Code of Virginia - Title 38.2 Insurance - Chapter 43 Health Maintenance Organizations
- 38.2-4300 Definitions
As used in this chapter: "Acceptable securities" means securities that (i) are legal investments under the laws of the Commonwealth for public sinking funds or ...
- 38.2-4301 Establishment of health maintenance organizations
A. No person shall establish or operate a health maintenance organization in the Commonwealth without obtaining a license from the Commission. Any person, including a ...
- 38.2-4302 Issuance of license; fee; minimum net worth; impairment
A. The Commission shall issue a license to a health maintenance organization after the receipt of a complete application and payment of a $500 nonrefundable ...
- 38.2-4303 Powers
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 ...
- 38.2-4304 Governing body
A. The governing body of any health maintenance organization may include providers of health care services, other individuals, or both, but in no event shall ...
- 38.2-4305 Fiduciary responsibilities
Any director, officer or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the organization ...
- 38.2-4306 Evidence of coverage and charges for health care services
A. 1. Each subscriber shall be entitled to evidence of coverage under a health care plan. 2. No evidence of coverage, or amendment to it, ...
- 38.2-4306.1 Interest on claim proceeds
A. If an action to recover the claim proceeds due under a health care plan results in a judgment against a health maintenance organization, interest ...
- 38.2-4307 Annual statement
A. Each health maintenance organization shall file a statement with the Commission annually by March 1. The statement shall be verified by at least two ...
- 38.2-4307.1 Additional reports
A. In addition to the annual statement, the Commission may require a licensed health maintenance organization to file additional reports, exhibits or statements considered necessary ...
- 38.2-4308 Description unavailable
Repealed by Acts 1998, c. 891. ...
- 38.2-4309 Investments
A health maintenance organization may invest in any Category 1 investment as defined in Chapter 14 of this title or any other investment the Commission ...
- 38.2-4310 Protection against insolvency
A. Each health maintenance organization shall deposit and maintain acceptable securities with the State Treasurer in amounts prescribed by § 38.2-4310.1. The deposit shall be ...
- 38.2-4310.1 Deposits
A. A health maintenance organization shall make its initial deposit prior to licensure in an amount not less than $300,000. The Commission shall review a ...
- 38.2-4311 Description unavailable
Repealed by Acts 1998, c. 891. ...
- 38.2-4312 Prohibited practices
A. No health maintenance organization or its representative may cause or knowingly permit the use of (i) advertising that is untrue or misleading, (ii) solicitation ...
- 38.2-4312.1 Pharmacies; freedom of choice
A. Notwithstanding any other provision in this chapter, no health maintenance organization providing health care plans shall prohibit any person receiving pharmaceutical benefits thereunder from ...
- 38.2-4312.2 Description unavailable
Repealed by Acts 1995, c. 467. ...
- 38.2-4312.3 Patient access to emergency services
A. A health maintenance organization shall have a system to provide to its members, on a twenty-four-hour basis: (i) access to medical care or (ii) ...
- 38.2-4313 Licensing of agents
Enrollee contracts may be solicited only through life and health insurance agents as provided for in Chapter 18 of this title. Home office salaried officers ...
- 38.2-4314 Powers of insurers and health services plans
A. An insurer or a health services plan licensed in this Commonwealth may, either directly or through a subsidiary or affiliate, organize and operate a ...
- 38.2-4315 Examinations
A. The Commission shall examine the affairs of each health maintenance organization as provided for in § 38.2-1317 at least once every five years. The ...
- 38.2-4316 Suspension or revocation of license
A. The Commission may suspend or revoke any license issued to a health maintenance organization under this chapter if it finds that any of the ...
- 38.2-4317 Rehabilitation, liquidation, or conservation
A. Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurer and ...
- 38.2-4317.1 Insolvency deposit assessment
In the event of an insolvency of a health maintenance organization occurring after July 1, 1989, the Commission may, (i) in the absence of an ...
- 38.2-4318 License renewals
A. Each health maintenance organization licensed under this chapter shall renew its license with the Commission annually by July 1. The renewal license shall not ...
- 38.2-4319 Statutory construction and relationship to other laws
A. No provisions of this title except this chapter and, insofar as they are not inconsistent with this chapter, §§ 38.2-100, 38.2-136, 38.2-200, 38.2-203, 38.2-209 ...
- 38.2-4320 Authority of Commonwealth to contract with health maintenance organizations
This Commonwealth is authorized to enter into contracts with health maintenance organizations on behalf of its employees and the citizens of the Commonwealth, including contracts ...
- 38.2-4320.1 Explanation of benefits for health maintenance organization enrollees who are recipients of medica...
In the case of any health maintenance organization that has contracted with the Virginia Department of Medical Assistance Services to provide health care services to ...
- 38.2-4321 Health maintenance organization affected by chapter
Except as otherwise provided by law, no health maintenance organization shall be operated in this Commonwealth other than in the manner set forth in this ...
- 38.2-4322 Affiliation period
A. A health maintenance organization which offers health insurance coverage in connection with a group health plan or group health insurance coverage and which does ...
- 38.2-4323 Alternative methods
A health maintenance organization may use alternative methods to an affiliation period to address adverse selection provided that they are approved by the Commission prior ...
Last modified: April 3, 2009