reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 405 - RULES GOVERNING BALANCE BILLING FOR OUT-OF-NETWORK HEALTH CARE SERVICES › Section 14VAC5-405-30 - Balance billing for out-of-network services

Current through Register Vol. 40, No. 24, July 15, 2024
A. Pursuant to §
									38.2-3445.01
				of the Code of Virginia, no out-of-network provider shall balance bill or
				attempt to collect payment amounts from an enrollee other than those described
				in subsection B of this section for:
1.
				Emergency services provided to an enrollee by an out-of-network provider;
				or
2. Nonemergency services
				provided to an enrollee at an in-network facility if the nonemergency services
				involve otherwise covered surgical or ancillary services provided by an
				out-of-network provider.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 405 - RULES GOVERNING BALANCE BILLING FOR OUT-OF-NETWORK HEALTH CARE SERVICES › Section 14VAC5-405-40 - Arbitration process

Current through Register Vol. 40, No. 24, July 15, 2024
A. If
				a good faith negotiation does not result in resolution of the dispute, the
				health carrier or provider may initiate arbitration by providing the notice of
				intent to arbitrate form to the commission and the non-initiating party within
				10 calendar days following completion of the good faith negotiation period. The
				notice shall state the initiating party's final payment offer. Failure to
				timely submit the notice of intent to arbitrate form shall negate the party's
				opportunity to seek arbitration for the claim that was the subject of the
				untimely notice.
B. Agreement
				between the parties may be reached at any time in the process. The arbitration
				will then be terminated. The claim shall then be paid within 10 calendar days
				and the matter closed upon agreement.
C. The commission shall maintain a list of
				qualified arbitrators and each arbitrator's fixed fee on its website.
1. Within five calendar days of the notice of
				intent to arbitrate, the initiating party shall notify the commission of either
				agreement on an arbitrator from the list or that the parties cannot agree on an
				arbitrator.
2. If the parties
				cannot agree on an arbitrator, within five calendar days the commission shall
				provide the parties with the names of five arbitrators from the list. Within
				five calendar days, each party is responsible for reviewing the list of five
				arbitrators and notifying the commission if there is an apparent conflict of
				interest with any of the arbitrators on the list. Each party may veto up to two
				of the named arbitrators. If one name remains, that arbitrator shall be chosen.
				If more than one name remains, the commission shall choose the arbitrator from
				the remaining names.
3. Once the
				arbitrator is chosen, the commission shall notify the parties and the
				arbitrator within five calendar days.
4. The arbitrator's fee is payable within 10
				calendar days of the assignment of the arbitrator with the health carrier and
				the provider to divide the fee equally.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 405 - RULES GOVERNING BALANCE BILLING FOR OUT-OF-NETWORK HEALTH CARE SERVICES › Section 14VAC5-405-50 - Arbitrator qualifications and application

Current through Register Vol. 40, No. 24, July 15, 2024
A. Any person meeting the minimum
				qualifications of an arbitrator may submit an application on a form prescribed
				by the commission. An application fee of up to $500 may be required. The
				commission shall review the application within 30 days of receipt and notify
				the arbitrator of its decision.
B.
				An arbitrator approved by the commission shall meet the following minimum
				qualifications:
1. Any professional license
				the arbitrator has is in good standing;
2. Training in the principles of arbitration
				or dispute resolution by an organization recognized by the
				commission;
3. Experience in
				matters related to medical or health care services;
4. Completion of any training made available
				to the applicants by the commission;
5. Experience in arbitration or dispute
				resolution; and 6. Any other information deemed relevant by the
				commission.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 405 - RULES GOVERNING BALANCE BILLING FOR OUT-OF-NETWORK HEALTH CARE SERVICES › Section 14VAC5-405-60 - Data sets

Current through Register Vol. 40, No. 24, July 15, 2024
A. The
				commission shall contract with Virginia Health Information or its successor 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. This contractor will develop the
				data sets and business process in collaboration with health carriers and health
				care providers. The data set shall be reviewed by the advisory committee
				established pursuant to §
									32.1-276.7:1
				of the Code of Virginia.
B. The
				2020 data set shall be based upon the most recently available full calendar
				year of claims data 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 adjusted annually for
				inflation 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.
C. The
				commission may implement other adjustments to the data sets in accordance with
				§
									38.2-3445.03
				of the Code of Virginia.
Statutory Authority: 12.1-13 and 38.2-223 of the Code of
					 Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 405 - RULES GOVERNING BALANCE BILLING FOR OUT-OF-NETWORK HEALTH CARE SERVICES › Section 14VAC5-405-70 - Notification to consumers

