{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-5801.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-5801.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-5801.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-5801.html"}],"law_id":64894,"edition_id":1,"section_id":64894,"structure_id":13783,"section_number":"38.2-5801","catch_line":"General provisions","history":"1998, c. 891.","full_text":"A\n\nNo person shall operate an MCHIP in this Commonwealth unless the health carrier who directly or indirectly manages, owns, contracts with, or employs the providers for the plan is licensed in accordance with provisions in this title as an insurance company, a health maintenance organization, or a nonstock corporation organized in accordance with provisions in Chapter 42 (§ 38.2-4200 et seq.) or Chapter 45 (§ 38.2-4500 et seq.) of this title. Such health carrier shall be deemed responsible for the MCHIP and its compliance with this chapter and the provisions of Title 32.1 concerning quality assurance of MCHIPs. A health carrier may be responsible for more than one MCHIP; however, no MCHIP shall have more than one responsible health carrier.B\n\nExcept as provided in subsection C, no person shall operate an MCHIP in this Commonwealth unless the health carrier responsible for the MCHIP holds an active or temporarily suspended certificate of quality assurance issued by the Department of Health.C\n\n1. A health maintenance organization applying for licensure under this title on or after July 1, 1998, or whose application for such licensure is pending before the Commission on July 1, 1998, shall request its initial certificate of quality assurance prior to licensing and a copy of its request shall be included with and made a part of the licensing application and material filed with the Commission pursuant to \u00a7 38.2-4301 and subsection B of \u00a7 38.2-5802. Until July 1, 2000, (i) issuance of a license under \u00a7 38.2-4302 shall be contingent upon receipt of notice from the State Health Commissioner that the health maintenance organization’s description of its complaint system has been reviewed and approved by the State Health Commissioner and (ii) upon issuance of the license such health maintenance organization shall be deemed in compliance with subsection B provided no certificate of quality assurance has been issued to the health maintenance organization which has been revoked or not renewed by the State Health Commissioner. Effective July 1, 2000, issuance of a license under \u00a7 38.2-4302 shall be contingent upon the Department of Health’s issuance of a certificate of quality assurance.2\n\nUntil July 1, 2000, a health maintenance organization licensed under this title on and before July 1, 1998, shall be deemed in compliance with the provisions of this section if (i) a request for initial certification has been filed with the Department of Health on or before December 1, 1998, and is pending before the State Health Commissioner and (ii) no certificate has been issued to the health maintenance organization which has been revoked or not renewed by the State Health Commissioner.3\n\nA health carrier, other than a health maintenance organization, responsible for an MCHIP pursuant to this chapter, shall request its initial certificate of quality assurance from the Department of Health on or before December 1, 1998, or becoming responsible for a MCHIP under this title. Until July 1, 2000, such health carrier shall be deemed in compliance with the provisions of this section if (i) a request for initial certification is pending before the Department of Health and (ii) no certificate has been issued to the health carrier which has been revoked or not renewed by the State Health Commissioner.D\n\nThe provisions of this chapter shall apply to all health carriers and all MCHIPs operating in this Commonwealth unless an exemption is recognized in accordance with § 38.2-3420; and, except as otherwise provided in this chapter, the provisions of this chapter shall be supplemental and in addition to those otherwise applicable under this title or Title 32.1.","order_by":null,"text":{"0":{"id":236127,"text":"No person shall operate an MCHIP in this Commonwealth unless the health carrier who directly or indirectly manages, owns, contracts with, or employs the providers for the plan is licensed in accordance with provisions in this title as an insurance company, a health maintenance organization, or a nonstock corporation organized in accordance with provisions in Chapter 42 (§ 38.2-4200 et seq.) or Chapter 45 (§ 38.2-4500 et seq.) of this title. Such health carrier shall be deemed responsible for the MCHIP and its compliance with this chapter and the provisions of Title 32.1 concerning quality assurance of MCHIPs. A health carrier may be responsible for more than one MCHIP; however, no MCHIP shall have more than one responsible health carrier.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":236128,"text":"Except as provided in subsection C, no person shall operate an MCHIP in this Commonwealth unless the health carrier responsible for the MCHIP holds an active or temporarily suspended certificate of quality assurance issued by the Department of Health.