                                 CODE OF VIRGINIA

GROUP ACCIDENT AND SICKNESS INSURANCE DEFINITIONS (§ 38.2-3521.1)

Except as provided in § 38.2-3522.1, no policy of group accident and sickness
insurance shall be delivered in this Commonwealth unless it conforms to one of
the following descriptions:

A. A policy issued to an employer, or to the trustees of a fund established by
an employer, which employer or trustees shall be deemed the policyholder, to
insure employees of the employer for the benefit of persons other than the
employer, subject to the following requirements:

   1. The employees eligible for insurance under the policy shall be all of the
   employees of the employer, or all of any class or classes thereof. The policy
   may provide that the term &#8220;employees&#8221; shall include the employees
   of one or more subsidiary corporations, and the employees, individual
   proprietors, and partners of one or more affiliated corporations,
   proprietorships or partnerships if the business of the employer and of such
   affiliated corporations, proprietorships or partnerships is under common
   control. The policy may provide that the term &#8220;employees&#8221; shall
   include retired employees, former employees and directors of a corporate
   employer. A policy issued to insure the employees of a public body may provide
   that the term &#8220;employees&#8221; shall include elected or appointed
   officials.

   2. The premium for the policy shall be paid either from the employer&#8217;s
   funds or from funds contributed by the insured employees, or from both. Except
   as provided in subdivision 3, a policy on which no part of the premium is to
   be derived from funds contributed by the insured employees must insure all
   eligible employees, except those who reject such coverage in writing.

   3. An insurer may exclude or limit the coverage on any person as to whom
   evidence of individual insurability is not satisfactory to the insurer, except
   as otherwise prohibited in this title.

B. A policy that is:

   1. Not subject to Chapter 37.1 (&#xA7; 38.2-3727 et seq.): and

   2. Issued to a creditor or its parent holding company or to a trustee or
   trustees or agent designated by two or more creditors, which creditor, holding
   company, affiliate, trustee, trustees or agent shall be deemed the
   policyholder, to insure debtors of the creditor or creditors with respect to
   their indebtedness, subject to the following requirements:
   				a. The debtors eligible for insurance under the policy shall be all of the
   debtors of the creditor or creditors, or all of any class or classes thereof.
   The policy may provide that the term &#8220;debtors&#8221; shall include:

      1. Borrowers of money or purchasers or lessees of goods, services, or
      property for which payment is arranged through a credit transaction;

      2. The debtors of one or more subsidiary corporations; and

      3. The debtors of one or more affiliated corporations, proprietorships or
      partnerships if the business of the policyholder and of such affiliated
      corporations, proprietorships or partnerships is under common control.
      					b. The premium for the policy shall be paid either from the
      creditor&#8217;s funds, or from charges collected from the insured debtors,
      or from both. Except as provided in subdivision 3, a policy on which no part
      of the premium is to be derived from funds contributed by insured debtors
      specifically for their insurance must insure all eligible debtors.

   3. An insurer may exclude any debtors as to whom evidence of individual
   insurability is not satisfactory to the insurer.

   4. The total amount of insurance payable with respect to an indebtedness shall
   not exceed the greater of the scheduled or actual amount of unpaid
   indebtedness to the creditor. The insurer may exclude any payments that are
   delinquent on the date the debtor becomes disabled as defined in the policy.

   5. The insurance may be payable to the creditor or any successor to the right,
   title, and interest of the creditor. Such payment or payments shall reduce or
   extinguish the unpaid indebtedness of the debtor to the extent of each such
   payment and any excess of the insurance shall be payable to the insured or the
   estate of the insured.

   6. Notwithstanding the preceding provisions of this section, insurance on
   agricultural credit transaction commitments may be written up to the amount of
   the loan commitment. Insurance on educational credit transaction commitments
   may be written up to the amount of the loan commitment less the amount of any
   repayments made on the loan.

C. A policy issued to a labor union, or similar employee organization, which
labor union or organization shall be deemed to be the policyholder, to insure
members of such union or organization for the benefit of persons other than the
union or organization or any of its officials, representatives, or agents,
subject to the following requirements:

   1. The members eligible for insurance under the policy shall be all of the
   members of the union or organization, or all of any class or classes thereof.

   2. The premium for the policy shall be paid from either funds of the union or
   organization, or from funds contributed by the insured members specifically
   for their insurance, or from both. Except as provided in subdivision 3, a
   policy on which no part of the premium is to be derived from funds contributed
   by the insured members specifically for their insurance must insure all
   eligible members, except those who reject such coverage in writing.

   3. An insurer may exclude or limit the coverage on any person as to whom
   evidence of individual insurability is not satisfactory to the insurer, except
   as otherwise prohibited in this title.

