                                 CODE OF VIRGINIA

COVERAGE FOR CHILD HEALTH SUPERVISION SERVICES (§ 38.2-3411.1)

A. Every individual or group accident and sickness insurance policy,
subscription contract providing coverage under a health services plan, or
evidence of coverage of a health care plan delivered or issued for delivery in
the Commonwealth or renewed, reissued, or extended if already issued, shall
offer and make available coverage under such policy or plan for child health
supervision services to provide for the periodic examination of children covered
under such policy or plan.

B. As used in this section, the term &#8220;child health supervision
services&#8221; means the periodic review of a child&#8217;s physical and
emotional status by a licensed and qualified physician or pursuant to a
physician&#8217;s supervision. A review shall include but not be limited to a
history, complete physical examination, developmental assessment, anticipatory
guidance, appropriate immunizations, and laboratory tests in keeping with
prevailing medical standards.

C. Each such policy or plan, offering and making available such coverage, shall,
at a minimum, provide benefits for child health supervision services at
approximately the following age intervals: birth, two months, four months, six
months, nine months, 12 months, 15 months, 18 months, two years, three years,
four years, five years, and six years. A policy or plan may provide that child
health supervision services which are rendered during a periodic review shall
only be covered to the extent that such services are provided by or under the
supervision of a single physician during the course of one visit.

D. Benefits for coverage for child health supervision services shall be exempt
from any copayment, coinsurance, deductible, or other dollar limit provision in
the policy or plan. Such exemption shall be expressly stated on the policy,
plan, rider, endorsement, or other attachment providing such coverage.

E. The premiums for such coverage shall take into consideration (i) the cost of
providing such coverage, (ii) cost savings realized or likely to be realized as
a consequence of such coverage, (iii) a reasonable profit for the insurer, and
(iv) any other relevant information or data the Commission deems appropriate.

F. This section shall not apply (i) to any insurer or health services plan
having fewer than 1,000 covered individuals insured or covered in Virginia or
less than $500,000 in premiums in Virginia as of its last annual statement, (ii)
to short-term travel or accident only policies, (iii) to short-term nonrenewable
policies of not more than six months&#8217; duration, or (iv) to specified
disease, hospital indemnity or other limited benefit policies issued to provide
supplemental benefits to a policy providing primary care benefits.

G. 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: 1990, c. 901; 2000, c. 118; 2011, c. 882.