Article 1 General Provisions
This article is comprised of the following sections:
- §38.2-3400 Application of chapter
- §38.2-3401 Forms of insurance authorized
- §38.2-3402 Certification to accompany application
- §38.2-3403 Fraudulent procurement of policy
- §38.2-3404 Commission may establish rules and regulations for simplified and readable accident and sickness insurance policies
- §38.2-3405 Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; limitations on disclosure of medical treatment options prohibited
- §38.2-3405.1 Commonwealth’s right to certain accident and sickness benefits
- §38.2-3406 Accident and sickness benefits not subject to legal process
- §38.2-3406.1 Application of requirements that policies offered by small employers include state-mandated health benefits
- §38.2-3406.2 Capped benefits under insurance policies and contracts
- §38.2-3407 Health benefit programs
- §38.2-3407.1 Interest on accident and sickness claim proceeds
- §38.2-3407.10 Health care provider panels
- §38.2-3407.10:1 Processing of new provider applications and reimbursement for services rendered during pendency of a participating provider’s credentialing application
- §38.2-3407.10:2 Credentialing of private mental health agencies
- §38.2-3407.11 Access to obstetrician-gynecologists
- §38.2-3407.11:1 Access to specialists; standing referrals
- §38.2-3407.11:2 Standing referral for cancer patients
- §38.2-3407.11:3 Breast cancer underwriting and preexisting condition restrictions
- §38.2-3407.11:4 Disability arising out of childbirth; minimum benefit
- §38.2-3407.11:5 Interhospital transfer for newborn or mother; prior authorization prohibited
- §38.2-3407.12 Patient optional point-of-service benefit
- §38.2-3407.13 Refusal to accept assignments prohibited; dentists and oral surgeons
- §38.2-3407.13:1 Coordination of benefits; notice of priority of coverage
- §38.2-3407.13:2 Claims paid to insureds for services from nonparticipating physicians
- §38.2-3407.14 Notice of premium or deductible increases
- §38.2-3407.14:1 Standard of clinical evidence for decisions on coverage for proton radiation therapy
- §38.2-3407.15 Ethics and fairness in carrier business practices
- §38.2-3407.15:1 Carrier contracts with pharmacy providers; required provisions; limit on termination or nonrenewal
- §38.2-3407.15:2 (Effective January 1, 2027) Carrier contracts; required provisions regarding prior authorization for drug benefits
- §38.2-3407.15:3 Carrier and intermediary contracts with pharmacy providers; disclosure and updating of maximum allowable cost of drugs; limit on termination or nonrenewal
- §38.2-3407.15:4 Limit on copayment for prescription drugs; permitted disclosures
- §38.2-3407.15:5 Limit on cost-sharing payments for prescription insulin drugs
- §38.2-3407.15:6 Prescription drug price transparency
- §38.2-3407.15:7 Carrier provision of certain information
- §38.2-3407.15:8 (Effective January 1, 2027) Carrier contracts; required provisions regarding prior authorization for health care services
- §38.2-3407.16 Requirements for obstetrical care
- §38.2-3407.17 Payment for services by dentists and oral surgeons
- §38.2-3407.17:1 Payment and reimbursement practices for dental services; network access
- §38.2-3407.18 Requirements for orally administered cancer chemotherapy drugs
- §38.2-3407.19 Payment for services by optometrists and ophthalmologists
- §38.2-3407.2 Coverage for medical child support
- §38.2-3407.20 Calculation of enrollee’s contribution to out-of-pocket maximum or cost-sharing requirement
- §38.2-3407.21 Short-term limited-duration medical plans
- §38.2-3407.22 Option for rebates to enrollees; protected information
- §38.2-3407.3 Calculation of cost-sharing provisions
- §38.2-3407.3:1 Premium payment arrearages; order of crediting payments
- §38.2-3407.4 Explanation of benefits
- §38.2-3407.4:1 Repealed
- §38.2-3407.4:2 Requirements for prescription benefit cards
- §38.2-3407.5 Denial of benefits for certain prescription drugs prohibited
- §38.2-3407.5:1 Coverage for prescription contraceptives
- §38.2-3407.5:2 Reimbursements for dispensing hormonal contraceptives
- §38.2-3407.6 Exclusion of podiatrist not permitted under certain circumstances
- §38.2-3407.6:1 Denial of benefits for certain prescription drugs prohibited
- §38.2-3407.7 Pharmacies; freedom of choice
- §38.2-3407.8 Repealed
- §38.2-3407.9 Reimbursement for emergency medical services vehicle transportation services
- §38.2-3407.9:01 Prescription drug formularies
- §38.2-3407.9:02 Requirement for prescription drug coverage
- §38.2-3407.9:03 Payment of clean claims to administrators of pharmacy benefits
- §38.2-3407.9:04 Medication synchronization
- §38.2-3407.9:05 Step therapy protocols