Current through Register Vol. 40, No. 24, July 15, 2024
A. The
				notice of consumer rights shall be in a standard format provided by the
				commission and available on the commission's website.
B. A health carrier shall provide an enrollee
				with:
1. A clear description of the managed
				care plan's out-of-network health benefits outlined in the plan documents that
				also explains the circumstances under which the enrollee may have payment
				responsibility in excess of cost-sharing amounts for services provided
				out-of-network;
2. The notice of
				consumer rights delivered with the plan documents; and
3. An explanation of benefits that clearly
				indicates whether the enrollee may or may not be subject to balance billing if
				it contains claims from out-of-network providers.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 405 - RULES GOVERNING BALANCE BILLING FOR OUT-OF-NETWORK HEALTH CARE SERVICES › Section 14VAC5-405-80 - Elective group health plans may opt-in

Current through Register Vol. 40, No. 24, July 15, 2024
A. An elective group health plan shall
				provide notice to the commission and to its third-party administrator of its
				opt-in decision on a form prescribed by the commission. The completed form must
				include an attestation that the elective group health plan has elected to
				participate in and be bound by §§
									38.2-3445
				through
				38.2-3445.07
				of the Code of Virginia and this chapter, except as described in subsection E
				of this section. The form will be posted on the commission's public website for
				use by elective group health plans.
B. An elective group health plan shall
				reflect in its coverage documents its participation pursuant to subsection A of
				this section. The elective group health plan or plan administrator shall submit
				the required form electronically to the commission at least 30 days prior to
				the effective date. No other documents are required to be filed with the
				commission.
C. An elective group
				health plan may elect to initiate its participation on January 1 of any year or
				in any year on the first day of the self-funded elective group health plan's
				plan year.
D. An elective group
				health plan's election occurs on an annual basis. An elective group health plan
				may choose to automatically renew its election to opt in to §§
									38.2-3445
				through
				38.2-3445.07
				of the Code of Virginia on an annual basis or it may choose to renew on an
				annual basis until the commission receives advance notice from the plan that it
				is terminating its election as of either December 31 of a calendar year or the
				last day of its plan year. Notices under this subsection must be submitted to
				the commission at least 30 days in advance of the effective date of the
				election to initiate participation and the effective date of the termination of
				participation.
E. Elective group
				health plan sponsors and their third-party administrators may develop their own
				internal processes related to member notification, member appeals, and other
				functions associated with any fiduciary duty to enrollees under ERISA, if
				applicable.
F. A list of all
				elective group health plans shall be posted on the commission's public website,
				to be updated at least each quarter. Posted information shall include relevant
				plan information.
G. A carrier that
				administers an elective group health plan shall, at the time of coverage
				verification through electronic and other methods of communication generally
				used by a provider to verify enrollee eligibility and benefits information,
				make information available to a provider of the elective group health plan's
				participation in the provisions of this chapter.
Statutory Authority: 12.1-13 and 38.2-223 of the Code of
					 Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 405 - RULES GOVERNING BALANCE BILLING FOR OUT-OF-NETWORK HEALTH CARE SERVICES › Section 14VAC5-405-90 - Severability

Current through Register Vol. 40, No. 24, July 15, 2024
If any provision of this chapter or its application to any
				  person or circumstance is for any reason held to be invalid by a court, the
				  remainder of this chapter and the application of the provisions to other
				  persons or circumstances shall not be affected.
Statutory Authority: 12.1-13 and 38.2-223 of the Code of
					 Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 405 - RULES GOVERNING BALANCE BILLING FOR OUT-OF-NETWORK HEALTH CARE SERVICES › Form - FORMS (14VAC5-405)

Current through Register Vol. 40, No. 24, July 15, 2024
Notice
				  of Consumer Rights, Form 405-A (rev. 9/2022)
Elective
				  Group Health Plan Opt-In, Form 405-B (rev. 3/2021)
Elective
				  Group Health Plan Change/Termination, Form 405-C (rev. 3/2021)
Notice
				  of Intent to Arbitrate, Form 405-D (rev. 9/2022)
Arbitrator
				  Application, Form 405-E (rev. 3/2021)
Statutory Authority: 12.1-13 and 38.2-223 of the Code of
					 Virginia.
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 14VAC5-410-10 - Purpose

