{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3417.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3417.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3417.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3417.html"}],"law_id":59007,"edition_id":1,"section_id":59007,"structure_id":14324,"section_number":"38.2-3417","catch_line":"Deductibles and coinsurance options required","history":"1981, c. 322, \u00a7 38.1-348.12:1; 1986, c. 562; 2013, c. 751; 2014, c. 814.","full_text":"A\n\nAn insurer issuing accident and sickness insurance or a corporation issuing subscription contracts on an expense incurred basis shall make available in offering such coverage or contract to the potential insured or contract holder one or more of the following options under which the individual insured or group certificate holder pays for:1\n\nThe first $100 of the cost of the services covered or benefits payable by the policy or contract during a 12-month period;2\n\nTwenty percent of the first $1,000 of the cost of the services covered or benefits payable by the policy or contract during a 12-month period;3\n\nThe first $100 and 20 percent of the next $1,000 of the cost of the services covered or benefits payable by the policy or contract during a 12-month period; or4\n\nAny other option containing a greater deductible, coinsurance, or cost-sharing provision. However, the option shall not be inconsistent with standards established with respect to deductibles, coinsurance, or cost-sharing pursuant to § 38.2-3519.B\n\nAs used in this section, “make available” means that the insurer or corporation shall disseminate information concerning the option or options and make a policy or contract containing the option or options available to potential insureds or contract holders at the same time and in the same manner as the insurer or corporation disseminates information concerning other policies or contracts and coverage options and makes other policies or contracts and coverage options available.C\n\nThis 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.D\n\nThe provisions of this section shall not apply in any instance in which the provisions of this section are inconsistent or in conflict with a provision of Article 6 (§ 38.2-3438 et seq.) of Chapter 34.","order_by":null,"text":{"0":{"id":216345,"text":"An insurer issuing accident and sickness insurance or a corporation issuing subscription contracts on an expense incurred basis shall make available in offering such coverage or contract to the potential insured or contract holder one or more of the following options under which the individual insured or group certificate holder pays for:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":216346,"text":"The first $100 of the cost of the services covered or benefits payable by the policy or contract during a 12-month period;","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":216347,"text":"Twenty percent of the first $1,000 of the cost of the services covered or benefits payable by the policy or contract during a 12-month period;","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":216348,"text":"The first $100 and 20 percent of the next $1,000 of the cost of the services covered or benefits payable by the policy or contract during a 12-month period; or","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"A4"},"4":{"id":216349,"text":"Any other option containing a greater deductible, coinsurance, or cost-sharing provision. However, the option shall not be inconsistent with standards established with respect to deductibles, coinsurance, or cost-sharing pursuant to § 38.2-3519.","type":"section","prefixes":["A","4"],"prefix":"4","entire_prefix":"A4","prefix_anchor":"A4","level":2,"prior_prefix":"A3","next_prefix":"B"},"5":{"id":216350,"text":"As used in this section, “make available” means that the insurer or corporation shall disseminate information concerning the option or options and make a policy or contract containing the option or options available to potential insureds or contract holders at the same time and in the same manner as the insurer or corporation disseminates information concerning other policies or contracts and coverage options and makes other policies or contracts and coverage options available.