reglab/housing_qa huggingface dataset:
VA Code § 38.2-3540.2 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3540.2. Employee wellness program

A. Each group accident and sickness insurance policy and health care plan may provide a premium discount to every employer instituting and maintaining an employee wellness program satisfying such criteria as each insurer may establish. An employer instituting and maintaining an employee wellness program in accordance with the insurer's criteria may require that any employee wishing to enroll in such program undergo a health assessment as a condition of enrollment.B. The provisions of this section shall not apply in any instance in which the provisions of this section are inconsistent or in conflict with a provision of Article 6 (§ 38.2-3438 et seq.) of Chapter 34.2010, c. 272; 2013, c. 751.
VA Code § 38.2-3541 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3541. Continuation on termination of eligibility

A. Each group hospital policy, group medical and surgical policy, or group major medical policy delivered or issued for delivery in the Commonwealth or renewed, reissued, or extended if already issued, shall contain a provision for continuation of coverage under the group policy if the insurance on a person covered under such a policy ceases because of the termination of the person's eligibility for coverage, prior to that person becoming eligible for Medicare or Medicaid benefits. This provision shall not be applicable if the group policyholder is required by federal law to provide for continuation of coverage under its group health plan pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).B. The insured's present coverage shall continue under the policy for a period of 12 months immediately following the date of the termination of the person's eligibility, without evidence of insurability, subject to the following requirements:1. The application and payment for the extended coverage is made to the group policyholder within 31 days after issuance of the written notice required in subsection C, but in no event beyond the 60-day period following the date of the termination of the person's eligibility;2. Each premium for such extended coverage is timely paid to the group policyholder on a monthly basis during the 12-month period;3. The premium for continuing the group coverage shall be at the insurer's current rate applicable to the group policy plus any applicable administrative fee not to exceed two percent of the current rate;4. Continuation shall only be available to an employee or member who has been continuously insured under the group policy during the entire three-month period immediately preceding termination of eligibility; and5. Continuation shall not be available to an individual whose eligibility for coverage under the group policy ceased because the individual was discharged from employment by the group policyholder for gross misconduct. As used in this subdivision, "gross misconduct" means any conduct connected with the individual's work that would constitute misconduct under § 60.2-618, including deliberately and willfully engaging in conduct evincing a complete disregard for the employer's workplace standards and policies.C. The group policyholder shall provide each employee or other person covered under such a policy written notice of the availability of continuation of coverage and the procedures and timeframes for obtaining continuation of the group policy. Such notice shall be provided within 14 days of the policyholder's knowledge of the employee's or other covered person's loss of eligibility under the policy.1979, c. 97, § 38.1-348.11; 1982, c. 625; 1984, c. 300; 1986, c. 562; 1988, c. 551; 2010, c. 503; 2014, c. 814; 2018, c. 471.
VA Code § 38.2-3542 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3542. Notice to employees upon termination of coverage; penalty for failure to remit funds

A. Any employer who (i) assumes part or all of the cost of providing group accident and sickness insurance or a group health services plan or group health care plan for his employees under a group insurance policy or subscription contract or other evidence of coverage; (ii) provides a facility for deducting the full amount of the premium from employees' salaries and remitting such premium to the insurer, health services plan, or health maintenance organization; or (iii) provides for health and medical care or reimbursement of medical expenses for his employees as a self-insurer, shall give written notice to participating employees in the event of termination or upon the receipt of notice of termination of any such policy, contract, coverage, or self-insurance not later than fifteen days after the termination of a self-insured plan or receipt of the notice of termination required by subsection C of this section.B. Any employer who collects from his employees or covers any part of the cost of any of the policies, contracts, or coverages specified in subsection A of this section and who knowingly fails to remit to the insurer or plan such funds required to maintain coverage in accordance with the policy or contract provisions under which the employees are covered shall be guilty of a Class 1 misdemeanor and shall be subject to civil suit for any medical expenses the employee may become liable for as a result of the employer letting such coverage be terminated.C. In the event the coverages specified in subsection A of this section are terminated due to nonpayment of premium by the employer, no such coverages shall be terminated by an insurer, health services plan, health maintenance organization or health insurance issuer as defined in § 38.2-3431 with respect to a covered individual unless and until the employer has been provided with a written or printed notice of termination, including a specific date, not less than fifteen days from the date of such notice, by which coverage will terminate if overdue premium is not paid. Coverage shall not be permitted to terminate for at least fifteen days after such notice has been mailed. Each insurer, health services plan, or health maintenance organization shall make reimbursement on all valid claims for services incurred prior to the date coverage is terminated.1982, c. 586, § 38.1-356.01; 1986, cc. 251, 562; 1990, c. 301; 1999, c. 276.
VA Code § 38.2-3543 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3543. Provisions required by other jurisdictions

