Code of Virginia
Title 38.2 - Insurance
Chapter 34 - Provisions Relating to Accident and Sickness Insurance

§ 38.2-3404. Commission may establish rules and regulations for simplified and readable accident and sickness insurance policies - A. Pursuant to the authority granted in § 38.2-223, the...

§ 38.2-3405. Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; limitations on disclosure of medical treatment options prohibited - A. No insurance contract providing hospital, medical, surgical and similar...

§ 38.2-3405.1. Commonwealth's right to certain accident and sickness benefits - A. The Department of Medical Assistance Services shall be entitled...

§ 38.2-3406. Accident and sickness benefits not subject to legal process - The installment payments to the holder of any accident and...

§ 38.2-3406.1. Application of requirements that policies offered by small employers include state-mandated health benefits - A. As used in this section: "Eligible individual" means an...

§ 38.2-3406.2. Capped benefits under insurance policies and contracts - A. Nothing in this chapter or Chapters 35 (§ 38.2-3500...

§ 38.2-3407. Health benefit programs - A. One or more insurers may offer or administer a...

§ 38.2-3407.1. Interest on accident and sickness claim proceeds - A. If an action to recover the claim proceeds due...

§ 38.2-3407.2. Coverage for medical child support - A. No insurer, health services plan, or health maintenance organization...

§ 38.2-3407.3. Calculation of cost-sharing provisions - A. An insurer, health services plan, or health maintenance organization...

§ 38.2-3407.3:1. Premium payment arrearages; order of crediting payments - Each (i) insurer proposing to issue individual or group accident...

§ 38.2-3407.4. Explanation of benefits - A. Each insurer issuing an accident and sickness insurance policy,...

§ 38.2-3407.4:1. Repealed - Repealed by Acts 2001, c. 208, cl. 1.

§ 38.2-3407.4:2. Requirements for prescription benefit cards - A. Each (i) insurer proposing to issue individual or group...

§ 38.2-3407.5. Denial of benefits for certain prescription drugs prohibited - A. Each (i) insurer proposing to issue individual or group...

§ 38.2-3407.5:1. Coverage for prescription contraceptives - A. Each (i) insurer proposing to issue individual or group...

§ 38.2-3407.5:2. Reimbursements for dispensing hormonal contraceptives - A. As used in this section: "Covered person" means a...

§ 38.2-3407.6. Exclusion of podiatrist not permitted under certain circumstances - No podiatrist shall be excluded from participating in any preferred...

§ 38.2-3407.6:1. Denial of benefits for certain prescription drugs prohibited - A. Each (i) insurer proposing to issue individual or group...

§ 38.2-3407.7. Pharmacies; freedom of choice - A. Notwithstanding any provision of § 38.2-3407 to the contrary,...

§ 38.2-3407.8. Repealed - Repealed by Acts 1995, c. 467.

§ 38.2-3407.9. Reimbursement for emergency medical services vehicle transportation services - A. If an accident and sickness insurance policy provides coverage...

§ 38.2-3407.9:01. Prescription drug formularies - A. Each (i) insurer proposing to issue individual or group...

§ 38.2-3407.9:02. Requirement for prescription drug coverage - No (i) insurer proposing to issue individual or group accident...

§ 38.2-3407.9:03. Payment of clean claims to administrators of pharmacy benefits - A. As used in this section, "clean claim," "carrier," and...

§ 38.2-3407.9:04. Medication synchronization - A. As used in this section: "Carrier," "health plan," and...

§ 38.2-3407.9:05. Step therapy protocols - A. As used in this section: "Carrier" means any (i)...

§ 38.2-3407.10. Health care provider panels - A. As used in this section: "Carrier" means: 1. Any...

§ 38.2-3407.10:1. Reimbursement for services rendered during pendency of a participating provider's credentialing application - A. As used in this section: "Carrier" means an entity...

§ 38.2-3407.10:2. Credentialing of private mental health agencies - A. As used in this section, "carrier," "covered person," and...

§ 38.2-3407.11. Access to obstetrician-gynecologists - A. Each (i) insurer proposing to issue individual or group...

