{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3443.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3443.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3443.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3443.html"}],"law_id":54833,"edition_id":1,"section_id":54833,"structure_id":13819,"section_number":"38.2-3443","catch_line":"Choice of a health care professional","history":"2011, c. 882.","full_text":"A\n\nNotwithstanding any provision of § 38.2-3407.11, 38.2-4312.3, or any other section of this title to the contrary, if a health carrier providing individual or group health insurance coverage requires or provides for the designation by a covered person of a participating primary care health care professional, the health carrier shall permit each covered person to designate any participating primary care health care professional who is available to accept the covered person. For a child, a participating health care professional who specializes in pediatrics and is available to accept the child may be designated as the child’s primary care health care professional.B\n\nIf a health carrier provides for obstetrical or gynecological care and requires the designation by a covered person of a participating primary care health care professional, the health carrier shall not require any person’s prior authorization or referral in the case of a female covered person who seeks coverage for obstetrical or gynecological care provided by a participating health care professional who specializes in obstetrics or gynecology. The provision of obstetrical and gynecological care, and the ordering of related items and services, shall be treated the same as an authorization from a primary care health care professional.C\n\nA health carrier shall provide notice to a covered person of the terms and conditions of the plan related to the designation of a participating health care professional.1\n\nSuch notice shall be included whenever the health carrier provides a covered person with a summary plan description, policy, certificate, or contract of health insurance.2\n\nThe health carrier may use the model language found in 45 C.F.R. § 147.138(a)(4)(iii) for such notice.D\n\nThis section shall apply to any health carrier providing individual or group health insurance coverage, except for any grandfathered plan.","order_by":null,"text":{"0":{"id":201198,"text":"Notwithstanding any provision of § 38.2-3407.11, 38.2-4312.3, or any other section of this title to the contrary, if a health carrier providing individual or group health insurance coverage requires or provides for the designation by a covered person of a participating primary care health care professional, the health carrier shall permit each covered person to designate any participating primary care health care professional who is available to accept the covered person. For a child, a participating health care professional who specializes in pediatrics and is available to accept the child may be designated as the child’s primary care health care professional.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":201199,"text":"If a health carrier provides for obstetrical or gynecological care and requires the designation by a covered person of a participating primary care health care professional, the health carrier shall not require any person’s prior authorization or referral in the case of a female covered person who seeks coverage for obstetrical or gynecological care provided by a participating health care professional who specializes in obstetrics or gynecology. The provision of obstetrical and gynecological care, and the ordering of related items and services, shall be treated the same as an authorization from a primary care health care professional.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":201200,"text":"A health carrier shall provide notice to a covered person of the terms and conditions of the plan related to the designation of a participating health care professional.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"C1"},"3":{"id":201201,"text":"Such notice shall be included whenever the health carrier provides a covered person with a summary plan description, policy, certificate, or contract of health insurance.","type":"section","prefixes":["C","1"],"prefix":"1","entire_prefix":"C1","prefix_anchor":"C1","level":2,"prior_prefix":"C","next_prefix":"C2"},"4":{"id":201202,"text":"The health carrier may use the model language found in 45 C.F.R. § 147.138(a)(4)(iii) for such notice.","type":"section","prefixes":["C","2"],"prefix":"2","entire_prefix":"C2","prefix_anchor":"C2","level":2,"prior_prefix":"C1","next_prefix":"D"},"5":{"id":201203,"text":"This section shall apply to any health carrier providing individual or group health insurance coverage, except for any grandfathered plan.