Code of Virginia - Title 38.2 Insurance - Chapter 34 Provisions Relating To Accident And Sickness Insurance

38.2-3400 Application of chapter
A. This chapter and Chapter 35 (§ 38.2-3500 et seq.) of this title apply to insurance policies or contracts of the class described in § ...
38.2-3401 Forms of insurance authorized
A. Accident and sickness insurance shall be issued only in the following forms: 1. Individual accident and sickness policies; or 2. Group accident and sickness ...
38.2-3402 Certification to accompany application
A. Each application for an individual accident and sickness insurance policy shall contain a certification, signed by both the applicant and the agent soliciting the ...
38.2-3403 Fraudulent procurement of policy
A. No person shall knowingly secure, attempt to secure or cause to be secured an individual accident and sickness insurance policy on any person not ...
38.2-3404 Commission may establish rules and regulations for simplified and readable accident and sickness in...
A. Pursuant to the authority granted in § 38.2-223, the Commission may issue rules and regulations establishing standards for simplified and readable accident and sickness ...
38.2-3405 Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies f...
A. No insurance contract providing hospital, medical, surgical and similar or related benefits, and no subscription contract or health services plan delivered or issued for ...
38.2-3405.1 Commonwealth's right to certain accident and sickness benefits
A. The Department of Medical Assistance Services shall be entitled to direct reimbursement under any accident and sickness insurance policy, health services plan, or health ...
38.2-3406 Accident and sickness benefits not subject to legal process
The installment payments to the holder of any accident and sickness insurance policy or certificate shall not be subject to the lien of any attachment, ...
38.2-3407 Health benefit programs
A. One or more insurers may offer or administer a health benefit program under which the insurer or insurers may offer preferred provider policies or ...
38.2-3407.1 Interest on accident and sickness claim proceeds
A. If an action to recover the claim proceeds due under an individual or group accident and sickness policy results in a judgment against an ...
38.2-3407.2 Coverage for medical child support
A. No insurer, health services plan, or health maintenance organization shall refuse to enroll a child under a parent's coverage because (i) the child was ...
38.2-3407.3 Calculation of cost-sharing provisions
A. An insurer, health services plan or health maintenance organization that issues an accident and sickness insurance policy or contract pursuant to which the insured, ...
38.2-3407.3:1 Premium payment arrearages; order of crediting payments
Each (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an ...
38.2-3407.4 Explanation of benefits
A. Each insurer issuing an accident and sickness insurance policy, a corporation issuing subscription contracts, and each health maintenance organization shall file for approval explanation ...
38.2-3407.4:1 Description unavailable
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 accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on ...
38.2-3407.5 Denial of benefits for certain prescription drugs prohibited
A. Each (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on ...
38.2-3407.5:1 Coverage for prescription contraceptives
A. Each (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on ...
38.2-3407.6 Exclusion of podiatrist not permitted under certain circumstances
No podiatrist shall be excluded from participating in any preferred provider plan pursuant to this chapter or Chapter 42 (§ 38.2-4200 et seq.) of this ...
38.2-3407.6:1 Denial of benefits for certain prescription drugs prohibited
A. Each (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on ...
38.2-3407.7 Pharmacies; freedom of choice
A. Notwithstanding any provision of § 38.2-3407 to the contrary, no insurer proposing to issue preferred provider policies or contracts shall prohibit any person receiving ...
38.2-3407.8 Description unavailable
Repealed by Acts 1995, c. 467. ...
38.2-3407.9 Reimbursement for ambulance services
A. If an accident and sickness insurance policy provides coverage for ambulance services, any person providing such services to a person covered under such policy ...
38.2-3407.9:01 Prescription drug formularies
A. Each (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on ...
38.2-3407.9:02 Requirement for prescription drug coverage
No (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an ...
38.2-3407.9:03 Payment of clean claims to administrators of pharmacy benefits
A. As used in this section, "clean claim," "carrier," and "provider contract," shall have the meanings set forth in subsection A of § 38.2-3407.15. B. ...
38.2-3407.10 Health care provider panels
A. As used in this section: "Carrier" means: 1. Any insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical ...
38.2-3407.11 Access to obstetrician-gynecologists
A. Each (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on ...
38.2-3407.11:1 Access to specialists; standing referrals
A. Each (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on ...
38.2-3407.11:2 Standing referral for cancer patients
A. Each (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on ...
38.2-3407.11:3 Breast cancer underwriting and preexisting condition restrictions
A. No (i) insurer proposing to issue group accident and sickness insurance policies or individual health insurance coverage providing hospital, medical and surgical, major medical ...
38.2-3407.12 Patient optional point-of-service benefit
A. As used in this section: "Affiliate" shall have the meaning set forth in § 38.2-1322. "Allowable charge" means the amount from which the carrier's ...
