{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3531.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3531.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3531.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3531.html"}],"law_id":57577,"edition_id":1,"section_id":57577,"structure_id":13628,"section_number":"38.2-3531","catch_line":"Additional exclusions and limitations","history":"1986, c. 562; 1998, c. 24.","full_text":"A\n\nEach group accident and sickness insurance policy shall contain a provision specifying all additional exclusions or limitations applicable under the policy for any disease or physical condition of a person, not otherwise excluded from the person’s coverage by name or specific description effective on the date of the person’s loss, which existed prior to the effective date of the person’s coverage under the policy.B\n\nAny such exclusion or limitation may only apply to a disease or physical condition for which medical advice or treatment was received by the person during the twelve months prior to the effective date of the person’s coverage. The exclusion or limitation shall not apply to loss incurred or disability commencing after the earlier of (i) the end of a continuous period of twelve months commencing on or after the effective date of the person’s coverage during which the person receives no medical advice or treatment in connection with the disease or physical condition, or (ii) the end of the two-year period commencing on the effective date of the person’s coverage.C\n\nThis section shall not apply to group accident and sickness policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis to an employer’s employees and their dependents.","order_by":null,"text":{"0":{"id":210934,"text":"Each group accident and sickness insurance policy shall contain a provision specifying all additional exclusions or limitations applicable under the policy for any disease or physical condition of a person, not otherwise excluded from the person’s coverage by name or specific description effective on the date of the person’s loss, which existed prior to the effective date of the person’s coverage under the policy.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":210935,"text":"Any such exclusion or limitation may only apply to a disease or physical condition for which medical advice or treatment was received by the person during the twelve months prior to the effective date of the person’s coverage. The exclusion or limitation shall not apply to loss incurred or disability commencing after the earlier of (i) the end of a continuous period of twelve months commencing on or after the effective date of the person’s coverage during which the person receives no medical advice or treatment in connection with the disease or physical condition, or (ii) the end of the two-year period commencing on the effective date of the person’s coverage.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":210936,"text":"This section shall not apply to group accident and sickness policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis to an employer’s employees and their dependents.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B"}},"ancestry":[{"id":13628,"edition_id":1,"name":"Group Accident and Sickness Insurance Policies","identifier":"3","label":"article","depth":3,"order_by":1,"parent_id":13348,"metadata":{},"date_created":"2026-06-26 03:45:25","date_modified":"2026-06-26 03:45:25","permalink":{"id":215739,"object_type":"structure","relational_id":13628,"identifier":"3","token":"38.2\/35\/3","url":"\/38.2\/35\/3\/","edition_id":1,"permalink":0,"preferred":1}},{"id":13348,"edition_id":1,"name":"Accident and Sickness Insurance Policies","identifier":"35","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:41","date_modified":"2026-06-26 03:44:41","permalink":{"id":215641,"object_type":"structure","relational_id":13348,"identifier":"35","token":"38.2\/35","url":"\/38.2\/35\/","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":82746,"structure_id":13628,"section_number":"38.2-3521","catch_line":"Repealed","url":"\/38.2-3521\/","token":"38.2\/35\/3\/38.2-3521","metadata":false},{"id":83222,"structure_id":13628,"section_number":"38.2-3521.1","catch_line":"Group accident and sickness insurance definitions","url":"\/38.2-3521.1\/","token":"38.2\/35\/3\/38.2-3521.1","metadata":false},{"id":62206,"structure_id":13628,"section_number":"38.2-3521.2","catch_line":"Blanket accident and sickness insurance","url":"\/38.2-3521.2\/","token":"38.2\/35\/3\/38.2-3521.2","metadata":false},{"id":61357,"structure_id":13628,"section_number":"38.2-3522","catch_line":"Repealed","url":"\/38.2-3522\/","token":"38.2\/35\/3\/38.2-3522","metadata":false},{"id":67462,"structure_id":13628,"section_number":"38.2-3522.1","catch_line":"Limits of group accident and sickness