{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3405.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3405.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3405.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3405.html"}],"law_id":62539,"edition_id":1,"section_id":62539,"structure_id":12994,"section_number":"38.2-3405","catch_line":"Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; limitations on disclosure of medical treatment options prohibited","history":"1973, c. 28, \u00a7 38.1-342.2; 1979, c. 341; 1986, c. 562; 1988, c. 840; 1989, c. 487; 1994, c. 609; 1995, c. 68; 2004, c. 675.","full_text":"A\n\nNo insurance contract providing hospital, medical, surgical and similar or related benefits, and no subscription contract or health services plan delivered or issued for delivery or providing for payment of benefits to or on behalf of persons residing in or employed in this Commonwealth shall contain any provision providing for subrogation of any person’s right to recovery for personal injuries from a third person.B\n\nNo such contract, subscription contract or health services plan shall contain any provision requiring the beneficiary of any such contract or plan to sign any agreement to pay back to any company issuing such a contract or creating a health services plan any benefits paid pursuant to the terms of such contract or plan from the proceeds of a recovery by such a beneficiary from any other source; provided, that this provision shall not prohibit an exclusion of benefits paid or payable under workers’ compensation laws or federal or state programs, nor shall this provision prohibit coordination of benefits provisions when there are two or more such accident and sickness insurance contracts or plans providing for the payment of the same benefits. Coordination of benefits provisions may not operate to reduce benefits because of any benefits paid, payable, or provided by any liability insurance contract or any benefits paid, payable, or provided by any medical expense or medical payments insurance provided in conjunction with liability coverage.C\n\nNo insurance contract providing hospital, medical, surgical and similar or related benefits, and no subscription contract or health services plan delivered or issued for delivery or providing for payment of benefits to or on behalf of persons residing in or employed in this Commonwealth shall contain any provision limiting, restricting, or prohibiting a physician from disclosing fully all medical treatment options to patients whether or not such treatment options are (i) experimental or covered services, (ii) services that the health insurer will not authorize, or (iii) the costs of the treatment will be borne by the health insurer or the patient to facilitate an informed decision by the patient, if the physician determines that such an option is in the best interest of the patient. For the purposes of this subsection, “medical treatment options” means any alternative or experimental therapeutic, psychiatric, medical treatment or procedure, health care service, drug, or remedy.D\n\nWhenever benefits paid or payable under workers’ compensation are excluded from coverage under the terms of any such contract, subscription contract or health services plan, the issuer thereof shall not exclude coverage for any medical condition pursuant to such exclusion if (i) an award of the Workers’ Compensation Commission pursuant to § 65.2-704 denies compensation benefits relating to such medical condition and no request for review of such award is made pursuant to and within the time prescribed by § 65.2-705 or (ii) an award of the Workers’ Compensation Commission, after review by the full Commission pursuant to § 65.2-705, denies compensation benefits relating to such medical condition. Following the entry of a workers’ compensation award pursuant to clause (i) or (ii) having the effect of prohibiting the application of any such exclusion, the issuer shall immediately provide coverage for such medical condition to the extent otherwise covered under the contract, subscription contract or health services plan. If, upon appeal to the Court of Appeals or the Supreme Court, such medical condition is held to be compensable under the Virginia Workers’ Compensation Act (Title 65.2), the issuer may recover from the applicable employer or workers’ compensation insurance carrier the costs of coverage for medical conditions found to be compensable under the Act.","order_by":null,"text":{"0":{"id":228077,"text":"No insurance contract providing hospital, medical, surgical and similar or related benefits, and no subscription contract or health services plan delivered or issued for delivery or providing for payment of benefits to or on behalf of persons residing in or employed in this Commonwealth shall contain any provision providing for subrogation of any person’s right to recovery for personal injuries from a third person.