A. No insurance contract providing hospital, medical, surgical and similar or related benefits, and no subscription contract or health services plan delivered or issued for delivery or providing for payment of benefits to or on behalf of persons residing in or employed in this Commonwealth shall contain any provision providing for subrogation of any person's right to recovery for personal injuries from a third person.
B. No such contract, subscription contract or health services plan shall contain any provision requiring the beneficiary of any such contract or plan to sign any agreement to pay back to any company issuing such a contract or creating a health services plan any benefits paid pursuant to the terms of such contract or plan from the proceeds of a recovery by such a beneficiary from any other source; provided, that this provision shall not prohibit an exclusion of benefits paid or payable under workers' compensation laws or federal or state programs, nor shall this provision prohibit coordination of benefits provisions when there are two or more such accident and sickness insurance contracts or plans providing for the payment of the same benefits. Coordination of benefits provisions may not operate to reduce benefits because of any benefits paid, payable, or provided by any liability insurance contract or any benefits paid, payable, or provided by any medical expense or medical payments insurance provided in conjunction with liability coverage.
C. No insurance contract providing hospital, medical, surgical and similar or related benefits, and no subscription contract or health services plan delivered or issued for delivery or providing for payment of benefits to or on behalf of persons residing in or employed in this Commonwealth shall contain any provision limiting, restricting, or prohibiting a physician from disclosing fully all medical treatment options to patients whether or not such treatment options are (i) experimental or covered services, (ii) services that the health insurer will not authorize, or (iii) the costs of the treatment will be borne by the health insurer or the patient to facilitate an informed decision by the patient, if the physician determines that such an option is in the best interest of the patient. For the purposes of this subsection, "medical treatment options" means any alternative or experimental therapeutic, psychiatric, medical treatment or procedure, health care service, drug, or remedy.
D. Whenever benefits paid or payable under workers' compensation are excluded from coverage under the terms of any such contract, subscription contract or health services plan, the issuer thereof shall not exclude coverage for any medical condition pursuant to such exclusion if (i) an award of the Workers' Compensation Commission pursuant to § 65.2-704 denies compensation benefits relating to such medical condition and no request for review of such award is made pursuant to and within the time prescribed by § 65.2-705 or (ii) an award of the Workers' Compensation Commission, after review by the full Commission pursuant to § 65.2-705, denies compensation benefits relating to such medical condition. Following the entry of a workers' compensation award pursuant to clause (i) or (ii) having the effect of prohibiting the application of any such exclusion, the issuer shall immediately provide coverage for such medical condition to the extent otherwise covered under the contract, subscription contract or health services plan. If, upon appeal to the Court of Appeals or the Supreme Court, such medical condition is held to be compensable under the Virginia Workers' Compensation Act (Title 65.2), the issuer may recover from the applicable employer or workers' compensation insurance carrier the costs of coverage for medical conditions found to be compensable under the Act.
1973, c. 28, § 38.1-342.2; 1979, c. 341; 1986, c. 562; 1988, c. 840; 1989, c. 487; 1994, c. 609; 1995, c. 68; 2004, c. 675.
