{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-6600.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-6600.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-6600.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-6600.html"}],"law_id":76403,"edition_id":1,"section_id":76403,"structure_id":15471,"section_number":"38.2-6600","catch_line":"Definitions","history":"2021, Sp. Sess. I, c. 480; 2022, cc. 547, 548.","full_text":"As used in this chapter, unless the context requires a different meaning:\n\t\t“Affordable Care Act” means the Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, P.L. 111-152, and as it may be further amended.\n\t\t“Allowed amount” has the same meaning as provided in \u00a7 38.2-3438.\n\t\t“Attachment point” means the amount set by the Commission for claims costs incurred by an eligible carrier for a covered person’s covered benefits in a benefit year, above which the claims costs for benefits are eligible for reinsurance payments under the Program.\n\t\t“Benefit year” means the calendar year for which an eligible carrier provides coverage through an individual health benefit plan.\n\t\t“Coinsurance rate” means the rate set by the Commission at which the Program will reimburse an eligible carrier for claims incurred for a covered person’s covered benefits in a benefit year, which claims exceed the attachment point but are below the reinsurance cap.\n\t\t“Covered benefits” has the same meaning as provided in \u00a7 38.2-3438.\n\t\t“Covered person” means an individual covered under individual health insurance coverage that (i) is delivered or issued for delivery in the Commonwealth and (ii) is neither a grandfathered plan, student health insurance coverage, nor transitional coverage that the federal government allows under a nonenforcement policy.\n\t\t“Eligible carrier” means a carrier that (i) offers individual health insurance coverage other than a grandfathered plan, student health insurance coverage, or transitional coverage that the federal government allows under a nonenforcement policy and (ii) incurs claims costs for a covered person’s covered benefits in the applicable benefit year.\n\t\t“Fund” means the Commonwealth Health Reinsurance Program Special Fund established by the Commission pursuant to \u00a7 38.2-6604.\n\t\t“Grandfathered plan” has the same meaning as provided in \u00a7 38.2-3438.\n\t\t“Group health insurance coverage” has the same meaning as provided in \u00a7 38.2-3438.\n\t\t“Individual health insurance coverage” has the same meaning as provided in \u00a7 38.2-3438.\n\t\t“Net written premiums” means premiums earned on individual and group health insurance coverage, including grandfathered plans, in the Commonwealth, less return premiums and dividends paid or credited to policy or contract holders on the health benefits plan business.\n\t\t“Payment parameters” means the attachment point, reinsurance cap, and coinsurance rate for the Program.\n\t\t“Program” means the Commonwealth Health Reinsurance Program established pursuant to this chapter.\n\t\t“Reinsurance cap” means the amount set by the Commission for claims costs incurred by an eligible carrier for a covered person’s covered benefits in a benefit year, above which the claims costs for benefits are no longer eligible for reinsurance payments under the Program.\n\t\t“Reinsurance payment” means an amount paid to an eligible carrier under the Program.\n\t\t“State Innovation Waiver” means a waiver of one or more requirements of the Affordable Care Act authorized by \u00a7 1332 of the Affordable Care Act, 42 U.S.C. \u00a7 18052, and applicable federal regulations.\n\t\t“Total amount paid by the eligible carrier for any eligible claim” means the amount paid by the eligible carrier based on the allowed amount less any deductible, coinsurance, or copayment, as of the time applicable data is submitted or made accessible under subdivision C 1 of \u00a7 38.2-6602.","order_by":null,"text":{"0":{"id":274260,"text":"As used in this chapter, unless the context requires a different meaning:\n\t\t“Affordable Care Act” means the Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, P.L. 111-152, and as it may be further amended.\n\t\t“Allowed amount” has the same meaning as provided in \u00a7 38.2-3438.\n\t\t“Attachment point” means the amount set by the Commission for claims costs incurred by an eligible carrier for a covered person’s covered benefits in a benefit year, above which the claims costs for benefits are eligible for reinsurance payments under the Program.\n\t\t“Benefit year” means the calendar year for which an eligible carrier provides coverage through an individual health benefit plan.