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":228078,"text":"No such contract, subscription contract or health services plan shall contain any provision requiring the beneficiary of any such contract or plan to sign any agreement to pay back to any company issuing such a contract or creating a health services plan any benefits paid pursuant to the terms of such contract or plan from the proceeds of a recovery by such a beneficiary from any other source; provided, that this provision shall not prohibit an exclusion of benefits paid or payable under workers’ compensation laws or federal or state programs, nor shall this provision prohibit coordination of benefits provisions when there are two or more such accident and sickness insurance contracts or plans providing for the payment of the same benefits. Coordination of benefits provisions may not operate to reduce benefits because of any benefits paid, payable, or provided by any liability insurance contract or any benefits paid, payable, or provided by any medical expense or medical payments insurance provided in conjunction with liability coverage.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":228079,"text":"No insurance contract providing hospital, medical, surgical and similar or related benefits, and no subscription contract or health services plan delivered or issued for delivery or providing for payment of benefits to or on behalf of persons residing in or employed in this Commonwealth shall contain any provision limiting, restricting, or prohibiting a physician from disclosing fully all medical treatment options to patients whether or not such treatment options are (i) experimental or covered services, (ii) services that the health insurer will not authorize, or (iii) the costs of the treatment will be borne by the health insurer or the patient to facilitate an informed decision by the patient, if the physician determines that such an option is in the best interest of the patient. For the purposes of this subsection, “medical treatment options” means any alternative or experimental therapeutic, psychiatric, medical treatment or procedure, health care service, drug, or remedy.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":228080,"text":"Whenever benefits paid or payable under workers’ compensation are excluded from coverage under the terms of any such contract, subscription contract or health services plan, the issuer thereof shall not exclude coverage for any medical condition pursuant to such exclusion if (i) an award of the Workers’ Compensation Commission pursuant to § 65.2-704 denies compensation benefits relating to such medical condition and no request for review of such award is made pursuant to and within the time prescribed by § 65.2-705 or (ii) an award of the Workers’ Compensation Commission, after review by the full Commission pursuant to § 65.2-705, denies compensation benefits relating to such medical condition. Following the entry of a workers’ compensation award pursuant to clause (i) or (ii) having the effect of prohibiting the application of any such exclusion, the issuer shall immediately provide coverage for such medical condition to the extent otherwise covered under the contract, subscription contract or health services plan. If, upon appeal to the Court of Appeals or the Supreme Court, such medical condition is held to be compensable under the Virginia Workers’ Compensation Act (Title 65.2), the issuer may recover from the applicable employer or workers’ compensation insurance carrier the costs of coverage for medical conditions found to be compensable under the Act.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C"}},"ancestry":[{"id":12994,"edition_id":1,"name":"General Provisions","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214889,"object_type":"structure","relational_id":12994,"identifier":"1","token":"38.2\/34\/1","url":"\/38.2\/34\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12993,"edition_id":1,"name":"Provisions Relating to Accident and Sickness Insurance","identifier":"34","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214887,"object_type":"structure","relational_id":12993,"identifier":"34","token":"38.2\/34","url":"\/38.2\/34\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":57593,"structure_id":12994,"section_number":"38.2-3400","catch_line":"Application of