{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3418.15.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3418.15.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3418.15.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3418.15.html"}],"law_id":71964,"edition_id":1,"section_id":71964,"structure_id":14324,"section_number":"38.2-3418.15","catch_line":"Coverage for prosthetic devices and components","history":"2009, c. 839; 2014, c. 814.","full_text":"A\n\nNotwithstanding the provisions of \u00a7 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription contracts; and each health maintenance organization providing a health care plan for health care services shall offer and make available coverage for medically necessary prosthetic devices, their repair, fitting, replacement, and components, as follows:1\n\nAs used in this section:\n\t\t\t\t“Component” means the materials and equipment needed to ensure the comfort and functioning of a prosthetic device.\n\t\t\t\t“Limb” means an arm, a hand, a leg, a foot, or any portion of an arm, a hand, a leg, or a foot.\n\t\t\t\t“Prosthetic device” means an artificial device to replace, in whole or in part, a limb.2\n\nProsthetic device coverage does not include repair and replacement due to enrollee neglect, misuse, or abuse. Coverage also does not include prosthetic devices designed primarily for an athletic purpose.3\n\nAn insurer shall not impose any annual or lifetime dollar maximum on coverage for prosthetic devices other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy. The coverage may be made subject to, and no more restrictive than, the provisions of a health insurance policy that apply to other benefits under the policy.4\n\nAn insurer shall not apply amounts paid for prosthetic devices to any annual or lifetime dollar maximum applicable to other durable medical equipment covered under the policy other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy.5\n\nNo insurer, corporation, or health maintenance organization shall impose upon any person receiving benefits pursuant to this section any coinsurance in excess of 30 percent of the carrier’s allowable charge for such prosthetic device or services when such device or service is provided by an in-network provider.6\n\nAn insurer, corporation, or health maintenance organization may require preauthorization to determine medical necessity and the eligibility of benefits for prosthetic devices and components, in the same manner that prior authorization is required for any other covered benefit.B\n\nThe requirements of this section shall apply to all insurance policies, contracts, and plans delivered, issued for delivery, reissued, or extended in the Commonwealth on and after January 1, 2010, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.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.","order_by":null,"text":{"0":{"id":259306,"text":"Notwithstanding the provisions of \u00a7 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription contracts; and each health maintenance organization providing a health care plan for health care services shall offer and make available coverage for medically necessary prosthetic devices, their repair, fitting, replacement, and components, as follows:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":259307,"text":"As used in this section:\n\t\t\t\t“Component” means the materials and equipment needed to ensure the comfort and functioning of a prosthetic device.\n\t\t\t\t“Limb” means an arm, a hand, a leg, a foot, or any portion of an arm, a hand, a leg, or a foot.\n\t\t\t\t“Prosthetic device” means an artificial device to replace, in whole or in part, a limb.","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":259308,"text":"Prosthetic device coverage does not include repair and replacement due to enrollee neglect, misuse, or abuse. Coverage also does not include prosthetic devices designed primarily for an athletic purpose.","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":259309,"text":"An insurer shall not impose any annual or lifetime dollar maximum on coverage for prosthetic devices other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy. The coverage may be made subject to, and no more restrictive than, the provisions of a health insurance policy that apply to other benefits under the policy.","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"A4"},"4":{"id":259310,"text":"An insurer shall not apply amounts paid for prosthetic devices to any annual or lifetime dollar maximum applicable to other durable medical equipment covered under the policy other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy.","type":"section","prefixes":["A","4"],"prefix":"4","entire_prefix":"A4","prefix_anchor":"A4","level":2,"prior_prefix":"A3","next_prefix":"A5"},"5":{"id":259311,"text":"No insurer, corporation, or health maintenance organization shall impose upon any person receiving benefits pursuant to this section any coinsurance in excess of 30 percent of the carrier’s allowable charge for such prosthetic device or services when such device or service is provided by an in-network provider.","type":"section","prefixes":["A","5"],"prefix":"5","entire_prefix":"A5","prefix_anchor":"A5","level":2,"prior_prefix":"A4","next_prefix":"A6"},"6":{"id":259312,"text":"An insurer, corporation, or health maintenance organization may require preauthorization to determine medical necessity and the eligibility of benefits for prosthetic devices and components, in the same manner that prior authorization is required for any other covered benefit.","type":"section","prefixes":["A","6"],"prefix":"6","entire_prefix":"A6","prefix_anchor":"A6","level":2,"prior_prefix":"A5","next_prefix":"B"},"7":{"id":259313,"text":"The requirements of this section shall apply to all insurance policies, contracts, and plans delivered, issued for delivery, reissued, or extended in the Commonwealth on and after January 1, 2010, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A6","next_prefix":"C"},"8":{"id":259314,"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"}},"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 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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":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},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3418.15\/","history_text":"

