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Virginia Statutes, Title 38.2

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Virginia/Statutes

← All Virginia coverage

Title 38.2, Insurance

68 chapters · 1,805 sections in this title.

All chapters in Title 38.21,805 Ch 34, Provisions Relating to Accident and …175 Ch 13, Reports, Reserves and Examinations, …121 Ch 18, Insurance Agents.115 Ch 10, Organization, Admission and Licensin…74 Ch 35, Accident and Sickness Insurance Poli…65 Ch 33, Life Insurance Policies.58 Ch 14, Investments.54 Ch 1, General Provisions.46 Ch 2, Provisions of a General Nature.41 Ch 22, Liability Insurance Policies.41 Ch 42, Health Services Plans.39 Ch 31, Life Insurance.38 Ch 41, Fraternal Benefit Societies.38 Ch 19, Regulation of Rates Generally.36

1,805 sections·Filtered byTitle 38.2✕

Va. Code Ann. § 38.2-6508 Open enrollment periods
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Health carriers shall be permitted to utilize open enrollment periods outside of an Exchange as permitted inside of an Exchange pursuant to § 1311(c)(6) of the Federal Act.
Va. Code Ann. § 38.2-6509 Choice
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A. In accordance with § 1312(f)(2)(A) of the Federal Act, a qualified employer may either designate one or more qualified health plans from which its eligible employees may choose or designate any level of coverage to be made available to eligible employees through an Exchange. B…
Va. Code Ann. § 38.2-6510 Health Insurance Exchange Fund; assessment
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A. The Exchange shall be authorized to fund its operations through (i) special fund revenues generated by assessment fees on health carriers offering plans through the Exchange, (ii) funds described in subsection H, or (iii) such funds as the General Assembly may from time to tim…
Va. Code Ann. § 38.2-6511 Procurement, contracting, and personnel
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A. The Commission may contract with other eligible entities and enter into memoranda of understanding with other agencies of the Commonwealth to carry out any of the functions of the Exchange, including agreements with other states or federal agencies to perform joint administrat…

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Va. Code Ann. § 38.2-6512 Confidentiality

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A. Notwithstanding any other provision of law, the records of the Exchange shall be open to public inspection, except that the following information shall not be subject to disclosure: (i) the names and applications of individuals and employers seeking coverage through the Exchan…

Va. Code Ann. § 38.2-6513 Navigators

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A. No person shall act as a Navigator unless the person is registered pursuant to Article 7 (§ 38.2-3455 et seq.) of Chapter 34 and is certified by either the U.S. Department of Health and Human Services or the Exchange. B. The Exchange shall establish a program under which it sh…

Va. Code Ann. § 38.2-6514 Certified application counselors

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A. The Exchange shall establish a Certified Application Counselor program pursuant to 45 C.F.R. § 155.225 and shall (i) certify individuals as certified application counselors to perform specified duties, (ii) designate an organization to certify individuals as certified applicat…

Va. Code Ann. § 38.2-6515 Regulations

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The Commission shall promulgate regulations to implement the provisions of this chapter in accordance with the Commission's rules of practice and procedure. Regulations promulgated under this section shall be consistent with applicable provisions of federal and state law.

Va. Code Ann. § 38.2-6516 Reports

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The Exchange, in collaboration with the Secretary of Health and Human Resources, shall submit a report by November 1 of each year to the Chairs of the Senate Committees on Commerce and Labor and Finance and Appropriations and the House Committees on Labor and Commerce and Appropr…

Va. Code Ann. § 38.2-6517 Relation to other laws

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Nothing in this chapter, and no action taken by the Exchange pursuant to this chapter, shall be construed to preempt or supersede the authority of the Commission to regulate the business of insurance within the Commonwealth. Except as expressly provided to the contrary in this ch…

Va. Code Ann. § 38.2-6600 Definitions

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As used in this chapter, unless the context requires a different meaning: "Affordable Care Act" means the Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, P.L. 111-152, and as it may be further amend…

Va. Code Ann. § 38.2-6601 Commission powers and duties; rules; report

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A. The Commission shall have all the powers necessary to implement the provisions of this chapter and is specifically authorized to: 1. Enter into contracts as necessary or proper to carry out the provisions and purposes of this chapter, including contracts for the administration…

Va. Code Ann. § 38.2-6602 Commonwealth Health Reinsurance Program; established

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A. The Commission shall implement a reinsurance program, known as the Commonwealth Health Reinsurance Program. Implementation and operation of the Program is contingent upon approval of the State Innovation Waiver submitted by the Commission in accordance with § 38.2-6606. If the…

Va. Code Ann. § 38.2-6603 Accounting; reports

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A. The Commission shall keep an accounting for each benefit year of all: 1. Funds appropriated for reinsurance payments and administrative and operational expenses; 2. Requests for reinsurance payments received from eligible carriers; 3. Reinsurance payments made to eligible carr…