Current through Register Vol. 40, No. 24, July 15, 2024
The purpose of this chapter is to set forth rules to carry
				  out the provisions of Article 3 (§ 38.2-3420 et seq.) of Chapter 34 of
				  Title 38.2 of the Code of Virginia so as to establish reasonable standards for
				  the licensing and operation of multiple employer welfare arrangements in the
				  Commonwealth of Virginia.
Statutory Authority
§ 38.2-223 and Article 3 (§ 38.2-3420 et seq.)
					 of Chapter 34 of Title 38.2 of the Code of Virginia.
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 14VAC5-410-20 - Applicability and scope

Current through Register Vol. 40, No. 24, July 15, 2024
A. This chapter
				shall apply to all multiple employer welfare arrangements offering or providing
				coverage in this Commonwealth if any of the following conditions is met:
1. The multiple employer welfare arrangement
				is domiciled in Virginia;
2. At
				least one employer whose principal office or headquarters is located in
				Virginia provides health care benefits to his employees through the multiple
				employer welfare arrangement, regardless of the plan's place of domicile;
				or
3. At least one employee who is
				employed in Virginia and who has been initially enrolled in the plan in
				Virginia is being provided health care benefits through the multiple employer
				welfare arrangement, regardless of the plan's place of domicile or the location
				of the employer's principal office or headquarters.
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 14VAC5-410-40 - Licensing and filing requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A. A multiple
				employer welfare arrangement that is not fully insured as defined in this
				chapter shall not operate in this Commonwealth without (i) complying with the
				requirements of Rules Governing Self-Funded Multiple Employer Welfare
				Arrangements (14VAC5-415) or (ii) meeting the criteria and becoming
				appropriately licensed as an insurance company, health maintenance
				organization, health services plan, or a dental or optometric services plan
				pursuant to Title 38.2 of the Code of Virginia.
B. A fully insured multiple employer welfare
				arrangement shall not operate in this Commonwealth without first filing with
				the commission:
1. The names, addresses, and
				biographical summaries of the plan's trustees, officers, directors, or other
				members of the plan's governing body.
2. The names, addresses, and qualifications
				of individuals responsible for the conduct of the plan's affairs, including any
				third-party administrators.
3. The
				names, addresses, and qualifications of persons who will solicit, negotiate,
				procure, or effect applications for coverage with the plan.
4. The names and addresses of employers
				participating in the plan.
5. Proof
				of coverage showing that the plan is fully insured by an insurer, health
				maintenance organization, health services plan, or dental or optometric
				services plan as required by the definition of "fully insured" in
				14VAC5-410-30. Proof of coverage
				shall be submitted on a form prescribed by the commission and shall include (i)
				a copy of the policy insuring the plan; (ii) confirmation from the insurer,
				health maintenance organization, health services plan, or a dental or
				optometric services plan that coverage is in force; and (iii) a statement
				indicating the length of time coverage has been in force.
6. Any other information the commission may
				require including information pertaining to the adequacy of the plan's level of
				reserves and contributions.
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 14VAC5-410-50 - Licensing of persons soliciting, negotiating, procuring, or effecting applications for coverage

