reglab/housing_qa huggingface dataset:
VA Code § 38.2-3430.5 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3430.5. Application of financial capacity limits

A. A health insurance issuer may deny health insurance coverage in the individual market to an eligible individual if the health insurance issuer has demonstrated to the satisfaction of the Commission that:1. It does not have the financial reserves necessary to underwrite additional coverage; and2. It is applying this section uniformly to all individuals in the individual market in the Commonwealth consistent with the laws of this Commonwealth and without regard to any health status-related factor of such individuals and without regard to whether the individuals are eligible individuals.B. A health insurance issuer, upon denying individual health insurance coverage in any service area in accordance with subsection A, may not offer such coverage in the individual market within such service area for a period of 180 days after the date such coverage is denied or until the health insurance issuer has demonstrated to the satisfaction of the Commission that the health insurance issuer has sufficient financial reserves to underwrite additional coverage, whichever is later.1997, cc. 807, 913.
VA Code § 38.2-3430.6 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3430.6. Market requirements

The provisions of § 38.2-3430.3 shall not be construed to require that a health insurance issuer offering health insurance coverage only in connection with group health plans or through one or more bona fide associations, or both, offer such health insurance coverage in the individual market.1997, cc. 807, 913; 1998, c. 24; 2014, c. 814.
VA Code § 38.2-3430.8 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3430.8. Certification of coverage

The provisions of § 38.2-3432.3 shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as they apply to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market.1997, cc. 807, 913; 1999, c. 1004.
VA Code § 38.2-3430.9 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3430.9. Regulations establishing standards

A. The Commission may adopt regulations to enable it to establish and administer such standards relating to the provisions of this article and Article 5 (§ 38.2-3431 et seq.) of this chapter as may be necessary to (i) implement the requirements of this article and (ii) assure that the Commonwealth's regulation of health insurance issuers is not preempted pursuant to P. L. 104-191 (The Health Insurance Portability & Accountability Act of 1996).B. The Commission may revise or amend such regulations and may increase the scope of the regulations to the extent necessary to maintain federal approval of the Commonwealth's program for regulation of health insurance issuers pursuant to the requirements established by the United States Department of Health and Human Services.C. The Commission shall annually advise the standing committees of the General Assembly having jurisdiction over insurance matters of revisions and amendments made pursuant to subsection B.1997, cc. 807, 913.
VA Code § 38.2-3430.10 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3430.10. Effective date

The provisions of this article shall be effective on July 1, 1997, with the exception of § 38.2-3430.3 which shall be effective on January 1, 1998.1997, cc. 807, 913.
VA Code § 38.2-3434 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3434. Disclosure of information

Any health insurance issuer offering health insurance coverage to a employer shall make a reasonable disclosure of the availability of information to such an employer, as part of its solicitation and sales materials, and upon request of such an employer, information concerning: (i) the provisions of such coverage concerning the health insurance issuer's right to change premium rates and the factors that may affect changes in premium rates; (ii) the provisions of such coverage relating to renewability of coverage; (iii) the provisions of such coverage relating to any preexisting condition exclusion; and (iv) the benefits and premiums available under all health insurance coverage for which the employer is qualified.A health insurance issuer is not required under this article to disclose any information that is proprietary and trade secret information.1997, cc. 807, 913.
VA Code § 38.2-3435 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3435. Exclusions

The provisions of this article shall not apply to:1. Any health insurance issuer offering group health insurance coverage for any plan year if, on the first day of such plan year, such plan has less than two participants who are current employees; or2. Any health insurance issuer offering group health insurance coverage for any of the excepted benefits.1997, cc. 807, 913; 1998, c. 24.
VA Code § 38.2-3436 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3436. Eligibility to enroll

A. A health insurance issuer offering group health insurance coverage, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the health status-related factors.B. The provisions of this section shall not be construed:1. To require a group health insurance coverage to provide particular benefits other than those provided under the terms of such plan or coverage; or2. To prevent a health insurance issuer offering group health insurance coverage from establishing limitations or restrictions on the amount, level, extent or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage rules for eligibility to enroll under a plan which includes rules defining any applicable waiting periods for such enrollment.C. A health insurance issuer offering group health insurance coverage, may not require an individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.D. Nothing in subsection C shall be construed:1. To restrict the amount that an employee may be charged for coverage under a group health plan or group health insurance coverage; or2. To prevent a health insurance issuer offering group health insurance coverage, from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.E. 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 34.1997, cc. 807, 913; 2013, c. 751.
VA Code § 38.2-3437 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3437. Rules used to determine group size