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A4","next_prefix":"C"},"6":{"id":216351,"text":"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.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"7":{"id":216352,"text":"The provisions of this section shall not apply in any instance in which the provisions of this section are inconsistent or in conflict with a provision of Article 6 (§ 38.2-3438 et seq.) of Chapter 34.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C"}},"ancestry":[{"id":14324,"edition_id":1,"name":"Mandated Benefits","identifier":"2","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:47:45","date_modified":"2026-06-26 03:47:45","permalink":{"id":215143,"object_type":"structure","relational_id":14324,"identifier":"2","token":"38.2\/34\/2","url":"\/38.2\/34\/2\/","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":87046,"structure_id":14324,"section_number":"38.2-3408","catch_line":"Policy providing for reimbursement for services that may be performed by certain practitioners other than physicians","url":"\/38.2-3408\/","token":"38.2\/34\/2\/38.2-3408","metadata":false},{"id":55621,"structure_id":14324,"section_number":"38.2-3409","catch_line":"Coverage of dependent children","url":"\/38.2-3409\/","token":"38.2\/34\/2\/38.2-3409","metadata":false},{"id":68501,"structure_id":14324,"section_number":"38.2-3410","catch_line":"Construction of policy generally; words \"physician\" and \"doctor\" to include dentist","url":"\/38.2-3410\/","token":"38.2\/34\/2\/38.2-3410","metadata":false},{"id":76551,"structure_id":14324,"section_number":"38.2-3411","catch_line":"Coverage of newborn children required","url":"\/38.2-3411\/","token":"38.2\/34\/2\/38.2-3411","metadata":false},{"id":71629,"structure_id":14324,"section_number":"38.2-3411.1","catch_line":"Coverage for child health supervision services","url":"\/38.2-3411.1\/","token":"38.2\/34\/2\/38.2-3411.1","metadata":false},{"id":70694,"structure_id":14324,"section_number":"38.2-3411.2","catch_line":"Coverage of adopted children required","url":"\/38.2-3411.2\/","token":"38.2\/34\/2\/38.2-3411.2","metadata":false},{"id":77817,"structure_id":14324,"section_number":"38.2-3411.3","catch_line":"Coverage for childhood immunizations","url":"\/38.2-3411.3\/","token":"38.2\/34\/2\/38.2-3411.3","metadata":false},{"id":86598,"structure_id":14324,"section_number":"38.2-3411.4","catch_line":"Coverage for infant hearing screening and related diagnostics","url":"\/38.2-3411.4\/","token":"38.2\/34\/2\/38.2-3411.4","metadata":false},{"id":63024,"structure_id":14324,"section_number":"38.2-3412","catch_line":"Repealed","url":"\/38.2-3412\/","token":"38.2\/34\/2\/38.2-3412","metadata":false},{"id":84153,"structure_id":14324,"section_number":"38.2-3412.1","catch_line":"Coverage for mental health and substance use disorders","url":"\/38.2-3412.1\/","token":"38.2\/34\/2\/38.2-3412.1","metadata":false},{"id":75255,"structure_id":14324,"section_number":"38.2-3412.1:01","catch_line":"Repealed","url":"\/38.2-3412.1_01\/","token":"38.2\/34\/2\/38.2-3412.1_01","metadata":false},{"id":67892,"structure_id":14324,"section_number":"38.2-3413","catch_line":"Repealed","url":"\/38.2-3413\/","token":"38.2\/34\/2\/38.2-3413","metadata":false},{"id":81885,"structure_id":14324,"section_number":"38.2-3414","catch_line":"Optional coverage for obstetrical services","url":"\/38.2-3414\/","token":"38.2\/34\/2\/38.2-3414","metadata":false},{"id":74497,"structure_id":14324,"section_number":"38.2-3414.1","catch_line":"Obstetrical benefits; coverage for postpartum services","url":"\/38.2-3414.1\/","token":"38.2\/34\/2\/38.2-3414.1","metadata":false},{"id":58957,"structure_id":14324,"section_number":"38.2-3415","catch_line":"Exclusion or reduction of benefits for certain causes prohibited","url":"\/38.2-3415\/","token":"38.2\/34\/2\/38.2-3415","metadata":false},{"id":69898,"structure_id":14324,"section_number":"38.2-3416","catch_line":"Repealed","url":"\/38.2-3416\/","token":"38.2\/34\/2\/38.2-3416","metadata":false},{"id":59007,"structure_id":14324,"section_number":"38.2-3417","catch_line":"Deductibles