Current through Register Vol. 40, No. 24, July 15, 2024
A. No
				person shall solicit, negotiate, procure, or effect applications for coverage
				or member enrollments, and no multiple employer welfare arrangement, insurer,
				health maintenance organization, nonstock health services plan, or nonstock
				dental or optometric services plan shall knowingly permit a person to solicit,
				negotiate, procure, or effect applications for coverage or member enrollments,
				in this Commonwealth for a multiple employer welfare arrangement whether or not
				the plan is licensed in this Commonwealth without first obtaining a license as
				a life and health agent, and an appointment, if such appointment is required,
				in a manner and in a form prescribed by the Commission pursuant to Chapter 18
				(§ 38.2-1800 et seq.) of Title 38.2 of the Code of Virginia.
B. Any person who solicits, negotiates,
				procures, or effects applications or member enrollments in this Commonwealth
				for coverage under a multiple employer welfare arrangement shall be subject to
				all appropriate provisions of Title 38.2 as set forth in Chapter 2 (§
				38.2-200 et seq.), 3 (§ 38.2-300 et seq.), 5 (§ 38.2-500 et seq.), 6
				(§ 38.2-600 et seq.), and 18 (§ 38.2-1800 et seq.) of the Code of
				Virginia regarding the conduct of his business.
C. Salaried officers or employees of any
				employer which provides coverage through a multiple employer welfare
				arrangement shall not be required to be licensed under this section provided
				that the principal duties and responsibilities of such officers and employees
				do not include soliciting, negotiating, procuring, or effecting applications
				for coverage or member enrollments for the plan.
Statutory Authority
§ 38.2-223 and Article 3 (§ 38.2-3420 et seq.)
					 of Chapter 34 of Title 38.2 of the Code of Virginia.
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 14VAC5-410-60 - Violations

Current through Register Vol. 40, No. 24, July 15, 2024
Any violation of this chapter shall be punished as provided
				  for in § 38.2-218 of the Code of Virginia and any applicable law of this
				  Commonwealth. The provisions of §§ 38.2-219 through 38.2-222 of the
				  Code of Virginia shall also apply to any multiple employer welfare arrangement
				  that fails to comply with the provisions set forth in this
				  chapter.
Statutory Authority
§ 38.2-223 and Article 3 (§ 38.2-3420 et seq.)
					 of Chapter 34 of Title 38.2 of the Code of Virginia.
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 14VAC5-410-70 - Service of process

Current through Register Vol. 40, No. 24, July 15, 2024
Suits, actions, and proceedings may be begun against any
				  multiple employer welfare arrangement providing coverage in this Commonwealth
				  by serving process on any trustee, director, officer, or agent of the plan, or,
				  if none can be found, on the Clerk of the Commission. Service of process shall
				  be made as provided for in Article 1 (§ 38.2-800 et seq.) of Chapter 8 of
				  Title 38.2 of the Code of Virginia.
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
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 14VAC5-410-80 - Severability

Current through Register Vol. 40, No. 24, July 15, 2024
If any provision of this chapter or the application thereof
				  to any person or circumstance is for any reason held to be invalid, the
				  remainder of the chapter and the application of such provision to other persons
				  or circumstances shall not be affected thereby.
Statutory Authority
§ 38.2-223 and Article 3 (§ 38.2-3420 et seq.)
					 of Chapter 34 of Title 38.2 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-415-10 - Applicability and scope

Current through Register Vol. 40, No. 24, July 15, 2024
A. This chapter
				shall apply to self-funded multiple employer welfare arrangements that issue
				health benefit plans in Virginia, including a benefits consortium established
				under Chapter 55 (§ 59.1-589 et. seq.) of Title 59.1 of the Code of
				Virginia.
B. This chapter shall not
				apply to a not-for-profit benefits consortium established under §
				15.2-1517.1 of the Code of Virginia, a benefits consortium established under
				§ 6.2-952 or 23.1-106 of the Code of Virginia, a multiple employer welfare
				arrangement meeting the requirements of § 38.2-3420 C of the Code of
				Virginia, or a fully insured multiple employer welfare arrangement registered
				pursuant to Rules Governing Fully Insured Multiple Employer Welfare
				Arrangements (14VAC5-410).
C.
				Self-funded multiple employer welfare arrangements shall be subject to the
				provisions of Title 38.2 of the Code of Virginia to the extent that such
				provisions are applicable to self-funded multiple employer welfare arrangements
				in accordance with § 38.2-3420 of the Code of Virginia.
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-415-20 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
Terms found in this chapter are used as defined in §
				  38.2-3431 B of the Code of Virginia. The following words and terms when used in
				  this chapter shall have the following meaning unless the context clearly
				  indicates otherwise:
"Benefits consortium" means a trust that is a self-funded
				  MEWA, as defined in § 38.2-3420 of the Code of Virginia, and that complies
				  with the conditions set forth in § 59.1-590 of the Code of
				  Virginia.
"Commission" means the State Corporation Commission.
"ERISA" means the federal Employee Retirement Income Security
				  Act of 1974, P.L.
				  93-406, 88 Stat. 829, as amended.
"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."
"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.
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-415-40 - Issuance of license; fee; minimum net worth; impairment