§ 38.2-3407.11:1. Access to specialists; standing referrals - A. Each (i) insurer proposing to issue individual or group...

§ 38.2-3407.11:2. Standing referral for cancer patients - A. Each (i) insurer proposing to issue individual or group...

§ 38.2-3407.11:3. Breast cancer underwriting and preexisting condition restrictions - A. No (i) insurer proposing to issue group accident and...

§ 38.2-3407.11:4. Disability arising out of childbirth; minimum benefit - A. Each insurer proposing to issue individual or group accident...

§ 38.2-3407.11:5. Interhospital transfer for newborn or mother; prior authorization prohibited - A. Notwithstanding any provision of § 38.2-3407.11 or 38.2-3419 or...

§ 38.2-3407.12. Patient optional point-of-service benefit - A. As used in this section: "Affiliate" shall have the...

§ 38.2-3407.13. Refusal to accept assignments prohibited; dentists and oral surgeons - A. No insurer proposing to issue individual or group accident...

§ 38.2-3407.13:1. Coordination of benefits; notice of priority of coverage - Each (i) insurer issuing individual or group accident and sickness...

§ 38.2-3407.13:2. Claims paid to insureds for services from nonparticipating physicians - When an insurer, health services plan or health maintenance organization...

§ 38.2-3407.14. Notice of premium or deductible increases - A. Each (i) insurer issuing individual or group accident and...

§ 38.2-3407.14:1. Standard of clinical evidence for decisions on coverage for proton radiation therapy - A. As used in this section, unless the context requires...

§ 38.2-3407.15. Ethics and fairness in carrier business practices - A. As used in this section: "Carrier," "enrollee," and "provider"...

§ 38.2-3407.15:1. Carrier contracts with pharmacy providers; required provisions; limit on termination or nonrenewal - A. As used in this section, unless the context requires...

§ 38.2-3407.15:2. Carrier contracts; required provisions regarding prior authorization - A. As used in this section, unless the context requires...

§ 38.2-3407.15:3. Carrier and intermediary contracts with pharmacy providers; disclosure and updating of maximum allowable cost of drugs; limit on termination or nonrenewal - A. As used in this section, unless the context requires...

§ 38.2-3407.15:4. Limit on copayment for prescription drugs; permitted disclosures - A. As used in this section: "Carrier" has the same...

§ 38.2-3407.15:5. Limit on cost-sharing payments for prescription insulin drugs - A. As used in this section: "Carrier" has the same...

§ 38.2-3407.15:6. Prescription drug price transparency - A. As used in this section: "Carrier" has the same...

§ 38.2-3407.16. Requirements for obstetrical care - A. Each (i) insurer proposing to issue individual or group...

§ 38.2-3407.17. Payment for services by dentists and oral surgeons - A. As used in this section: "Covered services" means the...

§ 38.2-3407.17:1. Payment and reimbursement practices for dental services; network access - A. As used in this section, unless the context requires...

§ 38.2-3407.18. Requirements for orally administered cancer chemotherapy drugs - A. Each (i) insurer proposing to issue individual or group...

§ 38.2-3407.19. Payment for services by optometrists and ophthalmologists - A. As used in this section, unless the context requires...

§ 38.2-3407.20. Calculation of enrollee's contribution to out-of-pocket maximum or cost-sharing requirement - A. As used in this section: "Carrier" shall have the...

§ 38.2-3407.21. Short-term limited-duration medical plans - A. As used in this section: "Carrier" means any entity...

§ 38.2-3407.22. Option for rebates to enrollees; protected information - A. As used in this section: "Carrier" has the same...

§ 38.2-3408. Policy providing for reimbursement for services that may be performed by certain practitioners other than physicians - A. If an accident and sickness insurance policy provides reimbursement...

§ 38.2-3409. Coverage of dependent children - A. Any group or individual accident and sickness insurance policy...

§ 38.2-3410. Construction of policy generally; words "physician" and "doctor" to include dentist - Each accident and sickness insurance policy or subscription contract shall...

§ 38.2-3411. Coverage of newborn children required - A. Each individual and group accident and sickness insurance policy...

