                                 CODE OF VIRGINIA

APPLICATION OF REQUIREMENTS THAT POLICIES OFFERED BY SMALL EMPLOYERS INCLUDE
STATE-MANDATED HEALTH BENEFITS (§ 38.2-3406.1)

A. As used in this section:
			&#8220;Eligible individual&#8221; means an individual who is employed by a
small employer and has satisfied applicable waiting period requirements.
			&#8220;Health insurance coverage&#8221; means benefits consisting of coverage
for costs of medical care, whether directly, through insurance or reimbursement,
or otherwise, and including items and services paid for as medical care under a
group policy of accident and sickness insurance, hospital or medical service
policy or certificate, hospital or medical service plan contract, or health
maintenance organization contract, which coverage is subject to this title or is
provided under a plan regulated under the Employee Retirement Income Security
Act of 1974.
			&#8220;Health insurer&#8221; means any insurance company that issues accident
and sickness insurance policies providing hospital, medical and surgical, or
major medical coverage on an expense-incurred basis, a corporation that provides
accident and sickness subscription contracts, or any health maintenance
organization that provides a health care plan that provides, arranges for, pays
for, or reimburses any part of the cost of any health care services, that is
licensed to engage in such business in the Commonwealth, and that is subject to
the laws of the Commonwealth that regulate insurance within the meaning of
&#xA7; 514(b)(2) of the Employee Retirement Income Security Act of 1974 (29
U.S.C. &#xA7; 1144(b)(2)).
			&#8220;Small employer&#8221; has the same meaning ascribed to the term in
&#xA7; 38.2-3431.
			&#8220;State-mandated health benefit&#8221; means coverage required under
this title or other laws of the Commonwealth to be provided in a policy of
accident and sickness insurance or a contract for a health-related condition
that (i) includes coverage for specific health care services or benefits; (ii)
places limitations or restrictions on deductibles, coinsurance, copayments, or
any annual or lifetime maximum benefit amounts; or (iii) includes a specific
category of licensed health care practitioners from whom an insured is entitled
to receive care. &#8220;State-mandated health benefit&#8221; includes, without
limitation, any coverage, or the offering of coverage, of a benefit or provider
pursuant to &#xA7;&#xA7; 38.2-3407.5 through 38.2-3407.6:1, 38.2-3407.9:01,
38.2-3407.9:02, 38.2-3407.11 through 38.2-3407.11:3, 38.2-3407.16, 38.2-3408,
38.2-3411 through 38.2-3414.1, 38.2-3418 through 38.2-3418.14, or &#xA7;
38.2-4221. For purposes of this article, &#8220;state-mandated health
benefit&#8221; does not include a benefit that is mandated by federal law.

B. Notwithstanding any statute, rule, or regulation to the contrary, and for the
purposes of this section, a group accident and sickness insurance policy
providing hospital, medical and surgical, or major medical coverage on an
expense-incurred basis; a group accident and sickness subscription contract
providing health insurance coverage for eligible individuals; and a health care
plan that provides, arranges for, pays for, or reimburses any part of the cost
of any health care services that is offered, sold, or issued by a health insurer
to a small employer:

   1. Shall not be required to include coverage, or the offer of coverage, for
   any state-mandated health benefit, except for:
   				a. Coverage for mammograms pursuant to &#xA7; 38.2-3418.1;
   				b. Coverage for pap smears pursuant to &#xA7; 38.2-3418.1:2;
   				c. Coverage for prostate cancer screening pursuant to &#xA7; 38.2-3418.7;
   and
   				d. Coverage for colorectal cancer screening pursuant to &#xA7;
   38.2-3418.7:1.

   2. May include any, or none, of the state-mandated health benefits not
   otherwise noted in subdivision B 1 as the health insurer and the small
   employer shall agree.
   				Notwithstanding any provision of this section to the contrary, if any plan
   authorized by this section includes and offers health care services covered by
   the plan that may be legally rendered by a health care provider listed in
   &#xA7; 38.2-3408, that plan shall allow for the reimbursement of such covered
   services when rendered by such provider. Unless otherwise provided in this
   section, this provision shall not require any benefit be provided as a covered
   service.

C. Any application and any enrollment form used in connection with coverage
under this section shall prominently disclose that the policy, contract, or
evidence of coverage is not required to provide state-mandated health benefits,
shall prominently disclose any and all state-mandated health benefits that the
policy, subscription contract, or evidence of coverage does not provide, and
shall clearly describe all eligibility requirements.

D. A policy form, subscription contract, or evidence of coverage issued under
this section to a small employer shall prominently disclose any and all
state-mandated health benefits that the policy, subscription contract, or
evidence of coverage does not provide. Such disclosure shall also be included in
certificate forms or other evidences of coverage furnished to each participant.
Health insurers proposing to issue forms providing coverage under this section
shall clearly disclose the intended purposes for such policies, contracts, or
evidences of coverage when submitting the forms to the Commission for approval
in accordance with &#xA7; 38.2-316.

E. The Commission shall adopt any regulations necessary to implement this
section.

F. 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; 38.2-3438 et seq.) of Chapter 34.

HISTORY: 2009, cc. 796, 877; 2010, cc. 155, 515, 687; 2011, c. 882; 2013, c.
751; 2016, c. 1; 2018, c. 782; 2025, cc. 237, 246.