\n\t\t“Coinsurance rate” means the rate set by the Commission at which the Program will reimburse an eligible carrier for claims incurred for a covered person’s covered benefits in a benefit year, which claims exceed the attachment point but are below the reinsurance cap.\n\t\t“Covered benefits” has the same meaning as provided in \u00a7 38.2-3438.\n\t\t“Covered person” means an individual covered under individual health insurance coverage that (i) is delivered or issued for delivery in the Commonwealth and (ii) is neither a grandfathered plan, student health insurance coverage, nor transitional coverage that the federal government allows under a nonenforcement policy.\n\t\t“Eligible carrier” means a carrier that (i) offers individual health insurance coverage other than a grandfathered plan, student health insurance coverage, or transitional coverage that the federal government allows under a nonenforcement policy and (ii) incurs claims costs for a covered person’s covered benefits in the applicable benefit year.\n\t\t“Fund” means the Commonwealth Health Reinsurance Program Special Fund established by the Commission pursuant to \u00a7 38.2-6604.\n\t\t“Grandfathered plan” has the same meaning as provided in \u00a7 38.2-3438.\n\t\t“Group health insurance coverage” has the same meaning as provided in \u00a7 38.2-3438.\n\t\t“Individual health insurance coverage” has the same meaning as provided in \u00a7 38.2-3438.\n\t\t“Net written premiums” means premiums earned on individual and group health insurance coverage, including grandfathered plans, in the Commonwealth, less return premiums and dividends paid or credited to policy or contract holders on the health benefits plan business.\n\t\t“Payment parameters” means the attachment point, reinsurance cap, and coinsurance rate for the Program.\n\t\t“Program” means the Commonwealth Health Reinsurance Program established pursuant to this chapter.\n\t\t“Reinsurance cap” means the amount set by the Commission for claims costs incurred by an eligible carrier for a covered person’s covered benefits in a benefit year, above which the claims costs for benefits are no longer eligible for reinsurance payments under the Program.\n\t\t“Reinsurance payment” means an amount paid to an eligible carrier under the Program.\n\t\t“State Innovation Waiver” means a waiver of one or more requirements of the Affordable Care Act authorized by \u00a7 1332 of the Affordable Care Act, 42 U.S.C. \u00a7 18052, and applicable federal regulations.\n\t\t“Total amount paid by the eligible carrier for any eligible claim” means the amount paid by the eligible carrier based on the allowed amount less any deductible, coinsurance, or copayment, as of the time applicable data is submitted or made accessible under subdivision C 1 of \u00a7 38.2-6602.","type":"section","prefixes":[""],"prefix":"","entire_prefix":"","prefix_anchor":"","level":1}},"ancestry":[{"id":15471,"edition_id":1,"name":"Commonwealth Health Reinsurance Program","identifier":"66","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:55:18","date_modified":"2026-06-26 03:55:18","permalink":{"id":218419,"object_type":"structure","relational_id":15471,"identifier":"66","token":"38.2\/66","url":"\/38.2\/66\/","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":76403,"structure_id":15471,"section_number":"38.2-6600","catch_line":"Definitions","url":"\/38.2-6600\/","token":"38.2\/66\/38.2-6600","metadata":false},{"id":58939,"structure_id":15471,"section_number":"38.2-6601","catch_line":"Commission powers and duties; rules; report","url":"\/38.2-6601\/","token":"38.2\/66\/38.2-6601","metadata":false},{"id":62335,"structure_id":15471,"section_number":"38.2-6602","catch_line":"Commonwealth Health Reinsurance Program; established","url":"\/38.2-6602\/","token":"38.2\/66\/38.2-6602","metadata":false},{"id":87443,"structure_id":15471,"section_number":"38.2-6603","catch_line":"Accounting; reports","url":"\/38.2-6603\/","token":"38.2\/66\/38.2-6603","metadata":false},{"id":87186,"structure_id":15471,"section_number":"38.2-6604","catch_line":"Commonwealth Health Reinsurance Program Special Fund","url":"\/38.2-6604\/","token":"38.2\/66\/38.2-6604","metadata":false},{"id":87098,"structure_id":15471,"section_number":"38.2-6605","catch_line":"Confidentiality of data","url":"\/38.2-6605\/","token":"38.2\/66\/38.2-6605","metadata":false},{"id":67978,"structure_id":15471,"section_number":"38.2-6606","catch_line":"State Innovation Waiver request","url":"\/38.2-6606\/","token":"38.2\/66\/38.2-6606","metadata":false}],"next_section":{"id":58939,"structure_id":15471,"section_number":"38.2-6601","catch_line":"Commission powers and duties; rules; report","url":"\/38.2-6601\/","token":"38.2\/66\/38.2-6601","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-6600\/","history_text":"

