch_line":"Governing body","url":"\/38.2-4304\/","token":"38.2\/43\/38.2-4304","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-4303\/","history_text":"

This law was first created in 1980. The record of its establishment is cataloged in chapter 720 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 1980 \u201cActs\u201d aren\u2019t available online. It has been modified 5 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 1986, chapter 562; in 1990, chapter 224; in 1992, chapter 481; in 2003, chapters 752<\/a> and 767<\/a>; in 2008, chapter 214<\/a>.<\/p>","references":false,"refers_to":false,"permalink":{"id":216849,"object_type":"law","relational_id":73205,"identifier":"38.2-4303","token":"38.2\/43\/38.2-4303","url":"\/38.2-4303\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-4303\/","token":"38.2\/43\/38.2-4303","dublin_core":{"Title":"Powers","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-4303","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> The powers of a health maintenance organization<\/span> shall include, but shall not be limited to, the following, provided that the activities comply with all applicable state<\/span> statutes<\/span> and regulations: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical or other health care facilities, and their ancillary equipment and other property reasonably required for its principal office or for other purposes necessary in the transaction of the business of the organization; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The making of loans to (i) health care providers<\/span> under contract<\/span> with it in advancement of its health care plan<\/span> or (ii) any corporation under its control for the purpose of acquiring or constructing medical or other health care facilities and hospitals or in advancement of its health care plan<\/span> providing health care services<\/span> to enrollees<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> The furnishing of health care services<\/span> through providers that are under contract<\/span> with or employed by the health maintenance organization<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> The contracting with any person<\/span> for the performance on its behalf of certain functions including, but not limited to, marketing, enrollment and administration; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> The contracting with an insurer<\/span> or with a health services plan<\/span> licensed in this Commonwealth, for the provision of insurance<\/span>, indemnity, or reimbursement for the cost of health care services<\/span> provided by the health maintenance organization<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> The offering, in addition to basic health care services<\/span><\/span>, of:\n\t\t\t\ta. Additional health care services<\/span>;\n\t\t\t\tb. Indemnity benefits covering out-of-area services; and\n\t\t\t\tc. Indemnity benefits, in addition to those relating to out-of-area services, provided through insurers<\/span> or health services plans<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

7.<\/span> The offering of health care plans<\/span> for limited health care services<\/span><\/span>; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

8.<\/span> The requirement for the enrollee<\/span> to pay a deductible<\/span> or copayment<\/span>, or both, for any health care services<\/span> offered pursuant to this chapter. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> 1. A health maintenance organization<\/span> shall file notice with the Commission<\/span> within 30 days after the exercise of any power granted in subdivision 1 or 2 of subsection A of this section that exceeds one percent of the admitted assets<\/span> of the organization or five percent of net worth<\/span>, whichever is less. A health maintenance organization<\/span> shall file notice, with adequate supporting information, with the Commission<\/span> prior to the exercise of any power granted in subdivision 1 or 2 of subsection A of this section that exceeds five percent of the admitted assets<\/span> of the organization or 25 percent of net worth<\/span>, whichever is less. Any series of transactions occurring within a 12-month period that are sufficiently similar in nature to be reasonably construed as a single transaction shall be subject to the limitations set forth in this section. The Commission<\/span> shall disapprove the exercise of power if the Commission<\/span> believes such exercise of power would substantially and adversely affect the financial soundness of the health maintenance organization<\/span> and endanger the health maintenance organization<\/span>’s ability to meet its obligations. If the Commission<\/span> does not disapprove the exercise of power within 30 days of the filing, it shall be deemed approved. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Upon application by the health maintenance organization<\/span>, the Commission<\/span> may exempt from the filing requirement of subdivision 1 of subsection B of this section those activities having a minimal effect. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nPOWERS (\u00a7 38.2-4303)\n\nA. The powers of a health maintenance organization shall include, but shall not\nbe limited to, the following, provided that the activities comply with all\napplicable state statutes and regulations:\n\n 1. The purchase, lease, construction, renovation, operation, or maintenance of\n hospitals, medical or other health care facilities, and their ancillary\n equipment and other property reasonably required for its principal office or\n for other purposes necessary in the transaction of the business of the\n organization;\n\n 2. The making of loans to (i) health care providers under contract with it in\n advancement of its health care plan or (ii) any corporation under its control\n for the purpose of acquiring or constructing medical or other health care\n facilities and hospitals or in advancement of its health care plan providing\n health care services to enrollees;\n\n 3. The furnishing of health care services through providers that are under\n contract with or employed by the health maintenance organization;\n\n 4. The contracting with any person for the performance on its behalf of\n certain functions including, but not limited to, marketing, enrollment and\n administration;\n\n 5. The contracting with an insurer or with a health services plan licensed in\n this Commonwealth, for the provision of insurance, indemnity, or reimbursement\n for the cost of health care services provided by the health maintenance\n organization;\n\n 6. The offering, in addition to basic health care services, of:\n \t\t\t\ta. Additional health care services;\n \t\t\t\tb. Indemnity benefits covering out-of-area services; and\n \t\t\t\tc. Indemnity benefits, in addition to those relating to out-of-area\n services, provided through insurers or health services plans;\n\n 7. The offering of health care plans for limited health care services; and\n\n 8. The requirement for the enrollee to pay a deductible or copayment, or both,\n for any health care services offered pursuant to this chapter.\n\nB. 1. A health maintenance organization shall file notice with the Commission\nwithin 30 days after the exercise of any power granted in subdivision 1 or 2 of\nsubsection A of this section that exceeds one percent of the admitted assets of\nthe organization or five percent of net worth, whichever is less. A health\nmaintenance organization shall file notice, with adequate supporting\ninformation, with the Commission prior to the exercise of any power granted in\nsubdivision 1 or 2 of subsection A of this section that exceeds five percent of\nthe admitted assets of the organization or 25 percent of net worth, whichever is\nless. Any series of transactions occurring within a 12-month period that are\nsufficiently similar in nature to be reasonably construed as a single\ntransaction shall be subject to the limitations set forth in this section. The\nCommission shall disapprove the exercise of power if the Commission believes\nsuch exercise of power would substantially and adversely affect the financial\nsoundness of the health maintenance organization and endanger the health\nmaintenance organization’s ability to meet its obligations. If the\nCommission does not disapprove the exercise of power within 30 days of the\nfiling, it shall be deemed approved.\n\n 2. Upon application by the health maintenance organization, the Commission may\n exempt from the filing requirement of subdivision 1 of subsection B of this\n section those activities having a minimal effect.\n\nHISTORY: 1980, c. 720, \u00a7 38.1-866; 1986, c. 562; 1990, c. 224; 1992, c. 481;\n2003, cc. 752, 767; 2008, c. 214.","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}}