{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3432.3.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3432.3.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3432.3.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3432.3.html"}],"law_id":63783,"edition_id":1,"section_id":63783,"structure_id":15009,"section_number":"38.2-3432.3","catch_line":"Limitation on preexisting condition exclusion period","history":"1997, cc. 807, 913; 1998, c. 24; 1999, c. 1004; 2000, c. 136; 2003, c. 221; 2011, c. 882; 2013, cc. 136, 210.","full_text":"A\n\nSubject to subsection B, a health insurer offering health insurance coverage may, with respect to a participant or beneficiary, impose a preexisting limitation only if:1\n\nFor group health insurance coverage, such exclusion relates to a condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the six-month period ending on the enrollment date;2\n\nFor individual health insurance coverage, such exclusion relates to a condition that, during a 12-month period immediately preceding the effective date of coverage, had manifested itself in such a manner as would cause an ordinarily prudent person to seek diagnosis, care, or treatment, or for which medical advice, diagnosis, care or treatment was recommended or received within 12 months immediately preceding the effective date of coverage;3\n\nSuch exclusion extends for a period of not more than 12 months (or 12 months in the case of a late enrollee) after the enrollment date; and4\n\nThe period of any such preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage, if any, applicable to the participant or beneficiary as of the enrollment date.B\n\nExceptions:1\n\nSubject to subdivision 4, a health insurance issuer offering health insurance coverage may not impose any preexisting condition exclusion in the case of an individual who, as of the last day of the 30-day period beginning with the date of birth, is covered under creditable coverage;2\n\nSubject to subdivision 4, a health insurance issuer offering health insurance coverage may not impose any preexisting condition exclusion in the case of a child who is adopted or placed for adoption before attaining 18 years of age and who, as of the last day of the 30-day period beginning on the date of the adoption or placement for adoption, is covered under creditable coverage. The previous sentence shall not apply to coverage before the date of such adoption or placement for adoption;3\n\nA health insurance issuer offering health insurance coverage may not impose any preexisting condition exclusion relating to pregnancy as a preexisting condition, except in the case of individual health insurance coverage for a person who is not considered an eligible individual, as defined in § 38.2-3430.2, in which case the health insurance issuer may impose a preexisting condition exclusion for a pregnancy existing on the effective date of coverage;4\n\nSubdivisions 1 and 2 shall no longer apply to an individual after the end of the first 63-day period during all of which the individual was not covered under any creditable coverage; and5\n\nSubdivision A 4 shall not apply to health insurance coverage offered in the individual market on a “guarantee issue” basis without regard to health status including policies, contracts, certificates, or evidences of coverage issued through a bona fide association or to students through school sponsored programs at an institution of higher education unless the person is an eligible individual as defined in § 38.2-3430.2.C\n\nA period of creditable coverage shall not be counted, with respect to enrollment of an individual under a health benefit plan, if, after such period and before the enrollment date, there was a 63-day period during all of which the individual was not covered under any creditable coverage.D\n\nFor purposes of subdivision B 4 and subsection C, any period that an individual is in a waiting period for any coverage under a group health plan (or for group health insurance coverage) or is in an affiliation period shall not be taken into account in determining the continuous period under subsection C.E\n\nMethods of crediting coverage:1\n\nExcept as otherwise provided under subdivision 2, a health insurance issuer offering group health coverage shall count a period of creditable coverage without regard to the specific benefits covered during the period;2\n\nA health insurance issuer offering group health insurance coverage may elect to count a period of creditable coverage based on coverage of benefits within each of several classes or categories of benefits rather than as provided under subdivision 1. Such election shall be made on a uniform basis for all participants and beneficiaries. Under such election a health insurance issuer shall count a period of creditable coverage with respect to any class or category of benefits if any level of benefits is covered within such class or category;3\n\nIn the case of an election with respect to a group plan under subdivision 2 (whether or not health insurance coverage is provided in connection with such plan), the plan shall (i) prominently state in any disclosure statements concerning the plan, and state to each enrollee at the time of enrollment under the plan, that the plan has made such election and (ii) include in such statements a description of the effect of this election; and4\n\nIn the case of an election under subdivision 2 with respect to health insurance coverage offered by a health insurance issuer in the small or large group market, the health insurance issuer shall (i) prominently state in any disclosure statements concerning the coverage, and to each employer at the time of the offer or sale of the coverage, that the health insurance issuer has made such election and (ii) include in such statements a description of the effect of such election.F\n\nPeriods of creditable coverage with respect to an individual shall be established through presentation of certifications described in subsection G or in such other manner as may be specified in federal regulations.G\n\nA health insurance issuer offering group health insurance coverage shall provide for certification of the period of creditable coverage:1\n\nAt the time an individual ceases to be covered under the plan or otherwise becomes covered under a COBRA continuation provision;2\n\nIn the case of an individual becoming covered under a COBRA continuation provision, at the time the individual ceases to be covered under such provision; and3\n\nAt the request, or on behalf of, an individual made not later than 24 months after the date of cessation of the coverage described in subdivision 1 or 2, whichever is later. The certification under subdivision 1 may be provided, to the extent practicable, at a time consistent with notices required under any applicable COBRA continuation provision.H\n\nTo the extent that medical care under a group health plan consists of group health insurance coverage, the plan is deemed to have satisfied the certification requirement under this section if the health insurance issuer offering the coverage provides for such certification in accordance with this section.I\n\nIn the case of an election described in subdivision E 2 by a health insurance issuer, if the health insurance issuer enrolls an individual for coverage under the plan and the individual provides a certification of coverage of the individual under subsection F:1\n\nUpon request of such health insurance issuer, the entity which issued the certification provided by the individual shall promptly disclose to such requesting group insurance issuer information on coverage of classes and categories of health benefits available under such entity’s plan or coverage; and2\n\nSuch entity may charge the requesting health insurance issuer for the reasonable cost of disclosing such information.J\n\nA health insurance issuer offering group health insurance coverage shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan if each of the following conditions is met:1\n\nThe employee or dependent was covered under a group health