chapter","url":"\/38.2-3400\/","token":"38.2\/34\/1\/38.2-3400","metadata":false},{"id":72072,"structure_id":12994,"section_number":"38.2-3401","catch_line":"Forms of insurance authorized","url":"\/38.2-3401\/","token":"38.2\/34\/1\/38.2-3401","metadata":false},{"id":65240,"structure_id":12994,"section_number":"38.2-3402","catch_line":"Certification to accompany application","url":"\/38.2-3402\/","token":"38.2\/34\/1\/38.2-3402","metadata":false},{"id":83988,"structure_id":12994,"section_number":"38.2-3403","catch_line":"Fraudulent procurement of policy","url":"\/38.2-3403\/","token":"38.2\/34\/1\/38.2-3403","metadata":false},{"id":65279,"structure_id":12994,"section_number":"38.2-3404","catch_line":"Commission may establish rules and regulations for simplified and readable accident and sickness insurance policies","url":"\/38.2-3404\/","token":"38.2\/34\/1\/38.2-3404","metadata":false},{"id":62539,"structure_id":12994,"section_number":"38.2-3405","catch_line":"Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; limitations on disclosure of medical treatment options prohibited","url":"\/38.2-3405\/","token":"38.2\/34\/1\/38.2-3405","metadata":false},{"id":84136,"structure_id":12994,"section_number":"38.2-3405.1","catch_line":"Commonwealth's right to certain accident and sickness benefits","url":"\/38.2-3405.1\/","token":"38.2\/34\/1\/38.2-3405.1","metadata":false},{"id":70730,"structure_id":12994,"section_number":"38.2-3406","catch_line":"Accident and sickness benefits not subject to legal process","url":"\/38.2-3406\/","token":"38.2\/34\/1\/38.2-3406","metadata":false},{"id":84333,"structure_id":12994,"section_number":"38.2-3406.1","catch_line":"Application of requirements that policies offered by small employers include state-mandated health benefits","url":"\/38.2-3406.1\/","token":"38.2\/34\/1\/38.2-3406.1","metadata":false},{"id":67972,"structure_id":12994,"section_number":"38.2-3406.2","catch_line":"Capped benefits under insurance policies and contracts","url":"\/38.2-3406.2\/","token":"38.2\/34\/1\/38.2-3406.2","metadata":false},{"id":76321,"structure_id":12994,"section_number":"38.2-3407","catch_line":"Health benefit programs","url":"\/38.2-3407\/","token":"38.2\/34\/1\/38.2-3407","metadata":false},{"id":66921,"structure_id":12994,"section_number":"38.2-3407.1","catch_line":"Interest on accident and sickness claim proceeds","url":"\/38.2-3407.1\/","token":"38.2\/34\/1\/38.2-3407.1","metadata":false},{"id":58079,"structure_id":12994,"section_number":"38.2-3407.10","catch_line":"Health care provider panels","url":"\/38.2-3407.10\/","token":"38.2\/34\/1\/38.2-3407.10","metadata":false},{"id":66411,"structure_id":12994,"section_number":"38.2-3407.10:1","catch_line":"Processing of new provider applications and reimbursement for services rendered during pendency of a participating provider's credentialing application","url":"\/38.2-3407.10_1\/","token":"38.2\/34\/1\/38.2-3407.10_1","metadata":false},{"id":56463,"structure_id":12994,"section_number":"38.2-3407.10:2","catch_line":"Credentialing of private mental health agencies","url":"\/38.2-3407.10_2\/","token":"38.2\/34\/1\/38.2-3407.10_2","metadata":false},{"id":82372,"structure_id":12994,"section_number":"38.2-3407.11","catch_line":"Access to obstetrician-gynecologists","url":"\/38.2-3407.11\/","token":"38.2\/34\/1\/38.2-3407.11","metadata":false},{"id":70024,"structure_id":12994,"section_number":"38.2-3407.11:1","catch_line":"Access to specialists; 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This law was first created in 1973. The record of its establishment is cataloged in chapter 28 of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. Unfortunately, the 1973 \u201cActs\u201d aren\u2019t available online. It has been modified 7 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1979, chapter 341; in 1986, chapter 562; in 1988, chapter 840; in 1989, chapter 487; in 1994, chapter 609<\/a>; in 1995, chapter 68<\/a>; in 2004, chapter 675<\/a>.<\/p>","references":[{"id":78608,"section_number":"38.2-207","catch_line":"Enforcement of right of subrogation in name of insured","order_by":null,"url":"\/38.2-207\/"},{"id":79541,"section_number":"38.2-3407.13:1","catch_line":"Coordination of benefits; notice of priority of coverage","order_by":null,"url":"\/38.2-3407.13_1\/"},{"id":55347,"section_number":"38.2-4214","catch_line":"Application of certain provisions of law","order_by":null,"url":"\/38.2-4214\/"},{"id":67952,"section_number":"38.2-4319","catch_line":"Statutory construction and relationship to other laws","order_by":null,"url":"\/38.2-4319\/"},{"id":62548,"section_number":"38.2-4509","catch_line":"Application of certain laws","order_by":null,"url":"\/38.2-4509\/"}],"refers_to":[{"id":77883,"section_number":"65.2-704","catch_line":"Hearing; award