insurance","url":"\/38.2-3522.1\/","token":"38.2\/35\/3\/38.2-3522.1","metadata":false},{"id":57697,"structure_id":13628,"section_number":"38.2-3523","catch_line":"Repealed","url":"\/38.2-3523\/","token":"38.2\/35\/3\/38.2-3523","metadata":false},{"id":71976,"structure_id":13628,"section_number":"38.2-3523.1","catch_line":"Review of records","url":"\/38.2-3523.1\/","token":"38.2\/35\/3\/38.2-3523.1","metadata":false},{"id":61669,"structure_id":13628,"section_number":"38.2-3523.2","catch_line":"Policies issued outside of the Commonwealth of Virginia","url":"\/38.2-3523.2\/","token":"38.2\/35\/3\/38.2-3523.2","metadata":false},{"id":59982,"structure_id":13628,"section_number":"38.2-3523.3","catch_line":"Requirements for those marketing group accident and sickness insurance","url":"\/38.2-3523.3\/","token":"38.2\/35\/3\/38.2-3523.3","metadata":false},{"id":84584,"structure_id":13628,"section_number":"38.2-3523.4","catch_line":"Minimum number of persons covered","url":"\/38.2-3523.4\/","token":"38.2\/35\/3\/38.2-3523.4","metadata":false},{"id":54597,"structure_id":13628,"section_number":"38.2-3524","catch_line":"Repealed","url":"\/38.2-3524\/","token":"38.2\/35\/3\/38.2-3524","metadata":false},{"id":78059,"structure_id":13628,"section_number":"38.2-3525","catch_line":"Group accident and sickness insurance coverages of spouses, dependent children or other persons","url":"\/38.2-3525\/","token":"38.2\/35\/3\/38.2-3525","metadata":false},{"id":70591,"structure_id":13628,"section_number":"38.2-3526","catch_line":"Standard provisions required; exceptions","url":"\/38.2-3526\/","token":"38.2\/35\/3\/38.2-3526","metadata":false},{"id":66611,"structure_id":13628,"section_number":"38.2-3527","catch_line":"Grace period","url":"\/38.2-3527\/","token":"38.2\/35\/3\/38.2-3527","metadata":false},{"id":71054,"structure_id":13628,"section_number":"38.2-3528","catch_line":"Incontestability","url":"\/38.2-3528\/","token":"38.2\/35\/3\/38.2-3528","metadata":false},{"id":80053,"structure_id":13628,"section_number":"38.2-3529","catch_line":"Entire contract; statements deemed representations","url":"\/38.2-3529\/","token":"38.2\/35\/3\/38.2-3529","metadata":false},{"id":59015,"structure_id":13628,"section_number":"38.2-3530","catch_line":"Evidence of individual insurability","url":"\/38.2-3530\/","token":"38.2\/35\/3\/38.2-3530","metadata":false},{"id":57577,"structure_id":13628,"section_number":"38.2-3531","catch_line":"Additional exclusions and limitations","url":"\/38.2-3531\/","token":"38.2\/35\/3\/38.2-3531","metadata":false},{"id":66450,"structure_id":13628,"section_number":"38.2-3532","catch_line":"Misstatement of age","url":"\/38.2-3532\/","token":"38.2\/35\/3\/38.2-3532","metadata":false},{"id":85603,"structure_id":13628,"section_number":"38.2-3533","catch_line":"Individual certificates","url":"\/38.2-3533\/","token":"38.2\/35\/3\/38.2-3533","metadata":false},{"id":72638,"structure_id":13628,"section_number":"38.2-3534","catch_line":"Notice of claim","url":"\/38.2-3534\/","token":"38.2\/35\/3\/38.2-3534","metadata":false},{"id":65149,"structure_id":13628,"section_number":"38.2-3535","catch_line":"Claim forms","url":"\/38.2-3535\/","token":"38.2\/35\/3\/38.2-3535","metadata":false},{"id":79101,"structure_id":13628,"section_number":"38.2-3536","catch_line":"Proofs of loss","url":"\/38.2-3536\/","token":"38.2\/35\/3\/38.2-3536","metadata":false},{"id":72065,"structure_id":13628,"section_number":"38.2-3537","catch_line":"Time of payment of claims","url":"\/38.2-3537\/","token":"38.2\/35\/3\/38.2-3537","metadata":false},{"id":65230,"structure_id":13628,"section_number":"38.2-3538","catch_line":"Payment of benefits","url":"\/38.2-3538\/","token":"38.2\/35\/3\/38.2-3538","metadata":false},{"id":69184,"structure_id":13628,"section_number":"38.2-3539","catch_line":"Physical examinations and autopsy","url":"\/38.2-3539\/","token":"38.2\/35\/3\/38.2-3539","metadata":false},{"id":77451,"structure_id":13628,"section_number":"38.2-3540","catch_line":"Legal actions","url":"\/38.2-3540\/","token":"38.2\/35\/3\/38.2-3540","metadata":false},{"id":58127,"structure_id":13628,"section_number":"38.2-3540.1","catch_line":"Claims experience","url":"\/38.2-3540.1\/","token":"38.2\/35\/3\/38.2-3540.1","metadata":false},{"id":82316,"structure_id":13628,"section_number":"38.2-3540.2","catch_line":"Employee wellness program","url":"\/38.2-3540.2\/","token":"38.2\/35\/3\/38.2-3540.2","metadata":false},{"id":55325,"structure_id":13628,"section_number":"38.2-3541","catch_line":"Continuation on termination of eligibility","url":"\/38.2-3541\/","token":"38.2\/35\/3\/38.2-3541","metadata":false},{"id":61422,"structure_id":13628,"section_number":"38.2-3541.1","catch_line":"Repealed","url":"\/38.2-3541.1\/","token":"38.2\/35\/3\/38.2-3541.1","metadata":false},{"id":63267,"structure_id":13628,"section_number":"38.2-3541.2","catch_line":"Enrollment following change in eligibility status under assistance programs","url":"\/38.2-3541.2\/","token":"38.2\/35\/3\/38.2-3541.2","metadata":false},{"id":75709,"structure_id":13628,"section_number":"38.2-3542","catch_line":"Notice to employees upon termination of coverage; penalty for failure