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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>62539</law_id><section_number>38.2-3405</section_number><catch_line>Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; limitations on disclosure of medical treatment options prohibited</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>38.2-207</reference><reference>38.2-3407.13:1</reference><reference>38.2-4214</reference><reference>38.2-4319</reference><reference>38.2-4509</reference></referred_to_by><structure><unit label="title" level="1" order_by="1" identifier="38.2">Insurance</unit><unit label="chapter" level="2" order_by="1" identifier="34">Provisions Relating to Accident and Sickness Insurance</unit><unit label="article" level="3" order_by="1" identifier="1">General Provisions</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> No <span class="dictionary">insurance</span> <span class="dictionary">contract</span> providing hospital, medical, surgical and similar or related benefits, and no subscription <span class="dictionary">contract</span> or <span class="dictionary">health services plan</span> delivered or issued for delivery or providing for payment of benefits to or on behalf of <span class="dictionary">persons</span> residing in or employed in this Commonwealth shall contain any provision providing for subrogation of any <span class="dictionary">person</span>&#x2019;s right to recovery for personal injuries from a third <span class="dictionary">person</span>. <a id="paragraph-228077" class="section-permalink" href="https://vacode.org/38.2-3405/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> No such <span class="dictionary">contract</span>, subscription <span class="dictionary">contract</span> or <span class="dictionary">health services plan</span> shall contain any provision requiring the beneficiary of any such <span class="dictionary">contract</span> or plan to sign any agreement to pay back to any <span class="dictionary">company</span> issuing such a <span class="dictionary">contract</span> or creating a <span class="dictionary">health services plan</span> any benefits paid pursuant to the terms of such <span class="dictionary">contract</span> or plan from the proceeds of a recovery by such a beneficiary from any other source; provided, that this provision shall not prohibit an exclusion of benefits paid or payable under workers&#x2019; compensation <span class="dictionary">laws</span> or federal or <span class="dictionary">state</span> programs, nor shall this provision prohibit coordination of benefits provisions when there are two or more such accident and sickness <span class="dictionary">insurance contracts</span> or plans providing for the payment of the same benefits. Coordination of benefits provisions may not operate to reduce benefits because of any benefits paid, payable, or provided by any liability insurance <span class="dictionary">contract</span> or any benefits paid, payable, or provided by any medical expense or medical payments insurance provided in conjunction with liability coverage. <a id="paragraph-228078" class="section-permalink" href="https://vacode.org/38.2-3405/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> No insurance <span class="dictionary">contract</span> providing hospital, medical, surgical and similar or related benefits, and no subscription <span class="dictionary">contract</span> or <span class="dictionary">health services plan</span> delivered or issued for delivery or providing for payment of benefits to or on behalf of <span class="dictionary">persons</span> residing in or employed in this Commonwealth shall contain any provision limiting, restricting, or prohibiting a physician from disclosing fully all <span class="dictionary">medical treatment options</span> to patients whether or not such treatment options are (i) experimental or covered services, (ii) services that the health <span class="dictionary">insurer</span> will not authorize, or (iii) the costs of the treatment will be borne by the health <span class="dictionary">insurer</span> or the patient to facilitate an informed decision by the patient, if the physician determines that such an option is in the best interest of the patient. For the purposes of this subsection, &#x201C;<span class="dictionary">medical treatment options</span>&#x201D; means any alternative or experimental therapeutic, psychiatric, medical treatment or procedure, health care service, drug, or remedy. <a id="paragraph-228079" class="section-permalink" href="https://vacode.org/38.2-3405/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> Whenever benefits paid or payable under workers&#x2019; compensation are excluded from coverage under the terms of any such <span class="dictionary">contract</span>, subscription <span class="dictionary">contract</span> or <span class="dictionary">health services plan</span>, the issuer thereof shall not exclude coverage for any medical condition pursuant to such exclusion if (i) an award of the Workers&#x2019; Compensation <span class="dictionary">Commission</span> pursuant to &#xA7; <a class="law" title="Hearing; award or opinion by Commission" href="/65.2-704/">65.2-704</a> denies compensation benefits relating to such medical condition and no request for review of such award is made pursuant to and within the time prescribed by &#xA7; <a class="law" title="Review of award; rehearing" href="/65.2-705/">65.2-705</a> or (ii) an award of the Workers&#x2019; Compensation <span class="dictionary">Commission</span>, after review by the full <span class="dictionary">Commission</span> pursuant to &#xA7; <a class="law" title="Review of award; rehearing" href="/65.2-705/">65.2-705</a>, denies compensation benefits relating to such medical condition. Following the entry of a workers&#x2019; compensation award pursuant to clause (i) or (ii) having the effect of prohibiting the application of any such exclusion, the issuer shall immediately provide coverage for such medical condition to the extent otherwise covered under the <span class="dictionary">contract</span>, subscription <span class="dictionary">contract</span> or <span class="dictionary">health services plan</span>. If, upon <span class="dictionary">appeal</span> to the <span class="dictionary">Court</span> of <span class="dictionary">Appeals</span> or the Supreme <span class="dictionary">Court</span>, such medical condition is held to be compensable under the Virginia Workers&#x2019; Compensation Act (Title 65.2), the issuer may recover from the applicable employer or workers&#x2019; compensation insurance carrier the costs of coverage for medical conditions found to be compensable under the Act. <a id="paragraph-228080" class="section-permalink" href="https://vacode.org/38.2-3405/#D"><i class="fa fa-link"/></a></p></section></text><history>1973, c. 28, &#xA7; 38.1-342.2; 1979, c. 341; 1986, c. 562; 1988, c. 840; 1989, c. 487; 1994, c. 609; 1995, c. 68; 2004, c. 675.</history><metadata></metadata></law>
