{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3407.11_3.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3407.11_3.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3407.11_3.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3407.11_3.html"}],"law_id":72434,"edition_id":1,"section_id":72434,"structure_id":12994,"section_number":"38.2-3407.11:3","catch_line":"Breast cancer underwriting and preexisting condition restrictions","history":"2001, c. 242.","full_text":"A\n\nNo (i) insurer proposing to issue group accident and sickness insurance policies or individual health insurance coverage providing hospital, medical and surgical, major medical or cancer-only coverage on an expense-incurred basis, and 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; (ii) corporation providing individual or group accident and sickness subscription contracts; or (iii) health maintenance organization providing a health care plan for health care services shall deny the issuance or renewal of, or cancel, a policy, subscription contract or plan or include any exception or exclusion of benefits in such policy, subscription contract or plan for the following:1\n\nSolely because the insured has been diagnosed as having a fibrocystic condition or a nonmalignant lesion, or solely due to the family history of the insured related to breast cancer, or solely due to any combination of these factors; or2\n\nSolely due to breast cancer, if the insured has been free from breast cancer for a period of five years or more prior to the date of application for coverage. In the case of coverage subject to §§ 38.2-3432.3, 38.2-3514.1 or § 38.2-3605, the provisions of those sections shall be controlling as to the extent of any preexisting conditions period under such coverage.\n\t\t\t\tBenefits provided under a policy, subscription contract or plan for such insureds shall be provided with durational limits, deductibles, coinsurance factors, and copayments that are no less favorable than for physical illness generally.B\n\nNo (i) insurer proposing to issue group accident and sickness insurance policies or individual health insurance coverage providing hospital, medical and surgical or major medical coverage on an expense-incurred basis, and 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; (ii) corporation providing individual or group accident and sickness subscription contracts; or (iii) health maintenance organization providing a health care plan for health care services shall consider routine follow-up care, used to determine whether a breast cancer has recurred in a person who has been previously determined to be free of breast cancer as evidenced by negative follow-up care for a period of at least five years following completion of local and adjuvant therapies, to constitute medical advice, diagnosis, care or treatment for purposes of determining a preexisting condition unless evidence of breast cancer is found during, or as a result of, the follow-up care.C\n\nThe requirements of this section shall apply to all insurance policies, contracts and plans delivered, issued for delivery, reissued, renewed or extended or at any time when any term of any such policy, contract or plan is changed or any premium adjustment is made. The provisions of this section shall not apply to short-term travel, accident-only, limited or specified disease policies except those providing coverage for cancer on an expense-incurred basis, nor to short-term nonrenewable policies of not more than six months’ duration.","order_by":null,"text":{"0":{"id":260889,"text":"No (i) insurer proposing to issue group accident and sickness insurance policies or individual health insurance coverage providing hospital, medical and surgical, major medical or cancer-only coverage on an expense-incurred basis, and 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; (ii) corporation providing individual or group accident and sickness subscription contracts; or (iii) health maintenance organization providing a health care plan for health care services shall deny the issuance or renewal of, or cancel, a policy, subscription contract or plan or include any exception or exclusion of benefits in such policy, subscription contract or plan for the following:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":260890,"text":"Solely because the insured has been diagnosed as having a fibrocystic condition or a nonmalignant lesion, or solely due to the family history of the insured related to breast cancer, or solely due to any combination of these factors; or","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":260891,"text":"Solely due to breast cancer, if the insured has been free from breast cancer for a period of five years or more prior to the date of application for coverage. In the case of coverage subject to §§ 38.2-3432.3, 38.2-3514.1 or § 38.2-3605, the provisions of those sections shall be controlling as to the extent of any preexisting conditions period under such coverage.