                                 CODE OF VIRGINIA

ESSENTIAL HEALTH BENEFITS (§ 38.2-3451)

A. Notwithstanding any provision of law to the contrary, any person offering or
providing a health benefit plan providing individual or small group health
insurance coverage, including (i) catastrophic health insurance policies, and
policies that pay on a cost-incurred basis; (ii) association health plans; and
(iii) plans provided by a multiple-employer welfare arrangement, shall provide
that such coverage includes essential health benefits. Nothing in this section
shall require a health benefit plan providing large group health insurance
coverage to provide coverage for essential health benefits in a manner that
exceeds the requirements of the PPACA as of January 1, 2019. The essential
health benefits package may also include associated cost-sharing requirements or
limitations.

B. The provisions of subsection A requiring minimum essential pediatric oral
health benefits shall be deemed to be satisfied for health benefit plans made
available in the small group market or individual market in the Commonwealth
outside an exchange, as defined in § 38.2-3455, issued for policy or plan years
beginning on or after January 1, 2015, that do not include the minimum essential
pediatric oral health benefits if the health carrier has obtained reasonable
assurance that such pediatric oral health benefits are provided to the purchaser
of the health benefit plan. The health carrier shall be deemed to have obtained
reasonable assurance that such pediatric oral health benefits are provided to
the purchaser of the health benefit plan if:

   1. At least one qualified dental plan, as defined in &#xA7; 38.2-3455, (i)
   offers the minimum essential pediatric oral health benefits and (ii) is
   available for purchase by the small group or individual purchaser; and

   2. The health carrier prominently discloses, in a form approved by the
   Commission, at the time that it offers the health benefit plan that the plan
   does not provide the minimum essential pediatric oral health benefits.

HISTORY: 2013, c. 751; 2014, cc. 307, 369; 2020, c. 1160; 2021, Sp. Sess. I, cc.
101, 102.