reglab/statecodes huggingface dataset:
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 42 - Health Services Plans › § 38.2-4235. Confidential treatment of information and documents

All information, documents and copies obtained by or disclosed to the Commission or any other person in the course of an examination or investigation made pursuant to § 38.2-4234, and all information reported pursuant to § 38.2-4231, shall be confidential, shall not be subject to subpoena, and shall not be made public by the Commission or any other person without the prior written consent of the nonstock corporation to which they pertain. However, this provision shall not apply to information disclosed to (i) a regulatory official of any state or country; (ii) the National Association of Insurance Commissioners, its affiliate or its subsidiary; or (iii) a law-enforcement authority of any state or country. Any such disclosure by the Commission shall not constitute a waiver of confidentiality of such information. After the licensed nonstock corporation and its affiliates have been given notice and opportunity to be heard, the Commission may publish all or any part of the information and materials referred to in this section in any manner it considers appropriate, if it determines that the interests of subscribers or the public will be served by the publication.
1989, c. 606; 2001, c. 519.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 any class of health care provider be excluded from eligibility for membership on the governing body of any health maintenance organization.
B. The governing body shall establish a mechanism to provide the enrollees with an opportunity to participate in matters of policy and operation through (i) the establishment of advisory panels, (ii) the use of advisory referenda on major policy decisions, or (iii) the use of other mechanisms.
1980, c. 720, § 38.1-867; 1985, c. 588; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 shall be responsible for the funds in a fiduciary relationship with the subscribers and enrollees.
1980, c. 720, § 38.1-868; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 on the judgment at the legal rate of interest shall be paid from the date of presentation to the health maintenance organization of proof of loss to the date judgment is entered.
B. If no action is brought, interest upon the claim proceeds paid to the subscriber, claimant, or assignee entitled thereto shall be computed daily at the legal rate of interest from the date of thirty calendar days from the health maintenance organization's receipt of proof of loss to the date of claim payment.
C. This section shall not apply to individual contracts issued prior to July 1, 1990, but shall apply to any renewals or reissues of group contracts occurring after that date.
D. This section shall not apply to claims for which payment has been or will be made directly to health care providers pursuant to a negotiated reimbursement arrangement requiring uniform or periodic interim payments to be applied against the health maintenance organization's obligation on such claims.
E. For purposes of this section, "proof of loss" means all necessary documentation reasonably required by the health maintenance organization to make a determination of benefit coverage.
1992, c. 23; 1996, c. 75.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 to secure complete information concerning the condition, solvency, experience, transactions or affairs of the health maintenance organization. The Commission shall establish reasonable deadlines for filing these additional reports, exhibits, or statements and may require verification by any officers of the health maintenance organization designated by the Commission.
B. The Commission may require a licensed health maintenance organization to file with the National Association of Insurance Commissioners (NAIC) a copy of its financial statement required to be filed pursuant to § 38.2-4307, on a quarterly basis. Unless otherwise prescribed by the Commission, all such financial statements, whether filed with the Commission or the NAIC, shall be prepared in accordance with applicable provisions of the annual statement instructions and the accounting practices and procedures manual adopted by the NAIC, or any successor publications. The Commission may prescribe that additional copies of financial statements and other reports be filed in machine-readable format.
C. Each annual and quarterly statement shall be accompanied by a statement of covered and uncovered expenses. The statement shall be prepared in accordance with instructions prescribed by the Commission for reporting the expenses of the health maintenance organization during the three months comprising the most recently ended calendar-year quarter. The statement of covered and uncovered expenses shall not be required for any health maintenance organization that reports a capital and surplus amount of at least $4,500,000 on its most recent annual or quarterly financial statement filed with the Commission.
1990, c. 224; 1999, c. 482; 2000, c. 503; 2006, c. 448.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 may permit pursuant to provisions in Chapter 14 (§ 38.2-1400 et seq.) of this title. For investments made prior to July 1, 1998, by a health maintenance organization which is licensed on and after June 30, 1998, July 1, 1998 may be deemed the date of investment.
1980, c. 720, § 38.1-873; 1986, c. 562; 1998, c. 42.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 38.2-4310. Protection against insolvency

