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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>66467</law_id><section_number>38.2-3445.06</section_number><catch_line>Applicability of certain sections</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>38.2-3445.06</reference><reference>38.2-3445.07</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="34">Provisions Relating to Accident and Sickness Insurance</unit><unit label="article" level="3" order_by="1" identifier="6">Federal Market Reforms</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> Except as provided in this section, the provisions of &#xA7;&#xA7; <a class="law" title="Patient access to emergency services" href="/38.2-3445/">38.2-3445</a> through <a class="law" title="Enforcement" href="/38.2-3445.05/">38.2-3445.05</a> shall not apply to an entity providing or administering an employee welfare benefit plan, as defined in &#xA7; 3(1) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. &#xA7; 1002(1), that is self-insured or self-funded with respect to such plan. Such an entity may elect to be subject to the provisions of &#xA7;&#xA7; <a class="law" title="Patient access to emergency services" href="/38.2-3445/">38.2-3445</a> through <a class="law" title="Applicability of certain sections" href="/38.2-3445.06/">38.2-3445.06</a> in the same manner as applied to a health carrier by providing notice to the <span class="dictionary">Commission</span> annually, in a form and manner prescribed by the <span class="dictionary">Commission</span>, attesting to the plan&#x2019;s participation and agreeing to be bound by the provisions of &#xA7;&#xA7; <a class="law" title="Patient access to emergency services" href="/38.2-3445/">38.2-3445</a> through <a class="law" title="Applicability of certain sections" href="/38.2-3445.06/">38.2-3445.06</a>. Such entity shall <span class="dictionary">amend</span> the plan, policies, <span class="dictionary">contracts</span>, and other documents to reflect such election. In addition, the entity that elects to opt in pursuant to this section shall file current plan documentation confirming that the plan accepts the obligations of &#xA7;&#xA7; <a class="law" title="Patient access to emergency services" href="/38.2-3445/">38.2-3445</a> through <a class="law" title="Applicability of certain sections" href="/38.2-3445.06/">38.2-3445.06</a> and attests that any amended plan documents will be filed with the <span class="dictionary">Commission</span> before the effective date of such amendments. The <span class="dictionary">Commission</span> shall post on its website a list of entities, including relevant plan information, that have elected to be subject to the provisions of &#xA7;&#xA7; <a class="law" title="Patient access to emergency services" href="/38.2-3445/">38.2-3445</a> through <a class="law" title="Applicability of certain sections" href="/38.2-3445.06/">38.2-3445.06</a>. The <span class="dictionary">Commission</span> shall update such list at least once per quarter. <a id="paragraph-241224" class="section-permalink" href="https://vacode.org/38.2-3445.06/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> The provisions of &#xA7;&#xA7; <a class="law" title="Balance billing for certain services; prohibited" href="/38.2-3445.01/">38.2-3445.01</a> and <a class="law" title="Arbitration" href="/38.2-3445.02/">38.2-3445.02</a> shall not apply to services when the provider&#x2019;s fees are subject to <span class="dictionary">schedules</span> or other monetary limitations under any other <span class="dictionary">law</span>, including the Virginia Workers&#x2019; Compensation Act, and such sections shall not preempt any such <span class="dictionary">law</span>. <a id="paragraph-241225" class="section-permalink" href="https://vacode.org/38.2-3445.06/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> The provisions of &#xA7;&#xA7; <a class="law" title="Patient access to emergency services" href="/38.2-3445/">38.2-3445</a> through <a class="law" title="Enforcement" href="/38.2-3445.05/">38.2-3445.05</a> shall apply to health coverage <span class="dictionary">insurance</span> offered to <span class="dictionary">state</span> employees pursuant to &#xA7; <a class="law" title="Health and related insurance for state employees" href="/2.2-2818/">2.2-2818</a> and may apply to health <span class="dictionary">insurance</span> coverage offered to employees of local governments, local officers, teachers, and retirees, and the dependents of such employees, officers, teachers, and retirees pursuant to &#xA7; <a class="law" title="Health insurance program for employees of local governments, local officers, teachers, etc.; definitions" href="/2.2-1204/">2.2-1204</a>. <a id="paragraph-241226" class="section-permalink" href="https://vacode.org/38.2-3445.06/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> Except for its facilitation of arbitration pursuant to &#xA7; <a class="law" title="Arbitration" href="/38.2-3445.02/">38.2-3445.02</a> and its role in any <span class="dictionary">appeals</span> process established pursuant to subsection J of &#xA7; <a class="law" title="Arbitration" href="/38.2-3445.02/">38.2-3445.02</a>, the <span class="dictionary">Commission</span> shall have no <span class="dictionary">jurisdiction</span> to resolve disputes arising out of &#xA7; <a class="law" title="Balance billing for certain services; prohibited" href="/38.2-3445.01/">38.2-3445.01</a>. <a id="paragraph-241227" class="section-permalink" href="https://vacode.org/38.2-3445.06/#D"><i class="fa fa-link"/></a></p></section>
						<section id="E"><p><span class="prefix-number">E.</span> Except for in a provider <span class="dictionary">contract</span> between a carrier and an in-network provider, no <span class="dictionary">person</span> shall <span class="dictionary">waive</span>, be required to <span class="dictionary">waive</span>, or require another <span class="dictionary">person</span> to <span class="dictionary">waive</span> the provisions of &#xA7;&#xA7; <a class="law" title="Patient access to emergency services" href="/38.2-3445/">38.2-3445</a> through <a class="law" title="Enforcement" href="/38.2-3445.05/">38.2-3445.05</a>. <a id="paragraph-241228" class="section-permalink" href="https://vacode.org/38.2-3445.06/#E"><i class="fa fa-link"/></a></p></section></text><history>2020, cc. 1080, 1081.</history><metadata></metadata></law>