A. All employers treated as a single employer under subsection (b), (c), (m), or (o) of § 414 of the Internal Revenue Code of 1986 (26 U.S.C. § 414) shall be treated as one employer.B. In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether such employer is a small or large group employer shall be based on the average number of employees that it is reasonably expected such employer will employ on business days in the current calendar year.C. Any reference in this section to an employer shall include a reference to any predecessor of such employer.1997, cc. 807, 913.
VA Code § 38.2-3440 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3440. Lifetime and annual limits

A. Notwithstanding any provision of § 38.2-3406.1, 38.2-3406.2, or 38.2-3418.5, or any other section of this title to the contrary, a health carrier offering group or individual health insurance coverage shall not establish a lifetime limit on the dollar amount of essential health benefits for any covered person.B. A health carrier shall not establish any annual limit on the dollar amount of essential health benefits for any covered person.C. The provisions of this section shall not prevent a health carrier from placing annual or lifetime dollar limits for any covered person on specific covered benefits that are not essential health benefits to the extent that such limits are otherwise permitted under applicable federal or state law.D. This section shall apply to any health carrier providing individual or group health insurance coverage, except that the prohibition and limits on annual limits shall not apply to a grandfathered plan providing individual health insurance coverage.2011, c. 882; 2013, c. 751.
VA Code § 38.2-3441 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3441. Rescissions

A. Notwithstanding any provision of § 38.2-508.5 or any other section of this title to the contrary, a health carrier shall not rescind coverage under a health benefit plan after an individual is covered under the plan unless the individual or a person seeking coverage on behalf of the individual performs an act, practice, or omission that constitutes fraud, or the individual makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan.B. A health carrier shall provide at least 30 days' advance written notice or electronic notice to any covered person who would be affected by the proposed rescission of coverage before coverage under the plan may be rescinded, regardless of whether the rescission applies to the entire group or only to an individual within the group. Such notice shall at a minimum contain:1. Clear identification of the alleged fraudulent act, practice, or omission or the intentional misrepresentation of material fact;2. An explanation as to why the act, practice, or omission was fraudulent or was an intentional misrepresentation of a material fact;3. Notice that the covered person or the covered person's authorized representative, prior to the date the advance notice of the proposed rescission ends, may immediately file an internal appeal to request a reconsideration of the rescission;4. A description of the health carrier's internal appeal process for rescissions, including any time limits applicable to those procedures; and5. The date when the advance notice ends and the date back to which the coverage will be rescinded.C. The provisions of this section apply regardless of any applicable contestability period.D. This section shall apply to any health carrier providing individual or group health insurance coverage, including any grandfathered plan.2011, c. 882.
VA Code § 38.2-3442 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3442. Preventive services

A. Notwithstanding any provision of § 38.2-3406.1 or 38.2-3411.1 or any other section of this title to the contrary, a health carrier shall provide coverage for preventive services and shall not impose any cost-sharing requirements such as a copayment, coinsurance, or deductible.B. A health carrier shall provide coverage for any items or services under the most current recommendations and guidelines within the scope of preventive services as required by the PPACA as in effect on January 1, 2019.C. 1. A health carrier may impose cost-sharing requirements with respect to an office visit if an item or service is billed separately or is tracked as individual encounter data separately from the office visit.2. A health carrier shall not impose cost-sharing requirements with respect to an office visit if an item or service is not billed separately or is not tracked as individual encounter data separately from the office visit and the primary purpose of the office visit is the delivery of the item or service.3. A health carrier may impose cost-sharing requirements with respect to an office visit if an item or service is not billed separately or is not tracked as individual encounter data separately from the office visit and the primary purpose of the office visit is not the delivery of the item or service.D. Nothing in this section shall preclude a health carrier that has a network of providers from imposing cost-sharing requirements for items or services that are delivered by an out-of-network provider.E. This section shall apply to any health carrier providing individual or group health insurance coverage, except for any grandfathered plan.2011, c. 882; 2013, c. 751; 2020, c. 1160.
VA Code § 38.2-3443 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3443. Choice of a health care professional

