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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>73205</law_id><section_number>38.2-4303</section_number><catch_line>Powers</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="43">Health Maintenance Organizations</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> The powers of a <span class="dictionary">health maintenance organization</span> shall include, but shall not be limited to, the following, provided that the activities comply with all applicable <span class="dictionary">state</span> <span class="dictionary">statutes</span> and regulations: <a id="paragraph-263527" class="section-permalink" href="https://vacode.org/38.2-4303/#A"><i class="fa fa-link"/></a></p></section>
						<section id="A1" class="indent-1"><p><span class="prefix-number">1.</span> The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical or other health care facilities, and their ancillary equipment and other property reasonably required for its principal office or for other purposes necessary in the transaction of the business of the organization; <a id="paragraph-263528" class="section-permalink" href="https://vacode.org/38.2-4303/#A1"><i class="fa fa-link"/></a></p></section>
						<section id="A2" class="indent-1"><p><span class="prefix-number">2.</span> The making of loans to (i) <span class="dictionary">health care providers</span> under <span class="dictionary">contract</span> with it in advancement of its <span class="dictionary">health care plan</span> or (ii) any corporation under its control for the purpose of acquiring or constructing medical or other health care facilities and hospitals or in advancement of its <span class="dictionary">health care plan</span> providing <span class="dictionary">health care services</span> to <span class="dictionary">enrollees</span>; <a id="paragraph-263529" class="section-permalink" href="https://vacode.org/38.2-4303/#A2"><i class="fa fa-link"/></a></p></section>
						<section id="A3" class="indent-1"><p><span class="prefix-number">3.</span> The furnishing of <span class="dictionary">health care services</span> through providers that are under <span class="dictionary">contract</span> with or employed by the <span class="dictionary">health maintenance organization</span>; <a id="paragraph-263530" class="section-permalink" href="https://vacode.org/38.2-4303/#A3"><i class="fa fa-link"/></a></p></section>
						<section id="A4" class="indent-1"><p><span class="prefix-number">4.</span> The contracting with any <span class="dictionary">person</span> for the performance on its behalf of certain functions including, but not limited to, marketing, enrollment and administration; <a id="paragraph-263531" class="section-permalink" href="https://vacode.org/38.2-4303/#A4"><i class="fa fa-link"/></a></p></section>
						<section id="A5" class="indent-1"><p><span class="prefix-number">5.</span> The contracting with an <span class="dictionary">insurer</span> or with a <span class="dictionary">health services plan</span> licensed in this Commonwealth, for the provision of <span class="dictionary">insurance</span>, indemnity, or reimbursement for the cost of <span class="dictionary">health care services</span> provided by the <span class="dictionary">health maintenance organization</span>; <a id="paragraph-263532" class="section-permalink" href="https://vacode.org/38.2-4303/#A5"><i class="fa fa-link"/></a></p></section>
						<section id="A6" class="indent-1"><p><span class="prefix-number">6.</span> The offering, in addition to <span class="dictionary">basic <span class="dictionary">health care services</span></span>, of:
				a. Additional <span class="dictionary">health care services</span>;
				b. Indemnity benefits covering out-of-area services; and
				c. Indemnity benefits, in addition to those relating to out-of-area services, provided through <span class="dictionary">insurers</span> or <span class="dictionary">health services plans</span>; <a id="paragraph-263533" class="section-permalink" href="https://vacode.org/38.2-4303/#A6"><i class="fa fa-link"/></a></p></section>
						<section id="A7" class="indent-1"><p><span class="prefix-number">7.</span> The offering of <span class="dictionary">health care plans</span> for <span class="dictionary">limited <span class="dictionary">health care services</span></span>; and <a id="paragraph-263534" class="section-permalink" href="https://vacode.org/38.2-4303/#A7"><i class="fa fa-link"/></a></p></section>
						<section id="A8" class="indent-1"><p><span class="prefix-number">8.</span> The requirement for the <span class="dictionary">enrollee</span> to pay a <span class="dictionary">deductible</span> or <span class="dictionary">copayment</span>, or both, for any <span class="dictionary">health care services</span> offered pursuant to this chapter. <a id="paragraph-263535" class="section-permalink" href="https://vacode.org/38.2-4303/#A8"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> 1. A <span class="dictionary">health maintenance organization</span> shall file notice with the <span class="dictionary">Commission</span> within 30 days after the exercise of any power granted in subdivision 1 or 2 of subsection A of this section that exceeds one percent of the admitted <span class="dictionary">assets</span> of the organization or five percent of <span class="dictionary">net worth</span>, whichever is less. A <span class="dictionary">health maintenance organization</span> shall file notice, with adequate supporting information, with the <span class="dictionary">Commission</span> prior to the exercise of any power granted in subdivision 1 or 2 of subsection A of this section that exceeds five percent of the admitted <span class="dictionary">assets</span> of the organization or 25 percent of <span class="dictionary">net worth</span>, whichever is less. Any series of transactions occurring within a 12-month period that are sufficiently similar in nature to be reasonably construed as a single transaction shall be subject to the limitations set forth in this section. The <span class="dictionary">Commission</span> shall disapprove the exercise of power if the <span class="dictionary">Commission</span> believes such exercise of power would substantially and adversely affect the financial soundness of the <span class="dictionary">health maintenance organization</span> and endanger the <span class="dictionary">health maintenance organization</span>&#x2019;s ability to meet its obligations. If the <span class="dictionary">Commission</span> does not disapprove the exercise of power within 30 days of the filing, it shall be deemed approved. <a id="paragraph-263536" class="section-permalink" href="https://vacode.org/38.2-4303/#B"><i class="fa fa-link"/></a></p></section>
						<section id="B2" class="indent-1"><p><span class="prefix-number">2.</span> Upon application by the <span class="dictionary">health maintenance organization</span>, the <span class="dictionary">Commission</span> may exempt from the filing requirement of subdivision 1 of subsection B of this section those activities having a minimal effect. <a id="paragraph-263537" class="section-permalink" href="https://vacode.org/38.2-4303/#B2"><i class="fa fa-link"/></a></p></section></text><history>1980, c. 720, &#xA7; 38.1-866; 1986, c. 562; 1990, c. 224; 1992, c. 481; 2003, cc. 752, 767; 2008, c. 214.</history><metadata></metadata></law>