A. Group accident and sickness insurance policies of a foreign or alien insurer, delivered or issued for delivery in this Commonwealth, may contain any provision that is not less favorable to the insured or the beneficiary than the provisions required by this article and that is prescribed by the laws of its domiciliary jurisdiction.B. Any group accident and sickness insurance policy of a domestic insurer may, when delivered or issued for delivery in any other jurisdiction, contain any provision permitted or required by the laws of that jurisdiction.1986, c. 562.
VA Code § 38.2-3543.1 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3543.1. Regulations

The Commission may establish rules and regulations for coordination of benefits, as well as to establish standards to be met in connection with the marketing and contracting for group accident and sickness insurance in this Commonwealth. Pursuant to the authority granted by § 38.2-223, the Commission may promulgate such rules and regulations as it may deem necessary to establish standards with regard to coordination of benefits provisions.1994, c. 316; 1998, c. 154.
VA Code § 38.2-3543.2 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3543.2. Applicability of laws

In the event of conflict between the provisions of this article and other provisions of this title, the provisions of this article shall be controlling.1998, c. 154.
VA Code § 38.2-3544 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3544. Definition of industrial sick benefit insurance

Industrial sick benefit insurance means life insurance combined with accident and sickness insurance under which:1. Premiums, dues or assessments are payable weekly;2. A ten dollar maximum weekly indemnity is paid to members or policyowners in the event of sickness or accident;3. A $250 maximum death benefit is provided, and the named beneficiary is confined to the spouse of the insured, a relative of the insured by blood, marriage or adoption, a person bound in a pledge of marriage to the insured, or any person dependent on the insured; and4. The issuing insurer is not required by its charter, bylaws, or by statute to maintain the legal reserve for death benefits.Code 1950, §§ 38-350, 38-351, 38-352; 1952, c. 317, § 38.1-483; 1986, c. 562.
VA Code § 38.2-3545 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3545. Further restrictions as to beneficiaries

Within the permitted classes of beneficiaries prescribed in § 38.2-3544, the issuing insurer may designate the classes of beneficiaries. No change of beneficiary shall be made by assignment, will, or otherwise to any person outside the designated classes without the consent of the insurer. If no person within the classes of beneficiaries prescribed in § 38.2-3544 survives the insured, the insurer may discharge its liability by payment of the proceeds of the policy to any person appearing to the insurer to be equitably entitled to the proceeds because of having incurred expense for the maintenance, medical attention or burial of the insured.Code 1950, § 38-352; 1952, c. 317, § 38.1-484; 1986, c. 562.
VA Code § 38.2-3546 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3546. Cancellation of sick benefit portion of policy

Every policy of industrial sick benefit insurance issued in this Commonwealth after June 18, 1922, shall contain a provision that:1. The sick benefit portion of the policy may be cancelled by either the insurer or the insured and the life portion continued by a payment of twenty percent of the original premium;2. If the cancellation is by the insurer, it shall be without prejudice to any claim arising on account of disability commencing prior to the date on which the cancellation takes effect; and3. Written notice of the cancellation and payment for the unearned portion of the premium shall be delivered to the insured or mailed to him at his last known address.Code 1950, § 38-359; 1952, c. 317, § 38.1-485; 1986, c. 562.
VA Code § 38.2-3547 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3547. Excessive insurance; remedy