38.2-3407.13 Refusal to accept assignments prohibited; dentists and oral surgeons
A. No insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an ...
38.2-3407.13:1 Coordination of benefits; notice of priority of coverage
Each (i) insurer issuing individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense-incurred basis, ...
38.2-3407.13:2 Claims paid to insureds for services from nonparticipating physicians
When an insurer, health services plan or health maintenance organization follows a policy of sending its payment to the insured, subscriber or enrollee for a ...
38.2-3407.14 Notice of premium increases
A. Each (i) insurer issuing individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense-incurred ...
38.2-3407.15 Ethics and fairness in carrier business practices
A. As used in this section: "Carrier," "enrollee" and "provider" shall have the meanings set forth in § 38.2-3407.10; however, a "carrier" shall also include ...
38.2-3407.16 Requirements for obstetrical care
A. Each (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on ...
38.2-3408 Policy providing for reimbursement for services that may be performed by certain practitioners othe...
A. If an accident and sickness insurance policy provides reimbursement for any service that may be legally performed by a person licensed in this Commonwealth ...
38.2-3409 Coverage of dependent children
A. Any group or individual accident and sickness insurance policy or subscription contract delivered or issued for delivery in this Commonwealth which provides that coverage ...
38.2-3410 Construction of policy generally; words "physician" and "doctor" to include dentist
Each accident and sickness insurance policy or subscription contract shall be construed according to the entirety of its terms and conditions as set forth in ...
38.2-3411 Coverage of newborn children required
A. Each individual and group accident and sickness insurance policy or individual and group subscription contract providing coverage on an expense incurred basis that provides ...
38.2-3411.1 Coverage for child health supervision services
A. Every individual or group accident and sickness insurance policy, subscription contract providing coverage under a health services plan, or evidence of coverage of a ...
38.2-3411.2 Coverage of adopted children required
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical ...
38.2-3411.3 Coverage for childhood immunizations
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, ...
38.2-3411.4 Coverage for infant hearing screening and related diagnostics
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, ...
38.2-3412 Description unavailable
Repealed by Acts 1993, c. 132. ...
38.2-3412.1 Coverage for mental health and substance abuse services
A. As used in this section: "Adult" means any person who is nineteen years of age or older. "Alcohol or drug rehabilitation facility" means a ...
38.2-3412.1:01 Coverage for biologically based mental illness
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue group accident and sickness insurance policies providing hospital, medical and surgical, or major ...
38.2-3413 Description unavailable
Repealed by Acts 1993, c. 132. ...
38.2-3414 Optional coverage for obstetrical services
A. Each insurer proposing to issue a group hospital policy or a group major medical policy in this Commonwealth and each corporation proposing to issue ...
38.2-3414.1 Obstetrical benefits; coverage for postpartum services
A. Each insurer proposing to issue an individual or group hospital policy or major medical policy in this Commonwealth, each corporation proposing to issue an ...
38.2-3415 Exclusion or reduction of benefits for certain causes prohibited
No group accident and sickness insurance policy, nor any group subscription contract, delivered or issued for delivery in this Commonwealth or renewed, reissued or extended ...
38.2-3416 Conversion on termination of eligibility; insurer required to offer conversion policy or group cove...
A. Before an insurer who delivers or issues for delivery in this Commonwealth or who renews, reissues or extends if already issued, any group hospital, ...
38.2-3417 Deductibles and coinsurance options required
A. An insurer issuing accident and sickness insurance or a corporation issuing subscription contracts on an expense incurred basis shall make available in offering such ...
38.2-3418 Coverage for victims of rape or incest
Each hospital expense, medical-surgical expense, major medical expense or hospital confinement indemnity insurance policy issued by an insurer, each individual and group subscription contract providing ...
38.2-3418.1 Coverage for mammograms
A. 1. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and ...
38.2-3418.1:1 Description unavailable
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 issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or ...
38.2-3418.2 Coverage of procedures involving bones and joints
A. Each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an ...
38.2-3418.3 Coverage for hemophilia and congenital bleeding disorders
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, ...
38.2-3418.4 Coverage for reconstructive breast surgery; notice; eligibility
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, ...
38.2-3418.5 Coverage for early intervention services
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, ...
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 to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, ...
38.2-3418.7 Coverage for PSA testing
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, ...
38.2-3418.7:1 Coverage for colorectal cancer screening
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical ...
38.2-3418.8 Coverage for clinical trials for treatment studies on cancer
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, ...
38.2-3418.9 Minimum hospital stay for hysterectomy
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue an individual or group hospital policy or major medical policy in this Commonwealth, ...
38.2-3418.10 Coverage for diabetes
A. Each insurer proposing to issue an individual or group hospital policy or major medical policy in this Commonwealth, each corporation proposing to issue an ...
38.2-3418.11 Coverage for hospice care
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, ...
38.2-3418.12 Coverage for hospitalization and anesthesia for dental procedures
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, ...
