{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-5805.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-5805.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-5805.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-5805.html"}],"law_id":81176,"edition_id":1,"section_id":81176,"structure_id":13783,"section_number":"38.2-5805","catch_line":"Provider contracts","history":"1998, c. 891.","full_text":"A\n\nEach health carrier subject to subsection B of § 38.2-5801 shall file with the Commission a list of the current providers who have executed a contract directly with the health carrier or indirectly through an intermediary organization for the purpose of providing health care services pursuant to an MCHIP or for the benefit of a covered person of an MCHIP. The list shall include the names and localities of the providers. The list shall be updated by the health carrier at least annually and more frequently as required by the Commission in accordance with provisions in this title or by the State Health Commissioner in accordance with provisions in Title 32.1.B\n\nEvery contract with a provider of health care services enabling an MCHIP to provide health care services shall be in writing.C\n\nWhen the health carrier is a health maintenance organization, the contracts with providers enabling the MCHIP to provide health care services to the covered persons shall contain a “hold harmless” clause setting forth that, in the event such health carrier fails to pay for health care services as set forth in the contract, the covered persons shall not be liable to the provider for any sums owed by the health carrier. The following requirements shall apply to such contracts:1\n\nSuch contracts shall require that if the provider terminates the agreement, the provider shall give the health carrier at least sixty days’ advance notice of termination.2\n\nNo provider party to such a contract, or agent, trustee or assignee thereof, may maintain any action at law against a covered person to collect sums owed by the health carrier.3\n\nIf there is an intermediary organization enabling a health carrier subject to subsection B of § 38.2-5801 to provide health care services by means of the intermediary organization’s own contracts with health care providers, the contracts between the intermediary organization and its providers shall be in writing.4\n\nThe contracts shall set forth that, in the event either the health carrier or the intermediary organization fails to pay for health care services as set forth in the contracts between the intermediary organization and its providers, or in the contract between the intermediary organization and the health carrier, the covered person shall not be liable to the provider for any sums owed by either the intermediary organization or the health carrier.5\n\nNo provider party to such a contract, or agent, trustee or assignee thereof, may maintain any action at law against a covered person to collect sums owed by the health carrier or the intermediary organization.6\n\nAn agreement to provide health care services between an intermediary organization and a health carrier subject to subsection B of § 38.2-5801 shall require that if the intermediary organization terminates the agreement, the intermediary organization shall give the health carrier at least sixty days’ advance notice of termination.7\n\nAn agreement to provide health care services between an intermediary organization and a provider shall require that if the provider terminates the agreement, the provider shall give the intermediary organization at least sixty days’ advance notice of termination.8\n\nEach such health carrier and intermediary organization shall be responsible for maintaining its executed contracts enabling it to provide health care services. These contracts shall be available for the Commission’s review and examination for a period of five years after the expiration of any such contract.9\n\nThe “hold harmless” clause required by this section shall read essentially as set forth in this subdivision. The health carrier may use a corresponding provision of different wording approved by the Commission that is not less favorable in any respect to the covered persons.\n\t\t\t\tHold Harmless Clause\n\t\t\t\t[Provider] hereby agrees that in no event, including, but not limited to nonpayment by the MCHIP or its health carrier, the insolvency of the [health carrier], or breach of this agreement, shall [Provider] bill, charge, collect a deposit from; seek compensation, remuneration or reimbursement from; or have any recourse against subscribers or persons other than the health carrier for services provided pursuant to this Agreement. This provision shall not prohibit collection of any applicable copayments or deductibles billed in accordance with the terms of the subscriber agreement for the MCHIP.