38.2-3551 - Definitions.
§ 38.2-3551. Definitions.
As used in this article:
"Eligible dependent" means an individual who may be covered as a dependentunder a group health policy or policies and who is eligible, as determined bya small employer health group cooperative, for coverage as a dependent of aneligible employee under a group health policy or policies issued to orthrough such small employer health group cooperative.
"Eligible employee" means an employee who works for a small employer on afull-time basis, has a normal work week of 30 or more hours, has satisfiedapplicable waiting period requirements, and is not a part-time, temporary, orsubstitute employee.
"Employer-member" means a small employer participating in a small employerhealth group cooperative.
"Group health policy" or "policy" means a group insurance policyproviding hospital, medical and surgical or major medical coverage on anexpense-incurred basis, a group accident and sickness insurance policy orsubscription contract, and a group health care plan for health care servicesor limited health care services provided by a health maintenanceorganization. For the purposes of this article, a group health policy orpolicy shall also mean a policy or plan provided by a dental or optometricservices plan, dental plan organization, and a health maintenanceorganization offering limited health care services as defined in § 38.2-4300.
"Health insurance issuer" or "issuer" means a company authorized to issuecoverage under Article 3 (§ 38.2-3521.1 et seq.) of Chapter 35, Chapter 42 (§38.2-4200 et seq.), Chapter 43 (§ 38.2-4300 et seq.), Chapter 45 (§ 38.2-4500et seq.), or Chapter 61 (§ 38.2-6100 et seq.) of this title.
"Health status-related factor" means the following in relation to theindividual or a dependent eligible for coverage under a group health plan orhealth insurance coverage offered by a health insurance issuer:
1. Health status;
2. Medical condition, including both physical and mental illnesses;
3. Claims experience;
4. Receipt of health care;
5. Medical history;
6. Genetic information;
7. Evidence of insurability, including conditions arising out of acts ofdomestic violence; or
8. Disability.
"Service area" means the geographic area within which a health insuranceissuer is authorized to sell a group health policy or policies.
"Small employer" means, in connection with a group health policy withrespect to a calendar year and a plan year, an employer who employed anaverage of at least two but not more than 50 employees on business daysduring the preceding calendar year and who employs at least two employees onthe first day of the plan year.
"Small employer health group cooperative" or "cooperative" means anentity authorized by its employer-members to negotiate with health insuranceissuers on their behalf as to the terms, including premium rates, under whicha group health policy or policies may be issued, providing coverage for theeligible employees of such employer-members and their eligible dependents.
(2006, c. 427.)