A. Notwithstanding any provision of § 38.2-3407.11, 38.2-4312.3, or any other section of this title to the contrary, if a health carrier providing individual or group health insurance coverage requires or provides for the designation by a covered person of a participating primary care health care professional, the health carrier shall permit each covered person to designate any participating primary care health care professional who is available to accept the covered person. For a child, a participating health care professional who specializes in pediatrics and is available to accept the child may be designated as the child's primary care health care professional.B. If a health carrier provides for obstetrical or gynecological care and requires the designation by a covered person of a participating primary care health care professional, the health carrier shall not require any person's prior authorization or referral in the case of a female covered person who seeks coverage for obstetrical or gynecological care provided by a participating health care professional who specializes in obstetrics or gynecology. The provision of obstetrical and gynecological care, and the ordering of related items and services, shall be treated the same as an authorization from a primary care health care professional.C. A health carrier shall provide notice to a covered person of the terms and conditions of the plan related to the designation of a participating health care professional.1. Such notice shall be included whenever the health carrier provides a covered person with a summary plan description, policy, certificate, or contract of health insurance.2. The health carrier may use the model language found in 45 C.F.R. § 147.138(a)(4)(iii) for such notice.D. This section shall apply to any health carrier providing individual or group health insurance coverage, except for any grandfathered plan.2011, c. 882.
VA Code § 38.2-3444 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3444. Preexisting condition exclusions

A. Notwithstanding any provision of § 38.2-508.1, 38.2-3432.3, 38.2-3438, 38.2-3503, 38.2-3520, or any other section of this title to the contrary, a health carrier providing individual or group health insurance coverage shall not limit or exclude coverage for an individual by imposing a preexisting condition exclusion on that individual.B. A health carrier that offers individual health insurance coverage may offer coverage continuously throughout the year or during an open enrollment period.C. This section shall apply to any health carrier providing individual or group health insurance coverage, including a grandfathered plan for group health insurance coverage, but not including a grandfathered plan for individual health insurance coverage.2011, c. 882; 2013, cc. 136, 210, 751.
VA Code § 38.2-3445 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3445. Patient access to emergency services

Notwithstanding any provision of § 38.2-3407.11, 38.2-4312.3, or any other section of this title to the contrary, if a health carrier providing individual or group health insurance coverage provides any benefits with respect to services in an emergency department of a hospital, the health carrier shall provide coverage for emergency services:1. Without the need for any prior authorization determination, regardless of whether the emergency services are provided on an in-network or out-of-network basis;2. Without regard to the final diagnosis rendered to the covered person or whether the health care provider furnishing the emergency services is a participating health care provider with respect to such services;3. If such services are provided out-of-network, without imposing any administrative requirement or limitation on coverage that is more restrictive than the requirements or limitations that apply to such services received from an in-network provider;4. If such services are provided out-of-network, the health carrier shall pay the out-of-network provider in accordance with § 38.2-3445.01 less any cost-sharing requirement. Any such cost-sharing requirement shall not exceed the cost-sharing requirement that would apply if such services were provided in-network as provided in § 38.2-3445.01; and5. Without regard to any term or condition of such coverage other than the exclusion of or coordination of benefits or an affiliation or waiting period.2011, c. 882; 2020, cc. 1080, 1081.
VA Code § 38.2-3445.03 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3445.03. Data sets for determining commercially reasonable payments

A. The Commission shall contract with the nonprofit data services organization to establish a data set and business process to provide health carriers, health care providers, and arbitrators with data to assist in determining commercially reasonable payments and resolving payment disputes for out-of-network medical services rendered by health care providers.B. Such data set and business protocols shall be (i) developed in collaboration with health carriers and health care providers and (ii) reviewed by the advisory committee established pursuant to § 32.1-276.7:1.C. The data set shall provide the amounts for the services described in subsection A of § 38.2-3445.01. The data used to calculate the median in-network and out-of-network allowed amounts and the median billed charge amounts by geographic area, for the same or similar services, shall be drawn from commercial health plan claims and shall not include claims paid under Medicare or Medicaid or other claims paid on other than a fee-for-service basis. The 2020 data set shall be based upon the most recently available full calendar year of claims data. The data set for each subsequent year shall be adjusted by applying the Consumer Price Index-Medical Component as published by the Bureau of Labor Statistics of the U.S. Department of Labor to the previous year's data set.2020, cc. 1080, 1081.
VA Code § 38.2-3445.05 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3445.05. Enforcement

