Code of Virginia
Chapter 35 - Accident and Sickness Insurance Policies
§ 38.2-3514.1. Preexisting conditions provisions

A. In determining whether a preexisting conditions provision applies to an insured, all coverage shall credit the time the person was covered under previous individual or group policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis if the previous coverage was continuous to a date not more than thirty days prior to the effective date of the new coverage, exclusive of any applicable waiting period under such coverage.
B. As used herein, a "preexisting conditions provision" means a policy provision that limits, denies, or excludes coverage for charges or expenses incurred during a twelve-month period following the insured's effective date of coverage, for a condition that, during a twelve-month period immediately preceding the effective date of coverage, had manifested itself in such a manner as would cause an ordinarily prudent person to seek diagnosis, care, or treatment, or for which medical advice, diagnosis, care, or treatment was recommended or received within twelve months immediately preceding the effective date of coverage or as to pregnancy existing on the effective date of coverage.
C. This section shall not apply to the following insurance policies or contracts:
1. Short-term travel;
2. Accident-only;
3. Limited or specified disease contracts;
4. Long-term care insurance;
5. Short-term nonrenewable policies or contracts of not more than six months' duration which are subject to no medical underwriting or minimal underwriting;
6. Policies subject to Article 4.1 (§ 38.2-3430.1 et seq.) of Chapter 34 of this title;
7. Policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under state or federal government plans; and
8. Disability income.
1995, c. 522; 1997, c. 291; 1999, c. 1004.

Structure Code of Virginia

Code of Virginia

Title 38.2 - Insurance

Chapter 35 - Accident and Sickness Insurance Policies

§ 38.2-3500. Form of policy

§ 38.2-3501. Policy forms; powers of Commission

§ 38.2-3502. Notice to be printed on policy; return of policy to insurer

§ 38.2-3503. Required accident and sickness policy provisions

§ 38.2-3504. Other provisions

§ 38.2-3505. Inapplicable or inconsistent provisions

§ 38.2-3506. Order of certain policy provisions

§ 38.2-3507. Third-party ownership

§ 38.2-3508. Requirements of other jurisdictions

§ 38.2-3509. Denial or reduction of benefits because of existence of other like insurance

§ 38.2-3510. Conforming to statute

§ 38.2-3511. Application

§ 38.2-3512. Notice; waiver

§ 38.2-3513. Age limit

§ 38.2-3514. When liability not to be denied because of preexisting disease, physical impairment or defect

§ 38.2-3514.1. Preexisting conditions provisions

§ 38.2-3514.2. Renewability of coverage

§ 38.2-3515. Repealed

§ 38.2-3516. Purpose

§ 38.2-3517. Definitions

§ 38.2-3518. Standards for policy provisions

§ 38.2-3519. Minimum standards for excepted benefits

§ 38.2-3520. Coverage of preexisting conditions

§ 38.2-3521. Repealed

§ 38.2-3521.1. Group accident and sickness insurance definitions

§ 38.2-3521.2. Blanket accident and sickness insurance

§ 38.2-3522. Repealed

§ 38.2-3522.1. Limits of group accident and sickness insurance

§ 38.2-3523. Repealed

§ 38.2-3523.1. Review of records

§ 38.2-3523.2. Policies issued outside of the Commonwealth of Virginia

§ 38.2-3523.3. Requirements for those marketing group accident and sickness insurance

§ 38.2-3523.4. Minimum number of persons covered

§ 38.2-3524. Repealed

§ 38.2-3525. Group accident and sickness insurance coverages of spouses, dependent children or other persons

§ 38.2-3526. Standard provisions required; exceptions

§ 38.2-3527. Grace period

§ 38.2-3528. Incontestability

§ 38.2-3529. Entire contract; statements deemed representations

§ 38.2-3530. Evidence of individual insurability

§ 38.2-3531. Additional exclusions and limitations

§ 38.2-3532. Misstatement of age

§ 38.2-3533. Individual certificates

§ 38.2-3534. Notice of claim

§ 38.2-3535. Claim forms

§ 38.2-3536. Proofs of loss

§ 38.2-3537. Time of payment of claims

§ 38.2-3538. Payment of benefits

§ 38.2-3539. Physical examinations and autopsy

§ 38.2-3540. Legal actions

§ 38.2-3540.1. Claims experience

§ 38.2-3540.2. Employee wellness program

§ 38.2-3541. Continuation on termination of eligibility

§ 38.2-3541.1. Repealed

§ 38.2-3541.2. Enrollment following change in eligibility status under assistance programs

§ 38.2-3542. Notice to employees upon termination of coverage; penalty for failure to remit funds

§ 38.2-3543. Provisions required by other jurisdictions

§ 38.2-3543.1. Regulations

§ 38.2-3543.2. Applicability of laws

§ 38.2-3544. Definition of industrial sick benefit insurance

§ 38.2-3545. Further restrictions as to beneficiaries

§ 38.2-3546. Cancellation of sick benefit portion of policy

§ 38.2-3547. Excessive insurance; remedy

§ 38.2-3548. Agents subject to other insurance laws

§ 38.2-3549. Benefits not subject to legal process

§ 38.2-3550. Effective date

§ 38.2-3551. Definitions

§ 38.2-3552. Small employer health group cooperatives

§ 38.2-3553. Membership in a small employer health group cooperative

§ 38.2-3554. Provisions relating to health insurance issuers

§ 38.2-3555. Authority of the Commission