Current through Register Vol. 40, No. 24, July 15, 2024
A. The
				commission shall issue a license to a self-funded MEWA after the receipt of a
				complete application and payment of a $500 nonrefundable application fee if the
				commission is satisfied that the following conditions are met:
1. The persons responsible for the conduct of
				the affairs of the applicant are competent, trustworthy, and
				reputable;
2. The self-funded MEWA
				is financially responsible and may reasonably be expected to meet its
				obligations to members and prospective members. In making this determination,
				the commission may consider:
a. The financial
				soundness of the health benefit plan's arrangements for health care
				services;
b. The adequacy of
				working capital;
c. Any agreement
				with an insurer, a health services plan, a government, or any other
				organization for insuring the payment of the cost of health care services or
				the provision for automatic applicability of an alternative coverage if the
				health care plan is discontinued;
d. The deposit of acceptable securities in an
				amount satisfactory to the commission, submitted in accordance with §
				38.2-1045 of the Code of Virginia as a guarantee to the self-funded MEWA's
				liabilities to its members and creditors;
e. The applicant's net worth, which shall
				include minimum net worth in an amount at least equal to $4 million;
				and
f. A financial statement of the
				self-funded MEWA on the form required by
				14VAC5-415-50; and
3. If applicable, the self-funded
				MEWA is in compliance with the requirements of § 59.1-590 B 5 through B 10
				of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-415-50 - Annual statement, additional reports, and examinations

Current through Register Vol. 40, No. 24, July 15, 2024
A. Each
				self-funded MEWA shall file an annual statement as provided in § 38.2-1300
				of the Code of Virginia with the commission annually by March 1. The statement
				shall be verified by at least two principal officers and shall cover the
				preceding calendar year.
B. In
				addition to the annual statement, the commission may require a licensed
				self-funded MEWA to file additional reports as provided in §§
				38.2-1301 and 38.2-1301.1 of the Code of Virginia, exhibits, or statements
				considered necessary to secure complete information concerning the condition,
				solvency, experience, transactions, or affairs of the self-funded MEWA. The
				commission shall establish deadlines for filing these additional reports,
				exhibits, or statements and may require verification by any officers of the
				self-funded MEWA designated by the commission.
C. The commission shall examine the affairs
				of each self-funded MEWA and its members as provided for in § 38.2-1317 of
				the Code of Virginia as often as the Bureau of Insurance deems necessary. The
				self-funded MEWA may be required to pay to the commission the expenses incurred
				by it in making an examination authorized under this section.
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-415-60 - Investments

Current through Register Vol. 40, No. 24, July 15, 2024
A self-funded MEWA must comply with Chapter 14 (§
				  38.2-1400 et seq.) of Title 38.2 of the Code of Virginia. In doing so, a
				  self-funded MEWA may only invest in any Category 1 investment. A self-funded
				  MEWA may petition the commission for permission to invest in any other
				  investment allowed under the provisions of Chapter 14 prior to making such
				  investment.
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-415-70 - Protection against insolvency

Current through Register Vol. 40, No. 24, July 15, 2024
Each self-funded MEWA shall deposit and maintain acceptable
				  securities with the State Treasurer in amounts prescribed by § 38.2-1045
				  of the Code of Virginia. The deposit shall be held as a special fund in trust,
				  as a guarantee to the self-funded MEWA's liabilities to its members and
				  creditors. 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.) of Title 38.2 of the Code of Virginia, the deposit shall be an asset
				  subject to the provisions of Chapter 15 and shall be used to protect the
				  interests of the self-funded MEWA's enrollees and to ensure continuation of
				  covered services to enrollees.
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-415-80 - Financial and solvency requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A. The
				financial and solvency requirements applicable to self-funded MEWAs granted a
				license under this chapter, insofar as they are not inconsistent with this
				chapter, include Articles 3 (§ 38.2-1017 et seq.), 4 (§ 38.2-1019 et
				seq.), 5 (§ 38.2-1024 et seq.), 6 (§ 38.2-1040 et seq.), and 7
				(§ 38.2-1045 et seq.) of Chapter 10; Articles 1 (§ 38.2-1300 et
				seq.), 2 (§ 38.2-1306.2 et seq.), 3 (§ 38.2-1311 et seq.), 3.1
				(§ 38.2-1316.1 et seq.), and 4 (§ 38.2-1317 et seq.) and §§
				38.2-1322 through 38.2-1332 and §§ 38.2-1333 through 38.2-1334.2:3 of
				Article 5 of Chapter 13; Articles 1 (§ 38.2-1400 et seq.), 2 (§
				38.2-1412 et seq.), and 4 (§ 38.2-1446 et seq.) of Chapter 14; Chapter 15
				(§ 38.2-1500 et seq.); and Chapter 55 (§ 38.2-5500 et seq.) of Title
				38.2 of the Code of Virginia.
B.
				For purposes of applying this section, "insurer" when used in a section of the
				Code of Virginia cited in subsection A of this section shall be construed to
				mean and include "self-funded MEWA" unless the section cited clearly applies to
				self-funded MEWAs without such construction.
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-415-90 - Disclosure

