                                 CODE OF VIRGINIA

COVERAGE FOR LYMPHEDEMA (§ 38.2-3418.14)

A. Notwithstanding the provisions of &#xA7; 38.2-3419, each 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; each corporation providing individual or group accident
and sickness subscription contracts; and each health maintenance organization
providing a health care plan for health care services shall provide coverage for
lymphedema as provided in this section.

B. Coverage under this section shall include benefits for equipment, supplies,
complex decongestive therapy, and outpatient self-management training and
education for the treatment of lymphedema, if prescribed by a health care
professional legally authorized to prescribe or provide such items under law.

C. A managed care health insurance plan, as defined in Chapter 58 (&#xA7;
38.2-5800 et seq.) of this title, may require such health care professional to
be a member of the plan&#8217;s provider network, provided that such network
includes sufficient health care professionals who are qualified by specific
education, experience, and credentials to provide the covered benefits described
in this section.

D. No insurer, corporation, or health maintenance organization shall impose upon
any person receiving benefits pursuant to this section any copayment, fee,
policy year or calendar year, or durational benefit limitation or maximum for
benefits or services that is not equally imposed upon all individuals in the
same benefit category.

E. The requirements of this section shall apply to all insurance policies,
contracts and plans delivered, issued for delivery, reissued, or extended in
this Commonwealth on and after January 1, 2004, or at any time thereafter when
any term of the policy, contract or plan is changed or any premium adjustment is
made.

F. This section shall not apply to short-term travel, accident only, or limited
or specified disease policies or contracts, nor to 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.

HISTORY: 2003, c. 243; 2014, c. 814.