plan or had health insurance coverage at the time coverage was previously offered to the employee or dependent;2\n\nThe employee stated in writing at such time that coverage under a group health plan or health insurance coverage was the reason for declining enrollment, but only if the plan sponsor or health insurance issuer (if applicable) required such a statement at such time and provided the employee with notice of such requirement (and the consequences of such requirement) at such time;3\n\nThe employee’s or dependent’s coverage described in subdivision 1 (i) was under a COBRA continuation provision and the coverage under such provision was exhausted or (ii) was not under such a provision and either the coverage was terminated as a result of loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment) or employer contributions towards such coverage were terminated; and4\n\nUnder the terms of the plan, the employee requests such enrollment not later than 30 days after the date of exhaustion of coverage described in clause (i) of subdivision 3 or termination of coverage or employer contribution described in clause (ii) of subdivision 3.K\n\nIf (i) a health insurance issuer makes coverage available with respect to a dependent of an individual; (ii) the individual is a participant under the plan (or has met any waiting period applicable to becoming a participant under the plan and is eligible to be enrolled under the plan but for a failure to enroll during a previous enrollment period); and (iii) a person becomes such a dependent of the individual through marriage, birth, or adoption or placement for adoption, the health insurance issuer shall provide for a dependent special enrollment period described in subsection L during which the person (or, if not otherwise enrolled, the individual) may also be enrolled under the plan as a dependent of the individual, and in the case of the birth or adoption of a child, the spouse of the individual may also be enrolled as a dependent of the individual if such spouse is otherwise eligible for coverage.L\n\nA dependent special enrollment period under this subsection shall be a period of not less than 30 days and shall begin on the later of:1\n\nThe date dependent coverage is made available; or2\n\nThe date of the marriage, birth, or adoption or placement for adoption (as the case may be) described in subsection K.M\n\nIf an individual seeks to enroll a dependent during the first 30 days of such a dependent special enrollment period, the coverage of the dependent shall become effective:1\n\nIn the case of marriage, not later than the first day of the first month beginning after the date the completed request for enrollment is received;2\n\nIn the case of a dependent’s birth, as of the date of such birth; or3\n\nIn the case of a dependent’s adoption or placement for adoption, the date of such adoption or placement for adoption.N\n\nA late enrollee may be excluded from coverage for up to 12 months or may have a preexisting condition limitation apply for up to 12 months; however, in no case shall a late enrollee be excluded from some or all coverage for more than 12 months. An eligible employee or dependent shall not be considered a late enrollee if all of the conditions set forth below in subdivisions 1 through 4 are met or one of the conditions set forth below in subdivision 5 or 6 is met:1\n\nThe individual was covered under a public or private health benefit plan at the time the individual was eligible to enroll.2\n\nThe individual certified at the time of initial enrollment that coverage under another health benefit plan was the reason for declining enrollment.3\n\nThe individual has lost coverage under a public or private health benefit plan as a result of termination of employment or employment status eligibility, the termination of the other plan’s entire group coverage, death of a spouse, or divorce.4\n\nThe individual requests enrollment within 30 days after termination of coverage provided under a public or private health benefit plan.5\n\nThe individual is employed by a small employer that offers multiple health benefit plans and the individual elects a different plan offered by that small employer during an open enrollment period.6\n\nA court has ordered that coverage be provided for a spouse or minor child under a covered employee’s health benefit plan, the minor is eligible for coverage and is a dependent, and the request for enrollment is made within 30 days after issuance of such court order.\n\t\t\t\tHowever, such individual may be considered a late enrollee for benefit riders or enhanced coverage levels not covered under the enrollee’s prior plan.O\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":232376,"text":"Subject to subsection B, a health insurer offering health insurance coverage may, with respect to a participant or beneficiary, impose a preexisting limitation only if:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":232377,"text":"For group health insurance coverage, such exclusion relates to a condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the six-month period ending on the enrollment date;","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":232378,"text":"For individual health insurance coverage, such exclusion relates to a condition that, during a 12-month period immediately preceding the effective date of coverage, had manifested itself in such a manner as would cause an ordinarily prudent person to seek diagnosis, care, or treatment, or for which medical advice, diagnosis, care or treatment was recommended or received within 12 months immediately preceding the effective date of coverage;","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":232379,"text":"Such exclusion extends for a period of not more than 12 months (or 12 months in the case of a late enrollee) after the enrollment date; and","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"A4"},"4":{"id":232380,"text":"The period of any such preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage, if any, applicable to the participant or beneficiary as of the enrollment date.","type":"section","prefixes":["A","4"],"prefix":"4","entire_prefix":"A4","prefix_anchor":"A4","level":2,"prior_prefix":"A3","next_prefix":"B"},"5":{"id":232381,"text":"Exceptions:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A4","next_prefix":"B1"},"6":{"id":232382,"text":"Subject to subdivision 4, a health insurance issuer offering health insurance coverage may not impose any preexisting condition exclusion in the case of an individual who, as of the last day of the 30-day period beginning with the date of birth, is covered under creditable coverage;","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"7":{"id":232383,"text":"Subject to subdivision 4, a health insurance issuer offering health insurance coverage may not impose any preexisting condition exclusion in the case of a child who is adopted or placed for adoption before attaining 18 years of age and who, as of the last day of the 30-day period beginning on the date of the adoption or placement for adoption, is covered under creditable coverage. The previous sentence shall not apply to coverage before the date of such adoption or placement for adoption;","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"8":{"id":232384,"text":"A health insurance issuer offering health insurance coverage may not impose any preexisting condition exclusion relating to pregnancy as a preexisting condition, except in the case of individual health insurance coverage for a person who is not considered an eligible individual, as defined in § 38.2-3430.2, in which case the health insurance issuer may impose a preexisting condition exclusion for a pregnancy existing on the effective date of coverage;","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B4"},"9":{"id":232385,"text":"Subdivisions 1 and 2 shall no longer apply to an individual after the end of the first 63-day period during all of which the individual was not covered under any creditable coverage; and","type":"section","prefixes":["B","4"],"prefix":"4","entire_prefix":"B4","prefix_anchor":"B4","level":2,"prior_prefix":"B3","next_prefix":"B5"},"10":{"id":232386,"text":"Subdivision A 4 shall not apply to health insurance coverage offered in the individual market on a “guarantee issue” basis without regard to health status including policies, contracts, certificates, or evidences of coverage issued through a bona fide association or to students through school sponsored programs at an institution of higher education unless the person is an eligible individual as defined in § 38.2-3430.2.","type":"section","prefixes":["B","5"],"prefix":"5","entire_prefix":"B5","prefix_anchor":"B5","level":2,"prior_prefix":"B4","next_prefix":"C"},"11":{"id":232387,"text":"A period of creditable coverage shall not be counted, with respect to enrollment of an individual under a health benefit plan, if, after such period and before the enrollment date, there was a 63-day period during all of which the individual was not covered under any creditable coverage.