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A BILL to amend and reenact §
38.1-4319
of the Code of Virginia and to amend the Code of Virginia by adding a section numbered
38.2-3418.23
, relating to health insurance; large group policies; coverage for scalp treatment during cancer chemotherapy treatment.
Be it enacted by the General Assembly of Virginia:
1. That §
38.2-4319
of the Code of Virginia is amended and reenacted and that the Code of Virginia is amended by adding a section numbered
38.2-3418.23
as follows:
§
38.2-3418
.
23. Coverage for scalp treatment during cancer chemotherapy treatment.
A.
Notwithstanding the provisions of §
38.2-3419
or subdivision A 1 of §
38.2-6506
,
in the large group market,
each insurer proposing to issue accident and sickness insurance policies providing
hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing accident and sickness subscription contracts; and each health maintenance organization providing a health care plan for health care services shall
provide
coverage under any such policy, contract, or plan
for scalp cooling systems for the preservation of hair during cancer chemotherapy treatment.
B. Coverage provided under this section may be subject to annual deductibles and coinsurance, including copayments, as may be deemed appr
opriate by the insurer, provided that such deductibles and coinsurance shall be consistently applied
as compared to other benefits
within the same policy, contract, or pla
n.
C. This section shall not apply to short-term travel, accident-only, or limited or specified disease policies or contracts
;
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 federal governmental plans
;
or
health care plans, contracts, or policies issued in the individual or small group market; or a qualified health plan when the plan is offered in the
Commonwealth by a health carrier through a health benefit exchange established under § 1311 of the federal Patient Protection and Affordable Care Act (P.L.
111-148
).
§
38.2-4319
. Statutory construction and relationship to other laws.
A. No provisions of this title except this chapter and, insofar as they are not inconsistent with this chapter, §§
38.2-100
,
38.2-136
,
38.2-200
,
38.2-203
,
38.2-209
through
38.2-213
,
38.2-216
,
38.2-218
through
38.2-225
,
38.2-229
,
38.2-232
,
38.2-305
,
38.2-316
,
38.2-316.1
,
38.2-316.2
,
38.2-322
,
38.2-325
,
38.2-326
,
38.2-400
,
38.2-402
through
38.2-413
,
38.2-500
through
38.2-515
,
38.2-600
through
38.2-629
, Chapter 9 (§
38.2-900
et seq.), §§
38.2-1016.1
through
38.2-1023
,
38.2-1057
, and
38.2-1306.1
, Article 2 (§
38.2-1306.2
et seq.), §
38.2-1315.1
, and Articles 3.1 (§
38.2-1316.1
et seq.), 4 (§
38.2-1317
et seq.), 5 (§
38.2-1322
et seq.), 5.1 (§
38.2-1334.3
et seq.), and 5.2 (§
38.2-1334.11
et seq.) of Chapter 13, Articles 1 (§
38.2-1400
et seq.), 2 (§
38.2-1412
et seq.), and 4 (§
38.2-1446
et seq.) of Chapter 14, Chapter 15 (§
38.2-1500
et seq.), Chapter 17 (§
38.2-1700
et seq.), §§
38.2-1800
through
38.2-1836
,
38.2-3401
,
38.2-3405
,
38.2-3405.1
,
38.2-3406.1
,
38.2-3407.2
through
38.2-3407.6:1
,
38.2-3407.9
through
38.2-3407.20
,
38.2-3411
,
38.2-3411.2
,
38.2-3411.3
,
38.2-3411.4
,
38.2-3412.1
,
38.2-3414.1
,
38.2-3418.1
through
38.2-3418.19
,
38.2-3418.21
,
38.2-3418.22
,
38.1-3418.23
,
38.2-3419.1
, and
38.2-3430.1
through
38.2-3454
, Articles 8 (§
38.2-3461
et seq.) and 9 (§
38.2-3465
et seq.) of Chapter 34, §
38.2-3500
, subdivision 13 of §
38.2-3503
, subdivision 8 of §
38.2-3504
, §§
38.2-3514.1
,
38.2-3514.2
,
38.2-3522.1
through
38.2-3523.4
,
38.2-3525
,
38.2-3540.1
,
38.2-3540.2
,
38.2-3541.2
,
38.2-3542
, and
38.2-3543.2
, Article 5 (§
38.2-3551
et seq.) of Chapter 35, Chapter 35.1 (§
38.2-3556
et seq.), §
38.2-3610
, Chapter 52 (§
38.2-5200
et seq.), Chapter 55 (§
38.2-5500
et seq.), Chapter 58 (§
38.2-5800
et seq.), Chapter 65 (§
38.2-6500
et seq.), and Chapter 66 (§
38.2-6600
et seq.) shall be applicable to any health maintenance organization granted a license under this chapter. This chapter shall not apply to an insurer or health services plan licensed and regulated in conformance with the insurance laws or Chapter 42 (§
38.2-4200
et seq.) except with respect to the activities of its health maintenance organization.
