{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-5803.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-5803.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-5803.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-5803.html"}],"law_id":62075,"edition_id":1,"section_id":62075,"structure_id":13783,"section_number":"38.2-5803","catch_line":"Disclosures and representations to enrollees","history":"1998, c. 891; 2000, c. 922; 2004, c. 715; 2006, c. 866.","full_text":"A\n\nThe following shall be provided to the MCHIP’s covered persons at the time of enrollment or at the time the contract or evidence of coverage is issued and shall be made available upon request or at least annually:1\n\nA list of the names and locations of all affiliated providers. Such list may be made available in a form other than a printed document, provided the purchaser or existing enrollee is given the means to request and receive a printed copy of such list.2\n\nA description of the service area or areas within which the MCHIP shall provide health care services.3\n\nA description of the method of resolving complaints of covered persons, including a description of any arbitration procedure if complaints may be resolved through a specified arbitration agreement.4\n\nNotice that the MCHIP is subject to regulation in the Commonwealth by both the State Corporation Commission Bureau of Insurance pursuant to Title 38.2 and the Virginia Department of Health pursuant to Title 32.1.5\n\nA prominent notice included within the evidence of coverage, providing substantially the following: “If you have any questions regarding an appeal or grievance concerning the health care services that you have been provided that have not been satisfactorily addressed by your plan, you may contact the Office of the Managed Care Ombudsman for assistance.” Such notice shall also provide the toll-free telephone number, mailing address, and electronic mail address of the Office of the Managed Care Ombudsman. This section shall not apply to evidences of coverage for enrollees in the plans administered by the Department of Medical Assistance Services that provide benefits pursuant to Title XIX or Title XXI of the Social Security Act, as amended.B\n\nThe following shall apply to MCHIPs that require a covered person to select a primary care physician with respect to the offer of basic health care services by the MCHIP:1\n\nAt the time of enrollment each covered person shall have the right to select a primary care physician from among the health carrier’s affiliated primary care physicians for the MCHIP, subject to availability.2\n\nAny covered person who is dissatisfied with his primary care physician shall have the right to select another primary care physician from among the affiliated primary care physicians, subject to availability. The health carrier may impose a reasonable waiting period for this transfer.","order_by":null,"text":{"0":{"id":226523,"text":"The following shall be provided to the MCHIP’s covered persons at the time of enrollment or at the time the contract or evidence of coverage is issued and shall be made available upon request or at least annually:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":226524,"text":"A list of the names and locations of all affiliated providers. Such list may be made available in a form other than a printed document, provided the purchaser or existing enrollee is given the means to request and receive a printed copy of such list.","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":226525,"text":"A description of the service area or areas within which the MCHIP shall provide health care services.","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":226526,"text":"A description of the method of resolving complaints of covered persons, including a description of any arbitration procedure if complaints may be resolved through a specified arbitration agreement.","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"A4"},"4":{"id":226527,"text":"Notice that the MCHIP is subject to regulation in the Commonwealth by both the State Corporation Commission Bureau of Insurance pursuant to Title 38.2 and the Virginia Department of Health pursuant to Title 32.1.","type":"section","prefixes":["A","4"],"prefix":"4","entire_prefix":"A4","prefix_anchor":"A4","level":2,"prior_prefix":"A3","next_prefix":"A5"},"5":{"id":226528,"text":"A prominent notice included within the evidence of coverage, providing substantially the following: “If you have any questions regarding an appeal or grievance concerning the health care services that you have been provided that have not been satisfactorily addressed by your plan, you may contact the Office of the Managed Care Ombudsman for assistance.” Such notice shall also provide the toll-free telephone number, mailing address, and electronic mail address of the Office of the Managed Care Ombudsman. This section shall not apply to evidences of coverage for enrollees in the plans administered by the Department of Medical Assistance Services that provide benefits pursuant to Title XIX or Title XXI of the Social Security Act, as amended.","type":"section","prefixes":["A","5"],"prefix":"5","entire_prefix":"A5","prefix_anchor":"A5","level":2,"prior_prefix":"A4","next_prefix":"B"},"6":{"id":226529,"text":"The following shall apply to MCHIPs that require a covered person to select a primary care physician with respect to the offer of basic health care services by the MCHIP:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A5","next_prefix":"B1"},"7":{"id":226530,"text":"At the time of enrollment each covered person shall have the right to select a primary care physician from among the health carrier’s affiliated primary care physicians for the MCHIP, subject to availability.","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"8":{"id":226531,"text":"Any covered person who is dissatisfied with his primary care physician shall have the right to select another primary care physician from among the affiliated primary care physicians, subject to availability. The health carrier may impose a reasonable waiting period for this transfer.","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1"}},"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":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},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-5803\/","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. 