{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-6507.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-6507.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-6507.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-6507.html"}],"law_id":81440,"edition_id":1,"section_id":81440,"structure_id":12800,"section_number":"38.2-6507","catch_line":"Appeal of decertification or denial of certification","history":"2020, cc. 916, 917.","full_text":"A\n\nThe Exchange shall give each health carrier the opportunity to appeal a decertification decision or the denial of certification as a qualified health plan or qualified dental plan.B\n\nThe Exchange shall give each health carrier that appeals a decertification decision or the denial of certification the opportunity for:1\n\nThe submission and consideration of facts, arguments, or proposals of adjustment of the plan or plans at issue; and2\n\nA hearing and a decision on the record, to the extent that the Exchange and the health carrier are unable to reach agreement following the submission of the information in subdivision 1.C\n\nAny hearing held pursuant to subsection B shall be conducted by the Commission in accordance with its rules of practice and procedure.D\n\nAny final action or order of the Commission shall be subject to judicial review in accordance with the provisions of &#xA7;&#xA7; 12.1-39, 12.1-40, and 12.1-41.","order_by":null,"text":{"0":{"id":291813,"text":"The Exchange shall give each health carrier the opportunity to appeal a decertification decision or the denial of certification as a qualified health plan or qualified dental plan.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":291814,"text":"The Exchange shall give each health carrier that appeals a decertification decision or the denial of certification the opportunity for:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"B1"},"2":{"id":291815,"text":"The submission and consideration of facts, arguments, or proposals of adjustment of the plan or plans at issue; and","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"3":{"id":291816,"text":"A hearing and a decision on the record, to the extent that the Exchange and the health carrier are unable to reach agreement following the submission of the information in subdivision 1.","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"C"},"4":{"id":291817,"text":"Any hearing held pursuant to subsection B shall be conducted by the Commission in accordance with its rules of practice and procedure.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B2","next_prefix":"D"},"5":{"id":291818,"text":"Any final action or order of the Commission shall be subject to judicial review in accordance with the provisions of &#xA7;&#xA7; 12.1-39, 12.1-40, and 12.1-41.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C"}},"ancestry":[{"id":12800,"edition_id":1,"name":"Virginia Health Benefit Exchange","identifier":"65","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:43:53","date_modified":"2026-06-26 03:43:53","permalink":{"id":218345,"object_type":"structure","relational_id":12800,"identifier":"65","token":"38.2\/65","url":"\/38.2\/65\/","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":75766,"structure_id":12800,"section_number":"38.2-6500","catch_line":"Definitions","url":"\/38.2-6500\/","token":"38.2\/65\/38.2-6500","metadata":false},{"id":84565,"structure_id":12800,"section_number":"38.2-6501","catch_line":"Exchange objectives","url":"\/38.2-6501\/","token":"38.2\/65\/38.2-6501","metadata":false},{"id":59610,"structure_id":12800,"section_number":"38.2-6502","catch_line":"Division established; Exchange created","url":"\/38.2-6502\/","token":"38.2\/65\/38.2-6502","metadata":false},{"id":74872,"structure_id":12800,"section_number":"38.2-6503","catch_line":"Advisory Committee","url":"\/38.2-6503\/","token":"38.2\/65\/38.2-6503","metadata":false},{"id":55843,"structure_id":12800,"section_number":"38.2-6504","catch_line":"Exchange requirements","url":"\/38.2-6504\/","token":"38.2\/65\/38.2-6504","metadata":false},{"id":76462,"structure_id":12800,"section_number":"38.2-6505","catch_line":"Duties