to remit funds","url":"\/38.2-3542\/","token":"38.2\/35\/3\/38.2-3542","metadata":false},{"id":81170,"structure_id":13628,"section_number":"38.2-3543","catch_line":"Provisions required by other jurisdictions","url":"\/38.2-3543\/","token":"38.2\/35\/3\/38.2-3543","metadata":false},{"id":83285,"structure_id":13628,"section_number":"38.2-3543.1","catch_line":"Regulations","url":"\/38.2-3543.1\/","token":"38.2\/35\/3\/38.2-3543.1","metadata":false},{"id":65251,"structure_id":13628,"section_number":"38.2-3543.2","catch_line":"Applicability of laws","url":"\/38.2-3543.2\/","token":"38.2\/35\/3\/38.2-3543.2","metadata":false}],"previous_section":{"id":59015,"structure_id":13628,"section_number":"38.2-3530","catch_line":"Evidence of individual insurability","url":"\/38.2-3530\/","token":"38.2\/35\/3\/38.2-3530","metadata":false},"next_section":{"id":66450,"structure_id":13628,"section_number":"38.2-3532","catch_line":"Misstatement of age","url":"\/38.2-3532\/","token":"38.2\/35\/3\/38.2-3532","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3531\/","history_text":"

This law was first created in 1986. The record of its establishment is cataloged in chapter 562 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. Unfortunately, the 1986 \u201cActs\u201d aren\u2019t available online. It has been modified 1 time. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. That modification is as follows: in 1998, chapter 24<\/a>.<\/p>","references":[{"id":70591,"section_number":"38.2-3526","catch_line":"Standard provisions required; exceptions","order_by":null,"url":"\/38.2-3526\/"}],"refers_to":false,"permalink":{"id":215809,"object_type":"law","relational_id":57577,"identifier":"38.2-3531","token":"38.2\/35\/3\/38.2-3531","url":"\/38.2-3531\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3531\/","token":"38.2\/35\/3\/38.2-3531","dublin_core":{"Title":"Additional exclusions and limitations","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3531","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Each group accident and sickness insurance<\/span> policy shall contain a provision specifying all additional exclusions or limitations applicable under the policy for any disease or physical condition of a person<\/span>, not otherwise excluded from the person<\/span>’s coverage by name or specific description effective on the date of the person<\/span>’s loss, which existed prior to the effective date of the person<\/span>’s coverage under the policy. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Any such exclusion or limitation may only apply to a disease or physical condition for which medical advice or treatment was received by the person<\/span> during the twelve months prior to the effective date of the person<\/span>’s coverage. The exclusion or limitation shall not apply to loss incurred or disability commencing after the earlier of (i) the end of a continuous period of twelve months commencing on or after the effective date of the person<\/span>’s coverage during which the person<\/span> receives no medical advice or treatment in connection with the disease or physical condition, or (ii) the end of the two-year period commencing on the effective date of the person<\/span>’s coverage. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> This section shall not apply to group accident and sickness policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis to an employer’s employees and their dependents. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nADDITIONAL EXCLUSIONS AND LIMITATIONS (\u00a7 38.2-3531)\n\nA. Each group accident and sickness insurance policy shall contain a provision\nspecifying all additional exclusions or limitations applicable under the policy\nfor any disease or physical condition of a person, not otherwise excluded from\nthe person’s coverage by name or specific description effective on the\ndate of the person’s loss, which existed prior to the effective date of\nthe person’s coverage under the policy.\n\nB. Any such exclusion or limitation may only apply to a disease or physical\ncondition for which medical advice or treatment was received by the person\nduring the twelve months prior to the effective date of the person’s\ncoverage. The exclusion or limitation shall not apply to loss incurred or\ndisability commencing after the earlier of (i) the end of a continuous period of\ntwelve months commencing on or after the effective date of the person’s\ncoverage during which the person receives no medical advice or treatment in\nconnection with the disease or physical condition, or (ii) the end of the\ntwo-year period commencing on the effective date of the person’s coverage.\n\nC. This section shall not apply to group accident and sickness policies\nproviding hospital, medical and surgical or major medical coverage on an expense\nincurred basis to an employer’s employees and their dependents.\n\nHISTORY: 1986, c. 562; 1998, c. 24.","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}}