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":236129,"text":"1. A health maintenance organization applying for licensure under this title on or after July 1, 1998, or whose application for such licensure is pending before the Commission on July 1, 1998, shall request its initial certificate of quality assurance prior to licensing and a copy of its request shall be included with and made a part of the licensing application and material filed with the Commission pursuant to \u00a7 38.2-4301 and subsection B of \u00a7 38.2-5802. Until July 1, 2000, (i) issuance of a license under \u00a7 38.2-4302 shall be contingent upon receipt of notice from the State Health Commissioner that the health maintenance organization’s description of its complaint system has been reviewed and approved by the State Health Commissioner and (ii) upon issuance of the license such health maintenance organization shall be deemed in compliance with subsection B provided no certificate of quality assurance has been issued to the health maintenance organization which has been revoked or not renewed by the State Health Commissioner. Effective July 1, 2000, issuance of a license under \u00a7 38.2-4302 shall be contingent upon the Department of Health’s issuance of a certificate of quality assurance.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"C2"},"3":{"id":236130,"text":"Until July 1, 2000, a health maintenance organization licensed under this title on and before July 1, 1998, shall be deemed in compliance with the provisions of this section if (i) a request for initial certification has been filed with the Department of Health on or before December 1, 1998, and is pending before the State Health Commissioner and (ii) no certificate has been issued to the health maintenance organization which has been revoked or not renewed by the State Health Commissioner.","type":"section","prefixes":["C","2"],"prefix":"2","entire_prefix":"C2","prefix_anchor":"C2","level":2,"prior_prefix":"C","next_prefix":"C3"},"4":{"id":236131,"text":"A health carrier, other than a health maintenance organization, responsible for an MCHIP pursuant to this chapter, shall request its initial certificate of quality assurance from the Department of Health on or before December 1, 1998, or becoming responsible for a MCHIP under this title. Until July 1, 2000, such health carrier shall be deemed in compliance with the provisions of this section if (i) a request for initial certification is pending before the Department of Health and (ii) no certificate has been issued to the health carrier which has been revoked or not renewed by the State Health Commissioner.","type":"section","prefixes":["C","3"],"prefix":"3","entire_prefix":"C3","prefix_anchor":"C3","level":2,"prior_prefix":"C2","next_prefix":"D"},"5":{"id":236132,"text":"The provisions of this chapter shall apply to all health carriers and all MCHIPs operating in this Commonwealth unless an exemption is recognized in accordance with § 38.2-3420; and, except as otherwise provided in this chapter, the provisions of this chapter shall be supplemental and in addition to those otherwise applicable under this title or Title 32.1.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C3"}},"ancestry":[{"id":13783,"edition_id":1,"name":"Managed Care Health Insurance Plans","identifier":"58","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:45:52","date_modified":"2026-06-26 03:45:52","permalink":{"id":217945,"object_type":"structure","relational_id":13783,"identifier":"58","token":"38.2\/58","url":"\/38.2\/58\/","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":77304,"structure_id":13783,"section_number":"38.2-5800","catch_line":"Definitions","url":"\/38.2-5800\/","token":"38.2\/58\/38.2-5800","metadata":false},{"id":64894,"structure_id":13783,"section_number":"38.2-5801","catch_line":"General provisions","url":"\/38.2-5801\/","token":"38.2\/58\/38.2-5801","metadata":false},{"id":54793,"structure_id":13783,"section_number":"38.2-5802","catch_line":"Establishment of an MCHIP","url":"\/38.2-5802\/","token":"38.2\/58\/38.2-5802","metadata":false},{"id":62075,"structure_id":13783,"section_number":"38.2-5803","catch_line":"Disclosures and representations to enrollees","url":"\/38.2-5803\/","token":"38.2\/58\/38.2-5803","metadata":false},{"id":74962,"structure_id":13783,"section_number":"38.2-5804","catch_line":"Complaint system","url":"\/38.2-5804\/","token":"38.2\/58\/38.2-5804","metadata":false},{"id":81176,"structure_id":13783,"section_number":"38.2-5805","catch_line":"Provider contracts","url":"\/38.2-5805\/","token":"38.2\/58\/38.2-5805","metadata":false},{"id":71053,"structure_id":13783,"section_number":"38.2-5806","catch_line":"Prohibited practices","url":"\/38.2-5806\/","token":"38.2\/58\/38.2-5806","metadata":false},{"id":63869,"structure_id":13783,"section_number":"38.2-5807","catch_line":"Access to care","url":"\/38.2-5807\/","token":"38.2\/58\/38.2-5807","metadata":false},{"id":60038,"structure_id":13783,"section_number":"38.2-5808","catch_line":"Examinations","url":"\/38.2-5808\/","token":"38.2\/58\/38.2-5808","metadata":false},{"id":75727,"structure_id":13783,"section_number":"38.2-5809","catch_line":"Suspension or revocation of license","url":"\/38.2-5809\/","token":"38.2\/58\/38.2-5809","metadata":false},{"id":70898,"structure_id":13783,"section_number":"38.2-5810","catch_line":"Statutory construction and relationship to other laws","url":"\/38.2-5810\/","token":"38.2\/58\/38.2-5810","metadata":false},{"id":68954,"structure_id":13783,"section_number":"38.2-5811","catch_line":"Controversies involving contracts","url":"\/38.2-5811\/","token":"38.2\/58\/38.2-5811","metadata":false}],"previous_section":{"id":77304,"structure_id":13783,"section_number":"38.2-5800","catch_line":"Definitions","url":"\/38.2-5800\/","token":"38.2\/58\/38.2-5800","metadata":false},"next_section":{"id":54793,"structure_id":13783,"section_number":"38.2-5802","catch_line":"Establishment of an MCHIP","url":"\/38.2-5802\/","token":"38.2\/58\/38.2-5802","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-5801\/","history_text":"

