Terms Used In Virginia Code > Title 38.2 > Chapter 43 - Health Maintenance Organizations

• Acceptable securities: means securities that (i) are legal investments under the laws of the Commonwealth for public sinking funds or for other public funds, (ii) are not in default as to principal or interest, (iii) have a current market value of not less than $50,000 nor more than $500,000, and (iv) are issued pursuant to a system of book-entry evidencing ownership interests of the securities with transfers of ownership effected on the records of the depository and its participants pursuant to rules and procedures established by the depository. See Virginia Code 38.2-4300
• Adult: means a person 18 years of age or more. See Virginia Code 1-203
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• 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.
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Authority: means any political subdivision, a body politic and corporate, created, organized and operated pursuant to the provisions of this chapter, or if the authority is abolished, the board, body, commission, department or officer succeeding to the principal functions thereof or to whom the powers given by this chapter are given by law. See Virginia Code 15.2-4902
• Basic health care services: means in and out-of-area emergency services, inpatient hospital and physician care, outpatient medical services, laboratory and radiologic services, mental health and substance use disorder benefits, and preventive health services. See Virginia Code 38.2-4300
• Bond: includes any interest-bearing obligation, including promissory notes. See Virginia Code 15.2-5201
• capital and surplus: means the excess of total admitted assets over the total liabilities of the health maintenance organization, provided that surplus notes shall be reported and accounted for in accordance with guidance set forth in the National Association of Insurance Commissioners (NAIC) accounting practice and procedures manuals. See Virginia Code 38.2-4300
• Commission: means the State Corporation Commission. See Virginia Code 38.2-100
• Contract: A legal written agreement that becomes binding when signed.
• Copayment: means an amount an enrollee is required to pay in order to receive a specific health care service. See Virginia Code 38.2-4300
• Council: means the State Council of Higher Education for Virginia. See Virginia Code 23.1-100
• Deductible: means an amount an enrollee is required to pay out-of-pocket before the health care plan begins to pay the costs associated with health care services. See Virginia Code 38.2-4300
• Devise: To gift property by will.
• Emergency services: means those health care services that are rendered by affiliated or nonaffiliated providers after the sudden onset of a medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent layperson who possesses an average knowledge of health and medicine to result in (i) serious jeopardy to the mental or physical health of the individual, (ii) danger of serious impairment of the individual's bodily functions, (iii) serious dysfunction of any of the individual's bodily organs, or (iv) in the case of a pregnant woman, serious jeopardy to the health of the fetus. See Virginia Code 38.2-4300
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Evidence of coverage: means any certificate or individual or group agreement or contract issued in conjunction with the certificate, agreement or contract, issued to a subscriber setting out the coverage and other rights to which an enrollee is entitled. See Virginia Code 38.2-4300
• Ex officio: Literally, by virtue of one's office.
• Ex officio: means service by virtue of one's office and includes voting privileges for ex officio members unless otherwise provided. See Virginia Code 1-215
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Foreclosure: A legal process in which property that is collateral or security for a loan may be sold to help repay the loan when the loan is in default. ^{Source: OCC}
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• Governing body: means the board of supervisors of a county, council of a city, or council of a town, as the context may require. See Virginia Code 15.2-102
• Health care plan: means any arrangement in which any person undertakes to provide, arrange for, pay for, or reimburse any part of the cost of any health care services. See Virginia Code 38.2-4300
• health care provider: means any physician, hospital, or other person that is licensed or otherwise authorized in the Commonwealth to furnish health care services. See Virginia Code 38.2-4300
• Health care services: means the furnishing of services to any individual for the purpose of preventing, alleviating, curing, or healing human illness, injury, or physical disability. See Virginia Code 38.2-4300
• Health maintenance organization: means any person who undertakes to provide or arrange for one or more health care plans. See Virginia Code 38.2-4300
• Health services plan: means any arrangement for offering or administering health services or similar or related services by a corporation licensed under Chapter 42 of Title 59. See Virginia Code 38.2-100
• Hospital or health center: means any and all medical facilities and approaches thereto and appurtenances thereof. See Virginia Code 15.2-5201
• in writing: include any representation of words, letters, symbols, numbers, or figures, whether (i) printed or inscribed on a tangible medium or (ii) stored in an electronic or other medium and retrievable in a perceivable form and whether an electronic signature authorized by Chapter 42. See Virginia Code 1-257
• Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. ^{Source: FDIC}
• inhabitants: means with reference to any county, city, town, political subdivision of the Commonwealth or any combination thereof, the natural persons in such county, city, town, political subdivision or combination as shown by the unadjusted United States decennial census last preceding the time at which any provision dependent upon population is being applied or the time as of which it is being construed. See Virginia Code 1-235
• Insurer: means an insurance company. See Virginia Code 38.2-100
• Issuing authority: means any political subdivision, governmental unit, authority, or other entity of the Commonwealth which is empowered to issue private activity bonds. See Virginia Code 15.2-5000
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Limited health care services: means dental care services, vision care services, and such other services as may be determined by the Commission to be limited health care services. See Virginia Code 38.2-4300
• Locality: means a county, city, or town as the context may require. See Virginia Code 1-221
• Manufacturing facility: means (i) any facility which is used in the manufacturing or production of tangible personal property, including the processing resulting in a change of condition of such property, (ii) any facility which is used in the creation or production of intangible property as described in § 197(d)(1)(C)(iii) of the Internal Revenue Code of 1986, as amended, to be any patent, copyright, formula, process, design, pattern, knowhow, format, or other similar item, or (iii) any facility which is functionally related and subordinate to a manufacturing facility if such facility is located on the same site as the manufacturing facility. See Virginia Code 15.2-5000
• member: means an individual who is enrolled in a health care plan. See Virginia Code 38.2-4300
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• Nonlegislative citizen member: means any natural person who is not a member of the General Assembly of Virginia. See Virginia Code 1-225
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Oversight: Committee review of the activities of a Federal agency or program.
• Participating provider: means a provider who has agreed to provide health care services to enrollees and to hold those enrollees harmless from payment with an expectation of receiving payment, other than copayments or deductibles, directly or indirectly from the health maintenance organization. See Virginia Code 38.2-4300
• Person: means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds type of organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Virginia Code 38.2-100
• President pro tempore: A constitutionally recognized officer of the Senate who presides over the chamber in the absence of the Vice President. The President Pro Tempore (or, "president for a time") is elected by the Senate and is, by custom, the Senator of the majority party with the longest record of continuous service.
• Private activity bond: means a part or all of any bond (or other instrument) required to obtain an allocation from the state's volume cap pursuant to § 146 of the Internal Revenue Code of 1986, as amended, in order to be tax exempt, including but not limited to the following:

