38.2-3432.2 - Availability.
§ 38.2-3432.2. Availability.
A. If coverage is offered under this article in the small employer market:
1. Such coverage shall be offered and made available to all the eligibleemployees of every small employer and their dependents, including lateenrollees, that apply for such coverage. No coverage may be offered only tocertain eligible employees or their dependents and no employees or theirdependents may be excluded or charged additional premiums because of healthstatus; and
2. All products that are approved for sale in the small group market that thehealth insurance issuer is actively marketing must be offered to all smallemployers, and the health insurance issuer must accept any employer thatapplies for any of those products. This subdivision shall not apply to healthinsurance coverage or products offered by a health insurance issuer if suchcoverage or product is made available in the small group market only throughone or more bona fide associations.
B. No coverage offered under this article shall exclude an employer basedsolely on the nature of the employer's business.
C. A health insurance issuer that offers health insurance coverage in a smallgroup market through a network plan may:
1. Limit the employers that may apply for such coverage to those eligibleindividuals who live, work or reside in the service area for such networkplan; and
2. Within the service area of such plan, deny such coverage to such employersif the health insurance issuer has demonstrated, if required, to thesatisfaction of the Commission that:
a. It will not have the capacity to deliver services adequately to enrolleesof any additional groups because of its obligations to existing groupcontract holders and enrollees; and
b. It is applying this subdivision uniformly to all employers without regardto the claims experience of those employers and their employees (and theirdependents) or any health status-related factors relating to such employeesand dependents.
3. A health insurance issuer upon denying health insurance coverage in anyservice area in accordance with subdivision D 1, may not offer coverage inthe small group market within such service area for a period of 180 daysafter the date such coverage is denied.
D. A health insurance issuer may deny health insurance coverage in the smallgroup market if the health insurance issuer has demonstrated, if required, tothe satisfaction of the Commission that:
1. It does not have the financial reserves necessary to underwrite additionalcoverage; and
2. It is applying this subdivision uniformly to all employers in the smallgroup market in the Commonwealth consistent with the laws of thisCommonwealth and without regard to the claims experience of those employersand their employees (and their dependents) or any health status-relatedfactor relating to such employees and dependents.
E. A health insurance issuer upon denying health insurance coverage inaccordance with subsection D in the Commonwealth may not offer coverage inthe small group market for a period of 180 days after the date such coverageis denied or until the health insurance issuer has demonstrated to thesatisfaction of the Commission that the health insurance issuer hassufficient financial reserves to underwrite additional coverage, whichever islater.
F. Nothing in this article shall be construed to preclude a health insuranceissuer from establishing employer contribution rules or group participationrules in connection with a health benefit plan offered in the small groupmarket. As used in this article, the term "employer contribution rule"means a requirement relating to the minimum level or amount of employercontribution toward the premium for enrollment of eligible individuals andthe term "group participation rule" means a requirement relating to theminimum number of eligible employees that must be enrolled in relation to aspecified percentage or number of eligible employees. Any employercontribution rule or group participation rule shall be applied uniformlyamong small employers without reference to the size of the small employergroup, health status of the small employer group, or other factors.
(1997, cc. 807, 913; 1998, c. 24; 2000, c. 544.)