HB 2201 — Association health plans; rates based on employer member's risk profile.

SESSION ENROLLED VIRGINIA ACTS OF ASSEMBLY ––-- 2023 SESSION CHAPTER E514 An Act to amend and reenact § 38.2-3521.1 of the Code of Virginia, relating to association health plans;

R O [H 2201] Approved LMarch L26, 2023 Be it enacted by the General Assembly of Virginia:

E § 38.2-3521.1.

DExcept as provided in § 38.2-3522.1, no policy of group accident and sickness insurance shall be delivered in this Commonwealth unless it conforms to one of the following descriptions:ncedescriptions: shall be A.

AA. policy issued to an employer, or to the trustees of a fund established by an employer, which employer or trustees shall be deemed the policyholder, to insure employees of the employer for the benefit of persons other than the employer, subject to the following requirements:

1.A policy issued to an employer, or to the trustees of a fund established by an employer, which employer or trustees shall be deemed the policyholder, to insure employees of the employer for the ben1.

The policy may provide that the term "employees" shall include the employees of one or more subsidiary corporations, and the employees, individual proHrietors,proprietors, and partners of one or more affiliated corporations, proprietorships or partnerships if the bus2nessbusiness of the Theemployer policyand mayof providesuch thataffiliated thecorporations, termproprietorships "employees"or shallpartnerships includeis retiredunder employees,common formercontrol. employeesrol.

The policy may provide that the term "employees" shall include retired employees, former employees and directors of a corporate employer.

R 2.

An insurer may exclude or limit the coverage on any person as to whom evidence of individual insB.insurability is not satisfactory to the insurer, except as otherwise prohibited in this title.

AB. policy that is:isfactory to the insurer, except as otherwise prohibited in this title.

A policy that is:

The policy may provide that the term "debtors" shall inc(1)include: Borrowers of money or purchasers or lessees of goods, services, or property for which payment is arranged through a credit transaction;

(1) Borrowers of money or purchasers or lessees of goods, services, or property for which payment is arranged through a credit transaction;

Except as provided in subdivision 3, a policy on which insuranceno mustpart insureof allthe eligiblepremium debtors.mis to be derived from funds contributed by insured debtors specifically for their 3.insurance must insure all eligible debtors.

3.

Such payment or payments shall reduce or extinguish the unpaid indebtedness of the debtor to the extent of each such payment and any excess of the insurance shall be payable to the insured or the estate of the insured.

payment and any excess of the insurance shall be payable to the insured or 6.

Notwithstanding the preceding provisions of this section, insurance on agricultural credit of 4 transaction commitments may be written up to the amount of the loan commitment.

Insurance on educational credit transaction commitments may be written up to the amount of the loan commitment of 4 less the amount of any repayments made on the loan.

of 4 a.

The policy may insure members of such association or associations, employees thereof or employees of members, or one or more of the preceding or all of any class or classes thereof foEfor the benefit of persons other than the employee's employer.

The premium for the policy shall be paid from funds contributed by the association or N associations, or by employer members, or by both, or from funds contributed by the covered persRnspersons or of 4 from both the covered persons and the association, associations, or employer members.

from3. funds contributed by the covered persons specifically for their insurance must insure all eligible persons, except those who reject such coverage in writing.

LExcept 4.as provided in subdivision 4, a policy on which no part of the premium is to be derived from funds contributed by the covered persons specifically for their insurance must insure all eligible persons, except those who reject such coverage in writing.

4.

L 5.

For a policy issued in the large group market and notwithstanding the provisions of § 38.E-3449,38.2-3449, an insurer may (i) establish base rates formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims and (ii) utilize each employer member's specific risk profile to determine contribution rates for each individual employer member's share of the premium by actuarially adjusting above or below established base rates.

creditF. unions, which credit union, trustee, trustees, or agent shall be deemed the policyholder, to insure members of such credit union or credit unions for the benefit of persons other than the credit union or credit unions, trustee or trustees, or agent or any of their officials, subject to the following requirements:

A policy issued to a credit union or to a trustee or trustees or agent designated by two or more credit unions, which credit union, trustee, trustees, or agent shall be deemed the policyholder, to insure members of such credit union or credit unions for the benefit of persons other than the credit union or credit unions, trustee or trustees, or agent or any of their officials, subject to the following requirements:

The members eligible for insurance shall be all of the members of the credit union or creHitcredit unions, or all of any class or classes thereof.

B 2.

1 3.

An insurer may exclude or limit the coverage on any person as to whom evidence of individRalindividual insurability is not satisfactory to the insurer.

Notwithstanding the provisions of subsection J, a policy issued to an association of real estate salespersons, as defined in § 54.1-2101, which association shall be deemed the policyholder, to insure members of such association, subject to the following requirements:

deemed the policyholder, to insure 1.

The association shall (i) have at the outset a minimum of 25,000 members, (ii) have been organized and maintained in good faith for purposes other than that of obtaining insurance, (iii) have been in active existence for at least five years, and (iv) have a constitution and bylaws that provide that (a) the association hold regular meetings not less than annually to further purposes of the members, (b) the association collects dues or solicits contributions from members, and (c) the members have voting privileges and representation on the governing board and committees.

other5. than in connection with a member of the association.rage offered through the association available 6.

The association shall not make health insurance coverage offered through the association available other than in connection with a member of the association.

6.