                                 CODE OF VIRGINIA

PREVENTIVE SERVICES (§ 38.2-3442)

A. Notwithstanding any provision of &#xA7; 38.2-3406.1 or 38.2-3411.1 or any
other section of this title to the contrary, a health carrier shall provide
coverage for preventive services and shall not impose any cost-sharing
requirements such as a copayment, coinsurance, or deductible.

B. A health carrier shall provide coverage for any items or services under the
most current recommendations and guidelines within the scope of preventive
services as required by the PPACA as in effect on January 1, 2019.

C. 1. A health carrier may impose cost-sharing requirements with respect to an
office visit if an item or service is billed separately or is tracked as
individual encounter data separately from the office visit.

   2. A health carrier shall not impose cost-sharing requirements with respect to
   an office visit if an item or service is not billed separately or is not
   tracked as individual encounter data separately from the office visit and the
   primary purpose of the office visit is the delivery of the item or service.

   3. A health carrier may impose cost-sharing requirements with respect to an
   office visit if an item or service is not billed separately or is not tracked
   as individual encounter data separately from the office visit and the primary
   purpose of the office visit is not the delivery of the item or service.

D. Nothing in this section shall preclude a health carrier that has a network of
providers from imposing cost-sharing requirements for items or services that are
delivered by an out-of-network provider.

E. This section shall apply to any health carrier providing individual or group
health insurance coverage, except for any grandfathered plan.

HISTORY: 2011, c. 882; 2013, c. 751; 2020, c. 1160.