The record of this law\u2019s original creation isn\u2019t available online. It has been modified 1 time. 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. That modification is as follows: in 2022, chapters 547<\/a> and 548<\/a>.<\/p>","references":[{"id":55347,"section_number":"38.2-4214","catch_line":"Application of certain provisions of law","order_by":null,"url":"\/38.2-4214\/"},{"id":67952,"section_number":"38.2-4319","catch_line":"Statutory construction and relationship to other laws","order_by":null,"url":"\/38.2-4319\/"}],"refers_to":[{"id":57210,"section_number":"38.2-3438","catch_line":"Definitions","order_by":null,"url":"\/38.2-3438\/"},{"id":62335,"section_number":"38.2-6602","catch_line":"Commonwealth Health Reinsurance Program; established","order_by":null,"url":"\/38.2-6602\/"},{"id":87186,"section_number":"38.2-6604","catch_line":"Commonwealth Health Reinsurance Program Special Fund","order_by":null,"url":"\/38.2-6604\/"}],"permalink":{"id":218421,"object_type":"law","relational_id":76403,"identifier":"38.2-6600","token":"38.2\/66\/38.2-6600","url":"\/38.2-6600\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-6600\/","token":"38.2\/66\/38.2-6600","dublin_core":{"Title":"Definitions","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-6600","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

As used in this chapter, unless the context requires a different meaning:\n\t\t“Affordable Care Act<\/span>” means the Patient Protection and Affordable Care Act<\/span>, P.L. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, P.L. 111-152, and as it may be further amended.\n\t\t“Allowed amount<\/span>” has the same meaning as provided in \u00a7 38.2-3438<\/a>.\n\t\t“Attachment point<\/span>” means the amount set by the Commission<\/span> for claims costs incurred by an eligible carrier for a covered person<\/span>’s covered benefits<\/span> in a benefit year<\/span>, above which the claims costs for benefits are eligible for reinsurance payments<\/span> under the Program<\/span>.\n\t\t“Benefit year<\/span>” means the calendar year for which an eligible carrier provides coverage through an individual health benefit plan.\n\t\t“Coinsurance rate<\/span>” means the rate set by the Commission<\/span> at which the Program<\/span> will reimburse an eligible carrier for claims incurred for a covered person<\/span>’s covered benefits<\/span> in a benefit year<\/span>, which claims exceed the attachment point<\/span> but are below the reinsurance cap<\/span>.\n\t\t“Covered benefits<\/span>” has the same meaning as provided in \u00a7 38.2-3438<\/a>.\n\t\t“Covered person<\/span>” means an individual covered under individual health insurance coverage<\/span> that (i) is delivered or issued for delivery in the Commonwealth and (ii) is neither a grandfathered plan<\/span>, student health insurance coverage, nor transitional coverage that the federal government allows under a nonenforcement policy.\n\t\t“Eligible carrier” means a carrier that (i) offers individual health insurance coverage<\/span> other than a grandfathered plan<\/span>, student health insurance coverage, or transitional coverage that the federal government allows under a nonenforcement policy and (ii) incurs claims costs for a covered person<\/span>’s covered benefits<\/span> in the applicable benefit year<\/span>.\n\t\t“Fund<\/span>” means the Commonwealth Health Reinsurance Program<\/span> Special Fund<\/span> established by the Commission<\/span> pursuant to \u00a7 38.2-6604<\/a>.\n\t\t“Grandfathered plan<\/span>” has the same meaning as provided in \u00a7 38.2-3438<\/a>.\n\t\t“Group health insurance coverage<\/span>” has the same meaning as provided in \u00a7 38.2-3438<\/a>.\n\t\t“Individual health insurance coverage<\/span>” has the same meaning as provided in \u00a7 38.2-3438<\/a>.\n\t\t“Net written premiums<\/span>” means premiums earned on individual and group health insurance coverage<\/span>, including grandfathered plans<\/span>, in the Commonwealth, less return premiums and dividends paid or credited to policy or contract<\/span> holders on the health benefits plan business.\n\t\t“Payment parameters<\/span>” means the attachment point<\/span>, reinsurance cap<\/span>, and coinsurance rate<\/span> for the Program<\/span>.\n\t\t“Program<\/span>” means the Commonwealth Health Reinsurance Program<\/span> established pursuant to this chapter.