and coinsurance options required","url":"\/38.2-3417\/","token":"38.2\/34\/2\/38.2-3417","metadata":false},{"id":81514,"structure_id":14324,"section_number":"38.2-3418","catch_line":"Coverage for victims of rape or incest","url":"\/38.2-3418\/","token":"38.2\/34\/2\/38.2-3418","metadata":false},{"id":85746,"structure_id":14324,"section_number":"38.2-3418.1","catch_line":"Coverage for mammograms","url":"\/38.2-3418.1\/","token":"38.2\/34\/2\/38.2-3418.1","metadata":false},{"id":86304,"structure_id":14324,"section_number":"38.2-3418.10","catch_line":"Coverage for diabetes","url":"\/38.2-3418.10\/","token":"38.2\/34\/2\/38.2-3418.10","metadata":false},{"id":87414,"structure_id":14324,"section_number":"38.2-3418.11","catch_line":"Coverage for hospice care","url":"\/38.2-3418.11\/","token":"38.2\/34\/2\/38.2-3418.11","metadata":false},{"id":81464,"structure_id":14324,"section_number":"38.2-3418.12","catch_line":"Coverage for hospitalization and anesthesia for dental procedures","url":"\/38.2-3418.12\/","token":"38.2\/34\/2\/38.2-3418.12","metadata":false},{"id":82972,"structure_id":14324,"section_number":"38.2-3418.13","catch_line":"Coverage for the treatment of morbid obesity","url":"\/38.2-3418.13\/","token":"38.2\/34\/2\/38.2-3418.13","metadata":false},{"id":85731,"structure_id":14324,"section_number":"38.2-3418.14","catch_line":"Coverage for lymphedema","url":"\/38.2-3418.14\/","token":"38.2\/34\/2\/38.2-3418.14","metadata":false},{"id":71964,"structure_id":14324,"section_number":"38.2-3418.15","catch_line":"Coverage for prosthetic devices and components","url":"\/38.2-3418.15\/","token":"38.2\/34\/2\/38.2-3418.15","metadata":false},{"id":57543,"structure_id":14324,"section_number":"38.2-3418.15:1","catch_line":"Coverage for prosthetic devices and components","url":"\/38.2-3418.15_1\/","token":"38.2\/34\/2\/38.2-3418.15_1","metadata":false},{"id":61286,"structure_id":14324,"section_number":"38.2-3418.16","catch_line":"Coverage for telemedicine services","url":"\/38.2-3418.16\/","token":"38.2\/34\/2\/38.2-3418.16","metadata":false},{"id":81144,"structure_id":14324,"section_number":"38.2-3418.17","catch_line":"Coverage for autism spectrum disorder","url":"\/38.2-3418.17\/","token":"38.2\/34\/2\/38.2-3418.17","metadata":false},{"id":60567,"structure_id":14324,"section_number":"38.2-3418.18","catch_line":"Coverage for formula and enteral nutrition products as medicine","url":"\/38.2-3418.18\/","token":"38.2\/34\/2\/38.2-3418.18","metadata":false},{"id":79176,"structure_id":14324,"section_number":"38.2-3418.19","catch_line":"Coverage for organ, eye or tissue transplant","url":"\/38.2-3418.19\/","token":"38.2\/34\/2\/38.2-3418.19","metadata":false},{"id":69963,"structure_id":14324,"section_number":"38.2-3418.1:1","catch_line":"Repealed","url":"\/38.2-3418.1_1\/","token":"38.2\/34\/2\/38.2-3418.1_1","metadata":false},{"id":72277,"structure_id":14324,"section_number":"38.2-3418.1:2","catch_line":"Coverage for pap smears","url":"\/38.2-3418.1_2\/","token":"38.2\/34\/2\/38.2-3418.1_2","metadata":false},{"id":64216,"structure_id":14324,"section_number":"38.2-3418.1:3","catch_line":"Cost sharing for breast examinations","url":"\/38.2-3418.1_3\/","token":"38.2\/34\/2\/38.2-3418.1_3","metadata":false},{"id":80233,"structure_id":14324,"section_number":"38.2-3418.2","catch_line":"Coverage of procedures involving bones and joints","url":"\/38.2-3418.2\/","token":"38.2\/34\/2\/38.2-3418.2","metadata":false},{"id":73658,"structure_id":14324,"section_number":"38.2-3418.20","catch_line":"Coverage for hearing aids and related services [Not in effect]","url":"\/38.2-3418.20\/","token":"38.2\/34\/2\/38.2-3418.20","metadata":false},{"id":76455,"structure_id":14324,"section_number":"38.2-3418.21","catch_line":"Coverage for hearing aids and related services","url":"\/38.2-3418.21\/","token":"38.2\/34\/2\/38.2-3418.21","metadata":false},{"id":67690,"structure_id":14324,"section_number":"38.2-3418.22","catch_line":"Coverage