                                 CODE OF VIRGINIA

AVAILABILITY (§ 38.2-3432.2)

A. If coverage is offered under this article in the small employer market:

   1. Such coverage shall be offered and made available to all the eligible
   employees of every small employer and their dependents, including late
   enrollees, that apply for such coverage. No coverage may be offered only to
   certain eligible employees or their dependents and no employees or their
   dependents may be excluded or charged additional premiums because of health
   status; and

   2. All products that are approved for sale in the small group market that the
   health insurance issuer is actively marketing must be offered to all small
   employers, and the health insurance issuer must accept any employer that
   applies for any of those products. This subdivision shall not apply to health
   insurance coverage or products offered by a health insurance issuer if such
   coverage or product is made available in the small group market only through
   one or more bona fide associations.

B. No coverage offered under this article shall exclude an employer based solely
on the nature of the employer&#8217;s business.

C. A health insurance issuer that offers health insurance coverage in a small
group market through a network plan may:

   1. Limit the employers that may apply for such coverage to those eligible
   individuals who live, work or reside in the service area for such network
   plan; and

   2. Within the service area of such plan, deny such coverage to such employers
   if the health insurance issuer has demonstrated, if required, to the
   satisfaction of the Commission that:
   				a. It will not have the capacity to deliver services adequately to
   enrollees of any additional groups because of its obligations to existing
   group contract holders and enrollees; and
   				b. It is applying this subdivision uniformly to all employers without
   regard to the claims experience of those employers and their employees (and
   their dependents) or any health status-related factors relating to such
   employees and dependents.

   3. A health insurance issuer upon denying health insurance coverage in any
   service area in accordance with subdivision D 1, may not offer coverage in the
   small group market within such service area for a period of 180 days after the
   date such coverage is denied.

D. A health insurance issuer may deny health insurance coverage in the small
group market if the health insurance issuer has demonstrated, if required, to
the satisfaction of the Commission that:

   1. It does not have the financial reserves necessary to underwrite additional
   coverage; and

   2. It is applying this subdivision uniformly to all employers in the small
   group market in the Commonwealth consistent with the laws of this Commonwealth
   and without regard to the claims experience of those employers and their
   employees (and their dependents) or any health status-related factor relating
   to such employees and dependents.

E. A health insurance issuer upon denying health insurance coverage in
accordance with subsection D in the Commonwealth may not offer coverage in the
small group market for a period of 180 days after the date such coverage is
denied or until the health insurance issuer has demonstrated to the satisfaction
of the Commission that the health insurance issuer has sufficient financial
reserves to underwrite additional coverage, whichever is later.

F. Nothing in this article shall be construed to preclude a health insurance
issuer from establishing employer contribution rules or group participation
rules in connection with a health benefit plan offered in the small group
market. As used in this article, the term &#8220;employer contribution
rule&#8221; means a requirement relating to the minimum level or amount of
employer contribution toward the premium for enrollment of eligible individuals
and the term &#8220;group participation rule&#8221; means a requirement relating
to the minimum number of eligible employees that must be enrolled in relation to
a specified percentage or number of eligible employees. Any employer
contribution rule or group participation rule shall be applied uniformly among
small employers without reference to the size of the small employer group,
health status of the small employer group, or other factors.

G. The provisions of this section shall not apply in any instance in which the
provisions of this section are inconsistent or in conflict with a provision of
Article 6 (&#xA7; 38.2-3438 et seq.) of Chapter 34.

HISTORY: 1997, cc. 807, 913; 1998, c. 24; 2000, c. 544; 2013, c. 751.