§ 38.2-3400 Application of chapter.
§ 38.2-3401 Forms of insurance authorized.
§ 38.2-3402 Certification to accompany application.
§ 38.2-3403 Fraudulent procurement of policy.
§ 38.2-3404 Commission may establish rules and regulations for simplified and readable accident and sickness insurance policies.
§ 38.2-3405 Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; limitations on disclosure of medical treatment options prohibited.
§ 38.2-3405.1 Commonwealth’s right to certain accident and sickness benefits.
§ 38.2-3406 Accident and sickness benefits not subject to legal process.
§ 38.2-3406.1 Application of requirements that policies offered by small employers include state-mandated health benefits.
§ 38.2-3406.2 Capped benefits under insurance policies and contracts.
§ 38.2-3407 Health benefit programs.
§ 38.2-3407.1 Interest on accident and sickness claim proceeds.
§ 38.2-3407.2 Coverage for medical child support.
§ 38.2-3407.3 Calculation of cost-sharing provisions.
§ 38.2-3407.3:1 Premium payment arrearages; order of crediting payments.
§ 38.2-3407.4 Explanation of benefits.
§ 38.2-3407.4:1 Repealed.
§ 38.2-3407.4:2 Requirements for prescription benefit cards.
§ 38.2-3407.5 Denial of benefits for certain prescription drugs prohibited.
§ 38.2-3407.5:1 Coverage for prescription contraceptives.
§ 38.2-3407.5:2 Reimbursements for dispensing hormonal contraceptives.
§ 38.2-3407.6 Exclusion of podiatrist not permitted under certain circumstances.
§ 38.2-3407.6:1 Denial of benefits for certain prescription drugs prohibited.
§ 38.2-3407.7 Pharmacies; freedom of choice.
§ 38.2-3407.8 Repealed.
§ 38.2-3407.9 Reimbursement for emergency medical services vehicle transportation services.
§ 38.2-3407.9:01 Prescription drug formularies.
§ 38.2-3407.9:02 Requirement for prescription drug coverage.
§ 38.2-3407.9:03 Payment of clean claims to administrators of pharmacy benefits.
§ 38.2-3407.9:04 Medication synchronization.
§ 38.2-3407.9:05 Step therapy protocols.
§ 38.2-3407.10 Health care provider panels.
§ 38.2-3407.10:1 Processing of new provider applications and reimbursement for services rendered during pendency of a participating provider’s credentialing application.
§ 38.2-3407.10:2 Credentialing of private mental health agencies.
§ 38.2-3407.11 Access to obstetrician-gynecologists.
§ 38.2-3407.11:1 Access to specialists; standing referrals.
§ 38.2-3407.11:2 Standing referral for cancer patients.
§ 38.2-3407.11:3 Breast cancer underwriting and preexisting condition restrictions.
§ 38.2-3407.11:4 Disability arising out of childbirth; minimum benefit.
§ 38.2-3407.11:5 Interhospital transfer for newborn or mother; prior authorization prohibited.
§ 38.2-3407.12 Patient optional point-of-service benefit.
§ 38.2-3407.13 Refusal to accept assignments prohibited; dentists and oral surgeons.
§ 38.2-3407.13:1 Coordination of benefits; notice of priority of coverage.
§ 38.2-3407.13:2 Claims paid to insureds for services from nonparticipating physicians.
§ 38.2-3407.14 Notice of premium or deductible increases.
§ 38.2-3407.14:1 Standard of clinical evidence for decisions on coverage for proton radiation therapy.
§ 38.2-3407.15 Ethics and fairness in carrier business practices.
§ 38.2-3407.15:1 Carrier contracts with pharmacy providers; required provisions; limit on termination or nonrenewal.
§ 38.2-3407.15:2 Carrier contracts; required provisions regarding prior authorization.
§ 38.2-3407.15:3 Carrier and intermediary contracts with pharmacy providers; disclosure and updating of maximum allowable cost of drugs; limit on termination or nonrenewal.
§ 38.2-3407.15:4 Limit on copayment for prescription drugs; permitted disclosures.
§ 38.2-3407.15:5 Limit on cost-sharing payments for prescription insulin drugs.
§ 38.2-3407.15:6 Prescription drug price transparency.
§ 38.2-3407.15:7 Carrier provision of certain information.
§ 38.2-3407.16 Requirements for obstetrical care.
