                                 CODE OF VIRGINIA

AUTHORITY AND JURISDICTION OF COMMISSION; EXCEPTION (§ 38.2-3420)

A. Except as provided in subsection C, any person offering or providing coverage
in the Commonwealth for health care services, whether the coverage is by direct
payment, reimbursement, or otherwise, shall be presumed to be subject to the
jurisdiction of the Commission to the extent the person is not regulated by
another agency of the Commonwealth, any subdivision of the Commonwealth, or the
federal government relating to the offering or providing of coverage for health
care services.

B. As used in this subsection:
			&#8220;Health benefit plan&#8221; has the same meaning as described in §
38.2-3431.
			&#8220;Self-funded multiple employer welfare arrangement&#8221; or
&#8220;self-funded MEWA&#8221; means any multiple employer welfare arrangement
that is not fully insured by a licensed insurance company. This term includes a
benefit consortium established under Chapter 55 (§ 59.1-589 et seq.) of Title
59.1.

   1. No self-funded multiple employer welfare arrangement shall issue health
   benefit plans in the Commonwealth until it has obtained a license pursuant to
   regulations promulgated by the Commission. No provision of this subsection
   shall authorize a self-funded MEWA domiciled outside of the Commonwealth to
   operate in the Commonwealth without obtaining a license pursuant to the
   regulations promulgated by the Commission.

   2. Notwithstanding any other section of this title or Chapter 55 (&#xA7;
   59.1-589 et seq.) of Title 59.1 to the contrary, all financial and solvency
   requirements imposed by provisions of this title upon domestic insurers shall
   apply to domestic self-funded MEWAs unless domestic self-funded MEWAs are
   otherwise specifically exempted. For the purposes of handling the
   rehabilitation, liquidation, or conservation of a domestic self-funded MEWA,
   the provisions of Chapter 15 (&#xA7; 38.2-1500 et seq.) shall apply.

   3. Notwithstanding any other section of this title or Chapter 55 (&#xA7;
   59.1-589 et seq.) of Title 59.1 to the contrary, any health benefit plan
   issued by a self-funded MEWA, including a trust, benefits consortium, or other
   arrangement, that covers one or more employees of one or more small employers
   shall (i) provide essential health benefits and cost-sharing requirements as
   set forth in &#xA7; 38.2-3451; (ii) offer a minimum level of coverage designed
   to provide benefits that are actuarially equivalent to 60 percent of the full
   actuarial value of the benefits provided under the plan; (iii) not limit or
   exclude coverage for an individual by imposing a preexisting condition
   exclusion on that individual pursuant to &#xA7; 38.2-3444; (iv) not establish
   discriminatory rules based on health status related to eligibility or premium
   or contribution requirements as imposed on health carriers pursuant to &#xA7;
   38.2-3432.2; (v) meet the renewability standards set forth for health
   insurance issuers in &#xA7; 38.2-3432.1; (vi) establish base rates formed on
   an actuarially sound, modified community rating methodology that considers the
   pooling of all participant claims; and (vii) utilize each employer
   member&#8217;s specific risk profile to determine premiums by actuarially
   adjusting above or below established base rates, and utilize either pooling or
   reinsurance of individual large claimants to reduce the adverse impact on any
   specific employer member&#8217;s premiums.

   4. The Commission shall have authority to adopt regulations applicable to
   self-funded MEWAs, whether domiciled inside or outside of the Commonwealth,
   including regulations addressing the self-funded MEWA&#8217;s financial
   condition, solvency requirements, and insolvency plan and its exclusion,
   pursuant to &#xA7; 59.1-592, from the Virginia Life, Accident and Sickness
   Insurance Guaranty Association established under Chapter 17 (&#xA7; 38.2-1700
   et seq.).

C. Neither the provisions of this section nor any other provision of this title
shall be construed to affect or apply to a multiple employer welfare arrangement
(MEWA) composed only of banks together with their plan-sponsoring organization,
and their respective employees, provided the multiple employer welfare
arrangement (i) is duly licensed as a MEWA by the insurance regulatory agency of
a state contiguous to the Commonwealth, (ii) files with the Commission a copy of
its certificate of authority or other proper license from the contiguous state,
(iii) has no more than 500 Virginia residents who are employees of its member
banks enrolled in or receiving accident and sickness benefits as insureds,
members, enrollees, or subscribers of the MEWA, and (iv) is subject to solvency
examination authority and reserve adequacy requirements determined by sound
actuarial principles by such domiciliary contiguous state. For purposes of this
subsection:
			&#8220;Bank&#8221; means an institution that has or is eligible for insurance
of deposits by the Federal Deposit Insurance Corporation.
			&#8220;Plan-sponsoring organization&#8221; means an association that (i)
sponsors a MEWA composed only of banks; (ii) has been actively in existence for
at least five years; (iii) has been formed and maintained in good faith for
purposes other than obtaining insurance; (iv) does not condition membership in
the association on any health status-related factor relating to an individual,
including an employee of an employer or a dependent of an employee; (v) makes
health insurance coverage offered through the association available to all
members regardless of any health status-related factor relating to such members
or individuals eligible for coverage through a member; (vi) does not make health
insurance coverage offered through the association available other than in
connection with a member of the association; and (vii) meets such additional
requirements as may be imposed under the laws of the Commonwealth, and includes
any subsidiary of such an association.

HISTORY: 1983, c. 417, § 38.1-43.7; 1986, c. 562; 1990, c. 477; 2004, c. 236;
2011, c. 329; 2012, c. 589; 2022, cc. 404, 405.