D. A policy issued (i) to or for a multiple employer welfare arrangement, a
rural electric cooperative, or a rural electric telephone cooperative as these
terms are defined in 29 U.S.C. § 1002, or (ii) to a trust, or to the trustees
of a fund, established or adopted by or for two or more employers, or by one or
more labor unions of similar employee organizations, or by one or more employers
and one or more labor unions or similar employee organizations, which trust or
trustees shall be deemed the policyholder, to insure employees of the employers
or members of the unions or organizations for the benefit of persons other than
the employers or the unions or organizations, subject to the following
requirements:

   1. The persons eligible for insurance shall be all of the employees of the
   employers or all of the members of the unions or organizations, or all of any
   class or classes thereof. The policy may provide that the term
   &#8220;employee&#8221; shall include the employees of one or more subsidiary
   corporations, and the employees, individual proprietors, and partners of one
   or more affiliated corporations, proprietorships or partnerships if the
   business of the employer and of such affiliated corporations, proprietorships
   or partnerships is under common control. The policy may provide that the term
   &#8220;employees&#8221; shall include retired employees, former employees and
   directors of a corporate employer. The policy may provide that the term
   &#8220;employees&#8221; shall include the trustees or their employees, or
   both, if their duties are principally connected with such trusteeship.

   2. The premium for the policy shall be paid from funds contributed by the
   employer or employers of the insured persons, or by the union or unions or
   similar employee organizations, or by both, or from funds contributed by the
   insured persons or from both the insured persons and the employers or unions
   or similar employee organizations. Except as provided in subdivision 3, a
   policy on which no part of the premium is to be derived from funds contributed
   by the insured persons specifically for their insurance must insure all
   eligible persons, except those who reject such coverage in writing.

   3. An insurer may exclude or limit the coverage on any person as to whom
   evidence of individual insurability is not satisfactory to the insurer, except
   as otherwise prohibited in this title.

E. A policy issued to an association or to a trust or to the trustees of a fund
established, created, or maintained for the benefit of members of one or more
associations which association or trust shall be deemed the policyholder.

   1. The association or associations shall:
   				a. Have at the outset a minimum of 100 persons;
   				b. Have been organized and maintained in good faith for purposes other
   than that of obtaining insurance;
   				c. Have been in active existence for at least five years;
   				d. Have a constitution and bylaws which provide that (i) the association
   or associations hold regular meetings not less than annually to further
   purposes of the members, (ii) except for credit unions, the association or
   associations collect dues or solicit contributions from members, and (iii) the
   members have voting privileges and representation on the governing board and
   committees;
   				e. 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);
   				f. 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);
   				g. Does not make health insurance coverage offered through the association
   available other than in connection with a member of the association; and
   				h. Meets such additional requirements as may be imposed under the laws of
   this Commonwealth.

   2. The policy shall be subject to the following requirements:
   				a. The policy may insure members of such association or associations,
   employees thereof or employees of members, or one or more of the preceding or
   all of any class or classes thereof for the benefit of persons other than the
   employee&#8217;s employer.
   				b. The premium for the policy shall be paid from funds contributed by the
   association or associations, or by employer members, or by both, or from funds
   contributed by the covered persons or from both the covered persons and the
   association, associations, or employer members.

   3. Except as provided in subdivision 4, a policy on which no part of the
   premium is to be derived from funds contributed by the covered persons
   specifically for their insurance must insure all eligible persons, except
   those who reject such coverage in writing.

   4. An insurer may exclude or limit the coverage on any person as to whom
   evidence of individual insurability is not satisfactory to the insurer, except
   as otherwise prohibited in this title.

   5. For a policy issued in the large group market and notwithstanding the
   provisions of &#xA7; 38.2-3449, an insurer may (i) establish base rates formed
   on an actuarially sound, modified community rating methodology that considers
   the pooling of all participant claims and (ii) utilize each employer
   member&#8217;s specific risk profile to determine contribution rates for each
   individual employer member&#8217;s share of the premium by actuarially
   adjusting above or below established base rates.

F. A policy issued to a credit union or to a trustee or trustees or agent
designated by two or more credit unions, which credit union, trustee, trustees,
or agent shall be deemed the policyholder, to insure members of such credit
union or credit unions for the benefit of persons other than the credit union or
credit unions, trustee or trustees, or agent or any of their officials, subject
to the following requirements:

   1. The members eligible for insurance shall be all of the members of the
   credit union or credit unions, or all of any class or classes thereof.

   2. The premium for the policy shall be paid by the policyholder from the
   credit union&#8217;s funds and, except as provided in subdivision 3, must
   insure all eligible members.