§ 38.2-3411.1. Coverage for child health supervision services - A. Every individual or group accident and sickness insurance policy,...

§ 38.2-3411.2. Coverage of adopted children required - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3411.3. Coverage for childhood immunizations - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3411.4. Coverage for infant hearing screening and related diagnostics - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3412. Repealed - Repealed by Acts 1993, c. 132.

§ 38.2-3412.1. Coverage for mental health and substance use disorders - A. As used in this section: "Adult" means any person...

§ 38.2-3412.1:01. Repealed - Repealed by Acts 2015, c. 649, cl. 2.

§ 38.2-3413. Repealed - Repealed by Acts 1993, c. 132.

§ 38.2-3414. Optional coverage for obstetrical services - A. Each insurer proposing to issue a group hospital policy...

§ 38.2-3414.1. Obstetrical benefits; coverage for postpartum services - A. Each insurer proposing to issue an individual or group...

§ 38.2-3415. Exclusion or reduction of benefits for certain causes prohibited - No group accident and sickness insurance policy, nor any group...

§ 38.2-3416. Repealed - Repealed by Acts 2014, c. 814, cl. 2.

§ 38.2-3417. Deductibles and coinsurance options required - A. An insurer issuing accident and sickness insurance or a...

§ 38.2-3418. Coverage for victims of rape or incest - Each hospital expense, medical-surgical expense, major medical expense or hospital...

§ 38.2-3418.1. Coverage for mammograms - A. 1. Notwithstanding the provisions of § 38.2-3419, each insurer...

§ 38.2-3418.1:1. Repealed - Repealed by Acts 2008, c. 420, cl. 2.

§ 38.2-3418.1:2. Coverage for pap smears - A. Notwithstanding the provisions § 38.2-3419, each insurer proposing to...

§ 38.2-3418.2. Coverage of procedures involving bones and joints - A. Each insurer proposing to issue individual or group accident...

§ 38.2-3418.3. Coverage for hemophilia and congenital bleeding disorders - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.4. Coverage for reconstructive breast surgery; notice; eligibility - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.5. Coverage for early intervention services - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.6. Minimum hospital stay for mastectomy and certain lymph node dissection patients - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.7. Coverage for PSA testing - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.7:1. Coverage for colorectal cancer screening - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.8. Coverage for clinical trials for treatment studies on cancer - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.9. Minimum hospital stay for hysterectomy - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.10. Coverage for diabetes - A. Each insurer proposing to issue an individual or group...

§ 38.2-3418.11. Coverage for hospice care - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.12. Coverage for hospitalization and anesthesia for dental procedures - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.13. Coverage for the treatment of morbid obesity - A. Notwithstanding the provisions of § 38.2-3419, in the large...

§ 38.2-3418.14. Coverage for lymphedema - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.15. Coverage for prosthetic devices and components - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.15:1. Coverage for prosthetic devices and components - A. As used in this section: "Component" means the materials...

§ 38.2-3418.16. Coverage for telemedicine services - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.17. Coverage for autism spectrum disorder - A. Notwithstanding the provisions of § 38.2-3419 and any other...

§ 38.2-3418.18. Coverage for formula and enteral nutrition products as medicine - A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing...

§ 38.2-3418.19. Coverage for organ, eye or tissue transplant - A. Notwithstanding the provisions of § 38.2-4319, each insurer proposing...

§ 38.2-3418.20. Coverage for hearing aids and related services - A. As used in this section: "Hearing aid" means any...

§ 38.2-3419. Additional mandated coverage made optional to group policy or contract holder - Any new or existing group policy or contract holder for...

§ 38.2-3419.1. Report of costs and utilization of mandated benefits - A. Beginning with the calendar year 1991, every insurer, health...

§ 38.2-3420. Authority and jurisdiction of Commission; exception - A. Except as provided in subsection C, any person offering...

§ 38.2-3421. How to show jurisdiction of other state agency or federal government - A person may show that it is regulated by another...

§ 38.2-3422. Examination - Any person that fails to show that it is regulated...

§ 38.2-3423. When subject to this title - Any person that fails to show that it is regulated...