or opinion by Commission","order_by":null,"url":"\/65.2-704\/"},{"id":64198,"section_number":"65.2-705","catch_line":"Review of award; rehearing","order_by":null,"url":"\/65.2-705\/"}],"permalink":{"id":214911,"object_type":"law","relational_id":62539,"identifier":"38.2-3405","token":"38.2\/34\/1\/38.2-3405","url":"\/38.2-3405\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3405\/","token":"38.2\/34\/1\/38.2-3405","dublin_core":{"Title":"Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; limitations on disclosure of medical treatment options prohibited","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3405","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> No insurance<\/span> contract<\/span> providing hospital, medical, surgical and similar or related benefits, and no subscription contract<\/span> or health services plan<\/span> delivered or issued for delivery or providing for payment of benefits to or on behalf of persons<\/span> residing in or employed in this Commonwealth shall contain any provision providing for subrogation of any person<\/span>’s right to recovery for personal injuries from a third person<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> No such contract<\/span>, subscription contract<\/span> or health services plan<\/span> shall contain any provision requiring the beneficiary of any such contract<\/span> or plan to sign any agreement to pay back to any company<\/span> issuing such a contract<\/span> or creating a health services plan<\/span> any benefits paid pursuant to the terms of such contract<\/span> or plan from the proceeds of a recovery by such a beneficiary from any other source; provided, that this provision shall not prohibit an exclusion of benefits paid or payable under workers’ compensation laws<\/span> or federal or state<\/span> programs, nor shall this provision prohibit coordination of benefits provisions when there are two or more such accident and sickness insurance contracts<\/span> or plans providing for the payment of the same benefits. Coordination of benefits provisions may not operate to reduce benefits because of any benefits paid, payable, or provided by any liability insurance contract<\/span> or any benefits paid, payable, or provided by any medical expense or medical payments insurance provided in conjunction with liability coverage. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> No insurance contract<\/span> providing hospital, medical, surgical and similar or related benefits, and no subscription contract<\/span> or health services plan<\/span> delivered or issued for delivery or providing for payment of benefits to or on behalf of persons<\/span> residing in or employed in this Commonwealth shall contain any provision limiting, restricting, or prohibiting a physician from disclosing fully all medical treatment options<\/span> to patients whether or not such treatment options are (i) experimental or covered services, (ii) services that the health insurer<\/span> will not authorize, or (iii) the costs of the treatment will be borne by the health insurer<\/span> or the patient to facilitate an informed decision by the patient, if the physician determines that such an option is in the best interest of the patient. For the purposes of this subsection, “medical treatment options<\/span>” means any alternative or experimental therapeutic, psychiatric, medical treatment or procedure, health care service, drug, or remedy. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> Whenever benefits paid or payable under workers’ compensation are excluded from coverage under the terms of any such contract<\/span>, subscription contract<\/span> or health services plan<\/span>, the issuer thereof shall not exclude coverage for any medical condition pursuant to such exclusion if (i) an award of the Workers’ Compensation Commission<\/span> pursuant to § 65.2-704<\/a> denies compensation benefits relating to such medical condition and no request for review of such award is made pursuant to and within the time prescribed by § 65.2-705<\/a> or (ii) an award of the Workers’ Compensation Commission<\/span>, after review by the full Commission<\/span> pursuant to § 65.2-705<\/a>, denies compensation benefits relating to such medical condition. Following the entry of a workers’ compensation award pursuant to clause (i) or (ii) having the effect of prohibiting the application of any such exclusion, the issuer shall immediately provide coverage for such medical condition to the extent otherwise covered under the contract<\/span>, subscription contract<\/span> or health services plan<\/span>. If, upon appeal<\/span> to the Court<\/span> of Appeals<\/span> or the Supreme Court<\/span>, such medical condition is held to be compensable under the Virginia Workers’ Compensation Act (Title 65.2), the issuer may recover from the applicable employer or workers’ compensation insurance carrier the costs of coverage for medical conditions found to be compensable under the Act. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nCERTAIN SUBROGATION PROVISIONS AND LIMITATIONS UPON RECOVERY IN HOSPITAL,\nMEDICAL, ETC., POLICIES FORBIDDEN; LIMITATIONS ON DISCLOSURE OF MEDICAL\nTREATMENT OPTIONS PROHIBITED (\u00a7 38.2-3405)\n\nA. No insurance contract providing hospital, medical, surgical and similar or\nrelated benefits, and no subscription contract or health services plan delivered\nor issued for delivery or providing for payment of benefits to or on behalf of\npersons residing in or employed in this Commonwealth shall contain any provision\nproviding for subrogation of any person’s right to recovery for personal\ninjuries from a third person.\n\nB. No such contract, subscription contract or health services plan shall contain\nany provision requiring the beneficiary of any such contract or plan to sign any\nagreement to pay back to any company issuing such a contract or creating a\nhealth services plan any benefits paid pursuant to the terms of such contract or\nplan from the proceeds of a recovery by such a beneficiary from any other\nsource; provided, that this provision shall not prohibit an exclusion of\nbenefits paid or payable under workers’ compensation laws or federal or\nstate programs, nor shall this provision prohibit coordination of benefits\nprovisions when there are two or more such accident and sickness insurance\ncontracts or plans providing for the payment of the same benefits. Coordination\nof benefits provisions may not operate to reduce benefits because of any\nbenefits paid, payable, or provided by any liability insurance contract or any\nbenefits paid, payable, or provided by any medical expense or medical payments\ninsurance provided in conjunction with liability coverage.\n\nC. No insurance contract providing hospital, medical, surgical and similar or\nrelated benefits, and no subscription contract or health services plan delivered\nor issued for delivery or providing for payment of benefits to or on behalf of\npersons residing in or employed in this Commonwealth shall contain any provision\nlimiting, restricting, or prohibiting a physician from disclosing fully all\nmedical treatment options to patients whether or not such treatment options are\n(i) experimental or covered services, (ii) services that the health insurer will\nnot authorize, or (iii) the costs of the treatment will be borne by the health\ninsurer or the patient to facilitate an informed decision by the patient, if the\nphysician determines that such an option is in the best interest of the patient.\nFor the purposes of this subsection, “medical treatment options”\nmeans any alternative or experimental therapeutic, psychiatric, medical\ntreatment or procedure, health care service, drug, or remedy.\n\nD. Whenever benefits paid or payable under workers’ compensation are\nexcluded from coverage under the terms of any such contract, subscription\ncontract or health services plan, the issuer thereof shall not exclude coverage\nfor any medical condition pursuant to such exclusion if (i) an award of the\nWorkers’ Compensation Commission pursuant to § 65.2-704 denies\ncompensation benefits relating to such medical condition and no request for\nreview of such award is made pursuant to and within the time prescribed by\n§ 65.2-705 or (ii) an award of the Workers’ Compensation Commission,\nafter review by the full Commission pursuant to § 65.2-705, denies\ncompensation benefits relating to such medical condition. Following the entry of\na workers’ compensation award pursuant to clause (i) or (ii) having the\neffect of prohibiting the application of any such exclusion, the issuer shall\nimmediately provide coverage for such medical condition to the extent otherwise\ncovered under the contract, subscription contract or health services plan. If,\nupon appeal to the Court of Appeals or the Supreme Court, such medical condition\nis held to be compensable under the Virginia Workers’ Compensation Act\n(Title 65.2), the issuer may recover from the applicable employer or\nworkers’ compensation insurance carrier the costs of coverage for medical\nconditions found to be compensable under the Act.\n\nHISTORY: 1973, c. 28, \u00a7 38.1-342.2; 1979, c. 341; 1986, c. 562; 1988, c. 840;\n1989, c. 487; 1994, c. 609; 1995, c. 68; 2004, c. 675.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}