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B5","next_prefix":"D"},"12":{"id":232388,"text":"For purposes of subdivision B 4 and subsection C, any period that an individual is in a waiting period for any coverage under a group health plan (or for group health insurance coverage) or is in an affiliation period shall not be taken into account in determining the continuous period under subsection C.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"13":{"id":232389,"text":"Methods of crediting coverage:","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"E1"},"14":{"id":232390,"text":"Except as otherwise provided under subdivision 2, a health insurance issuer offering group health coverage shall count a period of creditable coverage without regard to the specific benefits covered during the period;","type":"section","prefixes":["E","1"],"prefix":"1","entire_prefix":"E1","prefix_anchor":"E1","level":2,"prior_prefix":"E","next_prefix":"E2"},"15":{"id":232391,"text":"A health insurance issuer offering group health insurance coverage may elect to count a period of creditable coverage based on coverage of benefits within each of several classes or categories of benefits rather than as provided under subdivision 1. Such election shall be made on a uniform basis for all participants and beneficiaries. Under such election a health insurance issuer shall count a period of creditable coverage with respect to any class or category of benefits if any level of benefits is covered within such class or category;","type":"section","prefixes":["E","2"],"prefix":"2","entire_prefix":"E2","prefix_anchor":"E2","level":2,"prior_prefix":"E1","next_prefix":"E3"},"16":{"id":232392,"text":"In the case of an election with respect to a group plan under subdivision 2 (whether or not health insurance coverage is provided in connection with such plan), the plan shall (i) prominently state in any disclosure statements concerning the plan, and state to each enrollee at the time of enrollment under the plan, that the plan has made such election and (ii) include in such statements a description of the effect of this election; and","type":"section","prefixes":["E","3"],"prefix":"3","entire_prefix":"E3","prefix_anchor":"E3","level":2,"prior_prefix":"E2","next_prefix":"E4"},"17":{"id":232393,"text":"In the case of an election under subdivision 2 with respect to health insurance coverage offered by a health insurance issuer in the small or large group market, the health insurance issuer shall (i) prominently state in any disclosure statements concerning the coverage, and to each employer at the time of the offer or sale of the coverage, that the health insurance issuer has made such election and (ii) include in such statements a description of the effect of such election.","type":"section","prefixes":["E","4"],"prefix":"4","entire_prefix":"E4","prefix_anchor":"E4","level":2,"prior_prefix":"E3","next_prefix":"F"},"18":{"id":232394,"text":"Periods of creditable coverage with respect to an individual shall be established through presentation of certifications described in subsection G or in such other manner as may be specified in federal regulations.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E4","next_prefix":"G"},"19":{"id":232395,"text":"A health insurance issuer offering group health insurance coverage shall provide for certification of the period of creditable coverage:","type":"section","prefixes":["G"],"prefix":"G","entire_prefix":"G","prefix_anchor":"G","level":1,"prior_prefix":"F","next_prefix":"G1"},"20":{"id":232396,"text":"At the time an individual ceases to be covered under the plan or otherwise becomes covered under a COBRA continuation provision;","type":"section","prefixes":["G","1"],"prefix":"1","entire_prefix":"G1","prefix_anchor":"G1","level":2,"prior_prefix":"G","next_prefix":"G2"},"21":{"id":232397,"text":"In the case of an individual becoming covered under a COBRA continuation provision, at the time the individual ceases to be covered under such provision; and","type":"section","prefixes":["G","2"],"prefix":"2","entire_prefix":"G2","prefix_anchor":"G2","level":2,"prior_prefix":"G1","next_prefix":"G3"},"22":{"id":232398,"text":"At the request, or on behalf of, an individual made not later than 24 months after the date of cessation of the coverage described in subdivision 1 or 2, whichever is later. The certification under subdivision 1 may be provided, to the extent practicable, at a time consistent with notices required under any applicable COBRA continuation provision.","type":"section","prefixes":["G","3"],"prefix":"3","entire_prefix":"G3","prefix_anchor":"G3","level":2,"prior_prefix":"G2","next_prefix":"H"},"23":{"id":232399,"text":"To the extent that medical care under a group health plan consists of group health insurance coverage, the plan is deemed to have satisfied the certification requirement under this section if the health insurance issuer offering the coverage provides for such certification in accordance with this section.","type":"section","prefixes":["H"],"prefix":"H","entire_prefix":"H","prefix_anchor":"H","level":1,"prior_prefix":"G3","next_prefix":"I"},"24":{"id":232400,"text":"In the case of an election described in subdivision E 2 by a health insurance issuer, if the health insurance issuer enrolls an individual for coverage under the plan and the individual provides a certification of coverage of the individual under subsection F:","type":"section","prefixes":["I"],"prefix":"I","entire_prefix":"I","prefix_anchor":"I","level":1,"prior_prefix":"H","next_prefix":"I1"},"25":{"id":232401,"text":"Upon request of such health insurance issuer, the entity which issued the certification provided by the individual shall promptly disclose to such requesting group insurance issuer information on coverage of classes and categories of health benefits available under such entity’s plan or coverage; and","type":"section","prefixes":["I","1"],"prefix":"1","entire_prefix":"I1","prefix_anchor":"I1","level":2,"prior_prefix":"I","next_prefix":"I2"},"26":{"id":232402,"text":"Such entity may charge the requesting health insurance issuer for the reasonable cost of disclosing such information.","type":"section","prefixes":["I","2"],"prefix":"2","entire_prefix":"I2","prefix_anchor":"I2","level":2,"prior_prefix":"I1","next_prefix":"J"},"27":{"id":232403,"text":"A health insurance issuer offering group health insurance coverage shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan if each of the following conditions is met:","type":"section","prefixes":["J"],"prefix":"J","entire_prefix":"J","prefix_anchor":"J","level":1,"prior_prefix":"I2","next_prefix":"J1"},"28":{"id":232404,"text":"The employee or dependent was covered under a group health plan or had health insurance coverage at the time coverage was previously offered to the employee or dependent;","type":"section","prefixes":["J","1"],"prefix":"1","entire_prefix":"J1","prefix_anchor":"J1","level":2,"prior_prefix":"J","next_prefix":"J2"},"29":{"id":232405,"text":"The employee stated in writing at such time that coverage under a group