                                 CODE OF VIRGINIA

PROVISIONS RELATING TO HEALTH INSURANCE ISSUERS (§ 38.2-3554)

A. No group health policy shall be offered to a small employer group health
cooperative that will cover a resident of the Commonwealth unless the Commission
finds that:

   1. The issuance of such group health policy is not contrary to
   Virginia&#8217;s public policy and is in the best interest of the citizens of
   the Commonwealth;

   2. The issuance of the group health policy would result in economies of
   acquisition or administration; and

   3. The benefits are reasonable in relation to the premiums charged.

B. Issuers filing policy forms seeking approval under the provisions of this
subsection shall provide with the forms a certification, signed by the officer
of the company with the responsibility for forms compliance, in which the
company certifies that each such policy form will be issued only when the
requirements set forth in subdivisions 1 through 3 of subsection A have been
satisfied.

C. If a small employer health group cooperative has elected, under subdivision B
1 a of &#xA7; 38.2-3552, to be deemed the policyholder of a group health policy
covering the eligible employees and eligible dependents of its employer-members
within the service area of an issuer and has furnished the authorization
required under subdivision B 2 of &#xA7; 38.2-3552, the issuer of such policy
shall deem the small employer health group cooperative to be the policyholder in
all respects permissible under applicable state and federal laws and
regulations.

D. If a small employer health group cooperative has elected, under subdivision B
1 b of &#xA7; 38.2-3552, to be deemed only a sponsoring entity facilitating the
acquisition of separate group health policies for its employer-members within
the service area of an issuer, the issuer shall issue a separate policy to each
such employer-member of the cooperative. Each such policy shall conform to the
benefit and premium specifications and other policy terms mutually agreed upon
by the issuer and the small employer health group cooperative in accordance with
subsection B of &#xA7; 38.2-3552.

E. An issuer providing a group health policy or policies to or through a small
employer health group cooperative shall make such policy or policies available
to every eligible employee of an employer-member within its service area who
applies for such policy or policies, and their eligible dependents, subject to
an individual employee&#8217;s right to reject coverage in writing. No coverage
may be offered only to certain eligible employees or their eligible dependents,
and no eligible employees or their eligible dependents may be excluded or
charged additional premiums, because of health status-related factors.

F. The premiums for the policy or policies issued to or through a small employer
health group cooperative shall be paid from funds contributed by the small
employer health group cooperative, its employer-members, or both; or from funds
contributed by the covered persons, or from both the covered persons and the
employer-members or small employer health group cooperative.

HISTORY: 2006, c. 427.