\n\t\t\t\t[Provider] further agrees that (i) this provision shall survive the termination of this Agreement regardless of the cause giving rise to such termination and shall be construed to be for the benefit of the plan’s subscribers and (ii) this provision supersedes any oral or written agreement to the contrary now existing or hereafter entered into between [Provider] and the subscriber or persons acting on the subscriber’s behalf.10\n\nIf there is an intermediary organization between the health carrier and the health care providers, the hold harmless clause set forth in subdivision 5 shall be amended to include nonpayment by the plan, the health carrier, and the intermediary organization and shall be included in any contract between the intermediary organization and health care providers and in any contract between the health carrier on behalf of the MCHIP and the intermediary organization.D\n\nThe Commission may specify for each type of health carrier other than a health maintenance organization the circumstances, if any, under which a health carrier for an MCHIP shall contract with a provider with the “hold harmless” clause described in subsection C. The Commission may specify also the extent to which certain accounting treatment, reserves, net worth or surplus shall be required for liabilities arising from provider contracts without the “hold harmless” clause.","order_by":null,"text":{"0":{"id":290963,"text":"Each health carrier subject to subsection B of § 38.2-5801 shall file with the Commission a list of the current providers who have executed a contract directly with the health carrier or indirectly through an intermediary organization for the purpose of providing health care services pursuant to an MCHIP or for the benefit of a covered person of an MCHIP. The list shall include the names and localities of the providers. The list shall be updated by the health carrier at least annually and more frequently as required by the Commission in accordance with provisions in this title or by the State Health Commissioner in accordance with provisions in Title 32.1.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":290964,"text":"Every contract with a provider of health care services enabling an MCHIP to provide health care services shall be in writing.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":290965,"text":"When the health carrier is a health maintenance organization, the contracts with providers enabling the MCHIP to provide health care services to the covered persons shall contain a “hold harmless” clause setting forth that, in the event such health carrier fails to pay for health care services as set forth in the contract, the covered persons shall not be liable to the provider for any sums owed by the health carrier. The following requirements shall apply to such contracts:","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"C1"},"3":{"id":290966,"text":"Such contracts shall require that if the provider terminates the agreement, the provider shall give the health carrier at least sixty days’ advance notice of termination.","type":"section","prefixes":["C","1"],"prefix":"1","entire_prefix":"C1","prefix_anchor":"C1","level":2,"prior_prefix":"C","next_prefix":"C2"},"4":{"id":290967,"text":"No provider party to such a contract, or agent, trustee or assignee thereof, may maintain any action at law against a covered person to collect sums owed by the health carrier.","type":"section","prefixes":["C","2"],"prefix":"2","entire_prefix":"C2","prefix_anchor":"C2","level":2,"prior_prefix":"C1","next_prefix":"C3"},"5":{"id":290968,"text":"If there is an intermediary organization enabling a health carrier subject to subsection B of § 38.2-5801 to provide health care services by means of the intermediary organization’s own contracts with health care providers, the contracts between the intermediary organization and its providers shall be in writing.","type":"section","prefixes":["C","3"],"prefix":"3","entire_prefix":"C3","prefix_anchor":"C3","level":2,"prior_prefix":"C2","next_prefix":"C4"},"6":{"id":290969,"text":"The contracts shall set forth that, in the event either the health carrier or the intermediary organization fails to pay for health care services as set forth in the contracts between the intermediary organization and its providers, or in the contract between the intermediary organization and the health carrier, the covered person shall not be liable to the provider for any sums owed by either the intermediary organization or the health carrier.","type":"section","prefixes":["C","4"],"prefix":"4","entire_prefix":"C4","prefix_anchor":"C4","level":2,"prior_prefix":"C3","next_prefix":"C5"},"7":{"id":290970,"text":"No provider party to such a contract, or agent, trustee or assignee thereof, may maintain any action at law against a covered person to collect sums owed by the health carrier or the intermediary organization.","type":"section","prefixes":["C","5"],"prefix":"5","entire_prefix":"C5","prefix_anchor":"C5","level":2,"prior_prefix":"C4","next_prefix":"C6"},"8":{"id":290971,"text":"An agreement to provide health care services between an intermediary organization and a health carrier subject to subsection B of § 38.2-5801 shall require that if the intermediary organization terminates the agreement, the intermediary organization shall give the health carrier at least sixty days’ advance notice of termination.","type":"section","prefixes":["C","6"],"prefix":"6","entire_prefix":"C6","prefix_anchor":"C6","level":2,"prior_prefix":"C5","next_prefix":"C7"},"9":{"id":290972,"text":"An agreement to provide health care services between an intermediary organization and a provider shall require that if the provider terminates the agreement, the provider shall give the intermediary organization at least sixty days’ advance notice of termination.","type":"section","prefixes":["C","7"],"prefix":"7","entire_prefix":"C7","prefix_anchor":"C7","level":2,"prior_prefix":"C6","next_prefix":"C8"},"10":{"id":290973,"text":"Each such health carrier and intermediary organization shall be responsible for maintaining its executed contracts enabling it to provide health care services. These contracts shall be available for the Commission’s review and examination for a period of five years after the expiration of any such contract.","type":"section","prefixes":["C","8"],"prefix":"8","entire_prefix":"C8","prefix_anchor":"C8","level":2,"prior_prefix":"C7","next_prefix":"C9"},"11":{"id":290974,"text":"The “hold harmless” clause required by this section shall read essentially as set forth in this subdivision. The health carrier may use a corresponding provision of different wording approved by the Commission that is not less favorable in any respect to the covered persons.