health plan or health insurance coverage was the reason for declining enrollment, but only if the plan sponsor or health insurance issuer (if applicable) required such a statement at such time and provided the employee with notice of such requirement (and the consequences of such requirement) at such time;","type":"section","prefixes":["J","2"],"prefix":"2","entire_prefix":"J2","prefix_anchor":"J2","level":2,"prior_prefix":"J1","next_prefix":"J3"},"30":{"id":232406,"text":"The employee’s or dependent’s coverage described in subdivision 1 (i) was under a COBRA continuation provision and the coverage under such provision was exhausted or (ii) was not under such a provision and either the coverage was terminated as a result of loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment) or employer contributions towards such coverage were terminated; and","type":"section","prefixes":["J","3"],"prefix":"3","entire_prefix":"J3","prefix_anchor":"J3","level":2,"prior_prefix":"J2","next_prefix":"J4"},"31":{"id":232407,"text":"Under the terms of the plan, the employee requests such enrollment not later than 30 days after the date of exhaustion of coverage described in clause (i) of subdivision 3 or termination of coverage or employer contribution described in clause (ii) of subdivision 3.","type":"section","prefixes":["J","4"],"prefix":"4","entire_prefix":"J4","prefix_anchor":"J4","level":2,"prior_prefix":"J3","next_prefix":"K"},"32":{"id":232408,"text":"If (i) a health insurance issuer makes coverage available with respect to a dependent of an individual; (ii) the individual is a participant under the plan (or has met any waiting period applicable to becoming a participant under the plan and is eligible to be enrolled under the plan but for a failure to enroll during a previous enrollment period); and (iii) a person becomes such a dependent of the individual through marriage, birth, or adoption or placement for adoption, the health insurance issuer shall provide for a dependent special enrollment period described in subsection L during which the person (or, if not otherwise enrolled, the individual) may also be enrolled under the plan as a dependent of the individual, and in the case of the birth or adoption of a child, the spouse of the individual may also be enrolled as a dependent of the individual if such spouse is otherwise eligible for coverage.","type":"section","prefixes":["K"],"prefix":"K","entire_prefix":"K","prefix_anchor":"K","level":1,"prior_prefix":"J4","next_prefix":"L"},"33":{"id":232409,"text":"A dependent special enrollment period under this subsection shall be a period of not less than 30 days and shall begin on the later of:","type":"section","prefixes":["L"],"prefix":"L","entire_prefix":"L","prefix_anchor":"L","level":1,"prior_prefix":"K","next_prefix":"L1"},"34":{"id":232410,"text":"The date dependent coverage is made available; or","type":"section","prefixes":["L","1"],"prefix":"1","entire_prefix":"L1","prefix_anchor":"L1","level":2,"prior_prefix":"L","next_prefix":"L2"},"35":{"id":232411,"text":"The date of the marriage, birth, or adoption or placement for adoption (as the case may be) described in subsection K.","type":"section","prefixes":["L","2"],"prefix":"2","entire_prefix":"L2","prefix_anchor":"L2","level":2,"prior_prefix":"L1","next_prefix":"M"},"36":{"id":232412,"text":"If an individual seeks to enroll a dependent during the first 30 days of such a dependent special enrollment period, the coverage of the dependent shall become effective:","type":"section","prefixes":["M"],"prefix":"M","entire_prefix":"M","prefix_anchor":"M","level":1,"prior_prefix":"L2","next_prefix":"M1"},"37":{"id":232413,"text":"In the case of marriage, not later than the first day of the first month beginning after the date the completed request for enrollment is received;","type":"section","prefixes":["M","1"],"prefix":"1","entire_prefix":"M1","prefix_anchor":"M1","level":2,"prior_prefix":"M","next_prefix":"M2"},"38":{"id":232414,"text":"In the case of a dependent’s birth, as of the date of such birth; or","type":"section","prefixes":["M","2"],"prefix":"2","entire_prefix":"M2","prefix_anchor":"M2","level":2,"prior_prefix":"M1","next_prefix":"M3"},"39":{"id":232415,"text":"In the case of a dependent’s adoption or placement for adoption, the date of such adoption or placement for adoption.","type":"section","prefixes":["M","3"],"prefix":"3","entire_prefix":"M3","prefix_anchor":"M3","level":2,"prior_prefix":"M2","next_prefix":"N"},"40":{"id":232416,"text":"A late enrollee may be excluded from coverage for up to 12 months or may have a preexisting condition limitation apply for up to 12 months; however, in no case shall a late enrollee be excluded from some or all coverage for more than 12 months. An eligible employee or dependent shall not be considered a late enrollee if all of the conditions set forth below in subdivisions 1 through 4 are met or one of the conditions set forth below in subdivision 5 or 6 is met:","type":"section","prefixes":["N"],"prefix":"N","entire_prefix":"N","prefix_anchor":"N","level":1,"prior_prefix":"M3","next_prefix":"N1"},"41":{"id":232417,"text":"The individual was covered under a public or private health benefit plan at the time the individual was eligible to enroll.","type":"section","prefixes":["N","1"],"prefix":"1","entire_prefix":"N1","prefix_anchor":"N1","level":2,"prior_prefix":"N","next_prefix":"N2"},"42":{"id":232418,"text":"The individual certified at the time of initial enrollment that coverage under another health benefit plan was the reason for declining enrollment.","type":"section","prefixes":["N","2"],"prefix":"2","entire_prefix":"N2","prefix_anchor":"N2","level":2,"prior_prefix":"N1","next_prefix":"N3"},"43":{"id":232419,"text":"The individual has lost coverage under a public or private health benefit plan as a result of termination of employment or employment status eligibility, the termination of the other plan’s entire group coverage, death of a spouse, or divorce.","type":"section","prefixes":["N","3"],"prefix":"3","entire_prefix":"N3","prefix_anchor":"N3","level":2,"prior_prefix":"N2","next_prefix":"N4"},"44":{"id":232420,"text":"The individual requests enrollment within 30 days after termination of coverage provided under a public or private health benefit plan.","type":"section","prefixes":["N","4"],"prefix":"4","entire_prefix":"N4","prefix_anchor":"N4","level":2,"prior_prefix":"N3","next_prefix":"N5"},"45":{"id":232421,"text":"The individual is employed by a small employer that offers multiple health benefit plans and the individual elects a different plan offered by that small employer during an open enrollment period.","type":"section","prefixes":["N","5"],"prefix":"5","entire_prefix":"N5","prefix_anchor":"N5","level":2,"prior_prefix":"N4","next_prefix":"N6"},"46":{"id":232422,"text":"A court has ordered that coverage be provided for a spouse or minor child under a covered employee’s health benefit plan, the minor is eligible for coverage and is a dependent, and the request for enrollment is made within 30 days after issuance of such court order.