CODE OF VIRGINIA

ENROLLMENT FOLLOWING CHANGE IN ELIGIBILITY STATUS UNDER ASSISTANCE PROGRAMS (§
38.2-3541.2)

A. As used in this section, “assistance program” means the
Commonwealth’s medical assistance services program, established pursuant
to § 32.1-325, or the Family Access to Medical Insurance Security Plan,
established pursuant to § 32.1-351, including under any waiver or demonstration
project conducted under or in relation thereto.

B. Any employer providing health insurance coverage for his employees under a
group accident and sickness insurance policy, or subscription contract, or other
evidence of coverage shall permit an employee who is eligible, but not enrolled,
for coverage under the terms of the policy, contract or plan, or a dependent of
such an employee, if the dependent is eligible but not enrolled, for coverage
under such terms, to enroll for coverage under the terms of the policy, contract
or plan, if either of the following conditions is met:

   1.  The employee or dependent has received health insurance coverage under an
   assistance program, coverage of the employee or dependent under the assistance
   program is terminated as a result of loss of eligibility for such coverage,
   and the employee requests coverage under the group policy, contract or plan
   not later than 60 days after the date of termination of coverage under the
   assistance program; or

   2.  The employee or dependent becomes eligible under an assistance program for
   premium assistance for the purchase of coverage under the group policy,
   contract or plan, including contributions to the cost of employer-sponsored
   health insurance pursuant to subsection C of § 32.1-351.1, and the employee
   requests coverage under the group policy, contract or plan not later than 60
   days after the date the employee or dependent is determined to be eligible for
   such premium assistance.

C. Any employer providing health insurance coverage for his employees under a
group accident and sickness insurance policy, or subscription contract, or other
evidence of coverage within the Commonwealth, shall provide to each employee a
written notice informing the employee of premium assistance opportunities
currently available for the employee or the employee’s dependents through
the Commonwealth’s assistance programs. For purposes of compliance with
this subsection, for employees residing within the Commonwealth, the employer
may use a Virginia-specific model notice developed in accordance with section
701(f)(3)(B)(i)(II) of the Employee Retirement Income Security Act of 1974 (29
U.S.C. § 1181(f)(3)(B)(i)(II)). An employer may provide the Virginia-specific
model notice concurrent with (i) the furnishing of materials notifying the
employee of health plan eligibility; (ii) materials provided to the employee in
connection with an open season or election process conducted under the plan; or
(iii) the furnishing of the summary plan description as provided in section
104(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. §
1024).

D. If an employee or the employee’s dependents are covered under an
assistance program and potentially eligible for premium assistance for the
purchase of coverage under the employer’s group health plan, the plan
administrator of the group health plan shall disclose to the Department of
Medical Assistance Services, upon request, information about the benefits
available under the group health plan in sufficient specificity, as determined
under regulations of the Secretary of Health and Human Services in consultation
with the Secretary, that require use of the model coverage coordination
disclosure form developed under § 311(b)(1)(C) of the Children’s Health
Insurance Program Reauthorization Act of 2009, so as to permit the Department of
Medical Assistance Services to make a determination concerning the
cost-effectiveness of the provision by the Commonwealth of contributions to the
cost of employer-sponsored health insurance, through premium assistance for the
purchase of coverage under such group health plan, and in order for the
Department of Medical Assistance Services to provide any required supplemental
benefits under an assistance program.

HISTORY: 2010, c. 504.