                                 CODE OF VIRGINIA

STANDING REFERRAL FOR CANCER PATIENTS (§ 38.2-3407.11:2)

A. Each (i) insurer proposing to issue individual or group accident and sickness
insurance policies providing hospital, medical and surgical or major medical
coverage on an expense incurred basis, (ii) corporation providing individual or
group accident and sickness subscription contracts, and (iii) health maintenance
organization providing a health care plan for health care services, whose
policies, contracts or plans, including any certificate or evidence of coverage
issued in connection with such policies, contracts or plans, shall have a
procedure in place to permit any individual covered thereunder who has been
diagnosed with cancer to have a standing referral to a board-certified physician
in pain management or oncologist who is authorized to provide services under
such policy, contract or plan and has been selected by the cancer patient.

B. The board-certified physician in pain management or oncologist shall consult
on a regular basis, as required under the terms of the policy, contract or plan,
by telephone or through written communication, with the primary care physician
and any oncologist providing care to the patient concerning the plan of pain
management for the patient. Further, this section shall not be construed to
authorize the board-certified physician in pain management or oncologist to
direct the patient to other health care services.

C. Nothing contained herein shall prohibit an insurer, corporation, or health
maintenance organization from requiring a participating board-certified
physician in pain management or oncologist to provide written notification to
the cancer patient&#8217;s primary care physician of any visit to him. Such
notification may include a description of the health care services rendered at
the time of the visit.

D. Each insurer, corporation or health maintenance organization subject to the
provisions of this section shall inform subscribers, in writing, within the
policy or evidence of coverage of the provisions of this section.

E. The requirements of this section shall apply to all insurance policies,
contracts, and plans delivered, issued for delivery, reissued, renewed, or
extended or at any time when any term of any such policy, contract, or plan is
changed or any premium adjustment is made. The provisions of this section shall
not apply to short-term travel or accident-only policies, to short-term
nonrenewable policies of not more than six months&#8217; duration, or policies
or contracts issued to persons eligible under Title XVIII of the Social Security
Act, known as Medicare, or any other similar coverage under state or federal
governmental plans.

HISTORY: 1999, c. 856.