\n\t\t\t\tHowever, such individual may be considered a late enrollee for benefit riders or enhanced coverage levels not covered under the enrollee’s prior plan.","type":"section","prefixes":["N","6"],"prefix":"6","entire_prefix":"N6","prefix_anchor":"N6","level":2,"prior_prefix":"N5","next_prefix":"O"},"47":{"id":232423,"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":["O"],"prefix":"O","entire_prefix":"O","prefix_anchor":"O","level":1,"prior_prefix":"N6"}},"ancestry":[{"id":15009,"edition_id":1,"name":"Group Market Reforms and Individual Coverage Offered to Employees of Small Employers","identifier":"5","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:51:28","date_modified":"2026-06-26 03:51:28","permalink":{"id":215415,"object_type":"structure","relational_id":15009,"identifier":"5","token":"38.2\/34\/5","url":"\/38.2\/34\/5\/","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":86404,"structure_id":15009,"section_number":"38.2-3431","catch_line":"Application of article; definitions","url":"\/38.2-3431\/","token":"38.2\/34\/5\/38.2-3431","metadata":false},{"id":83361,"structure_id":15009,"section_number":"38.2-3432","catch_line":"Repealed","url":"\/38.2-3432\/","token":"38.2\/34\/5\/38.2-3432","metadata":false},{"id":79618,"structure_id":15009,"section_number":"38.2-3432.1","catch_line":"Renewability","url":"\/38.2-3432.1\/","token":"38.2\/34\/5\/38.2-3432.1","metadata":false},{"id":85868,"structure_id":15009,"section_number":"38.2-3432.2","catch_line":"Availability","url":"\/38.2-3432.2\/","token":"38.2\/34\/5\/38.2-3432.2","metadata":false},{"id":63783,"structure_id":15009,"section_number":"38.2-3432.3","catch_line":"Limitation on preexisting condition exclusion period","url":"\/38.2-3432.3\/","token":"38.2\/34\/5\/38.2-3432.3","metadata":false},{"id":64415,"structure_id":15009,"section_number":"38.2-3433","catch_line":"Repealed","url":"\/38.2-3433\/","token":"38.2\/34\/5\/38.2-3433","metadata":false},{"id":57232,"structure_id":15009,"section_number":"38.2-3434","catch_line":"Disclosure of information","url":"\/38.2-3434\/","token":"38.2\/34\/5\/38.2-3434","metadata":false},{"id":74752,"structure_id":15009,"section_number":"38.2-3435","catch_line":"Exclusions","url":"\/38.2-3435\/","token":"38.2\/34\/5\/38.2-3435","metadata":false},{"id":77749,"structure_id":15009,"section_number":"38.2-3436","catch_line":"Eligibility to enroll","url":"\/38.2-3436\/","token":"38.2\/34\/5\/38.2-3436","metadata":false},{"id":70799,"structure_id":15009,"section_number":"38.2-3437","catch_line":"Rules used to determine group size","url":"\/38.2-3437\/","token":"38.2\/34\/5\/38.2-3437","metadata":false}],"previous_section":{"id":85868,"structure_id":15009,"section_number":"38.2-3432.2","catch_line":"Availability","url":"\/38.2-3432.2\/","token":"38.2\/34\/5\/38.2-3432.2","metadata":false},"next_section":{"id":64415,"structure_id":15009,"section_number":"38.2-3433","catch_line":"Repealed","url":"\/38.2-3433\/","token":"38.2\/34\/5\/38.2-3433","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3432.3\/","history_text":"

This law was first created in 1997. The record of its establishment is cataloged in chapters 807<\/a> and 913<\/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 6 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 1998, chapter 24<\/a>; in 1999, chapter 1004<\/a>; in 2000, chapter 136<\/a>; in 2003, chapter 221<\/a>; in 2011, chapter 882<\/a>; in 2013, chapters 136<\/a> and 210<\/a>.<\/p>","references":[{"id":72434,"section_number":"38.2-3407.11:3","catch_line":"Breast cancer underwriting and preexisting condition restrictions","order_by":null,"url":"\/38.2-3407.11_3\/"},{"id":63144,"section_number":"38.2-3430.8","catch_line":"Certification of coverage","order_by":null,"url":"\/38.2-3430.8\/"},{"id":86404,"section_number":"38.2-3431","catch_line":"Application of article; definitions","order_by":null,"url":"\/38.2-3431\/"},{"id":68187,"section_number":"38.2-3444","catch_line":"Preexisting condition exclusions","order_by":null,"url":"\/38.2-3444\/"},{"id":78815,"section_number":"38.2-3449","catch_line":"Prohibiting discrimination based on health status","order_by":null,"url":"\/38.2-3449\/"},{"id":63129,"section_number":"38.2-4322","catch_line":"Affiliation period","order_by":null,"url":"\/38.2-4322\/"}],"refers_to":[{"id":60829,"section_number":"38.2-3430.2","catch_line":"Definitions","order_by":null,"url":"\/38.2-3430.2\/"},{"id":57210,"section_number":"38.2-3438","catch_line":"Definitions","order_by":null,"url":"\/38.2-3438\/"}],"permalink":{"id":215433,"object_type":"law","relational_id":63783,"identifier":"38.2-3432.3","token":"38.2\/34\/5\/38.2-3432.3","url":"\/38.2-3432.3\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3432.3\/","token":"38.2\/34\/5\/38.2-3432.3","dublin_core":{"Title":"Limitation on preexisting condition exclusion period","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3432.3","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Subject to subsection B, a health insurer<\/span> offering health insurance<\/span> coverage may, with respect to a participant or beneficiary, impose a preexisting limitation only if: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> For group health insurance<\/span> coverage, such exclusion relates to a condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the six-month period ending on the enrollment date; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> For individual health insurance<\/span> coverage, such exclusion relates to a condition that, during a 12-month period immediately preceding the effective date of coverage, had manifested itself in such a manner as would cause an ordinarily prudent person<\/span> to seek diagnosis, care, or treatment, or for which medical advice, diagnosis, care or treatment was recommended or received within 12 months immediately preceding the effective date of coverage; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Such exclusion extends for a period of not more than 12 months (or 12 months in the case of a late enrollee) after the enrollment date; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> The period of any such preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage, if any, applicable to the participant or beneficiary as of the enrollment date. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Exceptions: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Subject to subdivision 4, a health insurance<\/span> issuer offering health insurance<\/span> coverage may not impose any preexisting condition exclusion in the case of an individual who, as of the last day of the 30-day period beginning with the date of birth, is covered under creditable coverage; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Subject to subdivision 4, a health insurance<\/span> issuer offering health insurance<\/span> coverage may not impose any preexisting condition exclusion in the case of a child who is adopted or placed for adoption before attaining 18 years of age and who, as of the last day of the 30-day period beginning on the date of the adoption or placement for adoption, is covered under creditable coverage. The previous sentence shall not apply to coverage before the date of such adoption or placement for adoption; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> A health insurance<\/span> issuer offering health insurance<\/span> coverage may not impose any preexisting condition exclusion relating to pregnancy as a preexisting condition, except in the case of individual health insurance<\/span> coverage for a person<\/span> who is not considered an eligible individual, as defined in § 38.2-3430.2<\/a>, in which case the health insurance<\/span> issuer may impose a preexisting condition exclusion for a pregnancy existing on the effective date of coverage; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Subdivisions 1 and 2 shall no longer apply to an individual after the end of the first 63-day period during all of which the individual was not covered under any creditable coverage; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> Subdivision A 4 shall not apply to health insurance<\/span> coverage offered in the individual market on a “guarantee issue<\/span>” basis without regard to health status including policies, contracts<\/span>, certificates, or evidences<\/span> of coverage issued through a bona fide association or to students through school sponsored programs at an institution of higher education unless the person<\/span> is an eligible individual as defined in § 38.2-3430.2<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> A period of creditable coverage shall not be counted, with respect to enrollment of an individual under a health benefit plan, if, after such period and before the enrollment date, there was a 63-day period during all of which the individual was not covered under any creditable coverage. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> For purposes of subdivision B 4 and subsection C, any period that an individual is in a waiting period for any coverage under a group health plan (or for group health insurance<\/span> coverage) or is in an affiliation period shall not be taken into account in determining the continuous period under subsection C. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> Methods of crediting coverage: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Except as otherwise provided under subdivision 2, a health insurance<\/span> issuer offering group health coverage shall count a period of creditable coverage without regard to the specific benefits covered during the period; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> A health insurance<\/span> issuer offering group health insurance<\/span> coverage may elect to count a period of creditable coverage based on coverage of benefits within each of several classes or categories of benefits rather than as provided under subdivision 1. Such election shall be made on a uniform basis for all participants and beneficiaries. Under such election a health insurance<\/span> issuer shall count a period of creditable coverage with respect to any class or category of benefits if any level of benefits is covered within such class or category; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> In the case of an election with respect to a group plan under subdivision 2 (whether or not health insurance<\/span> coverage is provided in connection with such plan), the plan shall (i) prominently state<\/span> in any disclosure statements<\/span> concerning the plan, and state<\/span> to each enrollee at the time of enrollment under the plan, that the plan has made such election and (ii) include in such statements a description of the effect of this election; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> In the case of an election under subdivision 2 with respect to health insurance<\/span> coverage offered by a health insurance<\/span> issuer in the small or large group market, the health insurance<\/span> issuer shall (i) prominently state<\/span> in any disclosure statements<\/span> concerning the coverage, and to each employer at the time of the offer or sale of the coverage, that the health insurance<\/span> issuer has made such election and (ii) include in such statements a description of the effect of such election. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> Periods of creditable coverage with respect to an individual shall be established through presentation of certifications described in subsection G or in such other manner as may be specified in federal regulations. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

G.<\/span> A health insurance<\/span> issuer offering group health insurance<\/span> coverage shall provide for certification of the period of creditable coverage: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> At the time an individual ceases to be covered under the plan or otherwise becomes covered under a COBRA continuation provision; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> In the case of an individual becoming covered under a COBRA continuation provision, at the time the individual ceases to be covered under such provision; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> At the request, or on behalf of, an individual made not later than 24 months after the date of cessation of the coverage described in subdivision 1 or 2, whichever is later. The certification under subdivision 1 may be provided, to the extent practicable, at a time consistent with notices required under any applicable COBRA continuation provision. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

H.<\/span> To the extent that medical care under a group health plan consists of group health insurance<\/span> coverage, the plan is deemed to have satisfied the certification requirement under this section if the health insurance<\/span> issuer offering the coverage provides for such certification in accordance with this section. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

I.<\/span> In the case of an election described in subdivision E 2 by a health insurance<\/span> issuer, if the health insurance<\/span> issuer enrolls an individual for coverage under the plan and the individual provides a certification of coverage of the individual under subsection F: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Upon request of such health insurance<\/span> issuer, the entity which issued the certification provided by the individual shall promptly disclose to such requesting group insurance<\/span> issuer information on coverage of classes and categories of health benefits available under such entity’s plan or coverage; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Such entity may charge the requesting health insurance<\/span> issuer for the reasonable cost of disclosing such information. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

J.<\/span> A health insurance<\/span> issuer offering group health insurance<\/span> coverage shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan if each of the following conditions is met: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The employee or dependent was covered under a group health plan or had health insurance<\/span> coverage at the time coverage was previously offered to the employee or dependent; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The employee stated in writing at such time that coverage under a group health plan or health insurance<\/span> coverage was the reason for declining enrollment, but only if the plan sponsor or health insurance<\/span> issuer (if applicable) required such a statement at such time and provided the employee with notice of such requirement (and the consequences of such requirement) at such time; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> The employee’s or dependent’s coverage described in subdivision 1 (i) was under a COBRA continuation provision and the coverage under such provision was exhausted or (ii) was not under such a provision and either the coverage was terminated as a result of loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment) or employer contributions towards such coverage were terminated; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Under the terms of the plan, the employee requests such enrollment not later than 30 days after the date of exhaustion of coverage described in clause (i) of subdivision 3 or termination of coverage or employer contribution described in clause (ii) of subdivision 3. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

K.<\/span> If (i) a health insurance<\/span> issuer makes coverage available with respect to a dependent of an individual; (ii) the individual is a participant under the plan (or has met any waiting period applicable to becoming a participant under the plan and is eligible to be enrolled under the plan but for a failure to enroll during a previous enrollment period); and (iii) a person<\/span> becomes such a dependent of the individual through marriage, birth, or adoption or placement for adoption, the health insurance<\/span> issuer shall provide for a dependent special enrollment period described in subsection L during which the person<\/span> (or, if not otherwise enrolled, the individual) may also be enrolled under the plan as a dependent of the individual, and in the case of the birth or adoption of a child, the spouse of the individual may also be enrolled as a dependent of the individual if such spouse is otherwise eligible for coverage. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

L.<\/span> A dependent special enrollment period under this subsection shall be a period of not less than 30 days and shall begin on the later of: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The date dependent coverage is made available; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The date of the marriage, birth, or adoption or placement for adoption (as the case may be) described in subsection K. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