Structure Code of Virginia
Chapter 34 - Provisions Relating to Accident and Sickness Insurance
§ 38.2-3400. Application of chapter
§ 38.2-3401. Forms of insurance authorized
§ 38.2-3402. Certification to accompany application
§ 38.2-3403. Fraudulent procurement of policy
§ 38.2-3405.1. Commonwealth's right to certain accident and sickness benefits
§ 38.2-3406. Accident and sickness benefits not subject to legal process
§ 38.2-3406.2. Capped benefits under insurance policies and contracts
§ 38.2-3407. Health benefit programs
§ 38.2-3407.1. Interest on accident and sickness claim proceeds
§ 38.2-3407.2. Coverage for medical child support
§ 38.2-3407.3. Calculation of cost-sharing provisions
§ 38.2-3407.3:1. Premium payment arrearages; order of crediting payments
§ 38.2-3407.4. Explanation of benefits
§ 38.2-3407.4:2. Requirements for prescription benefit cards
§ 38.2-3407.5. Denial of benefits for certain prescription drugs prohibited
§ 38.2-3407.5:1. Coverage for prescription contraceptives
§ 38.2-3407.5:2. Reimbursements for dispensing hormonal contraceptives
§ 38.2-3407.6. Exclusion of podiatrist not permitted under certain circumstances
§ 38.2-3407.6:1. Denial of benefits for certain prescription drugs prohibited
§ 38.2-3407.7. Pharmacies; freedom of choice
§ 38.2-3407.9. Reimbursement for emergency medical services vehicle transportation services
§ 38.2-3407.9:01. Prescription drug formularies
§ 38.2-3407.9:02. Requirement for prescription drug coverage
§ 38.2-3407.9:03. Payment of clean claims to administrators of pharmacy benefits
§ 38.2-3407.9:04. Medication synchronization
§ 38.2-3407.9:05. Step therapy protocols
§ 38.2-3407.10. Health care provider panels
§ 38.2-3407.10:2. Credentialing of private mental health agencies
§ 38.2-3407.11. Access to obstetrician-gynecologists
§ 38.2-3407.11:1. Access to specialists; standing referrals
§ 38.2-3407.11:2. Standing referral for cancer patients
§ 38.2-3407.11:3. Breast cancer underwriting and preexisting condition restrictions
§ 38.2-3407.11:4. Disability arising out of childbirth; minimum benefit
§ 38.2-3407.11:5. Interhospital transfer for newborn or mother; prior authorization prohibited
§ 38.2-3407.12. Patient optional point-of-service benefit
§ 38.2-3407.13. Refusal to accept assignments prohibited; dentists and oral surgeons
§ 38.2-3407.13:1. Coordination of benefits; notice of priority of coverage
§ 38.2-3407.13:2. Claims paid to insureds for services from nonparticipating physicians
§ 38.2-3407.14. Notice of premium or deductible increases
§ 38.2-3407.15. Ethics and fairness in carrier business practices
§ 38.2-3407.15:2. Carrier contracts; required provisions regarding prior authorization
§ 38.2-3407.15:4. Limit on copayment for prescription drugs; permitted disclosures
§ 38.2-3407.15:5. Limit on cost-sharing payments for prescription insulin drugs
§ 38.2-3407.15:6. Prescription drug price transparency
§ 38.2-3407.16. Requirements for obstetrical care
§ 38.2-3407.17. Payment for services by dentists and oral surgeons
§ 38.2-3407.17:1. Payment and reimbursement practices for dental services; network access
§ 38.2-3407.18. Requirements for orally administered cancer chemotherapy drugs
§ 38.2-3407.19. Payment for services by optometrists and ophthalmologists
§ 38.2-3407.21. Short-term limited-duration medical plans
§ 38.2-3407.22. Option for rebates to enrollees; protected information
§ 38.2-3409. Coverage of dependent children
§ 38.2-3410. Construction of policy generally; words "physician" and "doctor" to include dentist
§ 38.2-3411. Coverage of newborn children required
§ 38.2-3411.1. Coverage for child health supervision services
§ 38.2-3411.2. Coverage of adopted children required
§ 38.2-3411.3. Coverage for childhood immunizations
§ 38.2-3411.4. Coverage for infant hearing screening and related diagnostics
§ 38.2-3412.1. Coverage for mental health and substance use disorders
§ 38.2-3414. Optional coverage for obstetrical services
§ 38.2-3414.1. Obstetrical benefits; coverage for postpartum services