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 held as a special fund in trust, as a guarantee that the obligations to the enrollees who are residents of this Commonwealth will be performed. The securities shall be deposited pursuant to a system of book-entry evidencing ownership interests of the securities with transfers of ownership interests effected on the records of a depository and its participants pursuant to rules and procedures established by the depository. Upon a determination of insolvency or action by the Commission pursuant to Chapter 15 (§ 38.2-1500 et seq.), the deposit shall be an asset subject to the provisions of Chapter 15 and shall be used to protect the interests of the health maintenance organization's enrollees and to assure continuation of covered services to enrollees. A health maintenance organization shall be subject to the provisions of Chapter 17 (§ 38.2-1700 et seq.).
1980, c. 720, § 38.1-874; 1986, c. 562; 1989, c. 216; 1990, c. 224; 1992, cc. 14, 20; 2000, c. 503; 2014, c. 814; 2018, c. 706; 2021, Sp. Sess. I, c. 158.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 health maintenance organization's deposit requirement at least once each year and may require an additional deposit in an amount equal to the greater of (i) the sum of all uncovered expenses for the most recent three months reported in accordance with § 38.2-4307.1 B or (ii) the value of liabilities representing uncovered health care expenses.
B. The Commission may reduce or waive, and also may direct the State Treasurer to return, any or all of a deposit requirement whenever the Commission, in its discretion, is satisfied that the assets of the health maintenance organization or its contracts with insurers, health services plans, governments, or other organizations are sufficient to assure the performance of its obligations to enrollees.
C. A health maintenance organization that has experienced an operating profit for the two most recent years may request that its deposit requirement be reduced. "Operating profit" shall be determined by reference to the annual statements filed by the health maintenance organization and shall mean the excess of total revenue, excluding net investment income, over total expenses.
2000, c. 503.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 24-hour basis: (i) access to medical care or (ii) access by telephone to a physician or licensed health care professional with appropriate medical training who can refer or direct a member for prompt medical care in cases where there is an immediate, urgent need or medical emergency. Access to a nonmedical professional who provides appropriate responses to calls from members and providers concerning after-hours care and covered benefits is not sufficient to meet the requirements of this section.
B. A health maintenance organization shall reimburse a hospital emergency facility and provider, less any applicable copayments, deductibles, or coinsurance, for medical screening and stabilization services rendered to meet the requirements of the Federal Emergency Medical Treatment and Active Labor Act (42 U.S.C. § 1395dd) and related to the condition for which the member presented in the hospital emergency facility if (i) the health maintenance organization or its designee or the member's primary care physician or its designee authorized, directed, or referred a member to use the hospital emergency facility; or (ii) the health maintenance organization fails to have a system for provision of 24-hour access in accordance with subsection A above. For purposes of (i) above, a primary care physician may include a physician with whom the primary care physician has made arrangements for on-call backup coverage.
C. Each evidence of coverage provided by a health maintenance organization shall include a description of procedures to be followed by the member for emergency services, including: (i) the appropriate use of hospital emergency facilities; (ii) the appropriate use of any urgent care facilities with which the health maintenance organization may contract; (iii) the potential responsibility of the member for payment for nonemergency services rendered in a hospital emergency facility; and (iv) the member's covered benefits for emergency services, including an explanation of the prudent layperson standard included in the definition of emergency services in § 38.2-4300.
D. 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, c. 139; 2011, c. 882.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 whose principal duties and responsibilities do not include the negotiation or solicitation of enrollee contracts shall not be required to be licensed.
1980, c. 720, § 38.1-877; 1986, c. 562; 1999, c. 86.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 health maintenance organization under the provisions of this chapter. Notwithstanding any other law that may be inconsistent with this section, any two or more licensed insurers, health services plans, or their subsidiaries or affiliates, may jointly organize and operate a health maintenance organization.
B. An insurer or a health services plan may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. The enrollees of a health maintenance organization constitute a permissible group for purposes of laws applicable to insurers and health services plans. Under the contracts the insurer or health services plans may make benefit payments to health maintenance organizations for health care services rendered by providers under the health care plan.
1980, c. 720, § 38.1-878; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 Commission may examine the affairs of providers with whom any health maintenance organization has contracts, agreements, or other arrangements according to its health care plan as often as it considers necessary for the protection of the interests of the people of this Commonwealth.
B. Instead of making its own examination, the Commission may accept the report of an examination of a foreign health maintenance organization certified by the insurance supervisory official, similar regulatory agency, or the state health commissioner of another state.
C. The Commission shall coordinate such examinations with the State Health Commissioner to ensure an appropriate level of regulatory oversight and to avoid any undue duplication of effort or regulation.
1980, c. 720, § 38.1-879; 1986, c. 562; 1990, c. 224; 1997, c. 688.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 be issued until the health maintenance organization has paid all fees and charges imposed on it and has complied with all other requirements of law.
B. The Commission shall not fail or refuse to renew the license of any health maintenance organization without first giving the health maintenance organization ten days' notice of its intention not to renew the license and giving it an opportunity to be heard and to introduce evidence on its behalf. Any such hearing may be informal. The required notice may be waived by the Commission and the health maintenance organization.
1980, c. 720, § 38.1-883; 1986, c. 562; 1987, c. 519.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 to furnish health care services to recipients of medical assistance under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq.
1980, c. 720, § 38.1-889; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 38.2-4320.1. Explanation of benefits for health maintenance organization enrollees who are recipients of medical assistance services or covered by the Family Access to Medical Insurance Security (FAMIS) Plan

