A. Each group accident and sickness insurance policy shall contain a provision specifying all additional exclusions or limitations applicable under the policy for any disease or physical condition of a person, not otherwise excluded from the person's coverage by name or specific description effective on the date of the person's loss, which existed prior to the effective date of the person's coverage under the policy.
B. Any such exclusion or limitation may only apply to a disease or physical condition for which medical advice or treatment was received by the person during the twelve months prior to the effective date of the person's coverage. The exclusion or limitation shall not apply to loss incurred or disability commencing after the earlier of (i) the end of a continuous period of twelve months commencing on or after the effective date of the person's coverage during which the person receives no medical advice or treatment in connection with the disease or physical condition, or (ii) the end of the two-year period commencing on the effective date of the person's coverage.
C. This section shall not apply to group accident and sickness policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis to an employer's employees and their dependents.
1986, c. 562; 1998, c. 24.
Structure Code of Virginia
Chapter 35 - Accident and Sickness Insurance Policies
§ 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
§ 38.2-3505. 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
§ 38.2-3514.1. Preexisting conditions provisions
§ 38.2-3514.2. Renewability of coverage
§ 38.2-3518. Standards for policy provisions
§ 38.2-3519. Minimum standards for excepted benefits
§ 38.2-3520. Coverage of preexisting conditions
§ 38.2-3521.1. Group accident and sickness insurance definitions
§ 38.2-3521.2. Blanket accident and sickness insurance
§ 38.2-3522.1. Limits of group accident and sickness insurance
§ 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
§ 38.2-3526. Standard provisions required; exceptions
§ 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
§ 38.2-3537. Time of payment of claims
§ 38.2-3538. Payment of benefits
§ 38.2-3539. Physical examinations and autopsy
§ 38.2-3540.1. Claims experience
§ 38.2-3540.2. Employee wellness program
§ 38.2-3541. Continuation on termination of eligibility
§ 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
§ 38.2-3543.2. 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
§ 38.2-3552. 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