Terms Used In Virginia Code > Title 38.2 > Chapter 65 - Virginia Health Benefit Exchange

• 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
• American Health Benefit Exchange: means the program established as a component of the Exchange pursuant to this chapter that is designed to facilitate the purchase of qualified health plans or qualified dental plans by qualified individuals. See Virginia Code 38.2-6500
• Arena: means an arena or stadium that is located in a Hampton Roads locality or Hampton Roads localities, has a seating capacity of at least 15,000, and (i) is built for the purpose of holding entertainment events, conventions, and conferences; (ii) is built for the purpose of conducting athletic events; or (iii) is built for the purposes described in clauses (i) and (ii). See Virginia Code 15.2-5935
• Athletic events: means events conducted by a sports team. See Virginia Code 15.2-5935
• Authority: means the authority created pursuant to § 15. See Virginia Code 15.2-5935
• Bond: means a note of any kind, an interim certificate, a refunding bond, and any other evidence of obligation, including private bonds and other forms of private financing. See Virginia Code 15.2-5935
• bonds: includes notes of any kind, interim certificates, refunding bonds, or any other evidence of obligation, provided that such bonds are issued by the City of Virginia Beach, the City of Virginia Beach Development Authority, or a community development authority formed by the City of Virginia Beach pursuant to the provisions of Article 6 (§ 15. See Virginia Code 15.2-5931
• Bureau: means the Bureau of Insurance, a division within the Commission through which it administers insurance law. See Virginia Code 38.2-6500
• business of insurance: include solicitation, negotiations preliminary to execution, execution of an insurance contract, and the transaction of matters subsequent to execution of the contract and arising out of it. See Virginia Code 38.2-100
• 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
• Certified application counselor: means individuals certified by the Exchange to perform the duties described in 45 C. See Virginia Code 38.2-6500
• City of Virginia Beach: means the City of Virginia Beach, the City of Virginia Beach Development Authority, or any community development authority formed by the City of Virginia Beach pursuant to the provisions of Article 6 (§ 15. See Virginia Code 15.2-5928
• Commission: means the State Corporation Commission. See Virginia Code 38.2-6500
• 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
• Commissioner of Insurance: means the administrative or executive officer of the Bureau. See Virginia Code 38.2-100
• Committee: means the Advisory Committee established pursuant to § 38. See Virginia Code 38.2-6500
• Director: means the Director of the Division appointed by the Commission pursuant to § 38. See Virginia Code 38.2-6500
• Division: means the Health Benefit Exchange Division, a division within the Commission through which it administers the Exchange. See Virginia Code 38.2-6500
• Eligible entity: means the Bureau, the Department of Medical Assistance Services, or a qualified vendor that has demonstrated experience on a statewide or regional basis in individual and small group health insurance markets and in benefits coverage; however, a health carrier or an affiliate of a health carrier is not an eligible entity. See Virginia Code 38.2-6500
• Eligible transactions: means transactions taking place upon the premises of a Facility, including (i) transactions generating revenues in connection with the development and construction of a Facility that would not be generated but for the existence of the Facility and (ii) transactions that occur while a Facility is under construction. See Virginia Code 15.2-5935
• Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
• Essential health benefits package: means the scope of covered benefits and associated limits of a health benefit plan that (i) provides benefits pursuant to § 38. 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
• Facility: includes any temporary construction related to the Facility. See Virginia Code 15.2-5935
• Facility Site: means real estate designated, donated, purchased, or otherwise acquired for the purpose of constructing a Facility. See Virginia Code 15.2-5935
• FAMIS: means the Family Access to Medical Insurance Security Plan, including the FAMIS Plus program, established pursuant to Chapter 13 of Title 32. See Virginia Code 38.2-6500
• Federal Act: means the federal Patient Protection and Affordable Care Act, P. See Virginia Code 38.2-6500
• 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
• Hampton Roads locality: means the City of Chesapeake, Norfolk, or Virginia Beach. See Virginia Code 15.2-5935
• 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
• Insurer: means an insurance company. See Virginia Code 38.2-100
• 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
• Minimum essential coverage: means coverage defined in 45 C. See Virginia Code 38.2-6500
• Navigator: means an individual or entity that is registered pursuant to § 38. See Virginia Code 38.2-6500
• Nonlegislative citizen member: means any natural person who is not a member of the General Assembly of Virginia. See Virginia Code 1-225