§ 38.2-3407.17 Payment for services by dentists and oral surgeons.
§ 38.2-3407.17:1 Payment and reimbursement practices for dental services; network access.
§ 38.2-3407.18 Requirements for orally administered cancer chemotherapy drugs.
§ 38.2-3407.19 Payment for services by optometrists and ophthalmologists.
§ 38.2-3407.20 Calculation of enrollee’s contribution to out-of-pocket maximum or cost-sharing requirement.
§ 38.2-3407.21 Short-term limited-duration medical plans.
§ 38.2-3407.22 Option for rebates to enrollees; protected information.
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Terms Used In Virginia Code > Title 38.2 > Chapter 34 > Article 1 - General Provisions.

  • Accident and sickness insurance: means insurance against loss resulting from sickness, or from bodily injury or death by accident or accidental means, or from a combination of any or all of these perils. See Virginia Code 38.2-109
  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Annuities: means all agreements to make periodic payments in specified or calculable sums pursuant to the terms of a contract for a stated period of time or for the life of the person or persons specified in the contract. See Virginia Code 38.2-106
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
  • Attorney: means the person designated and authorized by subscribers as the attorney-in-fact having authority to obligate them on reciprocal insurance contracts. See Virginia Code 38.2-1201
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Bureau of Insurance: means the division of the Commission established to administer the insurance laws of the Commonwealth. See Virginia Code 38.2-100
  • business of insurance: include solicitation, negotiations preliminary to execution, execution of an insurance contract, and the transaction of matters subsequent to execution of the contract and arising out of it. See Virginia Code 38.2-100
  • Commission: means the State Corporation Commission. See Virginia Code 38.2-100
  • Company: means any association, aggregate of individuals, business, corporation, individual, joint-stock company, Lloyds type of organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Virginia Code 38.2-100
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Dependent: A person dependent for support upon another.
  • Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) Source: OCC
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fraud: Intentional deception resulting in injury to another.
  • Garnishment: Generally, garnishment is a court proceeding in which a creditor asks a court to order a third party who owes money to the debtor or otherwise holds assets belonging to the debtor to turn over to the creditor any of the debtor
  • Health services plan: means any arrangement for offering or administering health services or similar or related services by a corporation licensed under Virginia Code 38.2-100
  • in writing: include any representation of words, letters, symbols, numbers, or figures, whether (i) printed or inscribed on a tangible medium or (ii) stored in an electronic or other medium and retrievable in a perceivable form and whether an electronic signature authorized by Virginia Code 1-257
  • Includes: means includes, but not limited to. See Virginia Code 1-218
  • insurance policies: shall include contracts of fidelity, indemnity, guaranty and suretyship. See Virginia Code 38.2-100
  • Insurer: means an insurance company. See Virginia Code 38.2-100
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • Life insurance: includes policies that also provide (i) endowment benefits; (ii) additional benefits incidental to a loss in the event of death, dismemberment, or loss by accident or accidental means; (iii) additional benefits to safeguard the contract from lapse or to provide a special surrender value, a special benefit or an annuity, in the event of total and permanent disability of the insured; and (iv) optional modes of settlement of proceeds. See Virginia Code 38.2-102
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • Medicare: means the "Health Insurance for the Aged Act" Title XVIII of the Social Security Amendment of 1965, as amended. See Virginia Code 38.2-100
  • Month: means a calendar month and "year" means a calendar year. See Virginia Code 1-223
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Person: means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds type of organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Virginia Code 38.2-100
  • Process: includes subpoenas, the summons and complaint in a civil action, and process in statutory actions. See Virginia Code 1-237
  • rates: means any rate of premium, policy fee, membership fee or any other charge made by an insurer for or in connection with a contract or policy of insurance. See Virginia Code 38.2-100
  • Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
  • Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
  • State: means any commonwealth, state, territory, district or insular possession of the United States. See Virginia Code 38.2-100
  • Statute: A law passed by a legislature.
  • Subscriber: means a person obligated under a reciprocal insurance agreement. See Virginia Code 38.2-1201
  • Supreme Court: means the Supreme Court of Virginia. See Virginia Code 1-249
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • United States: includes the 50 states, the District of Columbia the Commonwealth of Puerto Rico, Guam, the Northern Mariana Islands and the United States Virgin Islands. See Virginia Code 1-255
  • Writ: A formal written command, issued from the court, requiring the performance of a specific act.