{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3418.1_3.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3418.1_3.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3418.1_3.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3418.1_3.html"}],"law_id":64216,"edition_id":1,"section_id":64216,"structure_id":14324,"section_number":"38.2-3418.1:3","catch_line":"Cost sharing for breast examinations","history":"2025, cc. 485, 496.","full_text":"A\n\nNotwithstanding the provisions of § 38.2-3419 or subdivision A 1 of § 38.2-6506, and in addition to the coverage required by § 38.2-3418.1, 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 not impose cost sharing for diagnostic breast examinations and supplemental breast examinations under such policy, contract, or plan delivered, issued for delivery, or renewed in the Commonwealth.B\n\nAs used in this section:\n\t\t\t“Cost sharing” means any coinsurance, copayment, or deductible.\n\t\t\t“Diagnostic breast examination” means a medically necessary and appropriate, in accordance with the National Comprehensive Cancer Network Guidelines, examination of the breast, including such an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is used to evaluate (i) an abnormality seen or suspected from a screening for the detection of breast cancer or (ii) an abnormality detected by another means of examination.\n\t\t\t“Supplemental breast examination” means a medically necessary and appropriate, in accordance with the National Comprehensive Cancer Network Guidelines, examination of the breast, including such an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is (i) used to screen for breast cancer when there is no abnormality seen or suspected and (ii) based on personal or family medical history or additional factors that may increase the individual’s risk of breast cancer.C\n\nThe provisions of this section shall not apply to short-term travel, accident-only, or limited or specified disease policies, or to short-term nonrenewable policies of not more than six months’ duration.","order_by":null,"text":{"0":{"id":233759,"text":"Notwithstanding the provisions of § 38.2-3419 or subdivision A 1 of § 38.2-6506, and in addition to the coverage required by § 38.2-3418.1, 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 not impose cost sharing for diagnostic breast examinations and supplemental breast examinations under such policy, contract, or plan delivered, issued for delivery, or renewed in the Commonwealth.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":233760,"text":"As used in this section:\n\t\t\t“Cost sharing” means any coinsurance, copayment, or deductible.\n\t\t\t“Diagnostic breast examination” means a medically necessary and appropriate, in accordance with the National Comprehensive Cancer Network Guidelines, examination of the breast, including such an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is used to evaluate (i) an abnormality seen or suspected from a screening for the detection of breast cancer or (ii) an abnormality detected by another means of examination.\n\t\t\t“Supplemental breast examination” means a medically necessary and appropriate, in accordance with the National Comprehensive Cancer Network Guidelines, examination of the breast, including such an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is (i) used to screen for breast cancer when there is no abnormality seen or suspected and (ii) based on personal or family medical history or additional factors that may increase the individual’s risk of breast cancer.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":233761,"text":"The provisions of this section shall not apply to short-term travel, accident-only, or limited or specified disease policies, or 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":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 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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 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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":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},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3418.1:3\/","history_text":"

This law was first created in 2025. The record of its establishment is cataloged in chapters 485<\/a> and 496<\/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":false,"refers_to":[{"id":85746,"section_number":"38.2-3418.1","catch_line":"Coverage for mammograms","order_by":null,"url":"\/38.2-3418.1\/"},{"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\/"},{"id":81163,"section_number":"38.2-6506","catch_line":"Certification of health benefit plans as qualified health plans","order_by":null,"url":"\/38.2-6506\/"}],"permalink":{"id":215273,"object_type":"law","relational_id":64216,"identifier":"38.2-3418.1:3","token":"38.2\/34\/2\/38.2-3418.1_3","url":"\/38.2-3418.1_3\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3418.1_3\/","token":"38.2\/34\/2\/38.2-3418.1_3","dublin_core":{"Title":"Cost sharing for breast examinations","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3418.1:3","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Notwithstanding the provisions of § 38.2-3419<\/a> or subdivision A 1 of § 38.2-6506<\/a>, and in addition to the coverage required by § 38.2-3418.1<\/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 not impose cost sharing<\/span> for diagnostic breast examinations<\/span> and supplemental breast examinations<\/span> under such policy, contract<\/span>, or plan delivered, issued for delivery, or renewed in the Commonwealth. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> As used in this section:\n\t\t\t“Cost sharing<\/span>” means any coinsurance, copayment, or deductible.\n\t\t\t“Diagnostic breast examination<\/span>” means a medically necessary and appropriate, in accordance with the National Comprehensive Cancer Network Guidelines, examination of the breast, including such an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is used to evaluate (i) an abnormality seen or suspected from a screening for the detection of breast cancer or (ii) an abnormality detected by another means of examination.\n\t\t\t“Supplemental breast examination<\/span>” means a medically necessary and appropriate, in accordance with the National Comprehensive Cancer Network Guidelines, examination of the breast, including such an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is (i) used to screen for breast cancer when there is no abnormality seen or suspected and (ii) based on personal or family medical history or additional factors that may increase the individual’s risk of breast cancer. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> The provisions of this section shall not apply to short-term travel, accident-only, or limited or specified disease policies, or to short-term nonrenewable policies of not more than six months’ duration. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nCOST SHARING FOR BREAST EXAMINATIONS (\u00a7 38.2-3418.1:3)\n\nA. Notwithstanding the provisions of § 38.2-3419 or subdivision A 1 of\n§ 38.2-6506, and in addition to the coverage required by §\n38.2-3418.1, each insurer proposing to issue individual or group accident and\nsickness insurance policies providing hospital, medical and surgical, or major\nmedical coverage on an expense-incurred basis, each corporation providing\nindividual or group accident and sickness subscription contracts, and each\nhealth maintenance organization providing a health care plan for health care\nservices shall not impose cost sharing for diagnostic breast examinations and\nsupplemental breast examinations under such policy, contract, or plan delivered,\nissued for delivery, or renewed in the Commonwealth.\n\nB. As used in this section:\n\t\t\t“Cost sharing” means any coinsurance, copayment, or deductible.\n\t\t\t“Diagnostic breast examination” means a medically necessary and\nappropriate, in accordance with the National Comprehensive Cancer Network\nGuidelines, examination of the breast, including such an examination using\ndiagnostic mammography, breast magnetic resonance imaging, or breast ultrasound,\nthat is used to evaluate (i) an abnormality seen or suspected from a screening\nfor the detection of breast cancer or (ii) an abnormality detected by another\nmeans of examination.\n\t\t\t“Supplemental breast examination” means a medically necessary and\nappropriate, in accordance with the National Comprehensive Cancer Network\nGuidelines, examination of the breast, including such an examination using\ndiagnostic mammography, breast magnetic resonance imaging, or breast ultrasound,\nthat is (i) used to screen for breast cancer when there is no abnormality seen\nor suspected and (ii) based on personal or family medical history or additional\nfactors that may increase the individual’s risk of breast cancer.\n\nC. The provisions of this section shall not apply to short-term travel,\naccident-only, or limited or specified disease policies, or to short-term\nnonrenewable policies of not more than six months’ duration.\n\nHISTORY: 2025, cc. 485, 496.","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}}