Virginia Code 38.2-6507: Appeal of decertification or denial of certification
A. The Exchange shall give each health carrier the opportunity to appeal a decertification decision or the denial of certification as a qualified health plan or qualified dental plan.
Terms Used In Virginia Code 38.2-6507
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- carrier: means an entity subject to the insurance laws and regulations of the Commonwealth and subject to the jurisdiction of the Commission that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including an insurer licensed to sell accident and sickness insurance, a health maintenance organization, a health services plan, a dental plan organization, a dental services plan, or any other entity providing a plan of health insurance, health benefits, or health care services. See Virginia Code 38.2-6500
- Commission: means the State Corporation Commission. See Virginia Code 38.2-6500
- Exchange: means , as the context requires, either (i) the Division or (ii) the Virginia Health Benefit Exchange established pursuant to the provisions of this chapter and in accordance with § 1311(b) of the Federal Act, through which qualified health plans and qualified dental plans are made available to qualified individuals through the American Health Benefit Exchange and to qualified employers through the SHOP exchange. See Virginia Code 38.2-6500
- plan: means a policy, contract, certificate, or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. See Virginia Code 38.2-6500
- Qualified dental plan: means a limited scope dental plan that has been certified in accordance with § 38. See Virginia Code 38.2-6500
B. The Exchange shall give each health carrier that appeals a decertification decision or the denial of certification the opportunity for:
1. The submission and consideration of facts, arguments, or proposals of adjustment of the plan or plans at issue; and
2. A hearing and a decision on the record, to the extent that the Exchange and the health carrier are unable to reach agreement following the submission of the information in subdivision 1.
C. Any hearing held pursuant to subsection B shall be conducted by the Commission in accordance with its rules of practice and procedure.
D. Any final action or order of the Commission shall be subject to judicial review in accordance with the provisions of §§ 12.1-39, 12.1-40, and 12.1-41.