{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-4316.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-4316.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-4316.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-4316.html"}],"law_id":61029,"edition_id":1,"section_id":61029,"structure_id":12833,"section_number":"38.2-4316","catch_line":"Suspension or revocation of license","history":"1980, c. 720, \u00a7 38.1-880; 1986, c. 562; 1992, c. 481; 1998, c. 891.","full_text":"A\n\nThe Commission may suspend or revoke any license issued to a health maintenance organization under this chapter if it finds that any of the following conditions exist:1\n\nThe health maintenance organization is operating significantly at variance with its basic organizational document, its health care plan, or in a manner contrary to that described in and reasonably inferred from any other information submitted under § 38.2-4301, unless amendments to those submissions have been filed with and approved by the Commission;2\n\nThe health maintenance organization issues an evidence of coverage or uses a schedule of charges for health care services that do not comply with the requirements of § 38.2-4306;3\n\nThe health care plan does not provide or arrange for basic health care services or limited health care services;4\n\nThe health maintenance organization is no longer financially responsible and a reasonable expectation exists that it may be unable to meet its obligations to enrollees or prospective enrollees;5\n\nThe health maintenance organization has failed to implement a mechanism providing the enrollees with an opportunity to participate in matters of policy and operation as provided in § 38.2-4304;6\n\nThe health maintenance organization, or any person on its behalf, has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner;7\n\nThe continued operation of the health maintenance organization would be hazardous to its enrollees; or8\n\nThe health maintenance organization has otherwise failed to substantially comply with the provisions of this chapter.B\n\nWhen the license of a health maintenance organization is suspended, the health maintenance organization shall not enroll any additional enrollees during the period of the suspension except newborn children or other newly acquired dependents of existing enrollees, and shall not engage in any advertising or solicitation.C\n\nThe Commission shall not revoke or suspend the license of a health maintenance organization upon any of the grounds set out in subsection A of this section until it has given the organization ten days’ notice of the proposed revocation or suspension and the grounds for it, and has given the organization an opportunity to introduce evidence and be heard. Any hearing authorized by this section may be informal. The required notice may be waived by the Commission and the health maintenance organization.D\n\nWhen the license of a health maintenance organization is revoked, the organization shall proceed to wind up its affairs immediately following the effective date of the order of revocation. The health maintenance organization shall conduct no further business except as may be essential to the orderly conclusion of its affairs. It shall engage in no further advertising or solicitation. The Commission may, by written order, permit further operation of the organization that it finds to be in the best interests of enrollees for the purpose of giving them the greatest practical opportunity to obtain continuing health care coverage.","order_by":null,"text":{"0":{"id":223135,"text":"The Commission may suspend or revoke any license issued to a health maintenance organization under this chapter if it finds that any of the following conditions exist:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":223136,"text":"The health maintenance organization is operating significantly at variance with its basic organizational document, its health care plan, or in a manner contrary to that described in and reasonably inferred from any other information submitted under § 38.2-4301, unless amendments to those submissions have been filed with and approved by the Commission;","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":223137,"text":"The health maintenance organization issues an evidence of coverage or uses a schedule of charges for health care services that do not comply with the requirements of § 38.2-4306;","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":223138,"text":"The health care plan does not provide or arrange for basic health care services or limited health care services;","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"A4"},"4":{"id":223139,"text":"The health maintenance organization is no longer financially responsible and a reasonable expectation exists that it may be unable to meet its obligations to enrollees or prospective enrollees;","type":"section","prefixes":["A","4"],"prefix":"4","entire_prefix":"A4","prefix_anchor":"A4","level":2,"prior_prefix":"A3","next_prefix":"A5"},"5":{"id":223140,"text":"The health maintenance organization has failed to implement a mechanism providing the enrollees with an opportunity to participate in matters of policy and operation as provided in § 38.2-4304;","type":"section","prefixes":["A","5"],"prefix":"5","entire_prefix":"A5","prefix_anchor":"A5","level":2,"prior_prefix":"A4","next_prefix":"A6"},"6":{"id":223141,"text":"The health maintenance organization, or any person on its