§ 38.2-3424. Disclosure of extent and elements of coverage - A. Any agent, agency, administrator, or other person that advertises,...

§ 38.2-3424.1. Applicability - Nothing contained in this article shall be construed to apply...

§ 38.2-3425. Expired - Expired.

§ 38.2-3430.1. Application of article - This article applies to individual health insurance coverage offered, sold,...

§ 38.2-3430.1:1. Health insurance coverage not required - No resident of this Commonwealth, regardless of whether he has...

§ 38.2-3430.2. Definitions - A. The terms defined in § 38.2-3431 that are used...

§ 38.2-3430.3. Guaranteed availability of individual health insurance coverage to certain individuals with prior group coverage - A. Guaranteed availability. 1. All eligible individuals shall be provided...

§ 38.2-3430.3:1. Expired - Expired.

§ 38.2-3430.4. Special rules for network plans - A health insurance issuer that offers health insurance coverage in...

§ 38.2-3430.5. Application of financial capacity limits - A. A health insurance issuer may deny health insurance coverage...

§ 38.2-3430.6. Market requirements - The provisions of § 38.2-3430.3 shall not be construed to...

§ 38.2-3430.7. Renewability of individual health insurance coverage - A. Except as provided in this section, a health insurance...

§ 38.2-3430.8. Certification of coverage - The provisions of § 38.2-3432.3 shall apply to health insurance...

§ 38.2-3430.9. Regulations establishing standards - A. The Commission may adopt regulations to enable it to...

§ 38.2-3430.10. Effective date - The provisions of this article shall be effective on July...

§ 38.2-3431. Application of article; definitions - A. This article applies to group health plans and to...

§ 38.2-3432. Repealed - Repealed by Acts 1997, cc. 807 and 913.

§ 38.2-3432.1. Renewability - A. Every health insurance issuer that offers health insurance coverage...

§ 38.2-3432.2. Availability - A. If coverage is offered under this article in the...

§ 38.2-3432.3. Limitation on preexisting condition exclusion period - A. Subject to subsection B, a health insurer offering health...

§ 38.2-3433. Repealed - Repealed by Acts 2013, c. 751, cl. 2, effective January...

§ 38.2-3434. Disclosure of information - Any health insurance issuer offering health insurance coverage to a...

§ 38.2-3435. Exclusions - The provisions of this article shall not apply to: 1....

§ 38.2-3436. Eligibility to enroll - A. A health insurance issuer offering group health insurance coverage,...

§ 38.2-3437. Rules used to determine group size - A. All employers treated as a single employer under subsection...

§ 38.2-3438. Definitions - As used this article, unless the context requires a different...

§ 38.2-3439. Dependent coverage for individuals to age 26 - A. Notwithstanding any provision of § 38.2-3500 or 38.2-3525, or...

§ 38.2-3440. Lifetime and annual limits - A. Notwithstanding any provision of § 38.2-3406.1, 38.2-3406.2, or 38.2-3418.5,...

§ 38.2-3441. Rescissions - A. Notwithstanding any provision of § 38.2-508.5 or any other...

§ 38.2-3442. Preventive services - A. Notwithstanding any provision of § 38.2-3406.1 or 38.2-3411.1 or...

§ 38.2-3443. Choice of a health care professional - A. Notwithstanding any provision of § 38.2-3407.11, 38.2-4312.3, or any...

§ 38.2-3444. Preexisting condition exclusions - A. Notwithstanding any provision of § 38.2-508.1, 38.2-3432.3, 38.2-3438, 38.2-3503,...

§ 38.2-3445. Patient access to emergency services - Notwithstanding any provision of § 38.2-3407.11, 38.2-4312.3, or any other...

§ 38.2-3445.01. Balance billing for certain services; prohibited - A. No out-of-network provider shall balance bill an enrollee for...

§ 38.2-3445.02. Arbitration - A. If good faith negotiation, as described in § 38.2-3445.01,...

§ 38.2-3445.03. Data sets for determining commercially reasonable payments - A. The Commission shall contract with the nonprofit data services...

