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Provisions Relating to Accident and Sickness Insurance
Law
Code of Virginia
Insurance
Provisions Relating to Accident and Sickness Insurance
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Section
38.2-3400
Application of chapter
Section
38.2-3401
Forms of insurance authorized
Section
38.2-3402
Certification to accompany application
Section
38.2-3403
Fraudulent procurement of policy
Section
38.2-3404
Commission may establish rules and regulations for simplified and readable accident and sickness insurance policies
Section
38.2-3405
Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; limitations on disclosure of medical treatment options prohibited
Section
38.2-3405.1
Commonwealth's right to certain accident and sickness benefits
Section
38.2-3406
Accident and sickness benefits not subject to legal process
Section
38.2-3406.1
Application of requirements that policies offered by small employers include state-mandated health benefits
Section
38.2-3406.2
Capped benefits under insurance policies and contracts
Section
38.2-3407
Health benefit programs
Section
38.2-3407.1
Interest on accident and sickness claim proceeds
Section
38.2-3407.2
Coverage for medical child support
Section
38.2-3407.3
Calculation of cost-sharing provisions
Section
38.2-3407.3
1. Premium payment arrearages; order of crediting payments
Section
38.2-3407.4
Explanation of benefits
Section
38.2-3407.4
1. Repealed
Section
38.2-3407.4
2. Requirements for prescription benefit cards
Section
38.2-3407.5
Denial of benefits for certain prescription drugs prohibited
Section
38.2-3407.5
1. Coverage for prescription contraceptives
Section
38.2-3407.5
2. Reimbursements for dispensing hormonal contraceptives
Section
38.2-3407.6
Exclusion of podiatrist not permitted under certain circumstances
Section
38.2-3407.6
1. Denial of benefits for certain prescription drugs prohibited
Section
38.2-3407.7
Pharmacies; freedom of choice
Section
38.2-3407.8
Repealed
Section
38.2-3407.9
Reimbursement for emergency medical services vehicle transportation services
Section
38.2-3407.9
01. Prescription drug formularies
Section
38.2-3407.9
02. Requirement for prescription drug coverage
Section
38.2-3407.9
03. Payment of clean claims to administrators of pharmacy benefits
Section
38.2-3407.9
04. Medication synchronization
Section
38.2-3407.9
05. Step therapy protocols
Section
38.2-3407.10
Health care provider panels
Section
38.2-3407.10
1. Reimbursement for services rendered during pendency of a participating provider's credentialing application
Section
38.2-3407.10
2. Credentialing of private mental health agencies
Section
38.2-3407.11
Access to obstetrician-gynecologists
Section
38.2-3407.11
1. Access to specialists; standing referrals
Section
38.2-3407.11
2. Standing referral for cancer patients
Section
38.2-3407.11
3. Breast cancer underwriting and preexisting condition restrictions
Section
38.2-3407.11
4. Disability arising out of childbirth; minimum benefit
Section
38.2-3407.11
5. Interhospital transfer for newborn or mother; prior authorization prohibited
Section
38.2-3407.12
Patient optional point-of-service benefit
Section
38.2-3407.13
Refusal to accept assignments prohibited; dentists and oral surgeons
Section
38.2-3407.13
1. Coordination of benefits; notice of priority of coverage
Section
38.2-3407.13
2. Claims paid to insureds for services from nonparticipating physicians
Section
38.2-3407.14
Notice of premium or deductible increases
Section
38.2-3407.14
1. Standard of clinical evidence for decisions on coverage for proton radiation therapy
Section
38.2-3407.15
Ethics and fairness in carrier business practices
Section
38.2-3407.15
1. Carrier contracts with pharmacy providers; required provisions; limit on termination or nonrenewal
Section
38.2-3407.15
2. Carrier contracts; required provisions regarding prior authorization
