<?xml version="1.0"?>
<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>55817</law_id><section_number>38.2-1016.1</section_number><catch_line>Conversion of a health maintenance organization to an accident and sickness insurer</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>38.2-4319</reference></referred_to_by><structure><unit label="title" level="1" order_by="1" identifier="38.2">Insurance</unit><unit label="chapter" level="2" order_by="1" identifier="10">Organization, Admission and Licensing of Insurers</unit><unit label="article" level="3" order_by="1" identifier="2.1">Conversion of Health Maintenance Organization to Accident and Sickness Insurer</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> Any health maintenance organization domiciled in the Commonwealth and subject to the provisions of Chapter 43 (&#xA7; <a class="law" title="Definitions" href="/38.2-4300/">38.2-4300</a> et seq.) may, at its option and without reincorporation, convert to an <span class="dictionary">insurer</span> licensed to write accident and sickness <span class="dictionary">insurance</span>, hereinafter referred to as the &#x201C;converted <span class="dictionary">insurer</span>,&#x201D; by following the procedures set forth in this section. A health maintenance organization that becomes a converted <span class="dictionary">insurer</span> under this section shall have all of the rights to and titles and interests in the <span class="dictionary">assets</span> of the original health maintenance organization, as well as all of its liabilities and obligations. <a id="paragraph-204458" class="section-permalink" href="https://vacode.org/38.2-1016.1/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> A health maintenance organization eligible to become a converted <span class="dictionary">insurer</span> under subsection A may effect such conversion by (i) complying with the requirements for formation of a domestic <span class="dictionary">insurer</span> under Article 1 (&#xA7; <a class="law" title="Incorporation of domestic stock insurers" href="/38.2-1000/">38.2-1000</a> et seq.); (ii) promptly filing with the <span class="dictionary">Commission</span> any necessary amendments to its articles of incorporation, bylaws, and other corporate documents pursuant to the provisions of Chapter 9 (&#xA7; <a class="law" title="Short title" href="/13.1-601/">13.1-601</a> et seq.) of Title 13.1; and (iii) filing with the <span class="dictionary">Commission</span> such other information as the <span class="dictionary">Commission</span> may require to meet all of the requirements of an <span class="dictionary">insurer</span> in Virginia. When those requirements have been met, the <span class="dictionary">Commission</span> shall <span class="dictionary">issue</span> a license in accordance with the provisions of Article 5 (&#xA7; <a class="law" title="License required to transact the business of insurance; application fee requirements for license" href="/38.2-1024/">38.2-1024</a> et seq.) to permit the converted <span class="dictionary">insurer</span> to conduct the business of accident and sickness <span class="dictionary">insurance</span> in the Commonwealth. Upon the issuance of the converted <span class="dictionary">insurer</span>&#x2019;s license, and except as provided in this section, the converted <span class="dictionary">insurer</span> shall be subject to all of the provisions of this title that pertain to <span class="dictionary">insurers</span> licensed pursuant to Article 5 (&#xA7; <a class="law" title="License required to transact the business of insurance; application fee requirements for license" href="/38.2-1024/">38.2-1024</a> et seq.) of this chapter and the business of accident and sickness <span class="dictionary">insurance</span>. <a id="paragraph-204459" class="section-permalink" href="https://vacode.org/38.2-1016.1/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> After the effective date of the health maintenance organization&#x2019;s conversion to and licensure as an <span class="dictionary">insurer</span>, all of the converted <span class="dictionary">insurer</span>&#x2019;s individual and group health care plans, <span class="dictionary">contracts</span>, and <span class="dictionary">evidences</span> of coverage shall remain valid and in force in accordance with their terms until the earlier of (i) the expiration or termination of the plans, <span class="dictionary">contracts</span>, or <span class="dictionary">evidences</span> of coverage; or (ii) the last day of the eighteenth month after the effective date of conversion. For the period during which the converted <span