Virginia Law

A. As used in this section:

"Cost-sharing payment" means the total amount a covered person is required to pay at the point of sale in order to receive equipment and supplies that are covered under the covered person's policy, contract, or plan.

"Equipment and supplies" means blood glucose meters and strips, urine-testing strips, syringes, continuous glucose monitors and supplies, and insulin pump supplies. "Equipment and supplies" shall not be considered durable medical equipment.

B. Each insurer proposing to issue an individual or group hospital policy or major medical policy in this Commonwealth, each corporation proposing to issue an individual or group hospital, medical or major medical subscription contract, and each health maintenance organization providing a health care plan for health care services shall provide coverage for diabetes as provided in this section.

C. Such coverage shall include benefits for equipment and supplies and in-person outpatient self-management training and education, including medical nutrition therapy, for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and noninsulin-using diabetes if prescribed by a health care professional legally authorized to prescribe such items under law.

D. To qualify for coverage under this section, diabetes in-person outpatient self-management training and education shall be provided by a certified, registered or licensed health care professional. A managed care health insurance plan, as defined in Chapter 58 (§ 38.2-5800 et seq.) of this title, may require such health care professional to be a member of the plan's provider network; provided that such network includes sufficient health care professionals who are qualified by specific education, experience, and credentials to provide the covered benefits described in this section.

E. No insurer, corporation, or health maintenance organization shall impose upon any person receiving benefits pursuant to this section any copayment, fee, or condition that is not equally imposed upon all individuals in the same benefit category, nor shall any insurer, corporation, or health maintenance organization impose any policy-year or calendar-year dollar or durational benefit limitations or maximums for benefits or services provided under this section. Additionally, every policy, contract, or plan offered by an insurer, corporation, or health maintenance organization shall set the cost-sharing payment that a covered person is required to pay for equipment and supplies at an amount that does not exceed $35 in aggregate, including situations where the covered person is prescribed more than one piece of equipment or type of supplies, per 30-day supply of the equipment and supplies, regardless of the amount or type of equipment or supplies needed to fill the covered person's prescription.

F. The requirements of this section shall apply to all insurance policies, contracts and plans delivered, issued for delivery, reissued, or extended on and after July 1, 2000, or at any time thereafter when any term of the policy, contract or plan is changed or any premium adjustment is made.

G. This section shall not apply to short-term travel, accident only, or limited or specified disease policies or contracts, nor to 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 governmental plans.

1999, c. 35; 2000, cc. 1025, 1060; 2014, c. 814; 2026, c. 752.