                                 CODE OF VIRGINIA

COVERAGE OF NEWBORN CHILDREN REQUIRED (§ 38.2-3411)

A. Each individual and group accident and sickness insurance policy or
individual and group subscription contract providing coverage on an expense
incurred basis, and each health maintenance organization providing a health care
plan for health care services that provides coverage for a family member of the
insured or the subscriber shall, as to the family members&#8217; coverage, also
provide that the accident and sickness insurance benefits applicable for
children shall be payable with respect to a newly born child of the insured or
subscriber from the moment of birth.

B. Coverage for newly born children shall be identical to coverage provided to
the insured or subscriber except that, regardless of whether such coverage would
otherwise be provided under the terms and conditions of the insurance policy,
subscription contract, or health care plan, coverage shall be provided for:

   1. Necessary care and treatment of medically diagnosed congenital defects and
   birth abnormalities, with coverage limits no more restrictive than for any
   injury or sickness covered under the insurance policy, subscription contract,
   or health care plan; and

   2. Inpatient and outpatient dental, oral surgical, and orthodontic services
   that are medically necessary for the treatment of medically diagnosed cleft
   lip, cleft palate or ectodermal dysplasia. Such coverage shall be subject to
   any deductible, cost-sharing, and policy, contract, or health care plan
   maximum provisions, provided they are no more restrictive for such services
   than for any injury or sickness covered under the insurance policy,
   subscription contract, or health care plan.

C. If payment of a specific premium or subscription fee is required to provide
coverage for a child, the policy, subscription contract, or health care plan may
require that notification of birth of a newly born child and payment of the
required premium or fees shall be furnished to the insurer issuing the policy or
health care plan or corporation issuing the subscription contract within 31 days
after the date of birth in order to have the coverage continue beyond the 31-day
period.

HISTORY: 1975, c. 281, § 38.1-348.6; 1976, c. 342; 1986, c. 562; 1993, c. 263;
2013, c. 653.