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C2"}},"ancestry":[{"id":13819,"edition_id":1,"name":"Federal Market Reforms","identifier":"6","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:45:59","date_modified":"2026-06-26 03:45:59","permalink":{"id":215457,"object_type":"structure","relational_id":13819,"identifier":"6","token":"38.2\/34\/6","url":"\/38.2\/34\/6\/","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":57210,"structure_id":13819,"section_number":"38.2-3438","catch_line":"Definitions","url":"\/38.2-3438\/","token":"38.2\/34\/6\/38.2-3438","metadata":false},{"id":55902,"structure_id":13819,"section_number":"38.2-3439","catch_line":"Dependent coverage for individuals to age 26","url":"\/38.2-3439\/","token":"38.2\/34\/6\/38.2-3439","metadata":false},{"id":59514,"structure_id":13819,"section_number":"38.2-3440","catch_line":"Lifetime and annual limits","url":"\/38.2-3440\/","token":"38.2\/34\/6\/38.2-3440","metadata":false},{"id":74720,"structure_id":13819,"section_number":"38.2-3441","catch_line":"Rescissions","url":"\/38.2-3441\/","token":"38.2\/34\/6\/38.2-3441","metadata":false},{"id":81548,"structure_id":13819,"section_number":"38.2-3442","catch_line":"Preventive services","url":"\/38.2-3442\/","token":"38.2\/34\/6\/38.2-3442","metadata":false},{"id":54833,"structure_id":13819,"section_number":"38.2-3443","catch_line":"Choice of a health care professional","url":"\/38.2-3443\/","token":"38.2\/34\/6\/38.2-3443","metadata":false},{"id":68187,"structure_id":13819,"section_number":"38.2-3444","catch_line":"Preexisting condition exclusions","url":"\/38.2-3444\/","token":"38.2\/34\/6\/38.2-3444","metadata":false},{"id":60836,"structure_id":13819,"section_number":"38.2-3445","catch_line":"Patient access to emergency services","url":"\/38.2-3445\/","token":"38.2\/34\/6\/38.2-3445","metadata":false},{"id":57195,"structure_id":13819,"section_number":"38.2-3445.01","catch_line":"Balance billing for certain services; 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reporting requirements","url":"\/38.2-3445.2\/","token":"38.2\/34\/6\/38.2-3445.2","metadata":false},{"id":86937,"structure_id":13819,"section_number":"38.2-3446","catch_line":"Applicability of federal law","url":"\/38.2-3446\/","token":"38.2\/34\/6\/38.2-3446","metadata":false},{"id":66501,"structure_id":13819,"section_number":"38.2-3447","catch_line":"(Effective January 1, 2026) Restrictions relating to premium rates","url":"\/38.2-3447\/","token":"38.2\/34\/6\/38.2-3447","metadata":false},{"id":79799,"structure_id":13819,"section_number":"38.2-3448","catch_line":"Guaranteed availability","url":"\/38.2-3448\/","token":"38.2\/34\/6\/38.2-3448","metadata":false},{"id":78815,"structure_id":13819,"section_number":"38.2-3449","catch_line":"Prohibiting discrimination based on health status","url":"\/38.2-3449\/","token":"38.2\/34\/6\/38.2-3449","metadata":false},{"id":67706,"structure_id":13819,"section_number":"38.2-3449.1","catch_line":"Prohibited discrimination based on gender identity or status as a transgender individual","url":"\/38.2-3449.1\/","token":"38.2\/34\/6\/38.2-3449.1","metadata":false},{"id":64622,"structure_id":13819,"section_number":"38.2-3450","catch_line":"Genetic information and testing","url":"\/38.2-3450\/","token":"38.2\/34\/6\/38.2-3450","metadata":false},{"id":83154,"structure_id":13819,"section_number":"38.2-3451","catch_line":"Essential health benefits","url":"\/38.2-3451\/","token":"38.2\/34\/6\/38.2-3451","metadata":false},{"id":76537,"structure_id":13819,"section_number":"38.2-3452","catch_line":"Waiting periods","url":"\/38.2-3452\/","token":"38.2\/34\/6\/38.2-3452","metadata":false},{"id":86395,"structure_id":13819,"section_number":"38.2-3453","catch_line":"Clinical trials","url":"\/38.2-3453\/","token":"38.2\/34\/6\/38.2-3453","metadata":false},{"id":81951,"structure_id":13819,"section_number":"38.2-3454","catch_line":"Wellness programs","url":"\/38.2-3454\/","token":"38.2\/34\/6\/38.2-3454","metadata":false},{"id":84250,"structure_id":13819,"section_number":"38.2-3454.1","catch_line":"Renewal of health benefit plans; special exception","url":"\/38.2-3454.1\/","token":"38.2\/34\/6\/38.2-3454.1","metadata":false}],"previous_section":{"id":81548,"structure_id":13819,"section_number":"38.2-3442","catch_line":"Preventive services","url":"\/38.2-3442\/","token":"38.2\/34\/6\/38.2-3442","metadata":false},"next_section":{"id":68187,"structure_id":13819,"section_number":"38.2-3444","catch_line":"Preexisting condition exclusions","url":"\/38.2-3444\/","token":"38.2\/34\/6\/38.2-3444","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3443\/","history_text":"

