38.2-3554 - Provisions relating to health insurance issuers.
§ 38.2-3554. Provisions relating to health insurance issuers.
A. No group health policy shall be offered to a small employer group healthcooperative that will cover a resident of the Commonwealth unless theCommission finds that:
1. The issuance of such group health policy is not contrary to Virginia'spublic 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 ofacquisition 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 thissubsection shall provide with the forms a certification, signed by theofficer of the company with the responsibility for forms compliance, in whichthe company certifies that each such policy form will be issued only when therequirements set forth in subdivisions 1 through 3 of subsection A have beensatisfied.
C. If a small employer health group cooperative has elected, undersubdivision B 1 a of § 38.2-3552, to be deemed the policyholder of a grouphealth policy covering the eligible employees and eligible dependents of itsemployer-members within the service area of an issuer and has furnished theauthorization required under subdivision B 2 of § 38.2-3552, the issuer ofsuch policy shall deem the small employer health group cooperative to be thepolicyholder in all respects permissible under applicable state and federallaws and regulations.
D. If a small employer health group cooperative has elected, undersubdivision B 1 b of § 38.2-3552, to be deemed only a sponsoring entityfacilitating the acquisition of separate group health policies for itsemployer-members within the service area of an issuer, the issuer shall issuea separate policy to each such employer-member of the cooperative. Each suchpolicy shall conform to the benefit and premium specifications and otherpolicy terms mutually agreed upon by the issuer and the small employer healthgroup cooperative in accordance with subsection B of § 38.2-3552.
E. An issuer providing a group health policy or policies to or through asmall employer health group cooperative shall make such policy or policiesavailable to every eligible employee of an employer-member within its servicearea who applies for such policy or policies, and their eligible dependents,subject to an individual employee's right to reject coverage in writing. Nocoverage may be offered only to certain eligible employees or their eligibledependents, and no eligible employees or their eligible dependents may beexcluded or charged additional premiums, because of health status-relatedfactors.
F. The premiums for the policy or policies issued to or through a smallemployer health group cooperative shall be paid from funds contributed by thesmall employer health group cooperative, its employer-members, or both; orfrom funds contributed by the covered persons, or from both the coveredpersons and the employer-members or small employer health group cooperative.
(2006, c. 427.)