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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>73994</law_id><section_number>38.2-4314</section_number><catch_line>Powers of insurers and health services 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="43">Health Maintenance Organizations</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> An <span class="dictionary">insurer</span> or a <span class="dictionary">health services plan</span> licensed in this Commonwealth may, either directly or through a subsidiary or affiliate, organize and operate a <span class="dictionary">health maintenance organization</span> under the provisions of this chapter. Notwithstanding any other <span class="dictionary">law</span> that may be inconsistent with this section, any two or more licensed <span class="dictionary">insurers</span>, <span class="dictionary">health services plans</span>, or their subsidiaries or affiliates, may jointly organize and operate a <span class="dictionary">health maintenance organization</span>. <a id="paragraph-266134" class="section-permalink" href="https://vacode.org/38.2-4314/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> An <span class="dictionary">insurer</span> or a <span class="dictionary">health services plan</span> may <span class="dictionary">contract</span> with a <span class="dictionary">health maintenance organization</span> to provide <span class="dictionary">insurance</span> or similar protection against the cost of care provided through <span class="dictionary">health maintenance organizations</span> and to provide coverage in the event of the failure of the <span class="dictionary">health maintenance organization</span> to meet its obligations. The <span class="dictionary">enrollees</span> of a <span class="dictionary">health maintenance organization</span> constitute a permissible group for purposes of <span class="dictionary">laws</span> applicable to <span class="dictionary">insurers</span> and <span class="dictionary">health services plans</span>. Under the <span class="dictionary">contracts</span> the <span class="dictionary">insurer</span> or <span class="dictionary">health services plans</span> may make benefit payments to <span class="dictionary">health maintenance organizations</span> for <span class="dictionary">health care services</span> rendered by <span class="dictionary">providers</span> under the <span class="dictionary">health care plan</span>. <a id="paragraph-266135" class="section-permalink" href="https://vacode.org/38.2-4314/#B"><i class="fa fa-link"/></a></p></section></text><history>1980, c. 720, &#xA7; 38.1-878; 1986, c. 562.</history><metadata></metadata></law>