This law was first created in 2009. The record of its establishment is cataloged in chapter 839<\/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. It has been modified 1 time. 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. That modification is as follows: in 2014, chapter 814<\/a>.<\/p>","references":[{"id":57543,"section_number":"38.2-3418.15:1","catch_line":"Coverage for prosthetic devices and components","order_by":null,"url":"\/38.2-3418.15_1\/"}],"refers_to":[{"id":66144,"section_number":"38.2-3419","catch_line":"Additional mandated coverage made optional to group policy or contract holder","order_by":null,"url":"\/38.2-3419\/"}],"permalink":{"id":215241,"object_type":"law","relational_id":71964,"identifier":"38.2-3418.15","token":"38.2\/34\/2\/38.2-3418.15","url":"\/38.2-3418.15\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3418.15\/","token":"38.2\/34\/2\/38.2-3418.15","dublin_core":{"Title":"Coverage for prosthetic devices and components","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3418.15","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Notwithstanding the provisions of \u00a7 38.2-3419<\/a>, each insurer<\/span> proposing to issue<\/span> individual or group accident and sickness insurance policies<\/span> providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription contracts<\/span>; and each health maintenance organization providing a health care plan for health care services shall offer and make available coverage for medically necessary prosthetic devices<\/span>, their repair, fitting, replacement, and components<\/span>, as follows: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> As used in this section:\n\t\t\t\t“Component<\/span>” means the materials<\/span> and equipment needed to ensure the comfort and functioning of a prosthetic device<\/span>.\n\t\t\t\t“Limb<\/span>” means an arm, a hand, a leg, a foot, or any portion of an arm, a hand, a leg, or a foot.\n\t\t\t\t“Prosthetic device<\/span>” means an artificial device to replace, in whole or in part, a limb<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Prosthetic device<\/span> coverage does not include repair and replacement due to enrollee neglect, misuse, or abuse. Coverage also does not include prosthetic devices<\/span> designed primarily for an athletic purpose. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> An insurer<\/span> shall not impose any annual or lifetime dollar maximum on coverage for prosthetic devices<\/span> other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy. The coverage may be made subject to, and no more restrictive than, the provisions of a health insurance policy that apply to other benefits under the policy. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> An insurer<\/span> shall not apply amounts paid for prosthetic devices<\/span> to any annual or lifetime dollar maximum applicable to other durable medical equipment covered under the policy other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> No insurer<\/span>, corporation, or health maintenance organization shall impose upon any person<\/span> receiving benefits pursuant to this section any coinsurance in excess of 30 percent of the carrier’s allowable charge for such prosthetic device<\/span> or services when such device or service is provided by an in-network provider. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> An insurer<\/span>, corporation, or health maintenance organization may require preauthorization to determine medical necessity and the eligibility of benefits for prosthetic devices<\/span> and components<\/span>, in the same manner that prior authorization is required for any other covered benefit. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The requirements of this section shall apply to all insurance policies<\/span>, contracts<\/span>, and plans delivered, issued for delivery, reissued, or extended in the Commonwealth on and after January 1, 2010, or at any time thereafter when any term of the policy, contract<\/span>, or plan is changed or any premium adjustment is made. <\/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>","plain_text":" CODE OF VIRGINIA\n\nCOVERAGE FOR PROSTHETIC DEVICES AND COMPONENTS (\u00a7 38.2-3418.15)\n\nA. Notwithstanding the provisions of \u00a7 38.2-3419, each insurer proposing to\nissue individual or group accident and sickness insurance policies providing\nhospital, medical and surgical, or major medical coverage on an expense-incurred\nbasis; each corporation providing individual or group accident and sickness\nsubscription contracts; and each health maintenance organization providing a\nhealth care plan for health care services shall offer and make available\ncoverage for medically necessary prosthetic devices, their repair, fitting,\nreplacement, and components, as follows:\n\n 1. As used in this section:\n \t\t\t\t“Component” means the materials and equipment needed to ensure\n the comfort and functioning of a prosthetic device.\n \t\t\t\t“Limb” means an arm, a hand, a leg, a foot, or any portion of\n an arm, a hand, a leg, or a foot.\n \t\t\t\t“Prosthetic device” means an artificial device to replace, in\n whole or in part, a limb.\n\n 2. Prosthetic device coverage does not include repair and replacement due to\n enrollee neglect, misuse, or abuse. Coverage also does not include prosthetic\n devices designed primarily for an athletic purpose.\n\n 3. An insurer shall not impose any annual or lifetime dollar maximum on\n coverage for prosthetic devices other than an annual or lifetime dollar\n maximum that applies in the aggregate to all items and services covered under\n the policy. The coverage may be made subject to, and no more restrictive than,\n the provisions of a health insurance policy that apply to other benefits under\n the policy.\n\n 4. An insurer shall not apply amounts paid for prosthetic devices to any\n annual or lifetime dollar maximum applicable to other durable medical\n equipment covered under the policy other than an annual or lifetime dollar\n maximum that applies in the aggregate to all items and services covered under\n the policy.\n\n 5. No insurer, corporation, or health maintenance organization shall impose\n upon any person receiving benefits pursuant to this section any coinsurance in\n excess of 30 percent of the carrier’s allowable charge for such\n prosthetic device or services when such device or service is provided by an\n in-network provider.\n\n 6. An insurer, corporation, or health maintenance organization may require\n preauthorization to determine medical necessity and the eligibility of\n benefits for prosthetic devices and components, in the same manner that prior\n authorization is required for any other covered benefit.\n\nB. The requirements of this section shall apply to all insurance policies,\ncontracts, and plans delivered, issued for delivery, reissued, or extended in\nthe Commonwealth on and after January 1, 2010, or at any time thereafter when\nany term of the policy, contract, or plan is changed or any premium adjustment\nis made.\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\nHISTORY: 2009, c. 839; 2014, c. 814.","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}}