class="dictionary">insurer</span> continues to provide or arrange for health care services under such health care plan or plans, the <span class="dictionary">insurer</span>&#x2019;s obligation to pay license taxes under Chapter 25 (&#xA7; <a class="law" title="Definitions" href="/58.1-2500/">58.1-2500</a> et seq.) of Title 58.1 and fees for maintaining the <span class="dictionary">Bureau of Insurance</span> under Chapter 4 (&#xA7; <a class="law" title="Expense of administration of insurance laws borne by licensees; minimum contribution" href="/38.2-400/">38.2-400</a> et seq.), which are, in all cases, attributable to such health care plan or plans, shall be the same as the license taxes and fees required of health maintenance organizations generally. <a id="paragraph-204460" class="section-permalink" href="https://vacode.org/38.2-1016.1/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> Except as provided herein, a converted <span class="dictionary">insurer</span> shall not, after the effective date of its conversion, use in its accident and sickness <span class="dictionary">insurance policies</span>, <span class="dictionary">contracts</span> or other literature (i) the words &#x201C;health maintenance organization&#x201D; or &#x201C;HMO&#x201D; or (ii) any other words descriptive of a health maintenance organization or deceptively similar to the name or description of any health maintenance organization then doing business in the Commonwealth in any manner that misrepresents the benefits, advantages, conditions, or terms of the converted <span class="dictionary">insurer</span>&#x2019;s <span class="dictionary">insurance policies</span>, <span class="dictionary">contracts</span>, or other literature. <a id="paragraph-204461" class="section-permalink" href="https://vacode.org/38.2-1016.1/#D"><i class="fa fa-link"/></a></p></section>
						<section id="E"><p><span class="prefix-number">E.</span> For the purposes of handling the rehabilitation, <span class="dictionary">liquidation</span>, or conservation of a converted <span class="dictionary">insurer</span>, the provisions of Chapter 15 (&#xA7; <a class="law" title="Scope of chapter" href="/38.2-1500/">38.2-1500</a> et seq.) shall apply. Whenever an <span class="dictionary">order</span> has been entered pursuant to Chapter 15 authorizing the <span class="dictionary">Commission</span> or other receiver to proceed with the rehabilitation, <span class="dictionary">liquidation</span>, or conservation of a converted <span class="dictionary">insurer</span>, the <span class="dictionary">Commission</span> may utilize the provisions of &#xA7; <a class="law" title="Protection against insolvency" href="/38.2-4310/">38.2-4310</a>, to protect the interests of enrollees in the converted <span class="dictionary">insurer</span>&#x2019;s health care plans. If a receivership occurs in a converted <span class="dictionary">insurer</span> that continues to provide or arrange for health care services under such health care plan or plans, contracts, or policies, the receiver shall consider these plans, contracts, or policies as existing in the converted <span class="dictionary">insurer</span>. The <span class="dictionary">Commission</span> or other receiver appointed pursuant to Chapter 15 shall allocate the <span class="dictionary">assets</span>, liabilities, and obligations of the insolvent converted <span class="dictionary">insurer</span> in the manner that the <span class="dictionary">Commission</span> or other receiver determines is fair and <span class="dictionary">equitable</span> to the <span class="dictionary">insurer</span>&#x2019;s accident and sickness insurance policyholders, health care plan enrollees, and other <span class="dictionary">creditors</span>. The accident and sickness <span class="dictionary">insurance contracts</span> and policies issued by the converted <span class="dictionary">insurer</span> shall be governed by the provisions applicable to the Virginia Life, Accident and Sickness Insurance Guaranty Association pursuant to Chapter 17 (&#xA7; <a class="law" title="Purpose and applicability of chapter" href="/38.2-1700/">38.2-1700</a> et seq.). The health care plans, contracts, or policies of the converted <span class="dictionary">insurer</span>, associated with the business written as a health maintenance organization, shall be governed by the provisions of &#xA7; <a class="law" title="Protection against insolvency" href="/38.2-4310/">38.2-4310</a>. <a id="paragraph-204462" class="section-permalink" href="https://vacode.org/38.2-1016.1/#E"><i class="fa fa-link"/></a></p></section></text><history>2007, c. 579; 2018, c. 706.</history><metadata></metadata></law>