   3. An insurer may exclude or limit the coverage on any person as to whom
   evidence of individual insurability is not satisfactory to the insurer.

G. Notwithstanding the provisions of subsection J, a policy issued to an
association of real estate salespersons, as defined in § 54.1-2100, which
association shall be deemed the policyholder, to insure members of such
association, subject to the following requirements:

   1. All of the members of such association shall be eligible for coverage.
   Members shall include (i) an employer member with at least one employee that
   is domiciled in the Commonwealth or (ii) a self-employed individual who (a)
   has an ownership right in a &#8220;trade or business,&#8221; regardless of
   whether the trade or business is incorporated or unincorporated, (b) earns
   wages or self-employment income from the trade or business, and (c) works at
   least 20 hours a week or 80 hours a month providing personal services to the
   trade or business or earns income from the trade or business that at least
   equals the self-employed individual&#8217;s cost of the health coverage.

   2. The association shall (i) have at the outset a minimum of 25,000 members,
   (ii) have been organized and maintained in good faith for purposes other than
   that of obtaining insurance, (iii) have been in active existence for at least
   five years, and (iv) have a constitution and bylaws that provide that (a) the
   association hold regular meetings not less than annually to further purposes
   of the members, (b) the association collects dues or solicits contributions
   from members, and (c) the members have voting privileges and representation on
   the governing board and committees.

   3. In no case shall membership in the association be conditioned on any health
   status-related factor relating to an individual, including an employee of an
   employer or a dependent of an employee.

   4. The health insurance coverage offered through the association shall be
   available to all members regardless of any health status-related factor
   relating to such members or individuals eligible for coverage through a
   member.

   5. The association shall not make health insurance coverage offered through
   the association available other than in connection with a member of the
   association.

   6. The premium for the policy shall be paid from funds contributed by the
   association or by employer members, or by both, or from funds contributed by
   the covered persons or from both the covered persons and the association or
   employer members.

   7. The policy issued to such an association shall (i) be considered a large
   group market plan subject to all coverage mandates applicable to a large group
   market plan offered in the Commonwealth and the large group market insurance
   regulations under the federal Public Health Service Act, P.L. 78-410, as
   amended; (ii) be subject to the group health plan coverage requirements under
   the federal Patient Protection and Affordable Care Act, P.L. 111-148, as
   amended; (iii) be prohibited from denying coverage under the policy on the
   basis of a preexisting condition as set forth in &#xA7; 38.2-3444; (iv) be
   guaranteed issue and guaranteed renewable; (v) notwithstanding the provisions
   of subsection A of &#xA7; 38.2-3451 providing that a large group market plan
   is not required to provide coverage for essential health benefits in a manner
   that exceeds the requirements of the federal Patient Protection and Affordable
   Care Act, P.L. 111-148, as amended, as of January 1, 2019, be subject to the
   requirements to provide essential health benefits and cost-sharing
   requirements as set forth in &#xA7; 38.2-3451; and (vi) 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.

   8. The insurer issuing such a policy shall (i) treat all of the members and
   employees of employer members who are enrolled in coverage under the policy as
   a single risk pool; (ii) set premiums on the basis of all of the collective
   group experience of the members and employees of employer members who are
   enrolled in coverage under the policy; (iii) be permitted to vary premiums by
   age, but such rate shall not vary by more than four to one for adults; (iv) be
   prohibited from varying premiums on the basis of gender; (v) be prohibited
   from varying premiums on the basis of the health status of an individual
   employee of an employer member or a self-employed individual member; and (vi)
   not establish discriminatory rules based on the health status of an employer
   member, an individual employee of an employer member, or a self-employed
   individual for eligibility or contribution.

   9. A policy that meets the requirements of subdivisions 7 and 8 shall be
   considered to be compliant with the large group market insurance regulations
   under the federal Public Health Service Act, P.L. 78-410, as amended, and, as
   such, the Commonwealth, through the regulation of such policy by the
   Commission, shall be considered to be substantially enforcing the federal
   Patient Protection and Affordable Care Act, P.L. 111-148, as amended, with
   regard to such policy. The Commission shall regulate the policy in a manner
   that is consistent with this subdivision. In any case in which a federal
   agency renders a decision that is contrary to the provisions of this
   subdivision, notwithstanding any other provision of law, the Attorney General
   may resolve any difference between federal law and the laws of the
   Commonwealth.

H. A policy issued to a health maintenance organization as provided in
subsection B of &#xA7; 38.2-4314.

I. A policy of blanket insurance issued in accordance with &#xA7; 38.2-3521.2.

J. 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: 1998, c. 154; 2013, c. 751; 2014, c. 350; 2022, cc. 349, 350; 2023, cc.
514, 515; 2024, cc. 459, 621.