\n\t\t“Reinsurance cap<\/span>” means the amount set by the Commission<\/span> for claims costs incurred by an eligible carrier for a covered person<\/span>’s covered benefits<\/span> in a benefit year<\/span>, above which the claims costs for benefits are no longer eligible for reinsurance payments<\/span> under the Program<\/span>.\n\t\t“Reinsurance payment<\/span>” means an amount paid to an eligible carrier under the Program<\/span>.\n\t\t“State Innovation Waiver<\/span>” means a waiver of one or more requirements of the Affordable Care Act<\/span> authorized by \u00a7 1332 of the Affordable Care Act<\/span>, 42 U.S.C. \u00a7 18052, and applicable federal regulations.\n\t\t“Total amount paid by the eligible carrier for any eligible claim<\/span>” means the amount paid by the eligible carrier based on the allowed amount<\/span> less any deductible, coinsurance, or copayment, as of the time applicable data is submitted or made accessible under subdivision C 1 of \u00a7 38.2-6602<\/a>.<\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nDEFINITIONS (\u00a7 38.2-6600)\n\nAs used in this chapter, unless the context requires a different meaning:\n\t\t“Affordable Care Act” means the Patient Protection and Affordable\nCare Act, P.L. 111-148, as amended by the Health Care and Education\nReconciliation Act of 2010, P.L. 111-152, and as it may be further amended.\n\t\t“Allowed amount” has the same meaning as provided in \u00a7 38.2-3438.\n\t\t“Attachment point” means the amount set by the Commission for\nclaims costs incurred by an eligible carrier for a covered person’s\ncovered benefits in a benefit year, above which the claims costs for benefits\nare eligible for reinsurance payments under the Program.\n\t\t“Benefit year” means the calendar year for which an eligible\ncarrier provides coverage through an individual health benefit plan.\n\t\t“Coinsurance rate” means the rate set by the Commission at which\nthe Program will reimburse an eligible carrier for claims incurred for a covered\nperson’s covered benefits in a benefit year, which claims exceed the\nattachment point but are below the reinsurance cap.\n\t\t“Covered benefits” has the same meaning as provided in \u00a7\n38.2-3438.\n\t\t“Covered person” means an individual covered under individual\nhealth insurance coverage that (i) is delivered or issued for delivery in the\nCommonwealth and (ii) is neither a grandfathered plan, student health insurance\ncoverage, nor transitional coverage that the federal government allows under a\nnonenforcement policy.\n\t\t“Eligible carrier” means a carrier that (i) offers individual\nhealth insurance coverage other than a grandfathered plan, student health\ninsurance coverage, or transitional coverage that the federal government allows\nunder a nonenforcement policy and (ii) incurs claims costs for a covered\nperson’s covered benefits in the applicable benefit year.\n\t\t“Fund” means the Commonwealth Health Reinsurance Program Special\nFund established by the Commission pursuant to \u00a7 38.2-6604.\n\t\t“Grandfathered plan” has the same meaning as provided in \u00a7\n38.2-3438.\n\t\t“Group health insurance coverage” has the same meaning as provided\nin \u00a7 38.2-3438.\n\t\t“Individual health insurance coverage” has the same meaning as\nprovided in \u00a7 38.2-3438.\n\t\t“Net written premiums” means premiums earned on individual and\ngroup health insurance coverage, including grandfathered plans, in the\nCommonwealth, less return premiums and dividends paid or credited to policy or\ncontract holders on the health benefits plan business.\n\t\t“Payment parameters” means the attachment point, reinsurance cap,\nand coinsurance rate for the Program.\n\t\t“Program” means the Commonwealth Health Reinsurance Program\nestablished pursuant to this chapter.\n\t\t“Reinsurance cap” means the amount set by the Commission for\nclaims costs incurred by an eligible carrier for a covered person’s\ncovered benefits in a benefit year, above which the claims costs for benefits\nare no longer eligible for reinsurance payments under the Program.\n\t\t“Reinsurance payment” means an amount paid to an eligible carrier\nunder the Program.\n\t\t“State Innovation Waiver” means a waiver of one or more\nrequirements of the Affordable Care Act authorized by \u00a7 1332 of the Affordable\nCare Act, 42 U.S.C. \u00a7 18052, and applicable federal regulations.\n\t\t“Total amount paid by the eligible carrier for any eligible claim”\nmeans the amount paid by the eligible carrier based on the allowed amount less\nany deductible, coinsurance, or copayment, as of the time applicable data is\nsubmitted or made accessible under subdivision C 1 of \u00a7 38.2-6602.\n\nHISTORY: 2021, Sp. Sess. I, c. 480; 2022, cc. 547, 548.","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}}