Virginia Code 38.2-3553: Membership in a small employer health group cooperative
A. A small employer health group cooperative:
Terms Used In Virginia Code 38.2-3553
- cooperative: means an entity authorized by its employer-members to negotiate with health insurance issuers on their behalf as to the terms, including premium rates, under which a group health policy or policies may be issued, providing coverage for the eligible employees of such employer-members and their eligible dependents. See Virginia Code 38.2-3551
- Dependent: A person dependent for support upon another.
- Health status-related factor: means the following in relation to the individual or a dependent eligible for coverage under a group health plan or health insurance coverage offered by a health insurance issuer:
1. See Virginia Code 38.2-3551
- issuer: means a company authorized to issue coverage under Article 3 (§ 38. See Virginia Code 38.2-3551
- Service area: means the geographic area within which a health insurance issuer is authorized to sell a group health policy or policies. See Virginia Code 38.2-3551
- Small employer: means , in connection with a group health policy with respect to a calendar year and a plan year, an employer who employed an average of at least one but not more than 50 employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year. See Virginia Code 38.2-3551
1. Shall not limit, restrict, or condition a small employer’s membership in the small employer health group cooperative on any health status-related factor relating to an individual, including an employee of a small employer or a dependent of an employee; and
2. Shall make group health policies offered through the small employer health group cooperative available to all eligible employees of its employer-members and their eligible dependents, regardless of any health status-related factor relating to individuals eligible for coverage through a member.
B. Notwithstanding subdivision 2 of subsection A, nothing in this article shall be construed as requiring (i) an issuer to provide coverage outside its service area or (ii) a small employer health group cooperative to make such coverage available to employer-members located outside the service area of the issuer.
C. A small employer health group cooperative shall not make group health policies offered through the cooperative available other than to the eligible employees of its employer-members and their eligible dependents.
2006, c. 427.