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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>85161</law_id><section_number>38.2-3430.4</section_number><catch_line>Special rules for network plans</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><structure><unit label="title" level="1" order_by="1" identifier="38.2">Insurance</unit><unit label="chapter" level="2" order_by="1" identifier="34">Provisions Relating to Accident and Sickness Insurance</unit><unit label="article" level="3" order_by="1" identifier="4.1">Individual Health Insurance Coverage</unit></structure><text>
						<section><p>A health <span class="dictionary">insurance</span> issuer that offers health <span class="dictionary">insurance</span> coverage in the individual market may:</p></section>
						<section id="1"><p><span class="prefix-number">1.</span> Limit the eligible individuals who may be enrolled under such coverage to those who live, reside, or work within the service area for such network plan; <a id="paragraph-305156" class="section-permalink" href="https://vacode.org/38.2-3430.4/#1"><i class="fa fa-link"/></a></p></section>
						<section id="2"><p><span class="prefix-number">2.</span> Within the service area of such plan, deny such coverage to such individuals if the health <span class="dictionary">insurance</span> issuer has demonstrated to the <span class="dictionary">Commission</span> that: (i) it will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group <span class="dictionary">contract</span> holders, enrollees and enrollees covered under individual <span class="dictionary">contracts</span>; and (ii) it is applying this section uniformly to individuals without regard to any health status-related factor of such individuals and without regard to whether the individuals are eligible individuals; <a id="paragraph-305157" class="section-permalink" href="https://vacode.org/38.2-3430.4/#2"><i class="fa fa-link"/></a></p></section>
						<section id="3"><p><span class="prefix-number">3.</span> A health <span class="dictionary">insurance</span> issuer, upon denying health <span class="dictionary">insurance</span> coverage in any service area in accordance with subdivision 2, may not offer coverage in the individual market within such service area for a period of 180 days after such coverage is denied. <a id="paragraph-305158" class="section-permalink" href="https://vacode.org/38.2-3430.4/#3"><i class="fa fa-link"/></a></p></section></text><history>1997, cc. 807, 913; 1998, c. 24.</history><metadata></metadata></law>