Section
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
Section
38.2-3407.15
4. Limit on copayment for prescription drugs; permitted disclosures
Section
38.2-3407.15
5. Limit on cost-sharing payments for prescription insulin drugs
Section
38.2-3407.15
6. (Effective January 1, 2022) Prescription drug price transparency
Section
38.2-3407.16
Requirements for obstetrical care
Section
38.2-3407.17
Payment for services by dentists and oral surgeons
Section
38.2-3407.17
1. Payment and reimbursement practices for dental services; network access
Section
38.2-3407.18
Requirements for orally administered cancer chemotherapy drugs
Section
38.2-3407.19
Payment for services by optometrists and ophthalmologists
Section
38.2-3407.20
Calculation of enrollee's contribution to out-of-pocket maximum or cost-sharing requirement
Section
38.2-3407.21
Short-term limited-duration medical plans
Section
38.2-3407.22
(Effective January 1, 2022) Option for rebates to enrollees; protected information
Section
38.2-3408
Policy providing for reimbursement for services that may be performed by certain practitioners other than physicians
Section
38.2-3409
Coverage of dependent children
Section
38.2-3410
Construction of policy generally; words "physician" and "doctor" to include dentist
Section
38.2-3411
Coverage of newborn children required
Section
38.2-3411.1
Coverage for child health supervision services
Section
38.2-3411.2
Coverage of adopted children required
Section
38.2-3411.3
Coverage for childhood immunizations
Section
38.2-3411.4
Coverage for infant hearing screening and related diagnostics
Section
38.2-3412
Repealed
Section
38.2-3412.1
Coverage for mental health and substance use disorders
Section
38.2-3412.1
01. Repealed
Section
38.2-3413
Repealed
Section
38.2-3414
Optional coverage for obstetrical services
Section
38.2-3414.1
Obstetrical benefits; coverage for postpartum services
Section
38.2-3415
Exclusion or reduction of benefits for certain causes prohibited
Section
38.2-3416
Repealed
Section
38.2-3417
Deductibles and coinsurance options required
Section
38.2-3418
Coverage for victims of rape or incest
Section
38.2-3418.1
Coverage for mammograms
Section
38.2-3418.1
1. Repealed
Section
38.2-3418.1
2. Coverage for pap smears
Section
38.2-3418.2
Coverage of procedures involving bones and joints
Section
38.2-3418.3
Coverage for hemophilia and congenital bleeding disorders
Section
38.2-3418.4
Coverage for reconstructive breast surgery; notice; eligibility
Section
38.2-3418.5
Coverage for early intervention services
Section
38.2-3418.6
Minimum hospital stay for mastectomy and certain lymph node dissection patients
Section
38.2-3418.7
Coverage for PSA testing
Section
38.2-3418.7
1. Coverage for colorectal cancer screening
Section
38.2-3418.8
Coverage for clinical trials for treatment studies on cancer
Section
38.2-3418.9
Minimum hospital stay for hysterectomy
Section
38.2-3418.10
Coverage for diabetes
Section
38.2-3418.11
Coverage for hospice care
Section
38.2-3418.12
Coverage for hospitalization and anesthesia for dental procedures
Section
38.2-3418.13
Coverage for the treatment of morbid obesity
Section
38.2-3418.14
Coverage for lymphedema
Section
38.2-3418.15
Coverage for prosthetic devices and components
Section
38.2-3418.16
Coverage for telemedicine services
Section
38.2-3418.17
Coverage for autism spectrum disorder
Section
38.2-3418.18
Coverage for formula and enteral nutrition products as medicine
Section
38.2-3418.19
Coverage for organ, eye or tissue transplant
Section
38.2-3418.20
Coverage for hearing aids and related services
Section
38.2-3419
Additional mandated coverage made optional to group policy or contract holder
Section
38.2-3419.1
Report of costs and utilization of mandated benefits
Section
38.2-3420
Authority and jurisdiction of Commission; exception
Section
38.2-3421
How to show jurisdiction of other state agency or federal government
