Current through Register Vol. 41, No. 3, September 23, 2024
A. A multiple
employer welfare arrangement that is not fully insured as defined in this
chapter shall not operate in this Commonwealth without (i) complying with the
requirements of Rules Governing Self-Funded Multiple Employer Welfare
Arrangements (14VAC5-415) or (ii) meeting the criteria and becoming
appropriately licensed as an insurance company, health maintenance
organization, health services plan, or a dental or optometric services plan
pursuant to Title 38.2 of the Code of Virginia.
B. A fully insured multiple employer welfare
arrangement shall not operate in this Commonwealth without first filing with
the commission:
1. The names, addresses, and
biographical summaries of the plan's trustees, officers, directors, or other
members of the plan's governing body.
2. The names, addresses, and qualifications
of individuals responsible for the conduct of the plan's affairs, including any
third-party administrators.
3. The
names, addresses, and qualifications of persons who will solicit, negotiate,
procure, or effect applications for coverage with the plan.
4. The names and addresses of employers
participating in the plan.
5. Proof
of coverage showing that the plan is fully insured by an insurer, health
maintenance organization, health services plan, or dental or optometric
services plan as required by the definition of "fully insured" in
14VAC5-410-30. Proof of coverage
shall be submitted on a form prescribed by the commission and shall include (i)
a copy of the policy insuring the plan; (ii) confirmation from the insurer,
health maintenance organization, health services plan, or a dental or
optometric services plan that coverage is in force; and (iii) a statement
indicating the length of time coverage has been in force.
6. Any other information the commission may
require including information pertaining to the adequacy of the plan's level of
reserves and contributions.
C.
1. If a
multiple employer welfare arrangement changes coverage or does not remain fully
insured as the term is defined in
14VAC5-410-30, the plan shall
notify the commission at least 30 days prior to the effective date of any
change or reduction in coverage.
2.
Any multiple employer welfare arrangement that ceases to remain fully insured
shall, at least 30 days prior to the effective date of coverage termination,
(i) notify the commission of a replacement policy in accordance with
subdivision B 5 of this section, (ii) apply for a license as a self-funded MEWA
pursuant to 14VAC5-415, or (iii) apply for a license as an insurer, health
maintenance organization, health services plan, or a dental or optometric
services plan and be subject to all applicable provisions of Title 38.2 of the
Code of Virginia. Such plan shall not be required to cease operations or
discontinue benefits to existing members during this 30-day period. However,
such plan shall not solicit, negotiate, procure, or effect coverage for new
enrollments other than for dependents of employees already enrolled during this
30-day period unless (i) the plan has been licensed as required by this
chapter, (ii) the plan becomes fully insured as the term is defined in
14VAC5-410-30 and has provided the
commission with proof of coverage as required by subdivision B 5 of this
section, or (iii) the plan is granted an extension by the commission for good
cause shown. Nothing contained in this section shall prevent the commission
from proceeding with an action in accordance with the provisions of
14VAC5-410-60.
3. Any insurer, health maintenance
organization, health services plan, or dental or optometric services plan
providing coverage to a multiple employer welfare arrangement shall notify the
commission and the multiple employer welfare arrangement of any change or
reduction in coverage at least 45 days prior to the effective date of such
change or reduction in coverage.
4.
Any insurer, health maintenance organization, health services plan, or dental
or optometric services plan failing to provide notice to the commission as
required by subdivision 3 of this subsection shall be required to continue
coverage to the multiple employer welfare arrangement for an additional 45 days
after notice of cancellation is provided to the commission.
D. In addition to the filing
requirements stated in subsection B of this section, each fully insured
multiple employer welfare arrangement shall file on or before March 1 of each
year (i) proof of coverage as set forth in subdivision B 5 of this section and
(ii) notice of any changes in information as filed with the
commission.
E. Any multiple
employer welfare arrangement offering or providing coverage in this
Commonwealth shall be subject to examination by the commission in accordance
with § 38.2-3422 of the Code of Virginia.
F. Notwithstanding any other provision of
this chapter, any multiple employer health care plans licensed and operating,
or whose license application is pending with the commission on January 15,
1995, and subsequently approved by the commission may continue to operate as a
multiple employer health care plan in the Commonwealth of Virginia, pursuant to
the commission's Rules Governing Multiple Employer Health Care Plans, for a
period not to exceed three years after January 15, 1995.
Statutory Authority: §§ 12.1-13, 38.2-223, and
38.2-3420 of the Code of Virginia.