of Exchange","url":"\/38.2-6505\/","token":"38.2\/65\/38.2-6505","metadata":false},{"id":81163,"structure_id":12800,"section_number":"38.2-6506","catch_line":"Certification of health benefit plans as qualified health plans","url":"\/38.2-6506\/","token":"38.2\/65\/38.2-6506","metadata":false},{"id":81440,"structure_id":12800,"section_number":"38.2-6507","catch_line":"Appeal of decertification or denial of certification","url":"\/38.2-6507\/","token":"38.2\/65\/38.2-6507","metadata":false},{"id":67396,"structure_id":12800,"section_number":"38.2-6508","catch_line":"Open enrollment periods","url":"\/38.2-6508\/","token":"38.2\/65\/38.2-6508","metadata":false},{"id":84381,"structure_id":12800,"section_number":"38.2-6509","catch_line":"Choice","url":"\/38.2-6509\/","token":"38.2\/65\/38.2-6509","metadata":false},{"id":67117,"structure_id":12800,"section_number":"38.2-6510","catch_line":"Health Insurance Exchange Fund; assessment","url":"\/38.2-6510\/","token":"38.2\/65\/38.2-6510","metadata":false},{"id":62589,"structure_id":12800,"section_number":"38.2-6511","catch_line":"Procurement, contracting, and personnel","url":"\/38.2-6511\/","token":"38.2\/65\/38.2-6511","metadata":false},{"id":77639,"structure_id":12800,"section_number":"38.2-6512","catch_line":"Confidentiality","url":"\/38.2-6512\/","token":"38.2\/65\/38.2-6512","metadata":false},{"id":80784,"structure_id":12800,"section_number":"38.2-6513","catch_line":"Navigators","url":"\/38.2-6513\/","token":"38.2\/65\/38.2-6513","metadata":false},{"id":85399,"structure_id":12800,"section_number":"38.2-6514","catch_line":"Certified application counselors","url":"\/38.2-6514\/","token":"38.2\/65\/38.2-6514","metadata":false},{"id":82556,"structure_id":12800,"section_number":"38.2-6515","catch_line":"Regulations","url":"\/38.2-6515\/","token":"38.2\/65\/38.2-6515","metadata":false},{"id":53968,"structure_id":12800,"section_number":"38.2-6516","catch_line":"Reports","url":"\/38.2-6516\/","token":"38.2\/65\/38.2-6516","metadata":false},{"id":58428,"structure_id":12800,"section_number":"38.2-6517","catch_line":"Relation to other laws","url":"\/38.2-6517\/","token":"38.2\/65\/38.2-6517","metadata":false}],"previous_section":{"id":81163,"structure_id":12800,"section_number":"38.2-6506","catch_line":"Certification of health benefit plans as qualified health plans","url":"\/38.2-6506\/","token":"38.2\/65\/38.2-6506","metadata":false},"next_section":{"id":67396,"structure_id":12800,"section_number":"38.2-6508","catch_line":"Open enrollment periods","url":"\/38.2-6508\/","token":"38.2\/65\/38.2-6508","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-6507\/","history_text":"<p>This law was first created in 2020. The record of its establishment is cataloged in chapters <a href=\"https:\/\/legacylis.virginia.gov\/cgi-bin\/legp604.exe?201+ful+CHAP0916\">916<\/a> and <a href=\"https:\/\/legacylis.virginia.gov\/cgi-bin\/legp604.exe?201+ful+CHAP0917\">917<\/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":false,"refers_to":[{"id":67515,"section_number":"12.1-39","catch_line":"Appeals generally","order_by":null,"url":"\/12.1-39\/"},{"id":58213,"section_number":"12.1-40","catch_line":"Method of taking and prosecuting appeals","order_by":null,"url":"\/12.1-40\/"},{"id":58573,"section_number":"12.1-41","catch_line":"Petitions for writs of supersedeas","order_by":null,"url":"\/12.1-41\/"}],"permalink":{"id":218375,"object_type":"law","relational_id":81440,"identifier":"38.2-6507","token":"38.2\/65\/38.2-6507","url":"\/38.2-6507\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-6507\/","token":"38.2\/65\/38.2-6507","dublin_core":{"Title":"Appeal of decertification or denial of certification","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-6507","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t<section id=\"A\"><p><span class=\"prefix-number\">A.