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 recipients of medical assistance services pursuant to Title XIX of the Social Security Act, as amended, or to individuals who are covered by the Family Access to Medical Insurance Security (FAMIS) Plan developed pursuant to Title XXI of the Social Security Act, as amended, the requirements for furnishing an explanation of benefits to current or former members and their respective health care providers shall be as authorized and directed in the standards prescribed in the state plan for medical assistance services pursuant to Chapter 10 (§ 32.1-323 et seq.) of Title 32.1 and the FAMIS Plan pursuant to Chapter 13 (§ 32.1-351 et seq.) of Title 32.1. The requirements for an explanation of benefits otherwise addressed in this title shall not apply to such health maintenance organization when contracting to deliver such services to the extent that the statutory requirements differ from the standards of the Department of Medical Assistance Services.
2004, c. 185.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 43 - Health Maintenance Organizations › § 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 not impose any preexisting condition exclusion allowed under § 38.2-3432.3, with respect to any particular coverage option may impose an affiliation period for such coverage option, but only if:
1. Such period is applied uniformly without regard to any health status-related factors; and
2. Such period does not exceed two months (or three months in the case of a late enrollee).
B. An affiliation period as described in subsection A shall begin on the enrollment date.
C. An affiliation period under a plan shall run concurrently with any waiting period under the plan.
D. Defined terms as set forth in § 38.2-3431 which are used in this chapter shall have the same meaning here that they have in Chapter 34.
1997, cc. 807, 913.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4400. Definitions

As used in this chapter:
"Contract holder" means a person entering into a subscription contract with an organization;
"Fee discount" means predetermined amounts or reduced rates which are not substantially below the usual charge by the same attorney for those services, but not less than 70 percent of the rate usually charged non-participants for the same service, except for simple wills, simple name changes, preparation of non-complex legal documents, legal letters and calls, which may be less than 70 percent of the rate usually charged non-participants;
"Legal services organization" or "organization" means a person subject to regulation and licensing under this chapter who operates, conducts or administers a legal services plan;
"Legal services plan" or "plan" means a contractual obligation or an arrangement, whereby legal services are provided in consideration of a specified payment consisting in whole or in part of prepaid or periodic charges, regardless of whether the payment is made by the subscribers individually or by a third person for them;
"Licensed attorney" means an attorney licensed by the Virginia Board of Bar Examiners or other state licensing authority;
"Participating provider" or "participating providers" means a licensed attorney, group of attorneys or any other person who has agreed through an organization to provide legal services to subscribers enrolled in a legal services plan;
"Simple matters" or "simple legal matters" means legal matters that can be reasonably handled over the telephone, or with one or two office visits, or by a limited review of routine legal documents, and without legal representation to third parties;
"Subscriber" means any person entitled to benefits under the terms and conditions of a subscription contract;
"Subscription contract" means a written contract which is issued to a subscriber by an organization and which provides legal services or benefits for legal services.
1978, c. 658, § 38.1-791; 1986, c. 562; 1994, c. 224.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4401. Certain contracts, etc., not deemed plans