\n\t\t\t\tHold Harmless Clause\n\t\t\t\t[Provider] hereby agrees that in no event, including, but not limited to nonpayment by the MCHIP or its health carrier, the insolvency of the [health carrier], or breach of this agreement, shall [Provider] bill, charge, collect a deposit from; seek compensation, remuneration or reimbursement from; or have any recourse against subscribers or persons other than the health carrier for services provided pursuant to this Agreement. This provision shall not prohibit collection of any applicable copayments or deductibles billed in accordance with the terms of the subscriber agreement for the MCHIP.\n\t\t\t\t[Provider] further agrees that (i) this provision shall survive the termination of this Agreement regardless of the cause giving rise to such termination and shall be construed to be for the benefit of the plan’s subscribers and (ii) this provision supersedes any oral or written agreement to the contrary now existing or hereafter entered into between [Provider] and the subscriber or persons acting on the subscriber’s behalf.","type":"section","prefixes":["C","9"],"prefix":"9","entire_prefix":"C9","prefix_anchor":"C9","level":2,"prior_prefix":"C8","next_prefix":"C10"},"12":{"id":290975,"text":"If there is an intermediary organization between the health carrier and the health care providers, the hold harmless clause set forth in subdivision 5 shall be amended to include nonpayment by the plan, the health carrier, and the intermediary organization and shall be included in any contract between the intermediary organization and health care providers and in any contract between the health carrier on behalf of the MCHIP and the intermediary organization.","type":"section","prefixes":["C","10"],"prefix":"10","entire_prefix":"C10","prefix_anchor":"C10","level":2,"prior_prefix":"C9","next_prefix":"D"},"13":{"id":290976,"text":"The Commission may specify for each type of health carrier other than a health maintenance organization the circumstances, if any, under which a health carrier for an MCHIP shall contract with a provider with the “hold harmless” clause described in subsection C. The Commission may specify also the extent to which certain accounting treatment, reserves, net worth or surplus shall be required for liabilities arising from provider contracts without the “hold harmless” clause.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C10"}},"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":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},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-5805\/","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":80882,"section_number":"38.2-4301","catch_line":"Establishment of health maintenance organizations","order_by":null,"url":"\/38.2-4301\/"},{"id":54793,"section_number":"38.2-5802","catch_line":"Establishment of an MCHIP","order_by":null,"url":"\/38.2-5802\/"}],"refers_to":[{"id":64894,"section_number":"38.2-5801","catch_line":"General provisions","order_by":null,"url":"\/38.2-5801\/"}],"permalink":{"id":217967,"object_type":"law","relational_id":81176,"identifier":"38.2-5805","token":"38.2\/58\/38.2-5805","url":"\/38.2-5805\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-5805\/","token":"38.2\/58\/38.2-5805","dublin_core":{"Title":"Provider contracts","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-5805","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Each health carrier<\/span> subject to subsection B of § 38.2-5801<\/a> shall file with the Commission<\/span> a list of the current providers<\/span> who have executed a contract<\/span> directly with the health carrier<\/span> or indirectly through an intermediary organization for the purpose of providing health care services<\/span> pursuant to an MCHIP<\/span> or for the benefit of a covered person<\/span> of an MCHIP<\/span>. The list shall include the names and localities of the providers<\/span>. The list shall be updated by the health carrier<\/span> at least annually and more frequently as required by the Commission<\/span> in accordance with provisions in this title or by the State<\/span> Health Commissioner<\/span> in accordance with provisions in Title 32.1. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Every contract<\/span> with a provider<\/span> of health care services<\/span> enabling an MCHIP<\/span> to provide health care services<\/span> shall be in writing. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> When the health carrier<\/span> is a health maintenance organization<\/span>, the contracts<\/span> with providers<\/span> enabling the MCHIP<\/span> to provide health care services<\/span> to the covered persons<\/span> shall contain a “hold harmless” clause setting forth that, in the event such health carrier<\/span> fails to pay for health care services<\/span> as set forth in the contract<\/span>, the covered persons<\/span> shall not be liable to the provider<\/span> for any sums owed by the health carrier<\/span>. The following requirements shall apply to such contracts<\/span>: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Such contracts<\/span> shall require that if the provider<\/span> terminates the agreement, the provider<\/span> shall give the health carrier<\/span> at least sixty days’ advance notice of termination. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> No provider<\/span> party<\/span> to such a contract<\/span>, or agent, trustee or assignee thereof, may maintain any action at law<\/span> against a covered person<\/span> to collect sums owed by the health carrier<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> If there is an intermediary organization enabling a health carrier<\/span> subject to subsection B of § 38.2-5801<\/a> to provide health care services<\/span> by means of the intermediary organization’s own contracts<\/span> with health care providers<\/span>, the contracts<\/span> between the intermediary organization and its providers shall be in writing. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> The contracts<\/span> shall set forth that, in the event either the health carrier<\/span> or the intermediary organization fails to pay for health care services<\/span> as set forth in the contracts<\/span> between the intermediary organization and its providers, or in the contract<\/span> between the intermediary organization and the health carrier<\/span>, the covered person<\/span> shall not be liable to the provider<\/span> for any sums owed by either the intermediary organization or the health carrier<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> No provider<\/span> party<\/span> to such a contract<\/span>, or agent, trustee or assignee thereof, may maintain any action at law<\/span> against a covered person<\/span> to collect sums owed by the health carrier<\/span> or the intermediary organization. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> An agreement to provide health care services<\/span> between an intermediary organization and a health carrier<\/span> subject to subsection B of § 38.2-5801<\/a> shall require that if the intermediary organization terminates the agreement, the intermediary organization shall give the health carrier<\/span> at least sixty days’ advance notice of termination. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

7.<\/span> An agreement to provide health care services<\/span> between an intermediary organization and a provider<\/span> shall require that if the provider<\/span> terminates the agreement, the provider<\/span> shall give the intermediary organization at least sixty days’ advance notice of termination. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

8.<\/span> Each such health carrier<\/span> and intermediary organization shall be responsible for maintaining its executed contracts<\/span> enabling it to provide health care services<\/span>. These contracts<\/span> shall be available for the Commission<\/span>’s review and examination for a period of five years after the expiration of any such contract<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

9.<\/span> The “hold harmless” clause required by this section shall read essentially as set forth in this subdivision. The health carrier<\/span> may use a corresponding provision of different wording approved by the Commission<\/span> that is not less favorable in any respect to the covered persons<\/span>.\n\t\t\t\tHold Harmless Clause\n\t\t\t\t[Provider<\/span>] hereby agrees that in no event, including, but not limited to nonpayment by the MCHIP<\/span> or its health carrier<\/span>, the insolvency of the [health carrier<\/span>], or breach of this agreement, shall [Provider<\/span>] bill, charge, collect a deposit from; seek compensation, remuneration or reimbursement from; or have any recourse against subscribers or persons other than the health carrier<\/span> for services provided pursuant to this Agreement. This provision shall not prohibit collection of any applicable copayments<\/span> or deductibles billed in accordance with the terms of the subscriber agreement for the MCHIP<\/span>.\n\t\t\t\t[Provider<\/span>] further agrees that (i) this provision shall survive the termination of this Agreement regardless of the cause giving rise to such termination and shall be construed to be for the benefit of the plan’s subscribers and (ii) this provision supersedes any oral or written agreement to the contrary now existing or hereafter entered into between [Provider<\/span>] and the subscriber or persons acting on the subscriber’s behalf. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

10.<\/span> If there is an intermediary organization between the health carrier<\/span> and the health care providers<\/span>, the hold harmless clause set forth in subdivision 5 shall be amended to include nonpayment by the plan, the health carrier<\/span>, and the intermediary organization and shall be included in any contract<\/span> between the intermediary organization and health care providers<\/span> and in any contract<\/span> between the health carrier<\/span> on behalf of the MCHIP<\/span> and the intermediary organization. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> The Commission<\/span> may specify for each type of health carrier<\/span> other than a health maintenance organization<\/span> the circumstances, if any, under which a health carrier<\/span> for an MCHIP<\/span> shall contract<\/span> with a provider<\/span> with the “hold harmless” clause described in subsection C. The Commission<\/span> may specify also the extent to which certain accounting treatment, reserves, net worth or surplus shall be required for liabilities arising from provider<\/span> contracts<\/span> without the “hold harmless” clause. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nPROVIDER CONTRACTS (\u00a7 38.2-5805)\n\nA. Each health carrier subject to subsection B of § 38.2-5801 shall file\nwith the Commission a list of the current providers who have executed a contract\ndirectly with the health carrier or indirectly through an intermediary\norganization for the purpose of providing health care services pursuant to an\nMCHIP or for the benefit of a covered person of an MCHIP. The list shall include\nthe names and localities of the providers. The list shall be updated by the\nhealth carrier at least annually and more frequently as required by the\nCommission in accordance with provisions in this title or by the State Health\nCommissioner in accordance with provisions in Title 32.1.