                                 CODE OF VIRGINIA

CERTAIN SUBROGATION PROVISIONS AND LIMITATIONS UPON RECOVERY IN HOSPITAL,
MEDICAL, ETC., POLICIES FORBIDDEN; LIMITATIONS ON DISCLOSURE OF MEDICAL
TREATMENT OPTIONS PROHIBITED (§ 38.2-3405)

A. No insurance contract providing hospital, medical, surgical and similar or
related benefits, and no subscription contract or health services plan delivered
or issued for delivery or providing for payment of benefits to or on behalf of
persons residing in or employed in this Commonwealth shall contain any provision
providing for subrogation of any person&#8217;s right to recovery for personal
injuries from a third person.

B. No such contract, subscription contract or health services plan shall contain
any provision requiring the beneficiary of any such contract or plan to sign any
agreement to pay back to any company issuing such a contract or creating a
health services plan any benefits paid pursuant to the terms of such contract 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&#8217; compensation laws or federal or
state programs, nor shall this provision prohibit coordination of benefits
provisions when there are two or more such accident and sickness insurance
contracts 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 contract or any
benefits paid, payable, or provided by any medical expense or medical payments
insurance provided in conjunction with liability coverage.

C. No insurance contract providing hospital, medical, surgical and similar or
related benefits, and no subscription contract or health services plan delivered
or issued for delivery or providing for payment of benefits to or on behalf of
persons residing in or employed in this Commonwealth shall contain any provision
limiting, restricting, or prohibiting a physician from disclosing fully all
medical treatment options to patients whether or not such treatment options are
(i) experimental or covered services, (ii) services that the health insurer will
not authorize, or (iii) the costs of the treatment will be borne by the health
insurer 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, &#8220;medical treatment options&#8221;
means any alternative or experimental therapeutic, psychiatric, medical
treatment or procedure, health care service, drug, or remedy.

D. Whenever benefits paid or payable under workers&#8217; compensation are
excluded from coverage under the terms of any such contract, subscription
contract or health services plan, the issuer thereof shall not exclude coverage
for any medical condition pursuant to such exclusion if (i) an award of the
Workers&#8217; Compensation Commission pursuant to &#xA7; 65.2-704 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; 65.2-705 or (ii) an award of the Workers&#8217; Compensation Commission,
after review by the full Commission pursuant to &#xA7; 65.2-705, denies
compensation benefits relating to such medical condition. Following the entry of
a workers&#8217; 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 contract, subscription contract or health services plan. If,
upon appeal to the Court of Appeals or the Supreme Court, such medical condition
is held to be compensable under the Virginia Workers&#8217; Compensation Act
(Title 65.2), the issuer may recover from the applicable employer or
workers&#8217; compensation insurance carrier the costs of coverage for medical
conditions found to be compensable under the Act.

HISTORY: 1973, c. 28, § 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.