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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>59007</law_id><section_number>38.2-3417</section_number><catch_line>Deductibles and coinsurance options required</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><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="2">Mandated Benefits</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> An <span class="dictionary">insurer</span> issuing accident and sickness <span class="dictionary">insurance</span> or a corporation issuing subscription <span class="dictionary">contracts</span> on an expense incurred basis shall <span class="dictionary">make available</span> in offering such coverage or <span class="dictionary">contract</span> to the potential insured or <span class="dictionary">contract</span> holder one or more of the following options under which the individual insured or group certificate holder pays for: <a id="paragraph-216345" class="section-permalink" href="https://vacode.org/38.2-3417/#A"><i class="fa fa-link"/></a></p></section>
						<section id="A1" class="indent-1"><p><span class="prefix-number">1.</span> The first $100 of the cost of the services covered or benefits payable by the policy or <span class="dictionary">contract</span> during a 12-month period; <a id="paragraph-216346" class="section-permalink" href="https://vacode.org/38.2-3417/#A1"><i class="fa fa-link"/></a></p></section>
						<section id="A2" class="indent-1"><p><span class="prefix-number">2.</span> Twenty percent of the first $1,000 of the cost of the services covered or benefits payable by the policy or <span class="dictionary">contract</span> during a 12-month period; <a id="paragraph-216347" class="section-permalink" href="https://vacode.org/38.2-3417/#A2"><i class="fa fa-link"/></a></p></section>
						<section id="A3" class="indent-1"><p><span class="prefix-number">3.</span> The first $100 and 20 percent of the next $1,000 of the cost of the services covered or benefits payable by the policy or <span class="dictionary">contract</span> during a 12-month period; or <a id="paragraph-216348" class="section-permalink" href="https://vacode.org/38.2-3417/#A3"><i class="fa fa-link"/></a></p></section>
						<section id="A4" class="indent-1"><p><span class="prefix-number">4.</span> Any other option containing a greater deductible, coinsurance, or cost-sharing provision. However, the option shall not be inconsistent with standards established with respect to deductibles, coinsurance, or cost-sharing pursuant to &#xA7; <a class="law" title="Minimum standards for excepted benefits" href="/38.2-3519/">38.2-3519</a>. <a id="paragraph-216349" class="section-permalink" href="https://vacode.org/38.2-3417/#A4"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> As used in this section, &#x201C;<span class="dictionary">make available</span>&#x201D; means that the <span class="dictionary">insurer</span> or corporation shall disseminate information concerning the option or options and make a policy or <span class="dictionary">contract</span> containing the option or options available to potential insureds or <span class="dictionary">contract</span> holders at the same time and in the same manner as the <span class="dictionary">insurer</span> or corporation disseminates information concerning other policies or <span class="dictionary">contracts</span> and coverage options and makes other policies or <span class="dictionary">contracts</span> and coverage options available. <a id="paragraph-216350" class="section-permalink" href="https://vacode.org/38.2-3417/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> This section shall not apply to short-term travel, accident only, or limited or specified disease policies or <span class="dictionary">contracts</span>, nor to policies or <span class="dictionary">contracts</span> designed for issuance to <span class="dictionary">persons</span> eligible for coverage under Title XVIII of the Social Security Act, known as <span class="dictionary">Medicare</span>, or any other similar coverage under <span class="dictionary">state</span> or federal governmental plans. <a id="paragraph-216351" class="section-permalink" href="https://vacode.org/38.2-3417/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</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 (&#xA7; <a class="law" title="Definitions" href="/38.2-3438/">38.2-3438</a> et seq.) of Chapter 34. <a id="paragraph-216352" class="section-permalink" href="https://vacode.org/38.2-3417/#D"><i class="fa fa-link"/></a></p></section></text><history>1981, c. 322, &#xA7; 38.1-348.12:1; 1986, c. 562; 2013, c. 751; 2014, c. 814.</history><metadata></metadata></law>