behalf, has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner;","type":"section","prefixes":["A","6"],"prefix":"6","entire_prefix":"A6","prefix_anchor":"A6","level":2,"prior_prefix":"A5","next_prefix":"A7"},"7":{"id":223142,"text":"The continued operation of the health maintenance organization would be hazardous to its enrollees; or","type":"section","prefixes":["A","7"],"prefix":"7","entire_prefix":"A7","prefix_anchor":"A7","level":2,"prior_prefix":"A6","next_prefix":"A8"},"8":{"id":223143,"text":"The health maintenance organization has otherwise failed to substantially comply with the provisions of 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":223144,"text":"When the license of a health maintenance organization is suspended, the health maintenance organization shall not enroll any additional enrollees during the period of the suspension except newborn children or other newly acquired dependents of existing enrollees, and shall not engage in any advertising or solicitation.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A8","next_prefix":"C"},"10":{"id":223145,"text":"The Commission shall not revoke or suspend the license of a health maintenance organization upon any of the grounds set out in subsection A of this section until it has given the organization ten days’ notice of the proposed revocation or suspension and the grounds for it, and has given the organization an opportunity to introduce evidence and be heard. Any hearing authorized by this section may be informal. The required notice may be waived by the Commission and the health maintenance organization.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"11":{"id":223146,"text":"When the license of a health maintenance organization is revoked, the organization shall proceed to wind up its affairs immediately following the effective date of the order of revocation. The health maintenance organization shall conduct no further business except as may be essential to the orderly conclusion of its affairs. It shall engage in no further advertising or solicitation. The Commission may, by written order, permit further operation of the organization that it finds to be in the best interests of enrollees for the purpose of giving them the greatest practical opportunity to obtain continuing health care coverage.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C"}},"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":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},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-4316\/","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 3 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 1992, chapter 481; in 1998, chapter 891<\/a>.<\/p>","references":[{"id":77733,"section_number":"32.1-374","catch_line":"Obligations of nonprofit entity","order_by":null,"url":"\/32.1-374\/"},{"id":64417,"section_number":"38.2-4302","catch_line":"Issuance of license; fee; minimum net worth; impairment","order_by":null,"url":"\/38.2-4302\/"},{"id":67266,"section_number":"38.2-5509","catch_line":"Supplemental provisions; rules; exemption","order_by":null,"url":"\/38.2-5509\/"}],"refers_to":[{"id":80882,"section_number":"38.2-4301","catch_line":"Establishment of health maintenance organizations","order_by":null,"url":"\/38.2-4301\/"},{"id":68216,"section_number":"38.2-4304","catch_line":"Governing body","order_by":null,"url":"\/38.2-4304\/"},{"id":81322,"section_number":"38.2-4306","catch_line":"Evidence of coverage and charges for health care services","order_by":null,"url":"\/38.2-4306\/"}],"permalink":{"id":216925,"object_type":"law","relational_id":61029,"identifier":"38.2-4316","token":"38.2\/43\/38.2-4316","url":"\/38.2-4316\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-4316\/","token":"38.2\/43\/38.2-4316","dublin_core":{"Title":"Suspension or revocation of license","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-4316","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> The Commission<\/span> may suspend or revoke any license issued to a health maintenance organization<\/span> under this chapter if it finds that any of the following conditions exist: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The health maintenance organization<\/span> is operating significantly at variance with its basic organizational document, its health care plan<\/span>, or in a manner contrary to that described in and reasonably inferred from any other information submitted under § 38.2-4301<\/a>, unless amendments to those submissions have been filed with and approved by the Commission<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The health maintenance organization<\/span> issues<\/span> an evidence of coverage<\/span> or uses a schedule of charges for health care services<\/span> that do not comply with the requirements of § 38.2-4306<\/a>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> The health care plan<\/span> does not provide or arrange for basic health care services<\/span><\/span> or limited health care services<\/span><\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> The health maintenance organization<\/span> is no longer financially responsible and a reasonable expectation exists that it may be unable to meet its obligations to enrollees<\/span> or prospective enrollees<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> The health maintenance organization<\/span> has failed to implement a mechanism providing the enrollees<\/span> with an opportunity to participate in matters of policy and operation as provided in § 38.2-4304<\/a>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> The health maintenance organization<\/span>, or any person<\/span> on its behalf, has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