§ 38.2-3415. Exclusion or reduction of benefits for certain causes prohibited
§ 38.2-3417. Deductibles and coinsurance options required
§ 38.2-3418. Coverage for victims of rape or incest
§ 38.2-3418.1. Coverage for mammograms
§ 38.2-3418.1:2. Coverage for pap smears
§ 38.2-3418.2. Coverage of procedures involving bones and joints
§ 38.2-3418.3. Coverage for hemophilia and congenital bleeding disorders
§ 38.2-3418.4. Coverage for reconstructive breast surgery; notice; eligibility
§ 38.2-3418.5. Coverage for early intervention services
§ 38.2-3418.6. Minimum hospital stay for mastectomy and certain lymph node dissection patients
§ 38.2-3418.7. Coverage for PSA testing
§ 38.2-3418.7:1. Coverage for colorectal cancer screening
§ 38.2-3418.8. Coverage for clinical trials for treatment studies on cancer
§ 38.2-3418.9. Minimum hospital stay for hysterectomy
§ 38.2-3418.10. Coverage for diabetes
§ 38.2-3418.11. Coverage for hospice care
§ 38.2-3418.12. Coverage for hospitalization and anesthesia for dental procedures
§ 38.2-3418.13. Coverage for the treatment of morbid obesity
§ 38.2-3418.14. Coverage for lymphedema
§ 38.2-3418.15. Coverage for prosthetic devices and components
§ 38.2-3418.15:1. Coverage for prosthetic devices and components
§ 38.2-3418.16. Coverage for telemedicine services
§ 38.2-3418.17. Coverage for autism spectrum disorder
§ 38.2-3418.18. Coverage for formula and enteral nutrition products as medicine
§ 38.2-3418.19. Coverage for organ, eye or tissue transplant
§ 38.2-3418.20. Coverage for hearing aids and related services
§ 38.2-3419. Additional mandated coverage made optional to group policy or contract holder
§ 38.2-3419.1. Report of costs and utilization of mandated benefits
§ 38.2-3420. Authority and jurisdiction of Commission; exception
§ 38.2-3421. How to show jurisdiction of other state agency or federal government
§ 38.2-3423. When subject to this title
§ 38.2-3424. Disclosure of extent and elements of coverage
§ 38.2-3430.1. Application of article
§ 38.2-3430.1:1. Health insurance coverage not required
§ 38.2-3430.4. Special rules for network plans
§ 38.2-3430.5. Application of financial capacity limits
§ 38.2-3430.6. Market requirements
§ 38.2-3430.7. Renewability of individual health insurance coverage
§ 38.2-3430.8. Certification of coverage
§ 38.2-3430.9. Regulations establishing standards
§ 38.2-3430.10. Effective date
§ 38.2-3431. Application of article; definitions
§ 38.2-3432.3. Limitation on preexisting condition exclusion period
§ 38.2-3434. Disclosure of information
§ 38.2-3436. Eligibility to enroll
§ 38.2-3437. Rules used to determine group size
§ 38.2-3439. Dependent coverage for individuals to age 26
§ 38.2-3440. Lifetime and annual limits
§ 38.2-3442. Preventive services
§ 38.2-3443. Choice of a health care professional
§ 38.2-3444. Preexisting condition exclusions
§ 38.2-3445. Patient access to emergency services
§ 38.2-3445.01. Balance billing for certain services; prohibited
§ 38.2-3445.03. Data sets for determining commercially reasonable payments
§ 38.2-3445.06. Applicability of certain sections
§ 38.2-3445.07. Rules and regulations
§ 38.2-3445.2. Out-of-network claims; reporting requirements
§ 38.2-3446. Applicability of federal law
§ 38.2-3447. Restrictions relating to premium rates
§ 38.2-3448. Guaranteed availability
§ 38.2-3449. Prohibiting discrimination based on health status
§ 38.2-3450. Genetic information and testing
§ 38.2-3451. Essential health benefits
§ 38.2-3454. Wellness programs
§ 38.2-3454.1. Renewal of health benefit plans; special exception
§ 38.2-3456. Prohibited activities
§ 38.2-3457. Application for registration
§ 38.2-3458. Power of Commission to investigate navigators
§ 38.2-3462. Comparable Health Care Service Incentive Program
§ 38.2-3463. Health care price transparency tools
§ 38.2-3464. Rules and regulations; orders
§ 38.2-3467. Prohibited conduct by carriers and pharmacy benefits managers
§ 38.2-3468. Examination of books and records; reports; access to records
§ 38.2-3469. (Effective October 1, 2020) Enforcement; regulations