  1. See Virginia Code 15.2-5000

• Public institution of higher education: includes the System as a whole and each associate-degree-granting and baccalaureate public institution of higher education in the Commonwealth. See Virginia Code 23.1-100
• Quorum: The number of legislators that must be present to do business.
• rates: means any rate of premium, policy fee, membership fee or any other charge made by an insurer for or in connection with a contract or policy of insurance. See Virginia Code 38.2-100
• real estate: includes lands, tenements and hereditaments, and all rights and appurtenances thereto and interests therein, other than a chattel interest. See Virginia Code 1-219
• Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
• Recess: A temporary interruption of the legislative business.
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• Single family housing bonds: means any obligation described as a qualified mortgage bond under § 143 of the Internal Revenue Code of 1986, as amended. See Virginia Code 15.2-5000
• State: means any commonwealth, state, territory, district or insular possession of the United States. See Virginia Code 38.2-100
• state agency: means the same as that term is defined in § 2. See Virginia Code 1-206
• State Board: means the State Board for Community Colleges. See Virginia Code 23.1-100
• State ceiling: means the maximum amount of private activity bonds that the Commonwealth of Virginia may issue in a calendar year as limited by federal law under the Internal Revenue Code of 1986, as amended. See Virginia Code 15.2-5000
• Statute: A law passed by a legislature.
• stop loss insurance: means insurance issued to a health maintenance organization by an insurer licensed in the Commonwealth, on a form approved by the Commission, or a risk assumption transaction acceptable to the Commission, providing indemnity or reimbursement against the cost of health care services provided by the health maintenance organization. See Virginia Code 38.2-4300
• Subscriber: means a contract holder, an individual enrollee, or the enrollee in an enrolled family who is responsible for payment to the health maintenance organization or on whose behalf such payment is made. See Virginia Code 38.2-4300
• Supreme Court: means the Supreme Court of Virginia. See Virginia Code 1-249
• System: means the Virginia Community College System. See Virginia Code 23.1-100
• 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