• Officer: means a member of the Virginia Marine Police. See Virginia Code 28.2-100
• Participating locality: means a Hampton Roads locality that joins the Authority. See Virginia Code 15.2-5935
• 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
• PHSA: means the federal Public Health Service Act, Chapter 6A of Title 42 of the United States Code, as amended. 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
• Qualified employer: means a small employer that elects to make all of its full-time employees eligible for one or more qualified health plans or qualified dental plans in the small group market offered through the SHOP exchange and, at the employer's option, some or all of its part-time employees, provided that the employer (i) has its principal place of business in the Commonwealth and elects to provide coverage through the SHOP exchange to all of its eligible employees, wherever employed, or (ii) elects to provide coverage through the SHOP exchange to all of its eligible employees who are principally employed in the Commonwealth. See Virginia Code 38.2-6500
• Qualified health plan: means a health benefit plan that has in effect a certification that the plan meets the criteria for certification described in § 1311(c) of the Federal Act and § 38. See Virginia Code 38.2-6500
• Qualified individual: means an individual, including a minor, who (i) is seeking to enroll in a qualified health plan or qualified dental plan offered to individuals through the Exchange; (ii) resides in the Commonwealth; (iii) is not incarcerated at the time of enrollment, other than incarceration pending the disposition of charges; and (iv) is, and is reasonably expected to be, for the entire period for which enrollment is sought, a citizen or a national of the United States or an alien lawfully present in the United States. See Virginia Code 38.2-6500
• 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
• 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}
• related facilities: includes practice facilities and related offices. See Virginia Code 15.2-5935
• Related properties: means onsite and offsite offices, parking lots, and garages. See Virginia Code 15.2-5935
• Sales and use tax revenues: means tax collections under the Virginia Retail Sales and Use Tax Act (§ 58. See Virginia Code 15.2-5928
• Secretary: means the Secretary of the U. See Virginia Code 38.2-6500
• Shoals: means subaqueous elevations covered by water less than four feet deep at mean low water. See Virginia Code 28.2-200
• SHOP exchange: means the Small Business Health Options Program, established as a component of the Exchange pursuant to this chapter, through which a qualified employer can provide its eligible employees and their dependents with access to one or more qualified health plans or qualified dental plans. See Virginia Code 38.2-6500
• Small employer: means an employer that employed an average of not more than 50 employees during the preceding calendar year. See Virginia Code 38.2-6500
• Small group market: means the health insurance market under which individuals obtain health insurance coverage, directly or through any arrangement, on behalf of themselves and their dependents through a group health plan maintained by a small employer. See Virginia Code 38.2-6500
• Sports and entertainment district: means the geographic area in the City of Virginia Beach located south of 21st Street, north of Norfolk Avenue, east of Birdneck Road, and west of the Virginia Beach Boardwalk. See Virginia Code 15.2-5928
• Sports or entertainment project: includes multiple facilities located on multiple properties, provided that such facilities share a nexus of ownership or management. See Virginia Code 15.2-5928
• Sports team: means a sports franchise holder that is a part of the National Basketball Association, the National Basketball Association Development League, the Women's National Basketball Association, the National Hockey League, the American Hockey League, the ECHL, the Federal Prospects Hockey League, the Ligue Nord-Américaine de Hockey, or the Southern Professional Hockey League, and any other national sports league. See Virginia Code 15.2-5935
• State: means any commonwealth, state, territory, district or insular possession of the United States. See Virginia Code 38.2-100
• State Medicaid Program: means the Commonwealth's Medicaid program under Title XIX of the Social Security Act, as amended from time to time. See Virginia Code 38.2-6500
• State-mandated health benefit: means coverage required under this title or other laws of the Commonwealth to be provided in a policy of accident and sickness insurance, an accident and sickness subscription contract, or a health maintenance organization health care plan that includes coverage for specific health care services or benefits. See Virginia Code 38.2-6500
• Tort: A civil wrong or breach of a duty to another person, as outlined by law. A very common tort is negligent operation of a motor vehicle that results in property damage and personal injury in an automobile accident.
• Variable Rate: Having a "variable" rate means that the APR changes from time to time based on fluctuations in an external rate, normally the Prime Rate. This external rate is known as the "index." If the index changes, the variable rate normally changes. Also see Fixed Rate.