{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3445.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3445.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3445.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3445.html"}],"law_id":60836,"edition_id":1,"section_id":60836,"structure_id":13819,"section_number":"38.2-3445","catch_line":"Patient access to emergency services","history":"2011, c. 882; 2020, cc. 1080, 1081; 2024, cc. 199, 360.","full_text":"A\n\nNotwithstanding any provision of \u00a7 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 provides any benefits with respect to services in an emergency department of a hospital, the health carrier shall provide coverage for emergency services:1\n\nWithout the need for any prior authorization determination, regardless of whether the emergency services are provided on an in-network or out-of-network basis;2\n\nWithout regard to the final diagnosis rendered to the covered person or whether the health care provider furnishing the emergency services is a participating health care provider with respect to such services;3\n\nIf such services are provided out-of-network, without imposing any administrative requirement or limitation on coverage that is more restrictive than the requirements or limitations that apply to such services received from an in-network provider;4\n\nIf such services are provided out-of-network, the health carrier shall pay the out-of-network provider in accordance with § 38.2-3445.01 less any cost-sharing requirement. Any such cost-sharing requirement shall not exceed the cost-sharing requirement that would apply if such services were provided in-network as provided in § 38.2-3445.01; and5\n\nWithout regard to any term or condition of such coverage other than the exclusion of or coordination of benefits or an affiliation or waiting period.B\n\nCoverage for emergency services that are related to mental health services or substance abuse services, as those terms are defined in § 38.2-3412.1, shall be provided in accordance with the federal Mental Health Parity and Addiction Equity Act of 2008, P.L. 110-343, even where those requirements would not otherwise apply directly. Such emergency services may be rendered at a location other than the emergency department of a hospital, such as a behavioral health crisis service provider, as required.","order_by":null,"text":{"0":{"id":222372,"text":"Notwithstanding any provision of \u00a7 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 provides any benefits with respect to services in an emergency department of a hospital, the health carrier shall provide coverage for emergency services:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":222373,"text":"Without the need for any prior authorization determination, regardless of whether the emergency services are provided on an in-network or out-of-network basis;","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":222374,"text":"Without regard to the final diagnosis rendered to the covered person or whether the health care provider furnishing the emergency services is a participating health care provider with respect to such services;","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":222375,"text":"If such services are provided out-of-network, without imposing any administrative requirement or limitation on coverage that is more restrictive than the requirements or limitations that apply to such services received from an in-network provider;","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"A4"},"4":{"id":222376,"text":"If such services are provided out-of-network, the health carrier shall pay the out-of-network provider in accordance with § 38.2-3445.01 less any cost-sharing requirement. Any such cost-sharing requirement shall not exceed the cost-sharing requirement that would apply if such services were provided in-network as provided in § 38.2-3445.01; and","type":"section","prefixes":["A","4"],"prefix":"4","entire_prefix":"A4","prefix_anchor":"A4","level":2,"prior_prefix":"A3","next_prefix":"A5"},"5":{"id":222377,"text":"Without regard to any term or condition of such coverage other than the exclusion of or coordination of benefits or an affiliation or waiting period.","type":"section","prefixes":["A","5"],"prefix":"5","entire_prefix":"A5","prefix_anchor":"A5","level":2,"prior_prefix":"A4","next_prefix":"B"},"6":{"id":222378,"text":"Coverage for emergency services that are related to mental health services or substance abuse services, as those terms are defined in § 38.2-3412.1, shall be provided in accordance with the federal Mental Health Parity and Addiction Equity Act of 2008, P.L. 110-343, even where those requirements would not otherwise apply directly. Such emergency services may be rendered at a location other than the emergency department of a hospital, such as a behavioral health crisis service provider, as required.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A5"}},"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; prohibited","url":"\/38.2-3445.01\/","token":"38.2\/34\/6\/38.2-3445.01","metadata":false},{"id":74656,"structure_id":13819,"section_number":"38.2-3445.02","catch_line":"Arbitration","url":"\/38.2-3445.02\/","token":"38.2\/34\/6\/38.2-3445.02","metadata":false},{"id":57491,"structure_id":13819,"section_number":"38.2-3445.03","catch_line":"Data sets for determining commercially reasonable payments","url":"\/38.2-3445.03\/","token":"38.2\/34\/6\/38.2-3445.03","metadata":false},{"id":55717,"structure_id":13819,"section_number":"38.2-3445.04","catch_line":"Transparency","url":"\/38.2-3445.04\/","token":"38.2\/34\/6\/38.2-3445.04","metadata":false},{"id":67926,"structure_id":13819,"section_number":"38.2-3445.05","catch_line":"Enforcement","url":"\/38.2-3445.05\/","token":"38.2\/34\/6\/38.2-3445.05","metadata":false},{"id":66467,"structure_id":13819,"section_number":"38.2-3445.06","catch_line":"Applicability of certain sections","url":"\/38.2-3445.06\/","token":"38.2\/34\/6\/38.2-3445.06","metadata":false},{"id":72898,"structure_id":13819,"section_number":"38.2-3445.07","catch_line":"Rules and regulations","url":"\/38.2-3445.07\/","token":"38.2\/34\/6\/38.2-3445.07","metadata":false},{"id":68114,"structure_id":13819,"section_number":"38.2-3445.1","catch_line":"Repealed","url":"\/38.2-3445.1\/","token":"38.2\/34\/6\/38.2-3445.1","metadata":false},{"id":63588,"structure_id":13819,"section_number":"38.2-3445.2","catch_line":"Out-of-network claims; 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":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},"next_section":{"id":57195,"structure_id":13819,"section_number":"38.2-3445.01","catch_line":"Balance billing for certain services; prohibited","url":"\/38.2-3445.01\/","token":"38.2\/34\/6\/38.2-3445.01","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3445\/","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. It has been modified 2 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 2020, chapters 1080<\/a> and 1081<\/a>; in 2024, chapters 199<\/a> and 360<\/a>.