For the purposes of this chapter, the following are not deemed to be legal services plans:
1. Retainer contracts made by attorneys with individual clients where fees are based on estimates of the nature and amount of services that will be provided to the specific client, and similar contracts made with a group of clients involved in the same or closely related legal matters;
2. Plans providing no benefits other than a limited amount of consultation and advice on simple matters either alone or in combination with referral services or on the promise of fee discounts for other matters;
3. Plans providing limited benefits on simple legal matters on an informal basis, not involving a legally binding promise, in the context of an employment, educational or similar relationship;
4. Legal services provided by unions or employee associations to their members in matters relating to employment or occupation;
5. Legal services provided by an agency of federal or state government or a subdivision of federal or state government to its employees; or
6. Legal services insurance as provided for in §§ 38.2-127 and 38.2-300 when provided by an insurer licensed pursuant to Chapter 10 (§ 38.2-1000 et seq.) of this title.
1978, c. 658, § 38.1-802; 1986, c. 562; 1994, c. 224.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4402.1. Corporate organization required

Each plan shall be conducted by or through (i) a nonstock or stock corporation organized pursuant to the laws of this Commonwealth; (ii) a foreign corporation that is subject to regulation and licensing under the laws of its domiciliary jurisdiction that are substantially similar to those provided by this chapter; or (iii) a foreign corporation that is licensed as an insurer in its state of domicile and authorized to operate, conduct, or administer a legal services plan under the laws of any state. Any foreign insurer licensed pursuant to this chapter shall not be authorized to write any other classes of insurance under this title.
1994, c. 224; 2020, c. 408.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4403. The Virginia State Bar may sponsor plans

The Virginia State Bar may sponsor, and its member attorneys may, through a nonstock corporation, operate a legal services plan under the following conditions:
1. All members of the Virginia State Bar may participate in the plan.
2. No more than one-fourth of the board of directors of the nonstock corporation operating the plan may be attorneys who shall be appointed to the board by the Virginia State Bar. A majority of the members of the board shall not be providers of legal services to the plan nor employees or officers of the corporation conducting the plan. The nonprovider members of the board may not be elected or appointed by the Virginia State Bar or by attorneys participating in the plan.
3. No part of the dues paid by attorneys to the Virginia State Bar shall be used to financially support the nonstock corporation.
4. The Commission shall require quarterly compliance certification from all plans licensed pursuant to this section.
1982, c. 387, § 38.1-793.1; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4404. Liability of participating providers

A. Except for a plan established pursuant to § 38.2-4403, all participating providers in a plan shall be jointly and severally liable on all contracts made for the purposes of the plan by the organization as agent for them. Each contract may be executed and signed by their agent on their behalf. A contract so signed shall be binding on the participating providers and not on the agent.
B. Actions for breach of these contracts may be brought against the participating providers by naming the agent as the sole defendant. A judgment in favor of the plaintiff may be satisfied out of the assets of the legal services organization or out of the assets of each of the participating providers.
C. Each participating provider shall be liable for his own torts and not for the torts of any other participating provider or of the agent.
1978, c. 658, § 38.1-794; 1982, c. 387; 1986, c. 562; 1994, c. 224.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4405. Change of participating providers

A. Any participating provider may resign from a plan at any time but will continue to be liable on each subscription contract while effective. However, this liability shall not extend beyond the end of each such subscription contract's current contract year.
B. Participating providers may be admitted to a plan at any time and will then automatically become liable on all its outstanding contracts.
1978, c. 658, § 38.1-795; 1986, c. 562; 1994, c. 224.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4406. Board of directors of corporation operating plan

