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Code of Virginia

Article 1

General Provisions

38.2-3400Application of chapter 38.2-3401Forms of insurance authorized 38.2-3402Certification to accompany application 38.2-3403Fraudulent procurement of policy 38.2-3404Commission may establish rules and regulations for simplified and readable accident and sickness insurance policies 38.2-3405Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; limitations on disclosure of medical treatment options prohibited 38.2-3405.1Commonwealth's right to certain accident and sickness benefits 38.2-3406Accident and sickness benefits not subject to legal process 38.2-3406.1Application of requirements that policies offered by small employers include state-mandated health benefits 38.2-3406.2Capped benefits under insurance policies and contracts 38.2-3407Health benefit programs 38.2-3407.15(Effective until January 1, 2027) Ethics and fairness in carrier business practices 38.2-3407.15:2(Effective until January 1, 2027) Carrier contracts; required provisions regarding prior authorization 38.2-3407.5:3Coverage for early refills of prescription eye drops 38.2-3407.5:1Coverage for contraceptives 38.2-3407.5:2Reimbursements for dispensing hormonal contraceptives 38.2-3407.15:5Limit on cost-sharing payments for prescription insulin drugs 38.2-3407.15:9Limit on cost-sharing payments for prescription drugs under certain plans 38.2-3407.18:1Requirements for certain opioid antagonists 38.2-3407.23Prohibited restrictions on in-network referrals 38.2-3407.20Cost-sharing requirements; application of prohibition; calculation of enrollee's contribution 38.2-3407.1Interest on accident and sickness claim proceeds 38.2-3407.2Coverage for medical child support 38.2-3407.3Calculation of cost-sharing provisions 38.2-3407.3:1Premium payment arrearages; order of crediting payments 38.2-3407.4Explanation of benefits 38.2-3407.4:2Requirements for prescription benefit cards 38.2-3407.5Denial of benefits for certain prescription drugs prohibited 38.2-3407.6Exclusion of podiatrist not permitted under certain circumstances 38.2-3407.6:1Denial of benefits for certain prescription drugs prohibited 38.2-3407.7Pharmacies; freedom of choice 38.2-3407.9Reimbursement for emergency medical services vehicle transportation services 38.2-3407.9:01Prescription drug formularies 38.2-3407.9:02Requirement for prescription drug coverage 38.2-3407.9:03Payment of clean claims to administrators of pharmacy benefits 38.2-3407.9:04Medication synchronization 38.2-3407.9:05Step therapy protocols 38.2-3407.10Health care provider panels 38.2-3407.10:1Processing of new provider applications and reimbursement for services rendered during pendency of a participating provider's credentialing application 38.2-3407.10:2Credentialing of private mental health agencies 38.2-3407.11Access to obstetrician-gynecologists 38.2-3407.11:1Access to specialists; standing referrals 38.2-3407.11:2Standing referral for cancer patients 38.2-3407.11:3Breast cancer underwriting and preexisting condition restrictions 38.2-3407.11:4Disability arising out of childbirth; minimum benefit 38.2-3407.11:5Interhospital transfer for newborn or mother; prior authorization prohibited 38.2-3407.12Patient optional point-of-service benefit 38.2-3407.13Refusal to accept assignments prohibited; dentists and oral surgeons 38.2-3407.13:1Coordination of benefits; notice of priority of coverage 38.2-3407.13:2Claims paid to insureds for services from nonparticipating physicians 38.2-3407.14Notice of premium or deductible increases 38.2-3407.14:1Standard of clinical evidence for decisions on coverage for proton radiation therapy 38.2-3407.15:1Carrier contracts with pharmacy providers; required provisions; limit on termination or nonrenewal 38.2-3407.15:3Carrier and intermediary contracts with pharmacy providers; disclosure and updating of maximum allowable cost of drugs; limit on termination or nonrenewal 38.2-3407.15:4Limit on copayment for prescription drugs; permitted disclosures 38.2-3407.15:6Prescription drug price transparency 38.2-3407.15:7Carrier provision of certain information 38.2-3407.16Requirements for obstetrical care 38.2-3407.17Payment for services by dentists and oral surgeons 38.2-3407.17:1Payment and reimbursement practices for dental services; network access 38.2-3407.18Requirements for orally administered cancer chemotherapy drugs 38.2-3407.19Payment for services by optometrists and ophthalmologists 38.2-3407.21Short-term limited-duration medical plans 38.2-3407.22Option for rebates to enrollees; protected information