This law was first created in 1998. The record of its establishment is cataloged in chapter 891<\/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":61229,"section_number":"32.1-137.1","catch_line":"Definitions","order_by":null,"url":"\/32.1-137.1\/"},{"id":54793,"section_number":"38.2-5802","catch_line":"Establishment of an MCHIP","order_by":null,"url":"\/38.2-5802\/"},{"id":74962,"section_number":"38.2-5804","catch_line":"Complaint system","order_by":null,"url":"\/38.2-5804\/"},{"id":81176,"section_number":"38.2-5805","catch_line":"Provider contracts","order_by":null,"url":"\/38.2-5805\/"}],"refers_to":[{"id":64087,"section_number":"38.2-3420","catch_line":"Authority and jurisdiction of Commission; exception","order_by":null,"url":"\/38.2-3420\/"},{"id":78890,"section_number":"38.2-4200","catch_line":"Applicability of chapter","order_by":null,"url":"\/38.2-4200\/"},{"id":80882,"section_number":"38.2-4301","catch_line":"Establishment of health maintenance organizations","order_by":null,"url":"\/38.2-4301\/"},{"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":59325,"section_number":"38.2-4500","catch_line":"Applicability of chapter","order_by":null,"url":"\/38.2-4500\/"},{"id":54793,"section_number":"38.2-5802","catch_line":"Establishment of an MCHIP","order_by":null,"url":"\/38.2-5802\/"}],"permalink":{"id":217951,"object_type":"law","relational_id":64894,"identifier":"38.2-5801","token":"38.2\/58\/38.2-5801","url":"\/38.2-5801\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-5801\/","token":"38.2\/58\/38.2-5801","dublin_core":{"Title":"General provisions","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-5801","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> No person<\/span> shall operate an MCHIP<\/span> in this Commonwealth unless the health carrier<\/span> who directly or indirectly manages, owns, contracts<\/span> with, or employs the providers<\/span> for the plan is licensed in accordance with provisions in this title as an insurance company<\/span>, a health maintenance organization<\/span>, or a nonstock corporation organized in accordance with provisions in Chapter 42 (§ 38.2-4200<\/a> et seq.) or Chapter 45 (§ 38.2-4500<\/a> et seq.) of this title. Such health carrier<\/span> shall be deemed responsible for the MCHIP<\/span> and its compliance with this chapter and the provisions of Title 32.1 concerning quality assurance of MCHIPs<\/span>. A health carrier<\/span> may be responsible for more than one MCHIP<\/span>; however, no MCHIP<\/span> shall have more than one responsible health carrier<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Except as provided in subsection C, no person<\/span> shall operate an MCHIP<\/span> in this Commonwealth unless the health carrier<\/span> responsible for the MCHIP<\/span> holds an active or temporarily suspended certificate of quality assurance issued by the Department of Health. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> 1. A health maintenance organization<\/span> applying for licensure under this title on or after July 1, 1998, or whose application for such licensure is pending before the Commission<\/span> on July 1, 1998, shall request its initial certificate of quality assurance prior to licensing and a copy of its request shall be included with and made a part of the licensing application and material<\/span> filed with the Commission<\/span> pursuant to \u00a7 38.2-4301<\/a> and subsection B of \u00a7 38.2-5802<\/a>. Until July 1, 2000, (i) issuance of a license under \u00a7 38.2-4302<\/a> shall be contingent upon receipt of notice from the State<\/span> Health Commissioner<\/span> that the health maintenance organization<\/span>’s description of its complaint system has been reviewed and approved by the State<\/span> Health Commissioner<\/span> and (ii) upon issuance of the license such health maintenance organization<\/span> shall be deemed in compliance with subsection B provided no certificate of quality assurance has been issued to the health maintenance organization<\/span> which has been revoked or not renewed by the State<\/span> Health Commissioner<\/span>. Effective July 1, 2000, issuance of a license under \u00a7 38.2-4302<\/a> shall be contingent upon the Department of Health’s issuance of a certificate of quality assurance. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Until July 1, 2000, a health maintenance organization<\/span> licensed under this title on and before July 1, 1998, shall be deemed in compliance with the provisions of this section if (i) a request for initial certification has been filed with the Department of Health on or before December 1, 1998, and is pending before the State<\/span> Health Commissioner<\/span> and (ii) no certificate has been issued to the health maintenance organization<\/span> which has been revoked or not renewed by the State<\/span> Health Commissioner<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> A health carrier<\/span>, other than a health maintenance organization<\/span>, responsible for an MCHIP<\/span> pursuant to this chapter, shall request its initial certificate of quality assurance from the Department of Health on or before December 1, 1998, or becoming responsible for a MCHIP<\/span> under this title. Until July 1, 2000, such health carrier<\/span> shall be deemed in compliance with the provisions of this section if (i) a request for initial certification is pending before the Department of Health and (ii) no certificate has been issued to the health carrier<\/span> which has been revoked or not renewed by the State<\/span> Health Commissioner<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> The provisions of this chapter shall apply to all health carriers<\/span> and all MCHIPs<\/span> operating in this Commonwealth unless an exemption is recognized in accordance with § 38.2-3420<\/a>; and, except as otherwise provided in this chapter, the provisions of this chapter shall be supplemental and in addition to those otherwise applicable under this title or Title 32.1. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nGENERAL PROVISIONS (\u00a7 38.2-5801)\n\nA. No person shall operate an MCHIP in this Commonwealth unless the health\ncarrier who directly or indirectly manages, owns, contracts with, or employs the\nproviders for the plan is licensed in accordance with provisions in this title\nas an insurance company, a health maintenance organization, or a nonstock\ncorporation organized in accordance with provisions in Chapter 42 (§\n38.2-4200 et seq.) or Chapter 45 (§ 38.2-4500 et seq.) of this title. Such\nhealth carrier shall be deemed responsible for the MCHIP and its compliance with\nthis chapter and the provisions of Title 32.1 concerning quality assurance of\nMCHIPs. A health carrier may be responsible for more than one MCHIP; however, no\nMCHIP shall have more than one responsible health carrier.\n\nB. Except as provided in subsection C, no person shall operate an MCHIP in this\nCommonwealth unless the health carrier responsible for the MCHIP holds an active\nor temporarily suspended certificate of quality assurance issued by the\nDepartment of Health.\n\nC. 1. A health maintenance organization applying for licensure under this title\non or after July 1, 1998, or whose application for such licensure is pending\nbefore the Commission on July 1, 1998, shall request its initial certificate of\nquality assurance prior to licensing and a copy of its request shall be included\nwith and made a part of the licensing application and material filed with the\nCommission pursuant to \u00a7 38.2-4301 and subsection B of \u00a7 38.2-5802. Until July\n1, 2000, (i) issuance of a license under \u00a7 38.2-4302 shall be contingent upon\nreceipt of notice from the State Health Commissioner that the health maintenance\norganization’s description of its complaint system has been reviewed and\napproved by the State Health Commissioner and (ii) upon issuance of the license\nsuch health maintenance organization shall be deemed in compliance with\nsubsection B provided no certificate of quality assurance has been issued to the\nhealth maintenance organization which has been revoked or not renewed by the\nState Health Commissioner. Effective July 1, 2000, issuance of a license under\n\u00a7 38.2-4302 shall be contingent upon the Department of Health’s issuance\nof a certificate of quality assurance.\n\n 2. Until July 1, 2000, a health maintenance organization licensed under this\n title on and before July 1, 1998, shall be deemed in compliance with the\n provisions of this section if (i) a request for initial certification has been\n filed with the Department of Health on or before December 1, 1998, and is\n pending before the State Health Commissioner and (ii) no certificate has been\n issued to the health maintenance organization which has been revoked or not\n renewed by the State Health Commissioner.\n\n 3. A health carrier, other than a health maintenance organization, responsible\n for an MCHIP pursuant to this chapter, shall request its initial certificate\n of quality assurance from the Department of Health on or before December 1,\n 1998, or becoming responsible for a MCHIP under this title. Until July 1,\n 2000, such health carrier shall be deemed in compliance with the provisions of\n this section if (i) a request for initial certification is pending before the\n Department of Health and (ii) no certificate has been issued to the health\n carrier which has been revoked or not renewed by the State Health\n Commissioner.\n\nD. The provisions of this chapter shall apply to all health carriers and all\nMCHIPs operating in this Commonwealth unless an exemption is recognized in\naccordance with § 38.2-3420; and, except as otherwise provided in this\nchapter, the provisions of this chapter shall be supplemental and in addition to\nthose otherwise applicable under this title or Title 32.1.\n\nHISTORY: 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}}