Current through Register Vol. 40, No. 24, July 15, 2024
A. A
				self-funded MEWA shall provide meaningful disclosure to its members and to its
				members' participating and prospective participating employees regarding the
				medical, prescription drug, dental, and vision benefits provided to
				participating employees of the sponsoring association or its members and to the
				dependents of those employees through the health benefit plans offered by the
				self-funded MEWA.
B. A self-funded
				MEWA subject to Chapter 55 (§ 59.1-589 et seq.) of Title 59.1 of the Code
				of Virginia shall comply with the requirements of § 59.1-591 C of the Code
				of Virginia.
C. All other
				self-funded MEWAs shall include on health benefits plans, as applicable, the
				substance of the information required by § 59.1-591 C of the Code of
				Virginia.
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-415-100 - Acts of other persons

Current through Register Vol. 40, No. 24, July 15, 2024
A self-funded MEWA is responsible for the acts of all persons
				  who solicit, negotiate, procure, or effect applications for coverage with the
				  self-funded MEWA.
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-415-110 - Violations

Current through Register Vol. 40, No. 24, July 15, 2024
Any violation of this chapter shall be punished as provided
				  for in § 38.2-218 of the Code of Virginia and any applicable law of the
				  Commonwealth. The provisions of §§ 38.2-219 through 38.2-222 of the
				  Code of Virginia shall also apply to a self-funded MEWA that fails to comply
				  with the provisions set forth in this chapter.
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-415-120 - Service of process

Current through Register Vol. 40, No. 24, July 15, 2024
Suits, actions, and proceedings may be begun against a
				  self-funded MEWA offering or providing coverage in the Commonwealth by serving
				  process on any trustee, director, officer, or agent of the self-funded MEWA, or
				  if none can be found, on the Clerk of the Commission. If a benefits consortium
				  offers or provides coverage in this Commonwealth without obtaining a license as
				  required by this chapter, it shall be deemed to have thereby appointed the
				  Clerk of the Commission its attorney for service of process. Service of process
				  shall be made as provided for in Article 1 (§ 38.2-800 et seq.) of Chapter
				  8 of Title 38.2 of the Code of Virginia.
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 14VAC5-415-130 - Severability

Current through Register Vol. 40, No. 24, July 15, 2024
If any provision of this chapter or the application to any
				  person or circumstance is for any reason held to be invalid, the remainder of
				  the chapter and the application of the provision to other persons or
				  circumstances shall not be affected.
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 415 - RULES GOVERNING SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Form - FORMS (14VAC5-415)

Current through Register Vol. 40, No. 24, July 15, 2024
MEWA
				  Attestation R21 (eff. 5/2023)
Self-Funded
				  MEWA Application SCCBOI153 (eff. 5/2023)
Statutory Authority: §§ 12.1-13, 38.2-223, and
					 38.2-3420 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 420 - RULES GOVERNING MILITARY SALES PRACTICES › Section 14VAC5-420-10 - Purpose and scope

Current through Register Vol. 40, No. 24, July 15, 2024
A. The
				purpose of this chapter is to set forth standards to protect active duty
				service members of the United States Armed Forces from dishonest and predatory
				insurance sales practices by prohibiting certain false, misleading, deceptive
				or unfair acts and practices.
B.
				This chapter shall apply only to the solicitation or sale of any life insurance
				or annuity product by an insurer or insurance agent to an active duty service
				member of the United States Armed Forces.
C. Nothing in this chapter shall be construed
				to create or imply a private cause of action for a violation of any provision
				of this chapter.
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia;
					 P.L.
					 109-290 (Military Personnel Financial Services
					 Protection Act).
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 420 - RULES GOVERNING MILITARY SALES PRACTICES › Section 14VAC5-420-30 - Exemptions

