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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>76403</law_id><section_number>38.2-6600</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>38.2-4214</reference><reference>38.2-4319</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="66">Commonwealth Health Reinsurance Program</unit></structure><text>
						<section><p>As used in this chapter, unless the context requires a different meaning:
		&#x201C;<span class="dictionary">Affordable Care Act</span>&#x201D; means the Patient Protection and <span class="dictionary">Affordable Care Act</span>, P.L. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, P.L. 111-152, and as it may be further amended.
		&#x201C;<span class="dictionary">Allowed amount</span>&#x201D; has the same meaning as provided in &#xA7;&#xA0;<a class="law" title="Definitions" href="/38.2-3438/">38.2-3438</a>.
		&#x201C;<span class="dictionary">Attachment point</span>&#x201D; means the amount set by the <span class="dictionary">Commission</span> for claims costs incurred by an eligible carrier for a <span class="dictionary">covered person</span>&#x2019;s <span class="dictionary">covered benefits</span> in a <span class="dictionary">benefit year</span>, above which the claims costs for benefits are eligible for <span class="dictionary">reinsurance payments</span> under the <span class="dictionary">Program</span>.
		&#x201C;<span class="dictionary">Benefit year</span>&#x201D; means the calendar year for which an eligible carrier provides coverage through an individual health benefit plan.
		&#x201C;<span class="dictionary">Coinsurance rate</span>&#x201D; means the rate set by the <span class="dictionary">Commission</span> at which the <span class="dictionary">Program</span> will reimburse an eligible carrier for claims incurred for a <span class="dictionary">covered person</span>&#x2019;s <span class="dictionary">covered benefits</span> in a <span class="dictionary">benefit year</span>, which claims exceed the <span class="dictionary">attachment point</span> but are below the <span class="dictionary">reinsurance cap</span>.
		&#x201C;<span class="dictionary">Covered benefits</span>&#x201D; has the same meaning as provided in &#xA7;&#xA0;<a class="law" title="Definitions" href="/38.2-3438/">38.2-3438</a>.
		&#x201C;<span class="dictionary">Covered person</span>&#x201D; means an individual covered under <span class="dictionary">individual health insurance coverage</span> that (i) is delivered or issued for delivery in the Commonwealth and (ii) is neither a <span class="dictionary">grandfathered plan</span>, student health insurance coverage, nor transitional coverage that the federal government allows under a nonenforcement policy.
		&#x201C;Eligible carrier&#x201D; means a carrier that (i) offers <span class="dictionary">individual health insurance coverage</span> other than a <span class="dictionary">grandfathered plan</span>, student health insurance coverage, or transitional coverage that the federal government allows under a nonenforcement policy and (ii) incurs claims costs for a <span class="dictionary">covered person</span>&#x2019;s <span class="dictionary">covered benefits</span> in the applicable <span class="dictionary">benefit year</span>.
		&#x201C;<span class="dictionary">Fund</span>&#x201D; means the Commonwealth Health Reinsurance <span class="dictionary">Program</span> Special <span class="dictionary">Fund</span> established by the <span class="dictionary">Commission</span> pursuant to &#xA7;&#xA0;<a class="law" title="Commonwealth Health Reinsurance Program Special Fund" href="/38.2-6604/">38.2-6604</a>.
		&#x201C;<span class="dictionary">Grandfathered plan</span>&#x201D; has the same meaning as provided in &#xA7;&#xA0;<a class="law" title="Definitions" href="/38.2-3438/">38.2-3438</a>.
		&#x201C;<span class="dictionary">Group health insurance coverage</span>&#x201D; has the same meaning as provided in &#xA7;&#xA0;<a class="law" title="Definitions" href="/38.2-3438/">38.2-3438</a>.
		&#x201C;<span class="dictionary">Individual health insurance coverage</span>&#x201D; has the same meaning as provided in &#xA7;&#xA0;<a class="law" title="Definitions" href="/38.2-3438/">38.2-3438</a>.
		&#x201C;<span class="dictionary">Net written premiums</span>&#x201D; means premiums earned on individual and <span class="dictionary">group health insurance coverage</span>, including <span class="dictionary">grandfathered plans</span>, in the Commonwealth, less return premiums and dividends paid or credited to policy or <span class="dictionary">contract</span> holders on the health benefits plan business.
		&#x201C;<span class="dictionary">Payment parameters</span>&#x201D; means the <span class="dictionary">attachment point</span>, <span class="dictionary">reinsurance cap</span>, and <span class="dictionary">coinsurance rate</span> for the <span class="dictionary">Program</span>.
		&#x201C;<span class="dictionary">Program</span>&#x201D; means the Commonwealth Health Reinsurance <span class="dictionary">Program</span> established pursuant to this chapter.
		&#x201C;<span class="dictionary">Reinsurance cap</span>&#x201D; means the amount set by the <span class="dictionary">Commission</span> for claims costs incurred by an eligible carrier for a <span class="dictionary">covered person</span>&#x2019;s <span class="dictionary">covered benefits</span> in a <span class="dictionary">benefit year</span>, above which the claims costs for benefits are no longer eligible for <span class="dictionary">reinsurance payments</span> under the <span class="dictionary">Program</span>.
		&#x201C;<span class="dictionary">Reinsurance payment</span>&#x201D; means an amount paid to an eligible carrier under the <span class="dictionary">Program</span>.
		&#x201C;<span class="dictionary">State Innovation Waiver</span>&#x201D; means a waiver of one or more requirements of the <span class="dictionary">Affordable Care Act</span> authorized by &#xA7;&#xA0;1332 of the <span class="dictionary">Affordable Care Act</span>, 42 U.S.C. &#xA7;&#xA0;18052, and applicable federal regulations.
		&#x201C;<span class="dictionary">Total amount paid by the eligible carrier for any eligible claim</span>&#x201D; means the amount paid by the eligible carrier based on the <span class="dictionary">allowed amount</span> less any deductible, coinsurance, or copayment, as of the time applicable data is submitted or made accessible under subdivision C 1 of &#xA7;&#xA0;<a class="law" title="Commonwealth Health Reinsurance Program; established" href="/38.2-6602/">38.2-6602</a>.</p></section></text><history>2021, Sp. Sess. I, c. 480; 2022, cc. 547, 548.</history><metadata></metadata></law>