This law was first created in 2011. The record of its establishment is cataloged in chapter 882<\/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":82372,"section_number":"38.2-3407.11","catch_line":"Access to obstetrician-gynecologists","order_by":null,"url":"\/38.2-3407.11\/"},{"id":79585,"section_number":"38.2-4312.3","catch_line":"Patient access to emergency services","order_by":null,"url":"\/38.2-4312.3\/"}],"permalink":{"id":215479,"object_type":"law","relational_id":54833,"identifier":"38.2-3443","token":"38.2\/34\/6\/38.2-3443","url":"\/38.2-3443\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3443\/","token":"38.2\/34\/6\/38.2-3443","dublin_core":{"Title":"Choice of a health care professional","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3443","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Notwithstanding any provision of § 38.2-3407.11<\/a>, 38.2-4312.3<\/a>, or any other section of this title to the contrary, if a health carrier providing individual or group health insurance<\/span> coverage requires or provides for the designation by a covered person<\/span> of a participating primary care health care professional, the health carrier shall permit each covered person<\/span> to designate any participating primary care health care professional who is available to accept the covered person<\/span>. For a child, a participating health care professional who specializes in pediatrics and is available to accept the child may be designated as the child’s primary care health care professional. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> If a health carrier provides for obstetrical or gynecological care and requires the designation by a covered person<\/span> of a participating primary care health care professional, the health carrier shall not require any person<\/span>’s prior authorization or referral in the case of a female covered person<\/span> who seeks coverage for obstetrical or gynecological care provided by a participating health care professional who specializes in obstetrics or gynecology. The provision of obstetrical and gynecological care, and the ordering of related items and services, shall be treated the same as an authorization from a primary care health care professional. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> A health carrier shall provide notice to a covered person<\/span> of the terms and conditions of the plan related to the designation of a participating health care professional. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Such notice shall be included whenever the health carrier provides a covered person<\/span> with a summary plan description, policy, certificate, or contract<\/span> of health insurance<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The health carrier may use the model language found in 45 C.F.R. § 147.138(a)(4)(iii) for such notice. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> This section shall apply to any health carrier providing individual or group health insurance<\/span> coverage, except for any grandfathered plan. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nCHOICE OF A HEALTH CARE PROFESSIONAL (\u00a7 38.2-3443)\n\nA. Notwithstanding any provision of § 38.2-3407.11, 38.2-4312.3, or any\nother section of this title to the contrary, if a health carrier providing\nindividual or group health insurance coverage requires or provides for the\ndesignation by a covered person of a participating primary care health care\nprofessional, the health carrier shall permit each covered person to designate\nany participating primary care health care professional who is available to\naccept the covered person. For a child, a participating health care professional\nwho specializes in pediatrics and is available to accept the child may be\ndesignated as the child’s primary care health care professional.\n\nB. If a health carrier provides for obstetrical or gynecological care and\nrequires the designation by a covered person of a participating primary care\nhealth care professional, the health carrier shall not require any\nperson’s prior authorization or referral in the case of a female covered\nperson who seeks coverage for obstetrical or gynecological care provided by a\nparticipating health care professional who specializes in obstetrics or\ngynecology. The provision of obstetrical and gynecological care, and the\nordering of related items and services, shall be treated the same as an\nauthorization from a primary care health care professional.\n\nC. A health carrier shall provide notice to a covered person of the terms and\nconditions of the plan related to the designation of a participating health care\nprofessional.\n\n 1. Such notice shall be included whenever the health carrier provides a\n covered person with a summary plan description, policy, certificate, or\n contract of health insurance.\n\n 2. The health carrier may use the model language found in 45 C.F.R. §\n 147.138(a)(4)(iii) for such notice.\n\nD. This section shall apply to any health carrier providing individual or group\nhealth insurance coverage, except for any grandfathered plan.\n\nHISTORY: 2011, c. 882.","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}}