Current through Register Vol. 40, No. 24, July 15, 2024
A. This chapter
				shall not apply to solicitations or sales involving:
1. Credit insurance;
2. Group life insurance or group annuities
				where there is no in-person, face-to-face solicitation of individuals by an
				insurance agent or where the contract or certificate does not include a side
				fund;
3. An application to the
				existing insurer that issued the existing policy or contract when a contractual
				change or a conversion privilege is being exercised; or, when the existing
				policy or contract is being replaced by the same insurer pursuant to a program
				filed with and approved by the commission; or, when a term conversion privilege
				is exercised among corporate affiliates;
4. Individual standalone health policies,
				including disability income policies;
5. Contracts offered by SGLI or
				VGLI;
6. Life insurance contracts
				offered through or by a nonprofit military association, qualifying under §
				501(c)(23) of the Internal Revenue Code ( 26 USC § 501(c)(23) ) and that
				are not underwritten by an insurer; or
7. Contracts used to fund:
a. An employee pension or welfare benefit
				plan that is covered by the Employee Retirement and Income Security Act (ERISA)
				( 29 USC § 1001 et seq.);
b. A
				plan described by §§ 401(a), 401(k), 403(b), 408(k) or 408(p) of the
				Internal Revenue Code, if established or maintained by an employer;
c. A government or church plan defined in
				§ 414 of the Internal Revenue Code, a government or church welfare benefit
				plan, or a deferred compensation plan of a state or local government or tax
				exempt organization under § 457 of the Internal Revenue Code;
d. A nonqualified deferred compensation
				arrangement established or maintained by an employer or plan sponsor;
e. Settlements of or assumptions of
				liabilities associated with personal injury litigation or any dispute or claim
				resolution process; or
f.
				Prearranged funeral contracts.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 420 - RULES GOVERNING MILITARY SALES PRACTICES › Section 14VAC5-420-40 - Prohibited practices on a military installation

Current through Register Vol. 40, No. 24, July 15, 2024
A. The following acts or practices when
				committed on a military installation by an insurer or insurance agent with
				respect to the in-person, face-to-face solicitation of life insurance are
				prohibited:
1. Knowingly soliciting the
				purchase of any life insurance product door to door or without first
				establishing a specific appointment for each meeting with the prospective
				purchaser.
2. Soliciting service
				members in a group or mass audience or in a captive audience where attendance
				is not voluntary.
3. Knowingly
				making appointments with or soliciting service members during their normally
				scheduled duty hours.
4. Making
				appointments with or soliciting service members in barracks, day rooms, unit
				areas, or transient personnel housing or other areas where the installation
				commander has prohibited solicitation.
5. Soliciting the sale of life insurance
				without first obtaining permission from the installation commander or the
				commander's designee.
6. Posting
				unauthorized bulletins, notices or advertisements.
7. Failing to present DD Form 2885, Personal
				Commercial Solicitation Evaluation, to service members solicited, or
				encouraging service members solicited not to complete or submit a DD Form
				2885.
8. Knowingly accepting an
				application for life insurance or issuing a policy of life insurance on the
				life of an enlisted member of the United States Armed Forces without first
				obtaining for the insurer's files a completed copy of any required form that
				confirms that the applicant has received counseling or fulfilled any other
				similar requirement for the sale of life insurance established by regulations,
				directives or rules of the DoD or any branch of the Armed Forces.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 420 - RULES GOVERNING MILITARY SALES PRACTICES › Section 14VAC5-420-60 - Severability

Current through Register Vol. 40, No. 24, July 15, 2024
If any provision of this chapter or its application to any
				  person or circumstance is for any reason held to be invalid by a court, the
				  remainder of this chapter and the application of the provisions to other
				  persons or circumstances shall not be affected.
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia;
					 P.L.
					 109-290 (Military Personnel Financial Services
					 Protection Act).
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 420 - RULES GOVERNING MILITARY SALES PRACTICES › Form - FORMS (14VAC5-420)

