<?xml version="1.0"?>
<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>81548</law_id><section_number>38.2-3442</section_number><catch_line>Preventive services</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="6">Federal Market Reforms</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> Notwithstanding any provision of &#xA7; <a class="law" title="Application of requirements that policies offered by small employers include state-mandated health benefits" href="/38.2-3406.1/">38.2-3406.1</a> or <a class="law" title="Coverage for child health supervision services" href="/38.2-3411.1/">38.2-3411.1</a> or any other section of this title to the contrary, a health carrier shall provide coverage for preventive services and shall not impose any cost-sharing requirements such as a copayment, coinsurance, or deductible. <a id="paragraph-292080" class="section-permalink" href="https://vacode.org/38.2-3442/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> A health carrier shall provide coverage for any items or services under the most current recommendations and guidelines within the scope of preventive services as required by the PPACA as in effect on January 1, 2019. <a id="paragraph-292081" class="section-permalink" href="https://vacode.org/38.2-3442/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> 1. A health carrier may impose cost-sharing requirements with respect to an office visit if an item or service is billed separately or is tracked as individual encounter data separately from the office visit. <a id="paragraph-292082" class="section-permalink" href="https://vacode.org/38.2-3442/#C"><i class="fa fa-link"/></a></p></section>
						<section id="C2" class="indent-1"><p><span class="prefix-number">2.</span> A health carrier shall not impose cost-sharing requirements with respect to an office visit if an item or service is not billed separately or is not tracked as individual encounter data separately from the office visit and the primary purpose of the office visit is the delivery of the item or service. <a id="paragraph-292083" class="section-permalink" href="https://vacode.org/38.2-3442/#C2"><i class="fa fa-link"/></a></p></section>
						<section id="C3" class="indent-1"><p><span class="prefix-number">3.</span> A health carrier may impose cost-sharing requirements with respect to an office visit if an item or service is not billed separately or is not tracked as individual encounter data separately from the office visit and the primary purpose of the office visit is not the delivery of the item or service. <a id="paragraph-292084" class="section-permalink" href="https://vacode.org/38.2-3442/#C3"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> Nothing in this section shall preclude a health carrier that has a network of providers from imposing cost-sharing requirements for items or services that are delivered by an out-of-network provider. <a id="paragraph-292085" class="section-permalink" href="https://vacode.org/38.2-3442/#D"><i class="fa fa-link"/></a></p></section>
						<section id="E"><p><span class="prefix-number">E.</span> This section shall apply to any health carrier providing individual or group health <span class="dictionary">insurance</span> coverage, except for any grandfathered plan. <a id="paragraph-292086" class="section-permalink" href="https://vacode.org/38.2-3442/#E"><i class="fa fa-link"/></a></p></section></text><history>2011, c. 882; 2013, c. 751; 2020, c. 1160.</history><metadata></metadata></law>