for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome","url":"\/38.2-3418.22\/","token":"38.2\/34\/2\/38.2-3418.22","metadata":false},{"id":79724,"structure_id":14324,"section_number":"38.2-3418.3","catch_line":"Coverage for hemophilia and congenital bleeding disorders","url":"\/38.2-3418.3\/","token":"38.2\/34\/2\/38.2-3418.3","metadata":false},{"id":86337,"structure_id":14324,"section_number":"38.2-3418.4","catch_line":"Coverage for reconstructive breast surgery; notice; eligibility","url":"\/38.2-3418.4\/","token":"38.2\/34\/2\/38.2-3418.4","metadata":false},{"id":87401,"structure_id":14324,"section_number":"38.2-3418.5","catch_line":"Coverage for early intervention services","url":"\/38.2-3418.5\/","token":"38.2\/34\/2\/38.2-3418.5","metadata":false},{"id":61674,"structure_id":14324,"section_number":"38.2-3418.6","catch_line":"Minimum hospital stay for mastectomy and certain lymph node dissection patients","url":"\/38.2-3418.6\/","token":"38.2\/34\/2\/38.2-3418.6","metadata":false},{"id":71759,"structure_id":14324,"section_number":"38.2-3418.7","catch_line":"Coverage for prostate cancer screening","url":"\/38.2-3418.7\/","token":"38.2\/34\/2\/38.2-3418.7","metadata":false},{"id":62197,"structure_id":14324,"section_number":"38.2-3418.7:1","catch_line":"Coverage for colorectal cancer screening","url":"\/38.2-3418.7_1\/","token":"38.2\/34\/2\/38.2-3418.7_1","metadata":false},{"id":63576,"structure_id":14324,"section_number":"38.2-3418.8","catch_line":"Coverage for clinical trials for treatment studies on cancer","url":"\/38.2-3418.8\/","token":"38.2\/34\/2\/38.2-3418.8","metadata":false},{"id":72556,"structure_id":14324,"section_number":"38.2-3418.9","catch_line":"Minimum hospital stay for hysterectomy","url":"\/38.2-3418.9\/","token":"38.2\/34\/2\/38.2-3418.9","metadata":false},{"id":66144,"structure_id":14324,"section_number":"38.2-3419","catch_line":"Additional mandated coverage made optional to group policy or contract holder","url":"\/38.2-3419\/","token":"38.2\/34\/2\/38.2-3419","metadata":false},{"id":57559,"structure_id":14324,"section_number":"38.2-3419.1","catch_line":"Report of costs and utilization of mandated benefits","url":"\/38.2-3419.1\/","token":"38.2\/34\/2\/38.2-3419.1","metadata":false}],"previous_section":{"id":69898,"structure_id":14324,"section_number":"38.2-3416","catch_line":"Repealed","url":"\/38.2-3416\/","token":"38.2\/34\/2\/38.2-3416","metadata":false},"next_section":{"id":81514,"structure_id":14324,"section_number":"38.2-3418","catch_line":"Coverage for victims of rape or incest","url":"\/38.2-3418\/","token":"38.2\/34\/2\/38.2-3418","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3417\/","history_text":"

This law was first created in 1981. The record of its establishment is cataloged in chapter 322 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 1981 \u201cActs\u201d aren\u2019t available online. It has been modified 3 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 1986, chapter 562; in 2013, chapter 751<\/a>; in 2014, chapter 814<\/a>.<\/p>","references":false,"refers_to":[{"id":57210,"section_number":"38.2-3438","catch_line":"Definitions","order_by":null,"url":"\/38.2-3438\/"}],"permalink":{"id":215209,"object_type":"law","relational_id":59007,"identifier":"38.2-3417","token":"38.2\/34\/2\/38.2-3417","url":"\/38.2-3417\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3417\/","token":"38.2\/34\/2\/38.2-3417","dublin_core":{"Title":"Deductibles and coinsurance options required","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3417","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> An insurer<\/span> issuing accident and sickness insurance<\/span> or a corporation issuing subscription contracts<\/span> on an expense incurred basis shall make available<\/span> in offering such coverage or contract<\/span> to the potential insured or contract<\/span> holder one or more of the following options under which the individual insured or group certificate holder pays for: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The first $100 of the cost of the services covered or benefits payable by the policy or contract<\/span> during a 12-month period; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Twenty