                                 CODE OF VIRGINIA

POWERS (§ 38.2-4303)

A. The powers of a health maintenance organization shall include, but shall not
be limited to, the following, provided that the activities comply with all
applicable state statutes and regulations:

   1. The purchase, lease, construction, renovation, operation, or maintenance of
   hospitals, medical or other health care facilities, and their ancillary
   equipment and other property reasonably required for its principal office or
   for other purposes necessary in the transaction of the business of the
   organization;

   2. The making of loans to (i) health care providers under contract with it in
   advancement of its health care plan or (ii) any corporation under its control
   for the purpose of acquiring or constructing medical or other health care
   facilities and hospitals or in advancement of its health care plan providing
   health care services to enrollees;

   3. The furnishing of health care services through providers that are under
   contract with or employed by the health maintenance organization;

   4. The contracting with any person for the performance on its behalf of
   certain functions including, but not limited to, marketing, enrollment and
   administration;

   5. The contracting with an insurer or with a health services plan licensed in
   this Commonwealth, for the provision of insurance, indemnity, or reimbursement
   for the cost of health care services provided by the health maintenance
   organization;

   6. The offering, in addition to basic health care services, of:
   				a. Additional health care services;
   				b. Indemnity benefits covering out-of-area services; and
   				c. Indemnity benefits, in addition to those relating to out-of-area
   services, provided through insurers or health services plans;

   7. The offering of health care plans for limited health care services; and

   8. The requirement for the enrollee to pay a deductible or copayment, or both,
   for any health care services offered pursuant to this chapter.

B. 1. A health maintenance organization shall file notice with the Commission
within 30 days after the exercise of any power granted in subdivision 1 or 2 of
subsection A of this section that exceeds one percent of the admitted assets of
the organization or five percent of net worth, whichever is less. A health
maintenance organization shall file notice, with adequate supporting
information, with the Commission prior to the exercise of any power granted in
subdivision 1 or 2 of subsection A of this section that exceeds five percent of
the admitted assets of the organization or 25 percent of net worth, whichever is
less. Any series of transactions occurring within a 12-month period that are
sufficiently similar in nature to be reasonably construed as a single
transaction shall be subject to the limitations set forth in this section. The
Commission shall disapprove the exercise of power if the Commission believes
such exercise of power would substantially and adversely affect the financial
soundness of the health maintenance organization and endanger the health
maintenance organization&#8217;s ability to meet its obligations. If the
Commission does not disapprove the exercise of power within 30 days of the
filing, it shall be deemed approved.

   2. Upon application by the health maintenance organization, the Commission may
   exempt from the filing requirement of subdivision 1 of subsection B of this
   section those activities having a minimal effect.

HISTORY: 1980, c. 720, § 38.1-866; 1986, c. 562; 1990, c. 224; 1992, c. 481;
2003, cc. 752, 767; 2008, c. 214.