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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>74357</law_id><section_number>38.2-4320.1</section_number><catch_line>Explanation of benefits for health maintenance organization enrollees who are recipients of medical assistance services or covered by the Family Access to Medical Insurance Security (FAMIS) Plan</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><p>In the case of any <span class="dictionary">health maintenance organization</span> that has contracted with the Virginia Department of Medical Assistance Services to provide <span class="dictionary">health care services</span> to recipients of medical assistance services pursuant to Title XIX of the Social Security Act, as amended, or to individuals who are covered by the Family Access to Medical <span class="dictionary">Insurance</span> Security (FAMIS) Plan developed pursuant to Title XXI of the Social Security Act, as amended, the requirements for furnishing an explanation of benefits to current or former <span class="dictionary">members</span> and their respective <span class="dictionary">health care providers</span> shall be as authorized and directed in the standards prescribed in the <span class="dictionary">state</span> plan for medical assistance services pursuant to Chapter 10 (&#xA7;&#xA0;<a class="law" title="Department of Medical Assistance Services" href="/32.1-323/">32.1-323</a> et seq.) of Title 32.1 and the FAMIS Plan pursuant to Chapter 13 (&#xA7;&#xA0;<a class="law" title="Family Access to Medical Insurance Security Plan established" href="/32.1-351/">32.1-351</a> et seq.) of Title 32.1. The requirements for an explanation of benefits otherwise addressed in this title shall not apply to such <span class="dictionary">health maintenance organization</span> when contracting to deliver such services to the extent that the statutory requirements differ from the standards of the Department of Medical Assistance Services.</p></section></text><history>2004, c. 185.</history><metadata></metadata></law>
