Virginia Code 59.1-590: Conditions for a benefits consortium
A. This section does not apply to a multiple employer welfare arrangement (MEWA) that offers or provides health benefit plans that are fully insured by an insurer authorized to transact the business of health insurance in the Commonwealth.
Terms Used In Virginia Code 59.1-590
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- Benefits consortium: means a trust that is a self-funded MEWA, as defined in § 38. See Virginia Code 59.1-589
- Contract: A legal written agreement that becomes binding when signed.
- ERISA: means the federal Employee Retirement Income Security Act of 1974, P. See Virginia Code 59.1-589
- Fiduciary: A trustee, executor, or administrator.
- State: when applied to a part of the United States, includes any of the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Northern Mariana Islands, and the United States Virgin Islands. See Virginia Code 1-245
- Trust: means a trust that (i) is established to accept and hold assets of a health benefit plan in trust in accordance with the terms of the written trust document for the sole purposes of providing medical, prescription drug, dental, and vision benefits and defraying reasonable administrative costs of providing health benefits under a health benefit plan and (ii) complies with the conditions set forth in § 59. See Virginia Code 59.1-589
- Trustee: A person or institution holding and administering property in trust.
- United States: includes the 50 states, the District of Columbia the Commonwealth of Puerto Rico, Guam, the Northern Mariana Islands and the United States Virgin Islands. See Virginia Code 1-255
B. A trust shall constitute a benefits consortium and shall be authorized to sell or offer to sell health benefit plans to members of a sponsoring association in accordance with the provisions of this chapter if all of the following conditions are satisfied:
1. The trust shall be subject to (i) ERISA and U.S. Department of Labor regulations applicable to multiple employer welfare arrangements and (ii) the authority of the U.S. Department of Labor to enforce such law and regulations;
2. A Form M-1, Report for Multiple Employer Welfare Arrangements (MEWAs), for the applicable plan year shall be filed with the U.S. Department of Labor identifying the arrangement among the trust, sponsoring association, and health benefit plans offered through the trust as a multiple employer welfare arrangement;
3. The trust’s organizational documents shall:
a. Provide that the trust is sponsored by the sponsoring association;
b. State that the purpose of the trust is to provide medical, prescription drug, dental, and vision benefits to participating employees of the sponsoring association or its members, and the dependents of those employees, through health benefit plans;
c. Provide that the funds of the trust are to be used for the benefit of participating employees, and the dependents of those employees, through self-funding of claims, the purchase of reinsurance, or a combination thereof, as determined by the trustee, and for defraying reasonable expenses of administering and operating the trust and any health benefit plan;
d. Limit participation in health benefit plans to participating employees of the sponsoring association and its members;
e. Provide for a board of trustees, composed of no fewer than five trustees, that has complete fiscal control over the arrangement and is responsible for all operations of the arrangement. The trustees selected for the board shall be owners, partners, officers, directors, or employees of one or more employers in the arrangement. A trustee or director may not be an owner, officer, or employee of the administrator or service company of the arrangement. The board shall have the authority to approve applications of association members for participation in the arrangement and to contract with a licensed administrator or service company to administer the day-to-day affairs of the arrangement;
f. Provide for the election of trustees to the board of trustees; and
g. Require the trustees to discharge their duties with respect to the trust in accordance with the fiduciary duties defined in ERISA;
4. Five or more members shall participate in one or more health benefit plans;
5. The trust shall establish and maintain reserves determined in accordance with sound actuarial principles and in compliance with all financial and solvency requirements imposed upon domestic self-funded MEWAs;
6. The trust shall purchase and maintain policies of specific, aggregate, and terminal excess insurance with retention levels determined in accordance with sound actuarial principles from insurers licensed to transact the business of insurance in the Commonwealth;
7. The trust shall secure one or more guarantees or standby letters of credit that:
a. Guarantee the payment of claims under the health benefit plan in an aggregate amount not less than the amount of the trust’s annual aggregate excess insurance retention level minus (i) the annual premium assessments for the health benefit plans and (ii) the trust’s net assets, which amount shall be the net of the trust’s reasonable estimate of incurred but not reported claims; and
b. Have been issued by a qualified United States financial institution, as such term is used in subdivision 2 c of § 38.2-1316.4;
8. The trust shall purchase and maintain commercially reasonable fiduciary liability insurance;
9. The trust shall purchase and maintain a bond that satisfies the requirements of ERISA;
10. The trust is audited annually by an independent certified public accountant; and
11. The trust does not include in its name the words “insurance,” “insurer,” “underwriter,” “mutual,” or any other word or term or combination of words or terms that is uniquely descriptive of an insurance company or insurance business unless the context of the remaining words or terms clearly indicates that the entity is not an insurance company and is not transacting the business of insurance.