Section
38.2-3422
Examination
Section
38.2-3423
When subject to this title
Section
38.2-3424
Disclosure of extent and elements of coverage
Section
38.2-3424.1
Applicability
Section
38.2-3425
Expired
Section
38.2-3430.1
Application of article
Section
38.2-3430.1
1. Health insurance coverage not required
Section
38.2-3430.2
Definitions
Section
38.2-3430.3
Guaranteed availability of individual health insurance coverage to certain individuals with prior group coverage
Section
38.2-3430.3
1. Expired
Section
38.2-3430.4
Special rules for network plans
Section
38.2-3430.5
Application of financial capacity limits
Section
38.2-3430.6
Market requirements
Section
38.2-3430.7
Renewability of individual health insurance coverage
Section
38.2-3430.8
Certification of coverage
Section
38.2-3430.9
Regulations establishing standards
Section
38.2-3430.10
Effective date
Section
38.2-3431
Application of article; definitions
Section
38.2-3432
Repealed
Section
38.2-3432.1
Renewability
Section
38.2-3432.2
Availability
Section
38.2-3432.3
Limitation on preexisting condition exclusion period
Section
38.2-3433
Repealed
Section
38.2-3434
Disclosure of information
Section
38.2-3435
Exclusions
Section
38.2-3436
Eligibility to enroll
Section
38.2-3437
Rules used to determine group size
Section
38.2-3438
Definitions
Section
38.2-3439
Dependent coverage for individuals to age 26
Section
38.2-3440
Lifetime and annual limits
Section
38.2-3441
Rescissions
Section
38.2-3442
Preventive services
Section
38.2-3443
Choice of a health care professional
Section
38.2-3444
Preexisting condition exclusions
Section
38.2-3445
Patient access to emergency services
Section
38.2-3445.01
Balance billing for certain services; prohibited
Section
38.2-3445.02
Arbitration
Section
38.2-3445.03
Data sets for determining commercially reasonable payments
Section
38.2-3445.04
Transparency
Section
38.2-3445.05
Enforcement
Section
38.2-3445.06
Applicability of certain sections
Section
38.2-3445.07
Rules and regulations
Section
38.2-3445.1
Repealed
Section
38.2-3445.2
Out-of-network claims; reporting requirements
Section
38.2-3446
Applicability of federal law
Section
38.2-3447
Restrictions relating to premium rates
Section
38.2-3448
Guaranteed availability
Section
38.2-3449
Prohibiting discrimination based on health status
Section
38.2-3449.1
Prohibited discrimination based on gender identity or status as a transgender individual
Section
38.2-3450
Genetic information and testing
Section
38.2-3451
Essential health benefits
Section
38.2-3452
Waiting periods
Section
38.2-3453
Clinical trials
Section
38.2-3454
Wellness programs
Section
38.2-3454.1
Renewal of health benefit plans; special exception
Section
38.2-3455
Definitions
Section
38.2-3456
Prohibited activities
Section
38.2-3457
Application for registration
Section
38.2-3458
Power of Commission to investigate navigators
Section
38.2-3459
Grounds for termination, placing on probation, revocation, or suspension of registration
Section
38.2-3460
Sufficiency of federal requirements; additional standards and qualifications for navigators
Section
38.2-3461
Definitions
Section
38.2-3462
Comparable Health Care Service Incentive Program
Section
38.2-3463
Health care price transparency tools
Section
38.2-3464
Rules and regulations; orders
Section
38.2-3465
(Effective October 1, 2020) Definitions
Section
38.2-3466
(Effective October 1, 2020) License required to provide pharmacy benefits management services; requirements for a license, renewal, and revocation or suspension
Section
38.2-3467
(Effective October 1, 2020) Prohibited conduct by carriers and pharmacy benefits managers
Section
38.2-3468
(Effective October 1, 2020) Examination of books and records; reports; access to records
Section
38.2-3469
(Effective October 1, 2020) Enforcement; regulations
Section
38.2-3470
(Effective October 1, 2020) Scope of article