38.2-3418.13 Coverage for the treatment of morbid obesity
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, ...
38.2-3418.14 Coverage for lymphedema
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, ...
38.2-3419 Additional mandated coverage made optional to group policy or contract holder
Any new or existing group policy or contract holder for whom coverage under an accident and sickness insurance policy is issued or renewed by an ...
38.2-3419.1 Report of costs and utilization of mandated benefits
A. Beginning with the calendar year 1991, every insurer, health services plan, and health maintenance organization from which a report is deemed necessary under regulations ...
38.2-3420 Authority and jurisdiction of Commission; exception
A. Except as provided in subsection B, any person offering or providing coverage in the Commonwealth for health care services, whether the coverage is by ...
38.2-3421 How to show jurisdiction of other state agency or federal government
A person may show that it is regulated by another agency of this Commonwealth, any subdivision of this Commonwealth, or the federal government by providing ...
38.2-3422 Examination
Any person that fails to show that it is regulated by another agency of this Commonwealth, any subdivision of this Commonwealth, or the federal government ...
38.2-3423 When subject to this title
Any person that fails to show that it is regulated by another agency of this Commonwealth, any subdivision of this Commonwealth, or the federal government ...
38.2-3424 Disclosure of extent and elements of coverage
A. Any agent, agency, administrator, or other person that advertises, sells, transacts, or administers coverage for health care services in this Commonwealth where that coverage ...
38.2-3424.1 Applicability
Nothing contained in this article shall be construed to apply to any plan for providing health insurance coverage established pursuant to § 2.2-2818. (1990, c. ...
38.2-3425 through 38.2-3430
Expired. ...
38.2-3430.1 Application of article
This article applies to individual health insurance coverage offered, sold, issued, or renewed in this Commonwealth, but shall not apply to any individual health insurance ...
38.2-3430.2 Definitions
A. The terms defined in § 38.2-3431 that are used in this article shall have the meanings set forth in that section. B. For purposes ...
38.2-3430.3 Guaranteed availability of individual health insurance coverage to certain individuals with prior g...
A. Guaranteed availability. 1. All eligible individuals shall be provided a choice of all individual health insurance coverage currently being offered by a health insurance ...
38.2-3430.3:1 Description unavailable
Expired. ...
38.2-3430.4 Special rules for network plans
A health insurance issuer that offers health insurance coverage in the individual market may: 1. Limit the eligible individuals who may be enrolled under such ...
38.2-3430.5 Application of financial capacity limits
A. A health insurance issuer may deny health insurance coverage in the individual market to an eligible individual if the health insurance issuer has demonstrated ...
38.2-3430.6 Market requirements
A. The provisions of § 38.2-3430.3 shall not be construed to require that a health insurance issuer offering health insurance coverage only in connection with ...
38.2-3430.7 Renewability of individual health insurance coverage
A. Except as provided in this section, a health insurance issuer that provides individual health insurance coverage shall renew or continue in force such coverage ...
38.2-3430.8 Certification of coverage
The provisions of § 38.2-3432.3 shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner ...
38.2-3430.9 Regulations establishing standards
A. The Commission may adopt regulations to enable it to establish and administer such standards relating to the provisions of this article and Article 5 ...
38.2-3430.10 Effective date
The provisions of this article shall be effective on July 1, 1997, with the exception of § 38.2-3430.3 which shall be effective on January 1, ...
38.2-3431 Application of article; definitions
A. This article applies to group health plans and to health insurance issuers offering group health insurance coverage, and individual policies offered to employees of ...
38.2-3432 Description unavailable
Repealed by Acts 1997, cc. 807 and 913. ...
38.2-3432.1 Renewability
A. Every health insurance issuer that offers health insurance coverage in the group market in this Commonwealth shall renew or continue in force such coverage ...
38.2-3432.2 Availability
A. If coverage is offered under this article in the small employer market: 1. Such coverage shall be offered and made available to all the ...
38.2-3432.3 Limitation on preexisting condition exclusion period
A. Subject to subsection B, a health insurer offering health insurance coverage may, with respect to a participant or beneficiary, impose a preexisting limitation only ...
38.2-3433 Small employer market premium and disclosure provisions
A. New or renewal premium rates for essential or standard health benefit plans issued by a health insurance issuer to a small employer not currently ...
38.2-3434 Disclosure of information
Any health insurance issuer offering health insurance coverage to a employer shall make a reasonable disclosure of the availability of information to such an employer, ...
38.2-3435 Exclusions
The provisions of this article shall not apply to: 1. Any health insurance issuer offering group health insurance coverage for any plan year if, on ...
38.2-3436 Eligibility to enroll
A. A health insurance issuer offering group health insurance coverage, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under ...
38.2-3437 Rules used to determine group size
A. All employers treated as a single employer under subsection (b), (c), (m), or (o) of § 414 of the Internal Revenue Code of 1986 ...

Last modified: April 3, 2009