Notwithstanding the provisions of §§ 13.1-675 and 13.1-855, any corporation that operates any plan pursuant to the terms of this chapter shall have a board of directors consisting of no more than fifteen members of whom a majority shall be subscribers to the plan who are not providers of legal services and not employees or officers of any plan. This section does not apply to a plan operated by a group of attorneys except as provided in § 38.2-4403.
1978, c. 658, § 38.1-796; 1982, c. 387; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4407. Board of directors of plan created by attorneys

Notwithstanding the provisions of §§ 13.1-675, 13.1-677 and 13.1-855 to the contrary, any legal services organization operating a plan created by a group of attorneys shall have a board of directors consisting of no more than fifteen members of whom a majority may be providers of legal services. This section does not apply to a plan operated under § 38.2-4403.
1978, c. 658, § 38.1-797; 1982, c. 387; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4408. Application of certain provisions

No provision of this title except this chapter and insofar as they are not inconsistent with this chapter §§ 38.2-100, 38.2-200, 38.2-203, 38.2-209 through 38.2-213, 38.2-218 through 38.2-225, 38.2-229, 38.2-316, 38.2-400, 38.2-402 through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through 38.2-629, 38.2-700 through 38.2-704, 38.2-800 through 38.2-806, 38.2-1038, 38.2-1040 through 38.2-1044, and Articles 1 (§ 38.2-1300 et seq.), 2 (§ 38.2-1306.2 et seq.), and 4 (§ 38.2-1317 et seq.) of Chapter 13, insofar as they are not inconsistent with this chapter, and § 58.1-2500 et seq. shall apply to the operation of a plan.
1978, c. 658, § 38.1-798; 1986, c. 562; 1993, c. 158; 1994, c. 224; 2000, c. 50; 2015, c. 14; 2020, c. 264.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4408.1. Rehabilitation, liquidation, conservation

Any rehabilitation, liquidation, or conservation of a legal services organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurer and shall be subject to the provisions of Chapter 15 (§ 38.2-1500 et seq.) of Title 38.2.
1990, c. 331; 1994, c. 224.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4409. Payments under plan

The legal services organization shall not indemnify any subscriber for legal services rendered by any participating provider or nonparticipating attorney.
1978, c. 658, § 38.1-798; 1986, c. 562; 1994, c. 224.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4410. Financial reports

On or before March 1 of each year, each legal services organization shall file with the Commission a financial statement in accordance with § 38.2-1300. In lieu of a financial statement filed in accordance with § 38.2-1300, a foreign legal services organization may file a financial statement that is (i) prepared using an annual statement convention blank developed by the National Association of Insurance Commissioners (NAIC); (ii) prepared in accordance with the annual statement instructions and the accounting practices and procedures manuals adopted by the NAIC, or any other successor publications; and (iii) filed by the foreign legal services organization in its state of domicile.
On or before May 15, August 15, and November 15 of each year, each legal services organization shall file with the Commission a financial statement in accordance with § 38.2-1301. In lieu of a financial statement filed in accordance with § 38.2-1301, a foreign legal services organization, may file a financial statement that is (i) prepared using a quarterly statement convention blank developed by the NAIC; (ii) prepared in accordance with the quarterly statement instructions and the accounting practices and procedures manuals adopted by the NAIC, or any other successor publications; and (iii) filed by the foreign legal services organization in its state of domicile.
On or before June 1 of each year, each legal services organization shall file with the Commission an audited financial statement. The Commission may request supplemental financial information to ensure a legal services organization's financial stability.
A legal services organization operating, conducting, or administering a legal services plan shall not be required to file with the Commission any management discussion and analysis of financial condition and results of operations.
1978, c. 658, § 38.1-799; 1986, c. 562; 2020, c. 408.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4410.1. Examinations

The Commission may investigate or examine the affairs, transactions, accounts, records, and assets of a legal services organization as it deems necessary. Examinations shall be conducted pursuant to Article 4 (§ 38.2-1317 et seq.) of Chapter 13.
2020, c. 408.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4411. Subscriber to have free choice of participating providers available

A legal services organization shall organize and operate a plan in a manner that assures that any subscriber to the plan shall have free choice of the participating providers available and participating in the plan.
1978, c. 658, § 38.1-800; 1986, c. 562; 1994, c. 224.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4412. Subscriber to be advised in writing as to benefits and limitations thereon