M.<\/span> If an individual seeks to enroll a dependent during the first 30 days of such a dependent special enrollment period, the coverage of the dependent shall become effective: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> In the case of marriage, not later than the first day of the first month beginning after the date the completed request for enrollment is received; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> In the case of a dependent’s birth, as of the date of such birth; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> In the case of a dependent’s adoption or placement for adoption, the date of such adoption or placement for adoption. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

N.<\/span> A late enrollee may be excluded from coverage for up to 12 months or may have a preexisting condition limitation apply for up to 12 months; however, in no case shall a late enrollee be excluded from some or all coverage for more than 12 months. An eligible employee or dependent shall not be considered a late enrollee if all of the conditions set forth below in subdivisions 1 through 4 are met or one of the conditions set forth below in subdivision 5 or 6 is met: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> The individual was covered under a public or private health benefit plan at the time the individual was eligible to enroll. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The individual certified at the time of initial enrollment that coverage under another health benefit plan was the reason for declining enrollment. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> The individual has lost coverage under a public or private health benefit plan as a result of termination of employment or employment status eligibility, the termination of the other plan’s entire group coverage, death of a spouse, or divorce. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> The individual requests enrollment within 30 days after termination of coverage provided under a public or private health benefit plan. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> The individual is employed by a small employer that offers multiple health benefit plans and the individual elects a different plan offered by that small employer during an open enrollment period. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> A court has ordered that coverage be provided for a spouse or minor<\/span> child under a covered employee’s health benefit plan, the minor<\/span> is eligible for coverage and is a dependent, and the request for enrollment is made within 30 days after issuance of such court order<\/span>.\n\t\t\t\tHowever, such individual may be considered a late enrollee for benefit riders or enhanced coverage levels not covered under the enrollee’s prior plan. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

O.<\/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\nLIMITATION ON PREEXISTING CONDITION EXCLUSION PERIOD (\u00a7 38.2-3432.3)\n\nA. Subject to subsection B, a health insurer offering health insurance coverage\nmay, with respect to a participant or beneficiary, impose a preexisting\nlimitation only if:\n\n 1. For group health insurance coverage, such exclusion relates to a condition\n (whether physical or mental), regardless of the cause of the condition, for\n which medical advice, diagnosis, care, or treatment was recommended or\n received within the six-month period ending on the enrollment date;\n\n 2. For individual health insurance coverage, such exclusion relates to a\n condition that, during a 12-month period immediately preceding the effective\n date of coverage, had manifested itself in such a manner as would cause an\n ordinarily prudent person to seek diagnosis, care, or treatment, or for which\n medical advice, diagnosis, care or treatment was recommended or received\n within 12 months immediately preceding the effective date of coverage;\n\n 3. Such exclusion extends for a period of not more than 12 months (or 12\n months in the case of a late enrollee) after the enrollment date; and\n\n 4. The period of any such preexisting condition exclusion is reduced by the\n aggregate of the periods of creditable coverage, if any, applicable to the\n participant or beneficiary as of the enrollment date.\n\nB. Exceptions:\n\n 1. Subject to subdivision 4, a health insurance issuer offering health\n insurance coverage may not impose any preexisting condition exclusion in the\n case of an individual who, as of the last day of the 30-day period beginning\n with the date of birth, is covered under creditable coverage;\n\n 2. Subject to subdivision 4, a health insurance issuer offering health\n insurance coverage may not impose any preexisting condition exclusion in the\n case of a child who is adopted or placed for adoption before attaining 18\n years of age and who, as of the last day of the 30-day period beginning on the\n date of the adoption or placement for adoption, is covered under creditable\n coverage. The previous sentence shall not apply to coverage before the date of\n such adoption or placement for adoption;\n\n 3. A health insurance issuer offering health insurance coverage may not impose\n any preexisting condition exclusion relating to pregnancy as a preexisting\n condition, except in the case of individual health insurance coverage for a\n person who is not considered an eligible individual, as defined in §\n 38.2-3430.2, in which case the health insurance issuer may impose a\n preexisting condition exclusion for a pregnancy existing on the effective date\n of coverage;\n\n 4. Subdivisions 1 and 2 shall no longer apply to an individual after the end\n of the first 63-day period during all of which the individual was not covered\n under any creditable coverage; and\n\n 5. Subdivision A 4 shall not apply to health insurance coverage offered in the\n individual market on a “guarantee issue” basis without regard to\n health status including policies, contracts, certificates, or evidences of\n coverage issued through a bona fide association or to students through school\n sponsored programs at an institution of higher education unless the person is\n an eligible individual as defined in § 38.2-3430.2.\n\nC. A period of creditable coverage shall not be counted, with respect to\nenrollment of an individual under a health benefit plan, if, after such period\nand before the enrollment date, there was a 63-day period during all of which\nthe individual was not covered under any creditable coverage.\n\nD. For purposes of subdivision B 4 and subsection C, any period that an\nindividual is in a waiting period for any coverage under a group health plan (or\nfor group health insurance coverage) or is in an affiliation period shall not be\ntaken into account in determining the continuous period under subsection C.\n\nE. Methods of crediting coverage:\n\n 1. Except as otherwise provided under subdivision 2, a health insurance issuer\n offering group health coverage shall count a period of creditable coverage\n without regard to the specific benefits covered during the period;\n\n 2. A health insurance issuer offering group health insurance coverage may\n elect to count a period of creditable coverage based on coverage of benefits\n within each of several classes or categories of benefits rather than as\n provided under subdivision 1. Such election shall be made on a uniform basis\n for all participants and beneficiaries. Under such election a health insurance\n issuer shall count a period of creditable coverage with respect to any class\n or category of benefits if any level of benefits is covered within such class\n or category;\n\n 3. In the case of an election with respect to a group plan under subdivision 2\n (whether or not health insurance coverage is provided in connection with such\n plan), the plan shall (i) prominently state in any disclosure statements\n concerning the plan, and state to each enrollee at the time of enrollment\n under the plan, that the plan has made such election and (ii) include in such\n statements a description of the effect of this election; and\n\n 4. In the case of an election under subdivision 2 with respect to health\n insurance coverage offered by a health insurance issuer in the small or large\n group market, the health insurance issuer shall (i) prominently state in any\n disclosure statements concerning the coverage, and to each employer at the\n time of the offer or sale of the coverage, that the health insurance issuer\n has made such election and (ii) include in such statements a description of\n the effect of such election.