A. If the Commission has cause to believe that any health care provider has engaged in a pattern of potential violations of § 38.2-3445.01 with no corrective action, the Commission may submit information to the Board of Medicine or the Commissioner of Health for action. Prior to such submission, the Commission may provide the provider with an opportunity to cure the alleged violations or provide an explanation as to why the actions in question were not violations of § 38.2-3445.01.B. If any health care provider has engaged in a pattern of potential violations of § 38.2-3445.01 with no corrective action, the Board of Medicine or the Commissioner of Health may levy a fine or cost recovery upon the health care provider and take other action as permitted under the authority of the Board of Medicine or Commissioner of Health. Upon completion of its review of any potential violation submitted by the Commission or initiated directly by an enrollee, the Board of Medicine or Commissioner of Health shall notify the Commission of the results of the review, including whether the violation was substantiated and any enforcement action taken as a result of a finding of a substantiated violation.C. If a carrier has engaged in a pattern of substantiated violations of any provision of § 38.2-3445.01, the Commission may levy a fine or apply remedies authorized pursuant to Chapter 2 (§ 38.2-200 et seq.).D. No carrier or provider shall initiate arbitration pursuant to § 38.2-3445.02 with such frequency as to indicate a general business practice.2020, cc. 1080, 1081.
VA Code § 38.2-3445.06 (2021)
2021 Code of Virginia|Title 38.2 - Insurance|Chapter 34 - Provisions Relating to Accident and Sickness Insurance|§ 38.2-3445.06. Applicability of certain sections

A. Except as provided in this section, the provisions of §§ 38.2-3445 through 38.2-3445.05 shall not apply to an entity providing or administering an employee welfare benefit plan, as defined in § 3(1) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1002(1), that is self-insured or self-funded with respect to such plan. Such an entity may elect to be subject to the provisions of §§ 38.2-3445 through 38.2-3445.06 in the same manner as applied to a health carrier by providing notice to the Commission annually, in a form and manner prescribed by the Commission, attesting to the plan's participation and agreeing to be bound by the provisions of §§ 38.2-3445 through 38.2-3445.06. Such entity shall amend the plan, policies, contracts, and other documents to reflect such election. In addition, the entity that elects to opt in pursuant to this section shall file current plan documentation confirming that the plan accepts the obligations of §§ 38.2-3445 through 38.2-3445.06 and attests that any amended plan documents will be filed with the Commission before the effective date of such amendments. The Commission shall post on its website a list of entities, including relevant plan information, that have elected to be subject to the provisions of §§ 38.2-3445 through 38.2-3445.06. The Commission shall update such list at least once per quarter.B. The provisions of §§ 38.2-3445.01 and 38.2-3445.02 shall not apply to services when the provider's fees are subject to schedules or other monetary limitations under any other law, including the Virginia Workers' Compensation Act, and such sections shall not preempt any such law.C. The provisions of §§ 38.2-3445 through 38.2-3445.05 shall apply to health coverage insurance offered to state employees pursuant to § 2.2-2818 and may apply to health insurance coverage offered to employees of local governments, local officers, teachers, and retirees, and the dependents of such employees, officers, teachers, and retirees pursuant to § 2.2-1204.D. Except for its facilitation of arbitration pursuant to § 38.2-3445.02 and its role in any appeals process established pursuant to subsection J of § 38.2-3445.02, the Commission shall have no jurisdiction to resolve disputes arising out of § 38.2-3445.01.E. Except for in a provider contract between a carrier and an in-network provider, no person shall waive, be required to waive, or require another person to waive the provisions of §§ 38.2-3445 through 38.2-3445.05.2020, cc. 1080, 1081.