B. For plans administered by the Department of Medical Assistance Services that provide benefits pursuant to Title XIX or Title XXI of the Social Security Act, as amended, no provisions of this title except this chapter and, insofar as they are not inconsistent with this chapter, §§
38.2-100
,
38.2-136
,
38.2-200
,
38.2-203
,
38.2-209
through
38.2-213
,
38.2-216
,
38.2-218
through
38.2-225
,
38.2-229
,
38.2-232
,
38.2-322
,
38.2-325
,
38.2-400
,
38.2-402
through
38.2-413
,
38.2-500
through
38.2-515
, and
38.2-600
through
38.2-629
, Chapter 9 (§
38.2-900
et seq.), §§
38.2-1016.1
through
38.2-1023
,
38.2-1057
, and
38.2-1306.1
, Article 2 (§
38.2-1306.2
et seq.), §
38.2-1315.1
, Articles 3.1 (§
38.2-1316.1
et seq.), 4 (§
38.2-1317
et seq.), 5 (§
38.2-1322
et seq.), 5.1 (§
38.2-1334.3
et seq.), and 5.2 (§
38.2-1334.11
et seq.) of Chapter 13, Articles 1 (§
38.2-1400
et seq.), 2 (§
38.2-1412
et seq.), and 4 (§
38.2-1446
et seq.) of Chapter 14, §§
38.2-3401
,
38.2-3405
,
38.2-3407.2
through
38.2-3407.5
,
38.2-3407.6
,
38.2-3407.6:1
,
38.2-3407.9
,
38.2-3407.9:01
, and
38.2-3407.9:02
, subsection E of §
38.2-3407.10
, §§
38.2-3407.10:1
,
38.2-3407.11
,
38.2-3407.11:3
,
38.2-3407.13
,
38.2-3407.13:1
,
38.2-3407.14
,
38.2-3411.2
,
38.2-3418.1
,
38.2-3418.2
,
38.2-3418.16
,
38.2-3419.1
,
38.2-3430.1
through
38.2-3437
, and
38.2-3500
, subdivision 13 of §
38.2-3503
, subdivision 8 of §
38.2-3504
, §§
38.2-3514.1
,
38.2-3514.2
,
38.2-3522.1
through
38.2-3523.4
,
38.2-3525
,
38.2-3540.1
,
38.2-3540.2
,
38.2-3541.2
,
38.2-3542
, and
38.2-3543.2
, Chapter 52 (§
38.2-5200
et seq.), Chapter 55 (§
38.2-5500
et seq.), Chapter 58 (§
38.2-5800
et seq.), Chapter 65 (§
38.2-6500
et seq.), and Chapter 66 (§
38.2-6600
et seq.) shall be applicable to any health maintenance organization granted a license under this chapter. This chapter shall not apply to an insurer or health services plan licensed and regulated in conformance with the insurance laws or Chapter 42 (§
38.2-4200
et seq.) except with respect to the activities of its health maintenance organization.
C. Solicitation of enrollees by a licensed health maintenance organization or by its representatives shall not be construed to violate any provisions of law relating to solicitation or advertising by health professionals.
D. A licensed health maintenance organization shall not be deemed to be engaged in the unlawful practice of medicine. All health care providers associated with a health maintenance organization shall be subject to all provisions of law.
E. Notwithstanding the definition of an eligible employee as set forth in §
38.2-3431
, a health maintenance organization providing health care plans pursuant to §
38.2-3431
shall not be required to offer coverage to or accept applications from an employee who does not reside within the health maintenance organization's service area.
F. For purposes of applying this section, "insurer" when used in a section cited in subsections A and B shall be construed to mean and include "health maintenance organizations" unless the section cited clearly applies to health maintenance organizations without such construction.
2. That the provisions of this act shall apply to insurance policies, contracts, and plans delivered, issued for delivery, or renewed in the large group market in the Commonwealth on and after January 1, 2027.