A legal services organization shall, prior to and during the term of the subscription contract, fully, fairly, and currently advise the subscriber in writing of the benefits available under the contract and all limitations on the benefits available under the contract.
1978, c. 658, § 38.1-801; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4413. Licensing of organization

A. No person shall operate a legal services plan in this Commonwealth without a license issued by the Commission. Each organization shall apply for a license and furnish any relevant information the Commission requires. Each license shall expire at midnight on the following June 30. A nonrefundable application fee of $500 shall be paid with each application for a license.
B. The Commission shall not issue to or renew a license of an organization unless it is satisfied that the financial condition, the method of operation, and the manner of doing business of the organization enable it to meet its contractual obligations to all subscribers and that the organization has otherwise complied with all the requirements of law.
1978, c. 658, § 38.1-802; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4414. Renewal of organization license

A. Each legal services organization shall renew its license with the Commission annually by July 1. The renewal license shall not be issued unless the organization has paid all fees and charges imposed on it, and has complied with all other requirements of law.
B. The Commission shall not fail or refuse to renew the license of any organization without first giving the organization ten days' notice of its intention not to renew the license and giving it an opportunity to be heard and to introduce evidence in its behalf. Any nonrenewal hearing may be informal. The required notice may be waived by the Commission and the organization.
1978, c. 658, § 38.1-803; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 44 - Legal Services Plans › § 38.2-4416. Taxation

Except as provided by § 58.1-2501 and Chapter 4 of this title, the application fees paid by a legal services organization under this chapter shall be in lieu of all other state and local license fees or license taxes and state income taxes.
1978, c. 658, § 38.1-802; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4500. Applicability of chapter

A. Except as otherwise provided by law, no arrangement for furnishing prepaid dental services or prepaid optometric services shall be organized, conducted or offered in this Commonwealth other than in the manner set forth in this chapter.
B. Nothing contained in this chapter prohibits any dentist or optometrist individually, in partnership with other dentists or optometrists, or as part of a professional corporation of dentists or optometrists from entering into agreements directly with his own patients, or with a parent, guardian, conservator, spouse or other family member acting in a patient's behalf, involving payment for professional services to be rendered or made available in the future.
1980, c. 682, § 38.1-894; 1986, c. 562; 1997, c. 801.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4501. Definitions

As used in this chapter:
"Contract holder" means a person entering into a subscription contract with a nonstock corporation.
"Dental services plans" means any arrangement for offering or administering prepaid dental services by a nonstock corporation licensed under this chapter.
"Nonstock corporation" means a foreign or domestic nonstock corporation which is subject to regulation and licensing under this chapter and which operates a dental services plan or an optometric services plan.
"Optometric services plan" means any arrangement for offering or administering prepaid optometric services by a nonstock corporation licensed under this chapter.
"Plan" means any dental services plan or any optometric services plan subject to regulation under this chapter.
"Subscriber" means any person entitled to benefits under the terms and conditions of a subscription contract.
"Subscription contract" means a written contract which is issued to a contract holder by a nonstock corporation and which provides dental or optometric services or benefits for dental or optometric services.
1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4502. Dental services plans

A group of licensed dentists may conduct through a nonstock corporation as agent for them a dental services plan as defined in § 38.2-4501.
1980, c. 682, § 38.1-892; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4503. Optometric services plans

A group of licensed optometrists may conduct through a nonstock corporation as agent for them an optometric services plan as defined in § 38.2-4501.
1980, c. 682, § 38.1-893; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4504. Nonstock corporation required