\n\nB. Every contract with a provider of health care services enabling an MCHIP to\nprovide health care services shall be in writing.\n\nC. When the health carrier is a health maintenance organization, the contracts\nwith providers enabling the MCHIP to provide health care services to the covered\npersons shall contain a “hold harmless” clause setting forth that,\nin the event such health carrier fails to pay for health care services as set\nforth in the contract, the covered persons shall not be liable to the provider\nfor any sums owed by the health carrier. The following requirements shall apply\nto such contracts:\n\n 1. Such contracts shall require that if the provider terminates the agreement,\n the provider shall give the health carrier at least sixty days’ advance\n notice of termination.\n\n 2. No provider party to such a contract, or agent, trustee or assignee\n thereof, may maintain any action at law against a covered person to collect\n sums owed by the health carrier.\n\n 3. If there is an intermediary organization enabling a health carrier subject\n to subsection B of § 38.2-5801 to provide health care services by means\n of the intermediary organization’s own contracts with health care\n providers, the contracts between the intermediary organization and its\n providers shall be in writing.\n\n 4. The contracts shall set forth that, in the event either the health carrier\n or the intermediary organization fails to pay for health care services as set\n forth in the contracts between the intermediary organization and its\n providers, or in the contract between the intermediary organization and the\n health carrier, the covered person shall not be liable to the provider for any\n sums owed by either the intermediary organization or the health carrier.\n\n 5. No provider party to such a contract, or agent, trustee or assignee\n thereof, may maintain any action at law against a covered person to collect\n sums owed by the health carrier or the intermediary organization.\n\n 6. An agreement to provide health care services between an intermediary\n organization and a health carrier subject to subsection B of § 38.2-5801\n shall require that if the intermediary organization terminates the agreement,\n the intermediary organization shall give the health carrier at least sixty\n days’ advance notice of termination.\n\n 7. An agreement to provide health care services between an intermediary\n organization and a provider shall require that if the provider terminates the\n agreement, the provider shall give the intermediary organization at least\n sixty days’ advance notice of termination.\n\n 8. Each such health carrier and intermediary organization shall be responsible\n for maintaining its executed contracts enabling it to provide health care\n services. These contracts shall be available for the Commission’s review\n and examination for a period of five years after the expiration of any such\n contract.\n\n 9. The “hold harmless” clause required by this section shall read\n essentially as set forth in this subdivision. The health carrier may use a\n corresponding provision of different wording approved by the Commission that\n is not less favorable in any respect to the covered persons.\n \t\t\t\tHold Harmless Clause\n \t\t\t\t[Provider] hereby agrees that in no event, including, but not limited to\n nonpayment by the MCHIP or its health carrier, the insolvency of the [health\n carrier], or breach of this agreement, shall [Provider] bill, charge, collect\n a deposit from; seek compensation, remuneration or reimbursement from; or have\n any recourse against subscribers or persons other than the health carrier for\n services provided pursuant to this Agreement. This provision shall not\n prohibit collection of any applicable copayments or deductibles billed in\n accordance with the terms of the subscriber agreement for the MCHIP.\n \t\t\t\t[Provider] further agrees that (i) this provision shall survive the\n termination of this Agreement regardless of the cause giving rise to such\n termination and shall be construed to be for the benefit of the plan’s\n subscribers and (ii) this provision supersedes any oral or written agreement\n to the contrary now existing or hereafter entered into between [Provider] and\n the subscriber or persons acting on the subscriber’s behalf.\n\n 10. If there is an intermediary organization between the health carrier and\n the health care providers, the hold harmless clause set forth in subdivision 5\n shall be amended to include nonpayment by the plan, the health carrier, and\n the intermediary organization and shall be included in any contract between\n the intermediary organization and health care providers and in any contract\n between the health carrier on behalf of the MCHIP and the intermediary\n organization.\n\nD. The Commission may specify for each type of health carrier other than a\nhealth maintenance organization the circumstances, if any, under which a health\ncarrier for an MCHIP shall contract with a provider with the “hold\nharmless” clause described in subsection C. The Commission may specify\nalso the extent to which certain accounting treatment, reserves, net worth or\nsurplus shall be required for liabilities arising from provider contracts\nwithout the “hold harmless” clause.\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}}