A. Any person holding industrial sick benefit insurance policies of several insurers, that, in the aggregate, provide sick benefits in excess of 150 percent of his weekly salary, wages or earnings, shall not be permitted to recover the excess, nor shall the insurer be compelled to pay the excess, unless the existence of all previous policies was admitted by the insured in all applications for insurance in excess of such sum. If by misstatements, or by the failure to admit the existence of previous policies, the insured has obtained such excess additional policies, and has received benefits under such policies in excess of the amount specified above the excess paid may be deducted from the death benefit provided for in the policies.B. This section shall not apply in any case where the application for the excess policy did not contain any question in regard to the amount of insurance already carried by the applicant, nor where the application blank was printed in less than ten-point type.Code 1950, § 38-360; 1952, c. 317, § 38.1-486; 1986, c. 562.
VA Code § 38.2-3548 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3548. Agents subject to other insurance laws

Each person representing any insurer in the sale of industrial sick benefit insurance shall be subject to the laws governing agents of insurers.Code 1950, § 38-361; 1952, c. 317, § 38.1-487; 1986, c. 562.
VA Code § 38.2-3549 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3549. Benefits not subject to legal process

The payments in weekly or monthly installments to the holder of any policy of industrial sick benefit insurance shall not be subject to the lien of any attachment, garnishment proceeding, writ of fieri facias, or to levy or distress in any manner, for any debt due by the holder of the policy.Code 1950, § 38-227; 1952, c. 317, § 38.1-488; 1986, c. 562.
VA Code § 38.2-3550 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3550. Effective date

No industrial sick benefit insurance policy as defined in § 38.2-3544 shall be delivered or issued for delivery in this Commonwealth after June 30, 1987.1986, c. 562.
VA Code § 38.2-3553 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3553. Membership in a small employer health group cooperative

A. A small employer health group cooperative:1. Shall not limit, restrict, or condition a small employer's membership in the small employer health group cooperative on any health status-related factor relating to an individual, including an employee of a small employer or a dependent of an employee; and2. Shall make group health policies offered through the small employer health group cooperative available to all eligible employees of its employer-members and their eligible dependents, regardless of any health status-related factor relating to individuals eligible for coverage through a member.B. Notwithstanding subdivision 2 of subsection A, nothing in this article shall be construed as requiring (i) an issuer to provide coverage outside its service area or (ii) a small employer health group cooperative to make such coverage available to employer-members located outside the service area of the issuer.C. A small employer health group cooperative shall not make group health policies offered through the cooperative available other than to the eligible employees of its employer-members and their eligible dependents.2006, c. 427.
VA Code § 38.2-3554 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3554. Provisions relating to health insurance issuers

A. No group health policy shall be offered to a small employer group health cooperative that will cover a resident of the Commonwealth unless the Commission finds that:1. The issuance of such group health policy is not contrary to Virginia's public 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 of acquisition or administration; and3. The benefits are reasonable in relation to the premiums charged.B. Issuers filing policy forms seeking approval under the provisions of this subsection shall provide with the forms a certification, signed by the officer of the company with the responsibility for forms compliance, in which the company certifies that each such policy form will be issued only when the requirements set forth in subdivisions 1 through 3 of subsection A have been satisfied.C. If a small employer health group cooperative has elected, under subdivision B 1 a of § 38.2-3552, to be deemed the policyholder of a group health policy covering the eligible employees and eligible dependents of its employer-members within the service area of an issuer and has furnished the authorization required under subdivision B 2 of § 38.2-3552, the issuer of such policy shall deem the small employer health group cooperative to be the policyholder in all respects permissible under applicable state and federal laws and regulations.D. If a small employer health group cooperative has elected, under subdivision B 1 b of § 38.2-3552, to be deemed only a sponsoring entity facilitating the acquisition of separate group health policies for its employer-members within the service area of an issuer, the issuer shall issue a separate policy to each such employer-member of the cooperative. Each such policy shall conform to the benefit and premium specifications and other policy terms mutually agreed upon by the issuer and the small employer health group cooperative in accordance with subsection B of § 38.2-3552.E. An issuer providing a group health policy or policies to or through a small employer health group cooperative shall make such policy or policies available to every eligible employee of an employer-member within its service area who applies for such policy or policies, and their eligible dependents, subject to an individual employee's right to reject coverage in writing. No coverage may be offered only to certain eligible employees or their eligible dependents, and no eligible employees or their eligible dependents may be excluded or charged additional premiums, because of health status-related factors.F. The premiums for the policy or policies issued to or through a small employer health group cooperative shall be paid from funds contributed by the small employer health group cooperative, its employer-members, or both; or from funds contributed by the covered persons, or from both the covered persons and the employer-members or small employer health group cooperative.2006, c. 427.
VA Code § 38.2-3555 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35 - Accident and Sickness Insurance Policies|§ 38.2-3555. Authority of the Commission