§ 38.2-3445.04. Transparency - A. The Commission, in consultation with health carriers, health care...

§ 38.2-3445.05. Enforcement - A. If the Commission has cause to believe that any...

§ 38.2-3445.06. Applicability of certain sections - A. Except as provided in this section, the provisions of...

§ 38.2-3445.07. Rules and regulations - Pursuant to § 38.2-223, the Commission may adopt rules and...

§ 38.2-3445.1. Repealed - Repealed by Acts 2020, cc. 1080 and 1081, cl. 2,...

§ 38.2-3445.2. Out-of-network claims; reporting requirements - A. Any health carrier providing individual or group health insurance...

§ 38.2-3446. Applicability of federal law - A. The provisions of Title I of the PPACA shall...

§ 38.2-3447. Restrictions relating to premium rates - A. Notwithstanding any provision of § 38.2-3432.2, 38.2-3501, 38.2-4306, or...

§ 38.2-3448. Guaranteed availability - A. Notwithstanding any provision of § 38.2-3430.3, 38.2-3436, or any...

§ 38.2-3449. Prohibiting discrimination based on health status - A. Notwithstanding any provision of § 38.2-508.5, 38.2-3431, 38.2-3432.3, 38.2-3521.1,...

§ 38.2-3449.1. Prohibited discrimination based on gender identity or status as a transgender individual - A. As used in this section: "Gender identity" means an...

§ 38.2-3450. Genetic information and testing - A. A health carrier offering a health benefit plan providing...

§ 38.2-3451. Essential health benefits - A. Notwithstanding any provision of law to the contrary, any...

§ 38.2-3452. Waiting periods - Notwithstanding any provision of § 38.2-3436, 38.2-4216.1, or any other...

§ 38.2-3453. Clinical trials - A. Notwithstanding any provision of § 38.2-3418.8 or any other...

§ 38.2-3454. Wellness programs - A. A health carrier offering a health benefit plan providing...

§ 38.2-3454.1. Renewal of health benefit plans; special exception - Notwithstanding any other provision of state law, a health carrier...

§ 38.2-3455. Definitions - As used in this article, unless the context requires otherwise:...

§ 38.2-3456. Prohibited activities - A. A navigator shall not: 1. Engage in any activity...

§ 38.2-3457. Application for registration - A. On or after September 1, 2014, no individual or...

§ 38.2-3458. Power of Commission to investigate navigators - A. The Commission shall have the power to examine and...

§ 38.2-3459. Grounds for termination, placing on probation, revocation, or suspension of registration - A. If the Commission determines that a registered navigator has...

§ 38.2-3460. Sufficiency of federal requirements; additional standards and qualifications for navigators - The Commission may determine whether the standards and qualifications for...

§ 38.2-3461. Definitions - As used in this article, unless the context requires a...

§ 38.2-3462. Comparable Health Care Service Incentive Program - A. Beginning with health benefit plans offered or renewed on...

§ 38.2-3463. Health care price transparency tools - Beginning with health benefit plans offered or renewed on or...

§ 38.2-3464. Rules and regulations; orders - The Commission, after notice and opportunity for all interested parties...

§ 38.2-3465. Definitions - A. As used in this article, unless the context requires...

§ 38.2-3466. (Effective October 1, 2020) License required to provide pharmacy benefits management services; requirements for a license, renewal, and revocation or suspension - A. Unless otherwise covered by a license as a carrier,...

§ 38.2-3467. Prohibited conduct by carriers and pharmacy benefits managers - A. No carrier on its own or through its contracted...

§ 38.2-3468. Examination of books and records; reports; access to records - A. Each carrier, on its own or through its contract...

§ 38.2-3469. (Effective October 1, 2020) Enforcement; regulations - A. The Commission shall enforce this article. B. Pursuant to...

§ 38.2-3470. (Effective October 1, 2020) Scope of article - This article shall not apply with respect to claims under...

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Code of Virginia Title 38.2 - Insurance Chapter 34 - Provisions Relating to Accident and Sickness Insurance

Code of Virginia
Title 38.2 - Insurance
Chapter 34 - Provisions Relating to Accident and Sickness Insurance