Va. Code Ann. § 38.2-6604 Commonwealth Health Reinsurance Program Special Fund

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A. The Commission shall be authorized to fund the operations of the Program and to fund other purposes to implement the approved State Innovation Waiver through funds provided to the Commonwealth pursuant to the State Innovation Waiver requested pursuant to § 38.2-6606 and any su…

Va. Code Ann. § 38.2-6605 Confidentiality of data

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Data and information that an eligible carrier considers confidential proprietary information that is provided to the Commission pursuant to the provisions of this chapter shall be excluded from, and the Commission shall not be subject to, subpoena or public inspection with respec…

Va. Code Ann. § 38.2-6606 State Innovation Waiver request

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A. The Commission shall apply to the appropriate federal agencies under 42 U.S.C. § 18052 for a State Innovation Waiver for benefit years beginning January 1, 2023, and future years, (i) to establish a reinsurance program, in accordance with the provisions of this chapter; (ii) t…

Va. Code Ann. § 38.2-3556 Definitions

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As used in this chapter, unless the context requires a different meaning: "Adverse determination" means a determination by a health carrier or its designee utilization review entity that an admission, availability of care, continued stay, or other health care service that is a co…

Va. Code Ann. § 38.2-3557 Scope of chapter

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A. This chapter shall apply to all health carriers, except that the provisions of this chapter shall not apply to a policy or certificate that provides coverage only for a specified disease, specified accident or accident-only coverage, credit, disability income, hospital indemni…

Va. Code Ann. § 38.2-3558 Health carrier's internal appeal process

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Each health carrier shall establish an internal appeal process, including a process for urgent care appeals, to consider a utilization review adverse determination or other adverse benefit determination or decision that is appealed by a covered person, his authorized representati…

Va. Code Ann. § 38.2-3559 Notice of right to external review

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A. A health carrier shall notify the covered person in writing of an adverse determination or final adverse determination and the covered person's right to request an external review within five business days after the adverse determination or final adverse determination has been…

Va. Code Ann. § 38.2-3560 Exhaustion of internal appeal process

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A. A request for an external review shall not be made until the covered person has exhausted the health carrier's internal appeal process, provided that a covered person's exhaustion of the health carrier's internal appeal process shall not be required if the adverse determinatio…

Va. Code Ann. § 38.2-3561 Standard external review

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A. Within 120 days after the date of receipt of a notice of the right to an external review of a final adverse determination or an adverse determination if the internal appeal process has been deemed to be exhausted or waived, a covered person or his authorized representative may…

Va. Code Ann. § 38.2-3562 Expedited external review

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A. A covered person or his authorized representative may make a request for an expedited external review with the Commission at the time the covered person receives: 1. An adverse determination if the adverse determination involves (i) cancer or (ii) a medical condition of the co…

Va. Code Ann. § 38.2-3563 External review of experimental or investigational treatment adverse determinations

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A. Within 120 days after the date of receipt of a notice of the right to an external review of an adverse determination or final adverse determination that involves a denial of coverage based on a determination that the health care service or treatment recommended or requested is…

Va. Code Ann. § 38.2-3564 Binding nature of external review decision

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A. An external review decision is binding on the health carrier. Failure to comply with the assigned independent review organization's external review decision shall be a knowing and willful violation of this section and subject to one or more of the following: (i) punishment as …

Va. Code Ann. § 38.2-3565 Minimum qualifications for independent review organizations

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A. An independent review organization shall have and maintain written policies and procedures that govern all aspects of both the standard external review process and the expedited external review process and that include, at a minimum: 1. A quality assurance mechanism in place t…

Va. Code Ann. § 38.2-3566 Approval of independent review organizations

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A. Each independent review organization that wishes to be eligible to conduct external reviews shall submit an application to the Commission for approval or reapproval. The Commission may charge a reasonable fee for initial approval and each reapproval. B. The Commission shall ap…

Va. Code Ann. § 38.2-3567 Independent review organizations to be held harmless

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No independent review organization or clinical reviewer working on behalf of an independent review organization or an employee, agent, or contractor of an independent review organization shall be liable in damages to any person for any opinions rendered or acts or omissions perfo…

Va. Code Ann. § 38.2-3568 External review reporting requirements

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A. An independent review organization shall maintain written records, in the aggregate by state and by health carrier, on all external review requests and external reviews conducted during each calendar year. Each independent review organization shall submit a report to the Commi…

Va. Code Ann. § 38.2-3569 Funding of external review

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The health carrier against which a request for an external review is filed shall pay the cost incurred by the independent review organization in conducting the external review.

Va. Code Ann. § 38.2-3570 Disclosure requirements

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Each health carrier shall include a description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage it provides to covered persons. The description shall include a statement that infor…

Va. Code Ann. § 38.2-3571 Regulations

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Pursuant to the authority granted by § 38.2-223, the Commission may adopt such rules and regulations as it may deem necessary to implement this chapter.

