                                 CODE OF VIRGINIA

BREAST CANCER UNDERWRITING AND PREEXISTING CONDITION RESTRICTIONS (§
38.2-3407.11:3)

A. No (i) insurer proposing to issue group accident and sickness insurance
policies or individual health insurance coverage providing hospital, medical and
surgical, major medical or cancer-only coverage on an expense-incurred basis,
and policies or contracts designed for issuance to persons eligible for coverage
under Title XVIII of the Social Security Act, known as Medicare, or any other
similar coverage under state or federal governmental plans; (ii) corporation
providing individual or group accident and sickness subscription contracts; or
(iii) health maintenance organization providing a health care plan for health
care services shall deny the issuance or renewal of, or cancel, a policy,
subscription contract or plan or include any exception or exclusion of benefits
in such policy, subscription contract or plan for the following:

   1. Solely because the insured has been diagnosed as having a fibrocystic
   condition or a nonmalignant lesion, or solely due to the family history of the
   insured related to breast cancer, or solely due to any combination of these
   factors; or

   2. Solely due to breast cancer, if the insured has been free from breast
   cancer for a period of five years or more prior to the date of application for
   coverage. In the case of coverage subject to &#xA7;&#xA7; 38.2-3432.3,
   38.2-3514.1 or &#xA7; 38.2-3605, the provisions of those sections shall be
   controlling as to the extent of any preexisting conditions period under such
   coverage.
   				Benefits provided under a policy, subscription contract or plan for such
   insureds shall be provided with durational limits, deductibles, coinsurance
   factors, and copayments that are no less favorable than for physical illness
   generally.

B. No (i) insurer proposing to issue group accident and sickness insurance
policies or individual health insurance coverage providing hospital, medical and
surgical or major medical coverage on an expense-incurred basis, and policies or
contracts designed for issuance to persons eligible for coverage under Title
XVIII of the Social Security Act, known as Medicare, or any other similar
coverage under state or federal governmental plans; (ii) corporation providing
individual or group accident and sickness subscription contracts; or (iii)
health maintenance organization providing a health care plan for health care
services shall consider routine follow-up care, used to determine whether a
breast cancer has recurred in a person who has been previously determined to be
free of breast cancer as evidenced by negative follow-up care for a period of at
least five years following completion of local and adjuvant therapies, to
constitute medical advice, diagnosis, care or treatment for purposes of
determining a preexisting condition unless evidence of breast cancer is found
during, or as a result of, the follow-up care.

C. 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, accident-only, limited or specified disease
policies except those providing coverage for cancer on an expense-incurred
basis, nor to short-term nonrenewable policies of not more than six
months&#8217; duration.

HISTORY: 2001, c. 242.