A. Each plan shall be conducted either by or through (i) a nonstock corporation organized pursuant to the laws of this Commonwealth or (ii) a foreign nonstock corporation that is subject to regulation and licensing under the laws of its domiciliary jurisdiction that are substantially similar to those provided by this chapter.
B. Notwithstanding the provisions of §§ 38.2-4502 and 38.2-4503, a nonstock corporation may offer or administer a plan without being required to act as agent for participating dentists or optometrists.
C. A nonstock corporation applying for its initial license pursuant to this chapter to offer or administer a plan may elect in its application to act as a nonagent, in which case the provisions of this section shall apply to such nonagent.
D. A nonstock corporation operating a plan pursuant to § 38.2-4502 or § 38.2-4503 may petition the Commission to change its status from an agent nonstock corporation to a nonagent nonstock corporation by making application to the Commission no less than ninety days preceding the proposed date of the change. The nonstock corporation shall give notice of the petition to its contract holders and participating dentists or optometrists. The Commission shall not approve the change of status unless it is satisfied that the financial condition of the nonstock corporation and the proposed method of operation and manner of doing business enable the nonstock corporation to meet its contractual obligations to all subscribers and that the nonstock corporation has otherwise complied with the requirements of this chapter. The Commission shall (i) consider, among other things, the sufficiency of the contingency reserve required under subsection E and (ii) subject the nonstock corporation, notwithstanding the provisions of § 38.2-1700, to the requirements of Chapter 17 (§ 38.2-1700 et seq.). If the Commission fails to approve the change of status, it shall state the reason in its order. A change in status shall only be effective as to subscription contracts issued or renewed on and after the date of a change in status.
E. No nonstock corporation shall offer or administer a plan without acting as an agent for participating dentists or optometrists unless it maintains at all times a contingency reserve of at least $4 million. The contingency reserve shall be computed as the Commission requires.
F. The provisions of §§ 38.2-4505, 38.2-4507, 38.2-4508, and 38.2-4512 shall not apply to a nonstock corporation that does not act as agent for participating dentists or optometrists.
1980, c. 682, § 38.1-895; 1986, c. 562; 2000, cc. 171, 204; 2013, c. 11.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4505. Liability of participants

A. All dentists or optometrists participating in a plan shall be jointly and severally liable on all contracts made for the purpose of the plan by the nonstock corporation as agent for them. Each contract may be executed and signed by their agent on their behalf. A contract so signed shall be binding on the principals and not on the agent.
B. Actions for breach of these contracts may be brought against the principals by naming the agent as the sole defendant. A judgment in favor of the plaintiff may be satisfied out of the assets of the nonstock corporation or out of the assets of each of the principals.
C. Each participant shall be liable for his own torts and not for the torts of any other participant or of the agent.
1980, c. 682, § 38.1-896; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4506. Terms of participation

Each dentist or optometrist participating in any plan shall do so in accordance with the terms and conditions imposed on other participating providers under similar circumstances. Participating providers shall have the right to engage in other practice. A nonstock corporation shall not engage in the practice of dentistry or optometry.
1980, c. 682, § 38.1-897; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4507. Change of participants

A. Any participating dentist or optometrist may resign from a plan at any time but will continue to be liable on each subscription contract then in effect. However, this liability shall not extend beyond the end of each such subscription contract's current contract year.
B. Dentists or optometrists may be admitted to a plan at any time and will then automatically become liable on all its outstanding contracts.
1980, c. 682, § 38.1-897; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4508. Board of directors of nonstock corporation

Notwithstanding the provisions of § 13.1-855, a nonstock corporation shall have a board of directors consisting of at least twelve but no more than twenty members. A majority of the members of the board of directors of a nonstock corporation operating a dental services plan shall be participating dentists. A majority of the members of the board of directors of a nonstock corporation operating an optometric services plan shall be participating optometrists.
1980, c. 682, § 38.1-898; 1986, c. 562; 1987, c. 520.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4509. Application of certain laws