<\/p>","references":[{"id":66467,"section_number":"38.2-3445.06","catch_line":"Applicability of certain sections","order_by":null,"url":"\/38.2-3445.06\/"},{"id":72898,"section_number":"38.2-3445.07","catch_line":"Rules and regulations","order_by":null,"url":"\/38.2-3445.07\/"},{"id":63588,"section_number":"38.2-3445.2","catch_line":"Out-of-network claims; reporting requirements","order_by":null,"url":"\/38.2-3445.2\/"}],"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":84153,"section_number":"38.2-3412.1","catch_line":"Coverage for mental health and substance use disorders","order_by":null,"url":"\/38.2-3412.1\/"},{"id":57195,"section_number":"38.2-3445.01","catch_line":"Balance billing for certain services; prohibited","order_by":null,"url":"\/38.2-3445.01\/"},{"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":215487,"object_type":"law","relational_id":60836,"identifier":"38.2-3445","token":"38.2\/34\/6\/38.2-3445","url":"\/38.2-3445\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3445\/","token":"38.2\/34\/6\/38.2-3445","dublin_core":{"Title":"Patient access to emergency services","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3445","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Notwithstanding any provision of \u00a7 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 provides any benefits with respect to services in an emergency department of a hospital, the health carrier shall provide coverage for emergency services: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Without the need for any prior authorization determination, regardless of whether the emergency services are provided on an in-network or out-of-network basis; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Without regard to the final diagnosis rendered to the covered person<\/span> or whether the health care provider furnishing the emergency services is a participating health care provider with respect to such services; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> If such services are provided out-of-network, without imposing any administrative requirement or limitation on coverage that is more restrictive than the requirements or limitations that apply to such services received from an in-network provider; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> If such services are provided out-of-network, the health carrier shall pay the out-of-network provider in accordance with § 38.2-3445.01<\/a> less any cost-sharing requirement. Any such cost-sharing requirement shall not exceed the cost-sharing requirement that would apply if such services were provided in-network as provided in § 38.2-3445.01<\/a>; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> Without regard to any term or condition of such coverage other than the exclusion of or coordination of benefits or an affiliation or waiting period. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Coverage for emergency services that are related to mental health services or substance abuse services, as those terms are defined in § 38.2-3412.1<\/a>, shall be provided in accordance with the federal Mental Health Parity and Addiction Equity<\/span> Act of 2008, P.L. 110-343, even where those requirements would not otherwise apply directly. Such emergency services may be rendered at a location other than the emergency department of a hospital, such as a behavioral health crisis service provider, as required. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nPATIENT ACCESS TO EMERGENCY SERVICES (\u00a7 38.2-3445)\n\nA. Notwithstanding any provision of \u00a7 38.2-3407.11, 38.2-4312.3, or any other\nsection of this title to the contrary, if a health carrier providing individual\nor group health insurance coverage provides any benefits with respect to\nservices in an emergency department of a hospital, the health carrier shall\nprovide coverage for emergency services:\n\n 1. Without the need for any prior authorization determination, regardless of\n whether the emergency services are provided on an in-network or out-of-network\n basis;\n\n 2. Without regard to the final diagnosis rendered to the covered person or\n whether the health care provider furnishing the emergency services is a\n participating health care provider with respect to such services;\n\n 3. If such services are provided out-of-network, without imposing any\n administrative requirement or limitation on coverage that is more restrictive\n than the requirements or limitations that apply to such services received from\n an in-network provider;\n\n 4. If such services are provided out-of-network, the health carrier shall pay\n the out-of-network provider in accordance with § 38.2-3445.01 less any\n cost-sharing requirement. Any such cost-sharing requirement shall not exceed\n the cost-sharing requirement that would apply if such services were provided\n in-network as provided in § 38.2-3445.01; and\n\n 5. Without regard to any term or condition of such coverage other than the\n exclusion of or coordination of benefits or an affiliation or waiting period.\n\nB. Coverage for emergency services that are related to mental health services or\nsubstance abuse services, as those terms are defined in § 38.2-3412.1,\nshall be provided in accordance with the federal Mental Health Parity and\nAddiction Equity Act of 2008, P.L. 110-343, even where those requirements would\nnot otherwise apply directly. Such emergency services may be rendered at a\nlocation other than the emergency department of a hospital, such as a behavioral\nhealth crisis service provider, as required.\n\nHISTORY: 2011, c. 882; 2020, cc. 1080, 1081; 2024, cc. 199, 360.","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}}