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 2000, chapter 922<\/a>; in 2004, chapter 715<\/a>; in 2006, chapter 866<\/a>.<\/p>","references":false,"refers_to":false,"permalink":{"id":217959,"object_type":"law","relational_id":62075,"identifier":"38.2-5803","token":"38.2\/58\/38.2-5803","url":"\/38.2-5803\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-5803\/","token":"38.2\/58\/38.2-5803","dublin_core":{"Title":"Disclosures and representations to enrollees","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-5803","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> The following shall be provided to the MCHIP<\/span>’s covered persons<\/span> at the time of enrollment or at the time the contract<\/span> or evidence of coverage<\/span> is issued and shall be made available upon request or at least annually: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> A list of the names and locations of all affiliated providers<\/span>. Such list may be made available in a form other than a printed document, provided the purchaser or existing enrollee is given the means to request and receive a printed copy of such list. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> A description of the service area<\/span> or areas within which the MCHIP<\/span> shall provide health care services<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> A description of the method of resolving complaints of covered persons<\/span>, including a description of any arbitration procedure if complaints may be resolved through a specified arbitration agreement. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Notice that the MCHIP<\/span> is subject to regulation in the Commonwealth by both the State<\/span> Corporation Commission<\/span> Bureau of Insurance<\/span> pursuant to Title 38.2 and the Virginia Department of Health pursuant to Title 32.1. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> A prominent notice included within the evidence of coverage<\/span>, providing substantially the following: “If you have any questions regarding an appeal<\/span> or grievance concerning the health care services<\/span> that you have been provided that have not been satisfactorily addressed by your plan, you may contact the Office of the Managed Care Ombudsman for assistance.” Such notice shall also provide the toll-free telephone number, mailing address, and electronic mail address of the Office of the Managed Care Ombudsman. This section shall not apply to evidences<\/span> of coverage for enrollees in the plans administered by the Department of Medical Assistance Services that provide benefits pursuant to Title XIX or Title XXI of the Social Security Act, as amended. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The following shall apply to MCHIPs<\/span> that require a covered person<\/span> to select a primary care physician with respect to the offer of basic health care services<\/span><\/span> by the MCHIP<\/span>: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> At the time of enrollment each covered person<\/span> shall have the right to select a primary care physician from among the health carrier<\/span>’s affiliated primary care physicians for the MCHIP<\/span>, subject to availability. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Any covered person<\/span> who is dissatisfied with his primary care physician shall have the right to select another primary care physician from among the affiliated primary care physicians, subject to availability. The health carrier<\/span> may impose a reasonable waiting period for this transfer. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nDISCLOSURES AND REPRESENTATIONS TO ENROLLEES (\u00a7 38.2-5803)\n\nA. The following shall be provided to the MCHIP’s covered persons at the\ntime of enrollment or at the time the contract or evidence of coverage is issued\nand shall be made available upon request or at least annually:\n\n 1. A list of the names and locations of all affiliated providers. Such list\n may be made available in a form other than a printed document, provided the\n purchaser or existing enrollee is given the means to request and receive a\n printed copy of such list.\n\n 2. A description of the service area or areas within which the MCHIP shall\n provide health care services.\n\n 3. A description of the method of resolving complaints of covered persons,\n including a description of any arbitration procedure if complaints may be\n resolved through a specified arbitration agreement.\n\n 4. Notice that the MCHIP is subject to regulation in the Commonwealth by both\n the State Corporation Commission Bureau of Insurance pursuant to Title 38.2\n and the Virginia Department of Health pursuant to Title 32.1.\n\n 5. A prominent notice included within the evidence of coverage, providing\n substantially the following: “If you have any questions regarding an\n appeal or grievance concerning the health care services that you have been\n provided that have not been satisfactorily addressed by your plan, you may\n contact the Office of the Managed Care Ombudsman for assistance.” Such\n notice shall also provide the toll-free telephone number, mailing address, and\n electronic mail address of the Office of the Managed Care Ombudsman. This\n section shall not apply to evidences of coverage for enrollees in the plans\n administered by the Department of Medical Assistance Services that provide\n benefits pursuant to Title XIX or Title XXI of the Social Security Act, as\n amended.\n\nB. The following shall apply to MCHIPs that require a covered person to select a\nprimary care physician with respect to the offer of basic health care services\nby the MCHIP:\n\n 1. At the time of enrollment each covered person shall have the right to\n select a primary care physician from among the health carrier’s\n affiliated primary care physicians for the MCHIP, subject to availability.\n\n 2. Any covered person who is dissatisfied with his primary care physician\n shall have the right to select another primary care physician from among the\n affiliated primary care physicians, subject to availability. The health\n carrier may impose a reasonable waiting period for this transfer.\n\nHISTORY: 1998, c. 891; 2000, c. 922; 2004, c. 715; 2006, c. 866.","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}}