Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 410 - RULES GOVERNING FULLY INSURED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-410-30 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
As used in this chapter:
"Commission" means the State Corporation Commission.
"Contribution" means the amount paid or payable by the
				  employer or employee for services provided through the multiple employer
				  welfare arrangement.
"Direct basis" means that the liability of the insurer,
				  health maintenance organization, health services plan, or dental or optometric
				  services plan runs directly to the insured employee or certificate
				  holder.
"Domicile" means the situs of the trust through which the
				  multiple employer welfare arrangement is established, the plan's place of
				  incorporation or, if not set up through a trust or incorporated, the location
				  of the plan's headquarters.
"Fully insured" means all of the covered benefits are (i)
				  insured on a direct basis by an insurance company licensed and in good standing
				  to transact the business of insurance in Virginia pursuant to Title 38.2 of the
				  Code of Virginia or (ii) arranged for or provided on a direct basis by (a) a
				  health services plan licensed and in good standing in Virginia pursuant to
				  Chapter 42 (§ 38.2-4200 et seq.) of Title 38.2 of the Code of Virginia,
				  (b) a health maintenance organization licensed and in good standing in Virginia
				  pursuant to Chapter 43 (§ 38.2-4300 et seq.) of Title 38.2 of the Code of
				  Virginia, (c) a dental or optometric services plan licensed and in good
				  standing in Virginia pursuant to Chapter 45 (§ 38.2-4500 et seq.) of Title
				  38.2 of the Code of Virginia, or (d) any combination thereof. The existence of
				  contracts of reinsurance will not be considered in determining whether a plan
				  is "fully insured."
"Good standing" means the license of any (i) company to
				  transact the business of insurance in the Commonwealth of Virginia pursuant to
				  Title 38.2 of the Code of Virginia, (ii) health services plan licensed pursuant
				  to Chapter 42 (§ 38.2-4200 et seq.) of Title 38.2 of the Code of Virginia,
				  (iii) health maintenance organization licensed pursuant to Chapter 43 (§
				  38.2-4300 et seq.) of Title 38.2 of the Code of Virginia, or (iv) dental or
				  optometric services plan licensed pursuant to Chapter 45 (§ 38.2-4500 et
				  seq.) of Title 38.2 of the Code of Virginia where the license is not suspended
				  or revoked, or the company, health services plan, health maintenance
				  organization, or dental or optometric services plan is not precluded by order
				  of the commission from soliciting, negotiating, procuring, or effecting
				  contracts of insurance.
"Health care services" means services that are furnished to
				  an individual for the purpose of preventing, alleviating, or healing human
				  illness, injury, or physical disability. Such terminology may include services
				  for optometric or dental care.
"Member" means an employer that participates in a multiple
				  employer welfare arrangement.
"Multiple employer welfare arrangement" means any plan or
				  arrangement that is established or maintained for the purpose of offering or
				  providing coverage for health care services, whether such coverage is by direct
				  payment, reimbursement, or otherwise, to employees of two or more employers, or
				  to their beneficiaries except that such term does not include any such plan or
				  other arrangement that is established or maintained:
1. Under or pursuant to one or more
				agreements that the Secretary of the U.S. Department of Labor finds to be
				collective bargaining agreements, or
2. By a rural electric cooperative.
For purposes of the definition of multiple employer welfare
				  arrangement:
a. Two or more trades or
				businesses, whether or not incorporated, shall be deemed a single employer if
				such trades or businesses are within the same control group;
b. The term "control group" means a group of
				trades or businesses under common control;
c. The determination of whether a trade or
				business is under "common control" with another trade or business shall be
				determined under regulations of the Secretary of the U.S. Department of Labor
				applying principles similar to the principles applied in determining whether
				employees of two or more trades or businesses are treated as employed by a
				single employer under § 4001(b) of the Employee Retirement Income Security
				Act, (29 USC §
											1301(b)), except that, for
				purposes of this subdivision, common control shall not be based on an interest
				of less than 25%; and
d. The term
				"rural electric cooperative" means:
(1) Any
				organization that is exempt from tax under § 501(a) of the Internal
				Revenue Code of 1986 (26 USC
				§
												501(a)) and that is
				engaged primarily in providing electric service on a mutual or cooperative
				basis, and
(2) Any organization
				described in paragraph (4) or (6) of § 501(c) of the Internal Revenue Code
				of 1986 (26 USC §
												501(c)(4) or (6)) that is
				exempt from tax under § 501(a) of the Internal Revenue Code (26 USC §
												501(a)) and at least 80% of
				the members of which are organizations described in subdivision d (1) of this
				definition.
"Self-funded multiple employer welfare arrangement" or
				  "self-funded MEWA" means any multiple employer welfare arrangement that is not
				  fully insured by a licensed insurance company. This term includes a benefit
				  consortium established under Chapter 55 (§ 59.1-589 et seq.) of Title 59.1
				  of the Code of Virginia.