\n\nF. Periods of creditable coverage with respect to an individual shall be\nestablished through presentation of certifications described in subsection G or\nin such other manner as may be specified in federal regulations.\n\nG. A health insurance issuer offering group health insurance coverage shall\nprovide for certification of the period of creditable coverage:\n\n 1. At the time an individual ceases to be covered under the plan or otherwise\n becomes covered under a COBRA continuation provision;\n\n 2. In the case of an individual becoming covered under a COBRA continuation\n provision, at the time the individual ceases to be covered under such\n provision; and\n\n 3. At the request, or on behalf of, an individual made not later than 24\n months after the date of cessation of the coverage described in subdivision 1\n or 2, whichever is later. The certification under subdivision 1 may be\n provided, to the extent practicable, at a time consistent with notices\n required under any applicable COBRA continuation provision.\n\nH. To the extent that medical care under a group health plan consists of group\nhealth insurance coverage, the plan is deemed to have satisfied the\ncertification requirement under this section if the health insurance issuer\noffering the coverage provides for such certification in accordance with this\nsection.\n\nI. In the case of an election described in subdivision E 2 by a health insurance\nissuer, if the health insurance issuer enrolls an individual for coverage under\nthe plan and the individual provides a certification of coverage of the\nindividual under subsection F:\n\n 1. Upon request of such health insurance issuer, the entity which issued the\n certification provided by the individual shall promptly disclose to such\n requesting group insurance issuer information on coverage of classes and\n categories of health benefits available under such entity’s plan or\n coverage; and\n\n 2. Such entity may charge the requesting health insurance issuer for the\n reasonable cost of disclosing such information.\n\nJ. A health insurance issuer offering group health insurance coverage shall\npermit an employee who is eligible, but not enrolled, for coverage under the\nterms of the plan (or a dependent of such an employee if the dependent is\neligible, but not enrolled, for coverage under such terms) to enroll for\ncoverage under the terms of the plan if each of the following conditions is met:\n\n 1. The employee or dependent was covered under a group health plan or had\n health insurance coverage at the time coverage was previously offered to the\n employee or dependent;\n\n 2. The employee stated in writing at such time that coverage under a group\n health plan or health insurance coverage was the reason for declining\n enrollment, but only if the plan sponsor or health insurance issuer (if\n applicable) required such a statement at such time and provided the employee\n with notice of such requirement (and the consequences of such requirement) at\n such time;\n\n 3. The employee’s or dependent’s coverage described in subdivision\n 1 (i) was under a COBRA continuation provision and the coverage under such\n provision was exhausted or (ii) was not under such a provision and either the\n coverage was terminated as a result of loss of eligibility for the coverage\n (including as a result of legal separation, divorce, death, termination of\n employment, or reduction in the number of hours of employment) or employer\n contributions towards such coverage were terminated; and\n\n 4. Under the terms of the plan, the employee requests such enrollment not\n later than 30 days after the date of exhaustion of coverage described in\n clause (i) of subdivision 3 or termination of coverage or employer\n contribution described in clause (ii) of subdivision 3.\n\nK. If (i) a health insurance issuer makes coverage available with respect to a\ndependent of an individual; (ii) the individual is a participant under the plan\n(or has met any waiting period applicable to becoming a participant under the\nplan and is eligible to be enrolled under the plan but for a failure to enroll\nduring a previous enrollment period); and (iii) a person becomes such a\ndependent of the individual through marriage, birth, or adoption or placement\nfor adoption, the health insurance issuer shall provide for a dependent special\nenrollment period described in subsection L during which the person (or, if not\notherwise enrolled, the individual) may also be enrolled under the plan as a\ndependent of the individual, and in the case of the birth or adoption of a\nchild, the spouse of the individual may also be enrolled as a dependent of the\nindividual if such spouse is otherwise eligible for coverage.\n\nL. A dependent special enrollment period under this subsection shall be a period\nof not less than 30 days and shall begin on the later of:\n\n 1. The date dependent coverage is made available; or\n\n 2. The date of the marriage, birth, or adoption or placement for adoption (as\n the case may be) described in subsection K.\n\nM. If an individual seeks to enroll a dependent during the first 30 days of such\na dependent special enrollment period, the coverage of the dependent shall\nbecome effective:\n\n 1. In the case of marriage, not later than the first day of the first month\n beginning after the date the completed request for enrollment is received;\n\n 2. In the case of a dependent’s birth, as of the date of such birth; or\n\n 3. In the case of a dependent’s adoption or placement for adoption, the\n date of such adoption or placement for adoption.\n\nN. A late enrollee may be excluded from coverage for up to 12 months or may have\na preexisting condition limitation apply for up to 12 months; however, in no\ncase shall a late enrollee be excluded from some or all coverage for more than\n12 months. An eligible employee or dependent shall not be considered a late\nenrollee if all of the conditions set forth below in subdivisions 1 through 4\nare met or one of the conditions set forth below in subdivision 5 or 6 is met:\n\n 1. The individual was covered under a public or private health benefit plan at\n the time the individual was eligible to enroll.\n\n 2. The individual certified at the time of initial enrollment that coverage\n under another health benefit plan was the reason for declining enrollment.\n\n 3. The individual has lost coverage under a public or private health benefit\n plan as a result of termination of employment or employment status\n eligibility, the termination of the other plan’s entire group coverage,\n death of a spouse, or divorce.\n\n 4. The individual requests enrollment within 30 days after termination of\n coverage provided under a public or private health benefit plan.\n\n 5. The individual is employed by a small employer that offers multiple health\n benefit plans and the individual elects a different plan offered by that small\n employer during an open enrollment period.\n\n 6. A court has ordered that coverage be provided for a spouse or minor child\n under a covered employee’s health benefit plan, the minor is eligible\n for coverage and is a dependent, and the request for enrollment is made within\n 30 days after issuance of such court order.\n \t\t\t\tHowever, such individual may be considered a late enrollee for benefit\n riders or enhanced coverage levels not covered under the enrollee’s\n prior plan.\n\nO. 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: 1997, cc. 807, 913; 1998, c. 24; 1999, c. 1004; 2000, c. 136; 2003, c.\n221; 2011, c. 882; 2013, cc. 136, 210.","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}}