Va. Code Ann. § 38.2-3717 Scope

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All life insurance and all accident and sickness insurance issued or sold in connection with loans or other credit transactions shall be subject to the provisions of this chapter except: 1. Such insurance issued in connection with a loan or other credit transaction of more than t…

Va. Code Ann. § 38.2-3718 Definitions

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For the purposes of this chapter: "Commission" means the State Corporation Commission. "Creditor" means the lender of money or vendor or lessor of goods, services, or property, rights or privileges, for which payment is arranged through a credit transaction, or any successor to t…

Va. Code Ann. § 38.2-3719 Forms of credit life insurance and credit accident and sickness insurance

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A. Credit life insurance and credit accident and sickness insurance shall be issued only in the following forms: 1. Individual policies of life insurance issued to debtors on the term plan; 2. Individual policies of accident and sickness insurance issued to debtors on a term plan…

Va. Code Ann. § 38.2-3720 Amount of credit life insurance and credit accident and sickness insurance

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A. Credit life insurance. 1. Where an indebtedness is repayable in substantially equal installments, the amount of credit life insurance shall at no time exceed the actual amount of unpaid indebtedness. 2. Notwithstanding the provisions of subdivision A 1, insurance on agricultur…

Va. Code Ann. § 38.2-3721 Term of credit life insurance and credit accident and sickness insurance

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A. The term of any policy or certificate of credit life insurance or credit accident and sickness insurance shall, subject to acceptance by the insurer, commence on the date when the debtor becomes obligated to the creditor; except that where a group policy provides coverage with…

Va. Code Ann. § 38.2-3722 Variable interest rate indebtedness; amount; disclosure; refunds

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A. Notwithstanding the terms of § 38.2-3720, if the credit transaction provides for a variable interest rate and the insurance premiums are calculated and charged on a single premium basis, the initial amount of insurance coverage shall not exceed the scheduled amounts of unpaid …

Va. Code Ann. § 38.2-3723 Reserves

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A. Each insurer licensed to write credit life insurance in the Commonwealth shall establish and maintain reserves on all its credit life insurance. The minimum standard for the valuation for such reserves: 1. For both male and female insureds shall be the 2001 Commissioners' Stan…

Va. Code Ann. § 38.2-3724 Policy provisions; disclosure to debtors; delivery of policy or certificate

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A. Credit life insurance and credit accident and sickness insurance shall be evidenced by an individual policy, or in the case of group insurance by a certificate of insurance. The policy or certificate of insurance shall: (i) be a document separate and apart from the loan or cre…

Va. Code Ann. § 38.2-3725 Policy forms to be filed with Commission; approval or disapproval by Commission

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A. No form shall be delivered or issued for delivery in this Commonwealth until a copy of each form has been filed with and approved by the Commission. B. If a group policy of credit life or credit accident and sickness insurance is delivered in another state, the insurer shall b…

Va. Code Ann. § 38.2-3726 Credit life insurance rates

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A. The benefits provided by any credit life insurance form shall be deemed reasonable in relation to the premium charged or to be charged if the rates do not exceed the rates set forth below, except as such rates are modified pursuant to the requirements of § 38.2-3730: 1. $.7519…

Va. Code Ann. § 38.2-3727 Credit accident and sickness insurance rates

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A. The Commission shall, based on a morbidity study, promulgate seven-, fourteen- and thirty-day retroactive and nonretroactive credit accident and sickness insurance premium rates which will reasonably be expected to produce the loss ratio as required by subsection E of § 38.2-3…

Va. Code Ann. § 38.2-3728 Use of rates

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A. Use of prima facie rates. An insurer that files rates or has rates on file that are not in excess of the prima facie rates set forth in § 38.2-3726 or published as set forth in § 38.2-3727, to the extent adjusted pursuant to § 38.2-3730, may use those rates without further pro…

Va. Code Ann. § 38.2-3729 Refunds

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A. Each individual policy or group certificate shall provide that, in the event of termination of the insurance prior to the scheduled maturity date of the indebtedness, any refund of an amount paid by the debtor for insurance shall be paid or credited promptly to the debtor or p…

Va. Code Ann. § 38.2-3730 Experience reports and adjustment of prima facie rates

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A. Each insurer doing insurance business in this Commonwealth shall annually file with the National Association of Insurance Commissioners a report of credit life and credit accident and sickness written on a calendar year basis. Such report shall utilize the Credit Insurance Sup…

Va. Code Ann. § 38.2-3731 Claims

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A. All claims shall be promptly reported to the insurer or its designated claim representative. The insurer shall maintain adequate claim files. All claims shall be settled as soon as possible and in accordance with the terms of the insurance contract. B. All claims shall be paid…

Va. Code Ann. § 38.2-3732 Insurer delegation of duties

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Any insurer that delegates to a creditor any of its duties under the laws of this Commonwealth or the regulations of this Commission shall be responsible to see that such creditor discharges such duties in accordance with said laws and regulations. A finding by the Commission tha…

Va. Code Ann. § 38.2-3733 Portion of premium may be allowed to creditor; insurance may be provided and serviced at creditor's place of business

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A. A portion of the premium for credit life insurance or credit accident and sickness insurance may be allowed by the insurer to a creditor for providing and servicing such insurance. Such portion of the premium so allowed shall not be deemed as a rebate of premium or as interest…