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2017 Code of Virginia
Title 38.2 - Insurance
Chapter 34 - Provisions Relating to Accident and Sickness Insurance
Article 1. General Provisions
- § 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
- § 38.2-3404. Commission may establish rules and regulations for simplified and readable accident and sickness insurance policies
- § 38.2-3405. Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; limitations on disclosure of medical treatment options prohibited
- § 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
- § 38.2-3406.1. Application of requirements that policies offered by small employers include state-mandated health benefits
- § 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
- § 38.2-3407.4:1. Repealed
- § 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
- § 38.2-3407.8. Repealed
- § 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
- § 38.2-3407.10. Health care provider panels
- § 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
- § 38.2-3407.12. 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
- § 38.2-3407.14:1. Standard of clinical evidence for decisions on coverage for proton radiation therapy
- § 38.2-3407.15. Ethics and fairness in carrier business practices
- § 38.2-3407.15:1. Carrier contracts with pharmacy providers; required provisions; limit on termination or nonrenewal
- § 38.2-3407.15:2. Carrier contracts; required provisions regarding prior authorization
- § 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
- § 38.2-3407.16. Requirements for obstetrical care
- § 38.2-3407.17. Payment for services by dentists and oral surgeons
- § 38.2-3407.18. Requirements for orally administered cancer chemotherapy drugs
- § 38.2-3407.19. Payment for services by optometrists and ophthalmologists
Article 2. Mandated Benefits
- § 38.2-3408. Policy providing for reimbursement for services that may be performed by certain practitioners other than physicians
- § 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. Repealed
- § 38.2-3412.1. Coverage for mental health and substance use disorders
- § 38.2-3412.1:01. Repealed
- § 38.2-3413. Repealed
- § 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
- § 38.2-3416. Repealed
- § 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
- § 38.2-3418.1:1. Repealed
- § 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
- § 38.2-3418.16. Coverage for telemedicine services
- § 38.2-3418.17. Coverage for autism spectrum disorder
- § 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
Article 3. Jurisdiction over Providers of Health Care Services
- § 38.2-3420. Authority and jurisdiction of Commission; exception
- § 38.2-3421. How to show jurisdiction of other state agency or federal government
- § 38.2-3422. Examination
- § 38.2-3423. When subject to this title
- § 38.2-3424. Disclosure of extent and elements of coverage
- § 38.2-3424.1. Applicability
Article 4. Limited Mandated Benefit Accident and Sickness Insurance Policies and Subscription Contracts
Article 4.1. Individual Health Insurance Coverage
- § 38.2-3430.1. Application of article
- § 38.2-3430.1:1. Health insurance coverage not required
- § 38.2-3430.2. Definitions
- § 38.2-3430.3. Guaranteed availability of individual health insurance coverage to certain individuals with prior group coverage
- § 38.2-3430.3:1. Expired
- § 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
Article 5. Group Market Reforms and Individual Coverage Offered to Employees of Small Employers
- § 38.2-3431. Application of article; definitions
- § 38.2-3432. Repealed
- § 38.2-3432.1. Renewability
- § 38.2-3432.2. Availability
- § 38.2-3432.3. Limitation on preexisting condition exclusion period
- § 38.2-3433. Repealed
- § 38.2-3434. Disclosure of information
- § 38.2-3435. Exclusions
- § 38.2-3436. Eligibility to enroll
- § 38.2-3437. Rules used to determine group size
Article 6. Federal Market Reforms
- § 38.2-3438. Definitions
- § 38.2-3439. Dependent coverage for individuals to age 26
- § 38.2-3440. Lifetime and annual limits
- § 38.2-3441. Rescissions
- § 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
- § 38.2-3446. 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
- § 38.2-3452. Waiting periods
- § 38.2-3453. Clinical trials
- § 38.2-3454. Wellness programs
- § 38.2-3454.1. Sale or renewal or offer of health benefit plans; special exception
Article 7. Navigators
- § 38.2-3455. Definitions
- § 38.2-3456. Prohibited activities
- § 38.2-3457. Application for registration
- § 38.2-3458. Power of Commission to investigate navigators
- § 38.2-3459. Grounds for termination, placing on probation, revocation, or suspension of registration
- § 38.2-3460. Sufficiency of federal requirements; additional standards and qualifications for navigators
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