Current through Register Vol. 40, No. 24, July 15, 2024
Personal Commercial Solicitation Evaluation, DD Form 2885
				  (eff. 4/06).
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 420 - RULES GOVERNING MILITARY SALES PRACTICES › Section - DOCUMENTS INCORPORATED BY REFERENCE (14VAC5-420)

Current through Register Vol. 40, No. 24, July 15, 2024
Department of Defense Instruction, Number 1344.07, Personal
				  Commercial Solicitation on DoD Installations, March 30, 2006.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 430 - INSURANCE DATA SECURITY RISK ASSESSMENT AND REPORTING › Section 14VAC5-430-10 - Applicability and scope

Current through Register Vol. 40, No. 24, July 15, 2024
This chapter sets forth rules to carry out the provisions of
				  the Insurance Data Security Act, Article 2 (§
									38.2-621, et seq.) of
				  Chapter 6 of Title 38.2 of the Code of Virginia, and sets minimum standards for
				  risk assessment and security standards required of all licensees. However, as
				  outlined, the specific requirements for licensees may differ in certain
				  circumstances, depending on the size and complexity of the licensee. This
				  chapter applies to and protects physical and electronic data, including
				  nonpublic information, stored, transmitted, and processed across various
				  information systems or any other media used by licensees.
Statutory Authority: §§
											12.1-13
					 and
					 38.2-223
					 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 430 - INSURANCE DATA SECURITY RISK ASSESSMENT AND REPORTING › Section 14VAC5-430-20 - Severability

Current through Register Vol. 40, No. 24, July 15, 2024
If any provision of this chapter or its application to any
				  person or circumstance is for any reason held to be invalid by a court or the
				  commission, the remainder of this chapter and the application of the provisions
				  to other persons or circumstances shall not be affected.
Statutory Authority: §§
											12.1-13
					 and
					 38.2-223
					 of the Code of Virginia.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 430 - INSURANCE DATA SECURITY RISK ASSESSMENT AND REPORTING › Section 14VAC5-430-40 - Information security program risk assessment

Current through Register Vol. 40, No. 24, July 15, 2024
A. In addition to the information security
				program requirements of §
									38.2-623
				of the Code of Virginia, taking into consideration the licensee's size and
				complexity, each licensee shall conduct a periodic risk assessment consistent
				with the following processes:
1. Identify
				reasonably foreseeable internal or external threats that could result in
				unauthorized access, transmission, disclosure, misuse, alteration, or
				destruction of nonpublic information held by a licensee, including the security
				of information systems and nonpublic information that are accessible to or held
				by third-party service providers;
2. Assess the likelihood and potential damage
				of these threats taking into consideration the sensitivity of nonpublic
				information in the possession, custody, or control of the licensee;
3. Assess the sufficiency of policies,
				procedures, information systems, and other safeguards in place to manage these
				threats, including consideration of threats in each relevant area of the
				licensee's operations, such as employee training and management; information
				classification that includes the processing, storage, transmission, and
				disposal of information; and the detection, prevention, and response to attacks
				and intrusions; and
4. Implement
				information safeguards to manage the threats identified in the licensee's
				ongoing assessment and, no less than annually, assess the effectiveness of the
				key controls, systems, and procedures.
Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 430 - INSURANCE DATA SECURITY RISK ASSESSMENT AND REPORTING › Section 14VAC5-430-50 - Information security program security measures

Current through Register Vol. 40, No. 24, July 15, 2024
A. As part of its information security
				program and based on its risk assessments, each licensee shall implement
				appropriate security measures as follows:
1.
				Manage the data, personnel, devices, systems, and facilities of the licensee in
				accordance with its identified risk;
2. Protect, by encryption or other
				appropriate means, all nonpublic information while being transmitted over an
				external network;
3. Protect, by
				encryption or other appropriate means, all nonpublic information stored on
				portable computing, storage devices, or media;
4. Adopt secure development practices for
				applications developed in-house and used by the licensee;
5. Adopt procedures for evaluating and
				assessing the security of externally developed applications utilized by the
				licensee;
6. Implement effective
				controls, which may include multi-factor authentication, for authorized persons
				to access nonpublic information; and
7. Use audit trails or audit logs designed to
				detect and respond to cybersecurity events and to reconstruct material
				financial transactions.