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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>76670</law_id><section_number>38.2-3551</section_number><catch_line>Definitions</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>38.2-3449</reference><reference>38.2-4214</reference><reference>38.2-4319</reference><reference>38.2-4509</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="35">Accident and Sickness Insurance Policies</unit><unit label="article" level="3" order_by="1" identifier="5">Small Employer Health Insurance Pooling</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> As used in this article:
			&#x201C;<span class="dictionary">Eligible dependent</span>&#x201D; means an individual who may be covered as a dependent under a <span class="dictionary">group health policy</span> or policies and who is eligible, as determined by a <span class="dictionary">small employer health group cooperative</span>, for coverage as a dependent of an <span class="dictionary">eligible employee</span> under a <span class="dictionary">group health policy</span> or policies issued to or through such <span class="dictionary">small employer health group cooperative</span>.
			&#x201C;<span class="dictionary">Eligible employee</span>&#x201D; means an employee who works for a small employer on a full-time basis, has a normal work week of 30 or more hours, has satisfied applicable waiting period requirements, and is not a part-time, temporary, or substitute employee.
			&#x201C;<span class="dictionary">Employer-member</span>&#x201D; means a small employer participating in a <span class="dictionary">small employer health group cooperative</span>.
			&#x201C;<span class="dictionary">Group health policy</span>&#x201D; or &#x201C;policy&#x201D; means a group insurance policy providing hospital, medical and surgical or major medical coverage on an expense-incurred basis, a group accident and sickness insurance policy or subscription <span class="dictionary">contract</span>, and a group health care plan for health care services or limited health care services provided by a health maintenance organization. For the purposes of this article, a <span class="dictionary">group health policy</span> or policy shall also mean a policy or plan provided by a dental or optometric services plan, dental plan organization, and a health maintenance organization offering limited health care services as defined in &#xA7;&#xA0;<a class="law" title="Definitions" href="/38.2-4300/">38.2-4300</a>.
			&#x201C;<span class="dictionary">Health insurance issuer</span>&#x201D; or &#x201C;issuer&#x201D; means a <span class="dictionary">company</span> authorized to <span class="dictionary">issue</span> coverage under Article 3 (&#xA7;&#xA0;<a class="law" title="Group accident and sickness insurance definitions" href="/38.2-3521.1/">38.2-3521.1</a> et seq.) of Chapter 35, Chapter 42 (&#xA7;&#xA0;<a class="law" title="Applicability of chapter" href="/38.2-4200/">38.2-4200</a> et seq.), Chapter 43 (&#xA7;&#xA0;<a class="law" title="Definitions" href="/38.2-4300/">38.2-4300</a> et seq.), Chapter 45 (&#xA7;&#xA0;<a class="law" title="Applicability of chapter" href="/38.2-4500/">38.2-4500</a> et seq.), or Chapter 61 (&#xA7;&#xA0;<a class="law" title="Applicability of chapter" href="/38.2-6100/">38.2-6100</a> et seq.) of this title.
			&#x201C;<span class="dictionary">Health status-related factor</span>&#x201D; means the following in relation to the individual or a dependent eligible for coverage under a group health plan or health insurance coverage offered by a <span class="dictionary">health insurance issuer</span>: <a id="paragraph-275229" class="section-permalink" href="https://vacode.org/38.2-3551/#A"><i class="fa fa-link"/></a></p></section>
						<section id="A1" class="indent-1"><p><span class="prefix-number">1.</span> Health status; <a id="paragraph-275230" class="section-permalink" href="https://vacode.org/38.2-3551/#A1"><i class="fa fa-link"/></a></p></section>
						<section id="A2" class="indent-1"><p><span class="prefix-number">2.</span> Medical condition, including both physical and mental illnesses; <a id="paragraph-275231" class="section-permalink" href="https://vacode.org/38.2-3551/#A2"><i class="fa fa-link"/></a></p></section>
						<section id="A3" class="indent-1"><p><span class="prefix-number">3.</span> Claims experience; <a id="paragraph-275232" class="section-permalink" href="https://vacode.org/38.2-3551/#A3"><i class="fa fa-link"/></a></p></section>
						<section id="A4" class="indent-1"><p><span class="prefix-number">4.</span> Receipt of health care; <a id="paragraph-275233" class="section-permalink" href="https://vacode.org/38.2-3551/#A4"><i class="fa fa-link"/></a></p></section>
						<section id="A5" class="indent-1"><p><span class="prefix-number">5.</span> Medical history; <a id="paragraph-275234" class="section-permalink" href="https://vacode.org/38.2-3551/#A5"><i class="fa fa-link"/></a></p></section>
						<section id="A6" class="indent-1"><p><span class="prefix-number">6.</span> Genetic information; <a id="paragraph-275235" class="section-permalink" href="https://vacode.org/38.2-3551/#A6"><i class="fa fa-link"/></a></p></section>
						<section id="A7" class="indent-1"><p><span class="prefix-number">7.</span> <span class="dictionary">Evidence</span> of insurability, including conditions arising out of acts of domestic violence; or <a id="paragraph-275236" class="section-permalink" href="https://vacode.org/38.2-3551/#A7"><i class="fa fa-link"/></a></p></section>
						<section id="A8" class="indent-1"><p><span class="prefix-number">8.</span> Disability.
				&#x201C;<span class="dictionary">Service area</span>&#x201D; means the geographic area within which a <span class="dictionary">health insurance issuer</span> is authorized to sell a <span class="dictionary">group health policy</span> or policies.
				&#x201C;Small employer&#x201D; means, in connection with a <span class="dictionary">group health policy</span> with respect to a calendar year and a plan year, an employer who employed an average of at least one but not more than 50 employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year.
				&#x201C;<span class="dictionary">Small employer health group cooperative</span>&#x201D; or &#x201C;cooperative&#x201D; means an entity authorized by its <span class="dictionary">employer-members</span> to negotiate with <span class="dictionary">health insurance issuers</span> on their behalf as to the terms, including premium <span class="dictionary"><span class="dictionary">rates</span></span>, under which a <span class="dictionary">group health policy</span> or policies may be issued, providing coverage for the <span class="dictionary">eligible employees</span> of such <span class="dictionary">employer-members</span> and their <span class="dictionary">eligible dependents</span>. <a id="paragraph-275237" class="section-permalink" href="https://vacode.org/38.2-3551/#A8"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> The provisions of this section shall not apply in any instance in which the provisions of this section are inconsistent or in conflict with a provision of Article 6 (&#xA7; <a class="law" title="Definitions" href="/38.2-3438/">38.2-3438</a> et seq.) of Chapter 34. <a id="paragraph-275238" class="section-permalink" href="https://vacode.org/38.2-3551/#B"><i class="fa fa-link"/></a></p></section></text><history>2006, c. 427; 2013, c. 751; 2016, c. 1.</history><metadata></metadata></law>