7.<\/span> The continued operation of the health maintenance organization<\/span> would be hazardous to its enrollees<\/span>; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

8.<\/span> The health maintenance organization<\/span> has otherwise failed to substantially comply with the provisions of this chapter. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> When the license of a health maintenance organization<\/span> is suspended, the health maintenance organization<\/span> shall not enroll any additional enrollees<\/span> during the period of the suspension except newborn children or other newly acquired dependents of existing enrollees<\/span>, and shall not engage in any advertising or solicitation. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> The Commission<\/span> shall not revoke or suspend the license of a health maintenance organization<\/span> upon any of the grounds set out in subsection A of this section until it has given the organization ten days’ notice of the proposed revocation<\/span> or suspension and the grounds for it, and has given the organization an opportunity to introduce evidence and be heard. Any hearing<\/span> authorized by this section may be informal. The required notice may be waived by the Commission<\/span> and the health maintenance organization<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> When the license of a health maintenance organization<\/span> is revoked, the organization shall proceed to wind up its affairs immediately following the effective date of the order<\/span> of revocation<\/span>. The health maintenance organization<\/span> shall conduct no further business except as may be essential to the orderly conclusion of its affairs. It shall engage in no further advertising or solicitation. The Commission<\/span> may, by written order<\/span>, permit further operation of the organization that it finds to be in the best interests of enrollees<\/span> for the purpose of giving them the greatest practical opportunity to obtain continuing health care coverage. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nSUSPENSION OR REVOCATION OF LICENSE (\u00a7 38.2-4316)\n\nA. The Commission may suspend or revoke any license issued to a health\nmaintenance organization under this chapter if it finds that any of the\nfollowing conditions exist:\n\n 1. The health maintenance organization is operating significantly at variance\n with its basic organizational document, its health care plan, or in a manner\n contrary to that described in and reasonably inferred from any other\n information submitted under § 38.2-4301, unless amendments to those\n submissions have been filed with and approved by the Commission;\n\n 2. The health maintenance organization issues an evidence of coverage or uses\n a schedule of charges for health care services that do not comply with the\n requirements of § 38.2-4306;\n\n 3. The health care plan does not provide or arrange for basic health care\n services or limited health care services;\n\n 4. The health maintenance organization is no longer financially responsible\n and a reasonable expectation exists that it may be unable to meet its\n obligations to enrollees or prospective enrollees;\n\n 5. The health maintenance organization has failed to implement a mechanism\n providing the enrollees with an opportunity to participate in matters of\n policy and operation as provided in § 38.2-4304;\n\n 6. The health maintenance organization, or any person on its behalf, has\n advertised or merchandised its services in an untrue, misrepresentative,\n misleading, deceptive, or unfair manner;\n\n 7. The continued operation of the health maintenance organization would be\n hazardous to its enrollees; or\n\n 8. The health maintenance organization has otherwise failed to substantially\n comply with the provisions of this chapter.\n\nB. When the license of a health maintenance organization is suspended, the\nhealth maintenance organization shall not enroll any additional enrollees during\nthe period of the suspension except newborn children or other newly acquired\ndependents of existing enrollees, and shall not engage in any advertising or\nsolicitation.\n\nC. The Commission shall not revoke or suspend the license of a health\nmaintenance organization upon any of the grounds set out in subsection A of this\nsection until it has given the organization ten days’ notice of the\nproposed revocation or suspension and the grounds for it, and has given the\norganization an opportunity to introduce evidence and be heard. Any hearing\nauthorized by this section may be informal. The required notice may be waived by\nthe Commission and the health maintenance organization.\n\nD. When the license of a health maintenance organization is revoked, the\norganization shall proceed to wind up its affairs immediately following the\neffective date of the order of revocation. The health maintenance organization\nshall conduct no further business except as may be essential to the orderly\nconclusion of its affairs. It shall engage in no further advertising or\nsolicitation. The Commission may, by written order, permit further operation of\nthe organization that it finds to be in the best interests of enrollees for the\npurpose of giving them the greatest practical opportunity to obtain continuing\nhealth care coverage.\n\nHISTORY: 1980, c. 720, \u00a7 38.1-880; 1986, c. 562; 1992, c. 481; 1998, c. 891.","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}}