Pursuant to the authority granted by § 38.2-223, the Commission may promulgate such rules and regulations as it may deem necessary to implement this article.2006, c. 427.
VA Code § 38.2-3557 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35.1 - Health Carrier Internal Appeal Process and External Review|§ 38.2-3557. Scope of chapter

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 indemnity, long-term care, dental, vision care, or any other limited supplemental benefit or to a Medicare supplement policy of insurance, coverage under a plan through Medicare, Medicaid, or the federal employees health benefits program, self-insured plans, any coverage issued under Chapter 55 of Title 10 of the U.S. Code, and any coverage issued as supplemental to that coverage, any coverage issued as supplemental to liability insurance, workers' compensation or similar insurance, automobile medical payment insurance or any insurance under which benefits are payable with or without regard to fault, whether written on a group blanket or individual basis.B. Notwithstanding the provisions of this section, self-insured employee welfare benefit plans may request a standard external review from the Commission. "Employee welfare benefit plan" has the meaning set forth in the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002 (1).2011, c. 788.
VA Code § 38.2-3558 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35.1 - Health Carrier Internal Appeal Process and External Review|§ 38.2-3558. Health carrier's internal appeal process

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 representative, or his provider. The Commission shall promulgate regulations effectuating the purpose of this section, including timeframes for filing appeals, types of claims that may be appealed including rescissions, notice requirements, rights of the covered person, and reviewer requirements.2011, c. 788.
VA Code § 38.2-3560 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35.1 - Health Carrier Internal Appeal Process and External Review|§ 38.2-3560. Exhaustion of internal appeal process

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 determination relates to the treatment of a cancer of the covered person.B. A covered person shall be considered to have exhausted the health carrier's internal appeal process if the covered person or his authorized representative has filed an appeal requesting a review of an adverse determination, and, except to the extent the covered person or his authorized representative requested or agreed to a delay, has not received a written decision from the health carrier within 30 days following the date the appeal was filed with the health carrier.C. If a covered person or his authorized representative files a request for an expedited internal appeal of an adverse determination with the health carrier, the covered person or his authorized representative is deemed to have exhausted the internal appeal process and may file a request for an expedited external review of the adverse determination at the same time. Upon receipt of a request for an expedited external review of an adverse determination, the independent review organization conducting the external review shall determine whether the covered person shall be required to complete the health carrier's expedited internal appeal process before it conducts the expedited external review. The independent review organization shall promptly notify the covered person and his authorized representative, if any, of this determination, and either proceed with the expedited external review or wait until completion of the internal expedited appeal process.D. A request for an external review of an adverse determination may be made before the covered person has exhausted the health carrier's internal appeal process whenever the health carrier agrees to waive the exhaustion requirement. If the exhaustion requirement is waived, the covered person or his authorized representative may file a request in writing for a standard external review.2011, c. 788; 2019, cc. 826, 840.
VA Code § 38.2-3564 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 35.1 - Health Carrier Internal Appeal Process and External Review|§ 38.2-3564. Binding nature of external review decision

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 provided in § 38.2-218, (ii) the suspension or revocation of any license issued by the Commission, or (iii) any order that may be issued by the Commission pursuant to § 38.2-219.B. An external review decision is binding on the covered person except to the extent the covered person has other remedies available under applicable federal or state law.C. A covered person or his authorized representative may not file a subsequent request for external review involving the same adverse determination or final adverse determination for which the covered person has already received an external review decision.2011, c. 788.