\n\t\t\t\tBenefits provided under a policy, subscription contract or plan for such insureds shall be provided with durational limits, deductibles, coinsurance factors, and copayments that are no less favorable than for physical illness generally.","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"B"},"3":{"id":260892,"text":"No (i) insurer proposing to issue group accident and sickness insurance policies or individual health insurance coverage providing hospital, medical and surgical or major medical coverage on an expense-incurred basis, and 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; (ii) corporation providing individual or group accident and sickness subscription contracts; or (iii) health maintenance organization providing a health care plan for health care services shall consider routine follow-up care, used to determine whether a breast cancer has recurred in a person who has been previously determined to be free of breast cancer as evidenced by negative follow-up care for a period of at least five years following completion of local and adjuvant therapies, to constitute medical advice, diagnosis, care or treatment for purposes of determining a preexisting condition unless evidence of breast cancer is found during, or as a result of, the follow-up care.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A2","next_prefix":"C"},"4":{"id":260893,"text":"The requirements of this section shall apply to all insurance policies, contracts and plans delivered, issued for delivery, reissued, renewed or extended or at any time when any term of any such policy, contract or plan is changed or any premium adjustment is made. The provisions of this section shall not apply to short-term travel, accident-only, limited or specified disease policies except those providing coverage for cancer on an expense-incurred basis, nor to short-term nonrenewable policies of not more than six months’ duration.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B"}},"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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minimum benefit","url":"\/38.2-3407.11_4\/","token":"38.2\/34\/1\/38.2-3407.11_4","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3407.11:3\/","history_text":"

This law was first created in 2001. The record of its establishment is cataloged in chapter 242<\/a> 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.<\/p>","references":[{"id":84333,"section_number":"38.2-3406.1","catch_line":"Application of requirements that policies offered by small employers include state-mandated health benefits","order_by":null,"url":"\/38.2-3406.1\/"},{"id":67952,"section_number":"38.2-4319","catch_line":"Statutory construction and relationship to other laws","order_by":null,"url":"\/38.2-4319\/"}],"refers_to":[{"id":63783,"section_number":"38.2-3432.3","catch_line":"Limitation on preexisting condition exclusion period","order_by":null,"url":"\/38.2-3432.3\/"},{"id":77154,"section_number":"38.2-3514.1","catch_line":"Preexisting conditions provisions","order_by":null,"url":"\/38.2-3514.1\/"},{"id":64580,"section_number":"38.2-3605","catch_line":"Coverage of preexisting conditions; Medicare supplement policies","order_by":null,"url":"\/38.2-3605\/"}],"permalink":{"id":214963,"object_type":"law","relational_id":72434,"identifier":"38.2-3407.11:3","token":"38.2\/34\/1\/38.2-3407.11_3","url":"\/38.2-3407.11_3\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3407.11_3\/","token":"38.2\/34\/1\/38.2-3407.11_3","dublin_core":{"Title":"Breast cancer underwriting and preexisting condition restrictions","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3407.11:3","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> No (i) insurer<\/span> proposing to issue<\/span> group accident and sickness insurance policies<\/span> or individual health insurance coverage providing hospital, medical and surgical, major medical or cancer-only coverage on an expense-incurred basis, and policies or contracts<\/span> designed for issuance to persons<\/span> eligible for coverage under Title XVIII of the Social Security Act, known as Medicare<\/span>, or any other similar coverage under state<\/span> or federal governmental plans; (ii) corporation providing individual or group accident and sickness subscription contracts<\/span>; or (iii) health maintenance organization providing a health care plan for health care services shall deny the issuance or renewal of, or cancel, a policy, subscription contract<\/span> or plan or include any exception or exclusion of benefits in such policy, subscription contract<\/span> or plan for the following: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Solely because the insured has been diagnosed as having a fibrocystic condition or a nonmalignant lesion, or solely due to the family history of the insured related to breast cancer, or solely due to any combination of these factors; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Solely due to breast cancer, if the insured has been free from breast cancer for a period of five years or more prior to the date of application for coverage. In the case of coverage subject to §§ 38.2-3432.3<\/a>, 38.2-3514.1<\/a> or § 38.2-3605<\/a>, the provisions of those sections shall be controlling as to the extent of any preexisting conditions period under such coverage.\n\t\t\t\tBenefits provided under a policy, subscription contract<\/span> or plan for such insureds shall be provided with durational limits, deductibles, coinsurance factors, and copayments that are no less favorable than for physical illness generally. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> No (i) insurer<\/span> proposing to issue<\/span> group accident and sickness insurance policies<\/span> or individual health insurance coverage providing hospital, medical and surgical or major medical coverage on an expense-incurred basis, and policies or contracts<\/span> designed for issuance to persons<\/span> eligible for coverage under Title XVIII of the Social Security Act, known as Medicare<\/span>, or any other similar coverage under state<\/span> or federal governmental plans; (ii) corporation providing individual or group accident and sickness subscription contracts<\/span>; or (iii) health maintenance organization providing a health care plan for health care services shall consider routine follow-up care, used to determine whether a breast cancer has recurred in a person<\/span> who has been previously determined to be free of breast cancer as evidenced by negative follow-up care for a period of at least five years following completion of local and adjuvant therapies, to constitute medical advice, diagnosis, care or treatment for purposes of determining a preexisting condition unless evidence<\/span> of breast cancer is found during, or as a result of, the follow-up care. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> The requirements of this section shall apply to all insurance policies<\/span>, contracts<\/span> and plans delivered, issued for delivery, reissued, renewed or extended or at any time when any term of any such policy, contract<\/span> or plan is changed or any premium adjustment is made. The provisions of this section shall not apply to short-term travel, accident-only, limited or specified disease policies except those providing coverage for cancer on an expense-incurred basis, nor to short-term nonrenewable policies of not more than six months’ duration. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nBREAST CANCER UNDERWRITING AND PREEXISTING CONDITION RESTRICTIONS (\u00a7\n38.2-3407.11:3)\n\nA. No (i) insurer proposing to issue group accident and sickness insurance\npolicies or individual health insurance coverage providing hospital, medical and\nsurgical, major medical or cancer-only coverage on an expense-incurred basis,\nand policies or contracts designed for issuance to persons eligible for coverage\nunder Title XVIII of the Social Security Act, known as Medicare, or any other\nsimilar coverage under state or federal governmental plans; (ii) corporation\nproviding individual or group accident and sickness subscription contracts; or\n(iii) health maintenance organization providing a health care plan for health\ncare services shall deny the issuance or renewal of, or cancel, a policy,\nsubscription contract or plan or include any exception or exclusion of benefits\nin such policy, subscription contract or plan for the following:\n\n 1. Solely because the insured has been diagnosed as having a fibrocystic\n condition or a nonmalignant lesion, or solely due to the family history of the\n insured related to breast cancer, or solely due to any combination of these\n factors; or\n\n 2. Solely due to breast cancer, if the insured has been free from breast\n cancer for a period of five years or more prior to the date of application for\n coverage. In the case of coverage subject to §§ 38.2-3432.3,\n 38.2-3514.1 or § 38.2-3605, the provisions of those sections shall be\n controlling as to the extent of any preexisting conditions period under such\n coverage.\n \t\t\t\tBenefits provided under a policy, subscription contract or plan for such\n insureds shall be provided with durational limits, deductibles, coinsurance\n factors, and copayments that are no less favorable than for physical illness\n generally.\n\nB. No (i) insurer proposing to issue group accident and sickness insurance\npolicies or individual health insurance coverage providing hospital, medical and\nsurgical or major medical coverage on an expense-incurred basis, and policies or\ncontracts designed for issuance to persons eligible for coverage under Title\nXVIII of the Social Security Act, known as Medicare, or any other similar\ncoverage under state or federal governmental plans; (ii) corporation providing\nindividual or group accident and sickness subscription contracts; or (iii)\nhealth maintenance organization providing a health care plan for health care\nservices shall consider routine follow-up care, used to determine whether a\nbreast cancer has recurred in a person who has been previously determined to be\nfree of breast cancer as evidenced by negative follow-up care for a period of at\nleast five years following completion of local and adjuvant therapies, to\nconstitute medical advice, diagnosis, care or treatment for purposes of\ndetermining a preexisting condition unless evidence of breast cancer is found\nduring, or as a result of, the follow-up care.\n\nC. The requirements of this section shall apply to all insurance policies,\ncontracts and plans delivered, issued for delivery, reissued, renewed or\nextended or at any time when any term of any such policy, contract or plan is\nchanged or any premium adjustment is made. The provisions of this section shall\nnot apply to short-term travel, accident-only, limited or specified disease\npolicies except those providing coverage for cancer on an expense-incurred\nbasis, nor to short-term nonrenewable policies of not more than six\nmonths’ duration.\n\nHISTORY: 2001, c. 242.","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}}