Terms Used In Virginia Code > Title 38.2 > Chapter 58 - Managed Care Health Insurance Plans

• Accident and sickness insurance: means insurance against loss resulting from sickness, or from bodily injury or death by accident or accidental means, or from a combination of any or all of these perils. See Virginia Code 38.2-109
• Accident and sickness insurance company: means a person subject to licensing in accordance with provisions in Chapter 10 (§ 38. See Virginia Code 38.2-5800
• Authority: means an authority created under the provisions of § 15. See Virginia Code 15.2-5601
• Basic health care services: means emergency services, inpatient hospital and physician care, outpatient medical services, laboratory and radiological services, mental health and substance use disorder benefits, and preventive health services. See Virginia Code 38.2-5800
• Bureau of Insurance: means the division of the Commission established to administer the insurance laws of the Commonwealth. See Virginia Code 38.2-100
• Commission: means the State Corporation Commission. See Virginia Code 38.2-100
• Commission: means the Marine Resources Commission. See Virginia Code 28.2-100
• Commissioner: means the Commissioner of Marine Resources. See Virginia Code 28.2-100
• Company: means any association, aggregate of individuals, business, 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
• Cost: means , as applied to any project, all or any part of the cost of acquisition, construction, alteration, enlargement, reconstruction and remodeling of a project or portion thereof, including the cost of the acquisition of all land, rights-of-way, property, rights, easements and interests acquired by the authority for such construction, additions or expansion, the cost of demolishing or removing any building or structure on land so acquired, including the cost of acquiring any lands to which such building or structures may be removed, the cost of all labor, materials, machinery and equipment, financing charges, insurance, interest on all bonds prior to and during such construction, and during the construction of any addition or expansion, and if deemed advisable by the authority, for a period not exceeding one year after completion of such construction, addition or expansion, reserves for principal and interest and for extensions, enlargements, additions, replacements, renovations and improvements, provisions for working capital, the cost of surveys, engineering and architectural expenses, borings, plans and specifications and other engineering and architectural services, legal expenses, studies, estimates of cost and revenues, administrative expenses and such other expenses as may be necessary or incident to the construction of the project, and of such subsequent additions thereto or expansion thereof, the cost of financing such construction, additions or expansion and placing the project and such additions or expansion in operation. See Virginia Code 15.2-5601
• County: means any existing county or such unit hereafter created. See Virginia Code 15.2-102
• Covered person: means an individual, whether a policyholder, subscriber, enrollee, or member of a managed care health insurance plan (MCHIP) who is entitled to health care services or benefits provided, arranged for, paid for or reimbursed pursuant to an MCHIP. See Virginia Code 38.2-5800
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Evidence of coverage: includes any certificate, individual or group agreement or contract or related documents issued in conjunction with the certificate, agreement or contract, issued to a subscriber setting out the coverage and other rights to which a covered person is entitled. See Virginia Code 38.2-5800
• Federal agency: means the United States of America and any department, bureau, agency or instrumentality thereof. See Virginia Code 15.2-5601
• 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 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 38.2-5800
• Health carrier: means an entity subject to Title 38. See Virginia Code 38.2-5800
• Health maintenance organization: means a person licensed pursuant to Chapter 43 (§ 38. See Virginia Code 38.2-5800
• 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
• 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
• 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 38.2-5800
• MCHIP: means an arrangement for the delivery of health care in which a health carrier undertakes to provide, arrange for, pay for, or reimburse any of the costs of health care services for a covered person on a prepaid or insured basis which (i) contains one or more incentive arrangements, including any credentialing requirements intended to influence the cost or level of health care services between the health carrier and one or more providers with respect to the delivery of health care services and (ii) requires or creates benefit payment differential incentives for covered persons to use providers that are directly or indirectly managed, owned, under contract with or employed by the health carrier. See Virginia Code 38.2-5800
• medically necessary: means appropriate and necessary health care services which are rendered for any condition which, according to generally accepted principles of good medical practice, requires the diagnosis or direct care and treatment of an illness, injury, or pregnancy-related condition, and are not provided only as a convenience. See Virginia Code 38.2-5800
• Medicare: means the "Health Insurance for the Aged Act" Title XVIII of the Social Security Amendment of 1965, as amended. See Virginia Code 38.2-100
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• Network: means the set of providers directly or indirectly managed, owned, under contract with or employed directly or indirectly by a health carrier for the purpose of delivering health care services to the covered persons of an MCHIP. See Virginia Code 38.2-5800
• Officer: means a member of the Virginia Marine Police. See Virginia Code 28.2-100
• 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
• projects: means any one or more of the following: auditorium, theater, concert or entertainment hall, coliseum, convention center, arena, field house, stadium, fairground, campground, land conservation project, including but not limited to the holding of conservation easements, sports facilities, including racetracks, amusement park or center, garden, park, zoo and museum, as such terms are generally used, and parking, transportation, utility and restaurant facilities and concessions in connection with any of the foregoing, including any and all buildings, structures, approaches, roadways, and other facilities and appurtenances thereto which the authority may deem necessary or desirable, together with all property, rights, easements and interests which may be acquired by the authority for the construction, improvement and operation of any of the foregoing. See Virginia Code 15.2-5601
• Recourse: An arrangement in which a bank retains, in form or in substance, any credit risk directly or indirectly associated with an asset it has sold (in accordance with generally accepted accounting principles) that exceeds a pro rata share of the bank's claim on the asset. If a bank has no claim on an asset it has sold, then the retention of any credit risk is recourse. ^{Source: FDIC}
• Service area: means a clearly defined geographic area in which a health carrier has directly or indirectly arranged for the provision of health care services to be generally available and readily accessible to covered persons of an MCHIP. See Virginia Code 38.2-5800
• shellfish: means such species of mollusca as oysters and clams, and such species of crustacea as crabs. See Virginia Code 28.2-100
• Shoals: means subaqueous elevations covered by water less than four feet deep at mean low water. See Virginia Code 28.2-200
• State: means any commonwealth, state, territory, district or insular possession of the United States. See Virginia Code 38.2-100
• Subscriber: means a person obligated under a reciprocal insurance agreement. See Virginia Code 38.2-1201
• Town: means any existing town or an incorporated community within one or more counties which became a town before noon, July one, nineteen hundred seventy-one, as provided by law or which has within defined boundaries a population of 1,000 or more and which has become a town as provided by law. See Virginia Code 15.2-102
• Trustee: A person or institution holding and administering property in trust.
• User fees: Fees charged to users of goods or services provided by the government. In levying or authorizing these fees, the legislature determines whether the revenue should go into the treasury or should be available to the agency providing the goods or services.