<\/span> The Exchange shall give each <span class=\"dictionary\">health carrier<\/span> the opportunity to <span class=\"dictionary\">appeal<\/span> a decertification decision or the denial of certification as a <span class=\"dictionary\">qualified health plan<\/span> or <span class=\"dictionary\">qualified dental plan<\/span>. <a id=\"paragraph-291813\" class=\"section-permalink\" href=\"https:\/\/vacode.org\/38.2-6507\/#A\"><i class=\"fa fa-link\"><\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t<section id=\"B\"><p><span class=\"prefix-number\">B.<\/span> The Exchange shall give each <span class=\"dictionary\">health carrier<\/span> that <span class=\"dictionary\">appeals<\/span> a decertification decision or the denial of certification the opportunity for: <a id=\"paragraph-291814\" class=\"section-permalink\" href=\"https:\/\/vacode.org\/38.2-6507\/#B\"><i class=\"fa fa-link\"><\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t<section id=\"B1\" class=\"indent-1\"><p><span class=\"prefix-number\">1.<\/span> The submission and consideration of <span class=\"dictionary\">facts<\/span>, arguments, or proposals of adjustment of the plan or <span class=\"dictionary\">plans<\/span> at <span class=\"dictionary\">issue<\/span>; and <a id=\"paragraph-291815\" class=\"section-permalink\" href=\"https:\/\/vacode.org\/38.2-6507\/#B1\"><i class=\"fa fa-link\"><\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t<section id=\"B2\" class=\"indent-1\"><p><span class=\"prefix-number\">2.<\/span> A <span class=\"dictionary\">hearing<\/span> and a decision on the record, to the extent that the Exchange and the <span class=\"dictionary\">health carrier<\/span> are unable to reach agreement following the submission of the information in subdivision 1. <a id=\"paragraph-291816\" class=\"section-permalink\" href=\"https:\/\/vacode.org\/38.2-6507\/#B2\"><i class=\"fa fa-link\"><\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t<section id=\"C\"><p><span class=\"prefix-number\">C.<\/span> Any <span class=\"dictionary\">hearing<\/span> held pursuant to subsection B shall be conducted by the <span class=\"dictionary\">Commission<\/span> in accordance with its rules of practice and procedure. <a id=\"paragraph-291817\" class=\"section-permalink\" href=\"https:\/\/vacode.org\/38.2-6507\/#C\"><i class=\"fa fa-link\"><\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t<section id=\"D\"><p><span class=\"prefix-number\">D.<\/span> Any final action or <span class=\"dictionary\">order<\/span> of the <span class=\"dictionary\">Commission<\/span> shall be subject to judicial review in accordance with the provisions of &#xA7;&#xA7; <a class=\"law\" title=\"Appeals generally\" href=\"\/12.1-39\/\">12.1-39<\/a>, <a class=\"law\" title=\"Method of taking and prosecuting appeals\" href=\"\/12.1-40\/\">12.1-40<\/a>, and <a class=\"law\" title=\"Petitions for writs of supersedeas\" href=\"\/12.1-41\/\">12.1-41<\/a>. <a id=\"paragraph-291818\" class=\"section-permalink\" href=\"https:\/\/vacode.org\/38.2-6507\/#D\"><i class=\"fa fa-link\"><\/i><\/a><\/p><\/section>","plain_text":"                                 CODE OF VIRGINIA\n\nAPPEAL OF DECERTIFICATION OR DENIAL OF CERTIFICATION (\u00a7 38.2-6507)\n\nA. The Exchange shall give each health carrier the opportunity to appeal a\ndecertification decision or the denial of certification as a qualified health\nplan or qualified dental plan.\n\nB. The Exchange shall give each health carrier that appeals a decertification\ndecision or the denial of certification the opportunity for:\n\n   1. The submission and consideration of facts, arguments, or proposals of\n   adjustment of the plan or plans at issue; and\n\n   2. A hearing and a decision on the record, to the extent that the Exchange and\n   the health carrier are unable to reach agreement following the submission of\n   the information in subdivision 1.\n\nC. Any hearing held pursuant to subsection B shall be conducted by the\nCommission in accordance with its rules of practice and procedure.\n\nD. Any final action or order of the Commission shall be subject to judicial\nreview in accordance with the provisions of &#xA7;&#xA7; 12.1-39, 12.1-40, and\n12.1-41.\n\nHISTORY: 2020, cc. 916, 917.","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}}