Chapter 34. Provisions Relating to Accident and Sickness InsuranceRead Chapter
- Article 1. General ProvisionsRead all
- § 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- Repealed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- Repealed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
- § 38.2-3407.9:04
- Medication synchronization
- § 38.2-3407.9:05
- Step therapy protocols
- § 38.2-3407.10
- (Effective until January 1, 2024) Health care provider panels
- § 38.2-3407.10:1
- Processing of new provider applications and reimbursement for services rendered during pendency of a participating provider's credentialing application
- § 38.2-3407.10:2
- Credentialing of private mental health agencies
- § 38.2-3407.10
- (Effective January 1, 2024) 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
- § 38.2-3407.11:4
- 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
- § 38.2-3407.14:1
- 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
- § 38.2-3407.15:4
- 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
- § 38.2-3407.15:7
- Carrier provision of certain information
- § 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
- § 38.2-3407.20
- Calculation of enrollee's contribution to out-of-pocket maximum or cost-sharing requirement
- § 38.2-3407.21
- Short-term limited-duration medical plans
- § 38.2-3407.22
- Option for rebates to enrollees; protected information
- Article 2. Mandated BenefitsRead all
- § 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
- § 38.2-3418.15:1
- 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
- (Effective until January 1, 2025) Coverage for formula and enteral nutrition products as medicine
- § 38.2-3418.18
- (For effective date, see Acts 2023, cc. 271 and 272, cl. 2) 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 [Not in effect]
- § 38.2-3418.21
- 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
- Article 3. Jurisdiction over Providers of Health Care ServicesRead all
- § 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 ContractsRead all
- § 38.2-3425
- Expired
- Article 4.1. Individual Health Insurance CoverageRead all
- § 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 EmployersRead all
- § 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 ReformsRead all
- § 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
- § 38.2-3445.01
- Balance billing for certain services; prohibited
- § 38.2-3445.02
- Arbitration
- § 38.2-3445.03
- Data sets for determining commercially reasonable payments
- § 38.2-3445.04
- Transparency
- § 38.2-3445.05
- Enforcement
- § 38.2-3445.06
- Applicability of certain sections
- § 38.2-3445.07
- Rules and regulations
- § 38.2-3445.1
- Repealed
- § 38.2-3445.2
- Out-of-network claims; reporting requirements
- § 38.2-3446
- Applicability of federal law
- § 38.2-3447
- (Effective until January 1, 2026) Restrictions relating to premium rates
- § 38.2-3447
- (Effective January 1, 2026) Restrictions relating to premium rates
- § 38.2-3448
- Guaranteed availability
- § 38.2-3449
- Prohibiting discrimination based on health status
- § 38.2-3449.1
- Prohibited discrimination based on gender identity or status as a transgender individual
- § 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
- Renewal of health benefit plans; special exception
- Article 7. NavigatorsRead all
- § 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
- Article 8. Health Care Shared SavingsRead all
- § 38.2-3461
- Definitions
- § 38.2-3462
- Comparable Health Care Service Incentive Program
- § 38.2-3463
- Health care price transparency tools
- § 38.2-3464
- Rules and regulations; orders
- Article 9. Pharmacy Benefits ManagersRead all
- § 38.2-3465
- Definitions
- § 38.2-3466
- (Effective October 1, 2020) License required to provide pharmacy benefits management services; requirements for a license, renewal, and revocation or suspension
- § 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
- § 38.2-3470
- (Effective October 1, 2020) Scope of article