A. No provision of this title except this chapter and, insofar as they are not inconsistent with this chapter, §§ 38.2-200, 38.2-203, 38.2-209 through 38.2-213, 38.2-218 through 38.2-225, 38.2-229, 38.2-316, 38.2-326, 38.2-400, 38.2-402 through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through 38.2-629, 38.2-900 through 38.2-904, 38.2-1038, 38.2-1040 through 38.2-1044, Articles 1 (§ 38.2-1300 et seq.) and 2 (§ 38.2-1306.2 et seq.) of Chapter 13, §§ 38.2-1312, 38.2-1314, 38.2-1315.1, Articles 4 (§ 38.2-1317 et seq.), 5 (§ 38.2-1322 et seq.), and 6 (§ 38.2-1335 et seq.) of Chapter 13, §§ 38.2-1400 through 38.2-1442, 38.2-1446, 38.2-1447, 38.2-1800 through 38.2-1836, 38.2-3401, 38.2-3404, 38.2-3405, 38.2-3407.1, 38.2-3407.4, 38.2-3407.10, 38.2-3407.10:1, 38.2-3407.13, 38.2-3407.14, 38.2-3407.15, 38.2-3407.17, 38.2-3407.17:1, 38.2-3407.19, 38.2-3415, 38.2-3541, Article 5 (§ 38.2-3551 et seq.) of Chapter 35, §§ 38.2-3600 through 38.2-3603, Chapter 55 (§ 38.2-5500 et seq.), Chapter 58 (§ 38.2-5800 et seq.), and Chapter 65 (§ 38.2-6500 et seq.) shall apply to the operation of a plan.
B. The provisions of subsection A of § 38.2-322 shall apply to an optometric services plan. The provisions of subsection C of § 38.2-322 shall apply to a dental services plan.
C. The provisions of Article 1.2 (§ 32.1-137.7 et seq.) of Chapter 5 of Title 32.1 shall not apply to either an optometric or dental services plan.
D. The provisions of § 38.2-3407.1 shall apply to claim payments made on or after January 1, 2014. No optometric or dental services plan shall be required to pay interest computed under § 38.2-3407.1 if the total interest is less than $5.
1980, c. 682, § 38.1-899; 1983, c. 457; 1986, c. 562; 1989, c. 653; 1993, cc. 158, 307; 1996, c. 776; 1998, cc. 42, 891; 1999, cc. 643, 649, 709, 739; 2000, cc. 47, 50, 922; 2004, c. 315; 2006, c. 427; 2010, cc. 583, 734; 2011, c. 788; 2013, cc. 473, 670, 679; 2014, c. 309; 2015, cc. 14, 723; 2019, c. 655; 2020, cc. 264, 916, 917; 2021, Sp. Sess. I, c. 161.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4509.1. Rehabilitation, liquidation, conservation

Any rehabilitation, liquidation, or conservation of a dental or optometric plan shall be deemed to be the rehabilitation, liquidation, or conservation of an insurer and shall be subject to the provisions of Chapter 15 of this title.
1990, c. 331.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4510. Quarterly reports

In addition to the annual statement required by § 38.2-1300, the Commission shall require each nonstock corporation to file on a quarterly basis any additional reports, exhibits or statements the Commission considers necessary to furnish full information concerning the condition, solvency, experience, transactions or affairs of the nonstock corporation. The Commission shall establish deadlines for submitting additional reports, exhibits or statements. The Commission may require verification by any officers of the nonstock corporation the Commission designates.
1980, c. 682, § 38.1-900; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4511. Corporation's contracts with participating dentists or optometrists

Participating dentists or optometrists shall agree to (i) perform the dental services or optometric services specified by the plan at the rates of compensation determined by the nonstock corporation and filed with the Commission, and (ii) abide by the bylaws, rules and regulations of the nonstock corporation.
1980, c. 682, § 38.1-901; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4512. Contracts between participating dentists or optometrists and subscribers

Participating dentists or optometrists, acting through their agents, may enter into contracts with subscribers to furnish specified dental or optometric services at specified rates to a subscriber or subscriber's members, officers, or employees. Contracts may vary as to services and rates.
1980, c. 682, § 38.1-902; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4513. Subscriber to have free choice of practitioners available

A plan shall be organized and operated to assure that any subscriber shall have free choice of any participating dentist or optometrist who agrees to accept the subscriber as a patient for services provided by the plan.
1980, c. 682, § 38.1-903; 1986, c. 562.
2023 Code of Virginia › Title 38.2 - Insurance › Chapter 45 - Dental or Optometric Services Plans › § 38.2-4514. Subscriber to be advised in writing as to benefits and limitations thereon

A nonstock corporation shall, prior to and during the term of the subscription contract, fully, fairly, and currently advise the subscriber in writing of the benefits available under the contract and all limitations on the benefits available under the contract.
1980, c. 682, § 38.1-903; 1986, c. 562.