percent of the first $1,000 of the cost of the services covered or benefits payable by the policy or contract<\/span> during a 12-month period; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> The first $100 and 20 percent of the next $1,000 of the cost of the services covered or benefits payable by the policy or contract<\/span> during a 12-month period; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Any other option containing a greater deductible, coinsurance, or cost-sharing provision. However, the option shall not be inconsistent with standards established with respect to deductibles, coinsurance, or cost-sharing pursuant to § 38.2-3519<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> As used in this section, “make available<\/span>” means that the insurer<\/span> or corporation shall disseminate information concerning the option or options and make a policy or contract<\/span> containing the option or options available to potential insureds or contract<\/span> holders at the same time and in the same manner as the insurer<\/span> or corporation disseminates information concerning other policies or contracts<\/span> and coverage options and makes other policies or contracts<\/span> and coverage options available. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> This section shall not apply to short-term travel, accident only, or limited or specified disease policies or contracts<\/span>, nor to 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. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> The provisions of this section shall not apply in any instance in which the provisions of this section are inconsistent or in conflict with a provision of Article 6 (§ 38.2-3438<\/a> et seq.) of Chapter 34. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nDEDUCTIBLES AND COINSURANCE OPTIONS REQUIRED (\u00a7 38.2-3417)\n\nA. An insurer issuing accident and sickness insurance or a corporation issuing\nsubscription contracts on an expense incurred basis shall make available in\noffering such coverage or contract to the potential insured or contract holder\none or more of the following options under which the individual insured or group\ncertificate holder pays for:\n\n 1. The first $100 of the cost of the services covered or benefits payable by\n the policy or contract during a 12-month period;\n\n 2. Twenty percent of the first $1,000 of the cost of the services covered or\n benefits payable by the policy or contract during a 12-month period;\n\n 3. The first $100 and 20 percent of the next $1,000 of the cost of the\n services covered or benefits payable by the policy or contract during a\n 12-month period; or\n\n 4. Any other option containing a greater deductible, coinsurance, or\n cost-sharing provision. However, the option shall not be inconsistent with\n standards established with respect to deductibles, coinsurance, or\n cost-sharing pursuant to § 38.2-3519.\n\nB. As used in this section, “make available” means that the insurer\nor corporation shall disseminate information concerning the option or options\nand make a policy or contract containing the option or options available to\npotential insureds or contract holders at the same time and in the same manner\nas the insurer or corporation disseminates information concerning other policies\nor contracts and coverage options and makes other policies or contracts and\ncoverage options available.\n\nC. This section shall not apply to short-term travel, accident only, or limited\nor specified disease policies or contracts, nor to policies or contracts\ndesigned for issuance to persons eligible for coverage under Title XVIII of the\nSocial Security Act, known as Medicare, or any other similar coverage under\nstate or federal governmental plans.\n\nD. The provisions of this section shall not apply in any instance in which the\nprovisions of this section are inconsistent or in conflict with a provision of\nArticle 6 (§ 38.2-3438 et seq.) of Chapter 34.\n\nHISTORY: 1981, c. 322, \u00a7 38.1-348.12:1; 1986, c. 562; 2013, c. 751; 2014, c.\n814.","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}}