§ 38.2-3405. Certain subrogation provisions and limitations upon recovery inhospital, medical, etc., policies forbidden; limitations on disclosure ofmedical treatment options prohibited.
A. No insurance contract providing hospital, medical, surgical and similar orrelated benefits, and no subscription contract or health services plandelivered or issued for delivery or providing for payment of benefits to oron behalf of persons residing in or employed in this Commonwealth shallcontain any provision providing for subrogation of any person's right torecovery for personal injuries from a third person.
B. No such contract, subscription contract or health services plan shallcontain any provision requiring the beneficiary of any such contract or planto sign any agreement to pay back to any company issuing such a contract orcreating a health services plan any benefits paid pursuant to the terms ofsuch contract or plan from the proceeds of a recovery by such a beneficiaryfrom any other source; provided, that this provision shall not prohibit anexclusion of benefits paid or payable under workers' compensation laws orfederal or state programs, nor shall this provision prohibit coordination ofbenefits provisions when there are two or more such accident and sicknessinsurance contracts or plans providing for the payment of the same benefits.Coordination of benefits provisions may not operate to reduce benefitsbecause of any benefits paid, payable, or provided by any liability insurancecontract or any benefits paid, payable, or provided by any medical expense ormedical payments insurance provided in conjunction with liability coverage.
C. No insurance contract providing hospital, medical, surgical and similar orrelated benefits, and no subscription contract or health services plandelivered or issued for delivery or providing for payment of benefits to oron behalf of persons residing in or employed in this Commonwealth shallcontain any provision limiting, restricting, or prohibiting a physician fromdisclosing fully all medical treatment options to patients whether or notsuch treatment options are (i) experimental or covered services, (ii)services that the health insurer will not authorize, or (iii) the costs ofthe treatment will be borne by the health insurer or the patient tofacilitate an informed decision by the patient, if the physician determinesthat such an option is in the best interest of the patient. For the purposesof this subsection, "medical treatment options" means any alternative orexperimental therapeutic, psychiatric, medical treatment or procedure, healthcare service, drug, or remedy.
D. Whenever benefits paid or payable under workers' compensation are excludedfrom coverage under the terms of any such contract, subscription contract orhealth services plan, the issuer thereof shall not exclude coverage for anymedical condition pursuant to such exclusion if (i) an award of the Workers'Compensation Commission pursuant to § 65.2-704 denies compensation benefitsrelating to such medical condition and no request for review of such award ismade pursuant to and within the time prescribed by § 65.2-705 or (ii) anaward of the Workers' Compensation Commission, after review by the fullCommission pursuant to § 65.2-705, denies compensation benefits relating tosuch medical condition. Following the entry of a workers' compensation awardpursuant to clause (i) or (ii) having the effect of prohibiting theapplication of any such exclusion, the issuer shall immediately providecoverage for such medical condition to the extent otherwise covered under thecontract, subscription contract or health services plan. If, upon appeal tothe Court of Appeals or the Supreme Court, such medical condition is held tobe compensable under the Virginia Workers' Compensation Act (Title 65.2), theissuer may recover from the applicable employer or workers' compensationinsurance carrier the costs of coverage for medical conditions found to becompensable under the Act.
(1973, c. 28, § 38.1-342.2; 1979, c. 341; 1986, c. 562; 1988, c. 840; 1989,c. 487; 1994, c. 609; 1995, c. 68; 2004, c. 675.)
§ 38.2-3405. Certain subrogation provisions and limitations upon recovery inhospital, medical, etc., policies forbidden; limitations on disclosure ofmedical treatment options prohibited.
A. No insurance contract providing hospital, medical, surgical and similar orrelated benefits, and no subscription contract or health services plandelivered or issued for delivery or providing for payment of benefits to oron behalf of persons residing in or employed in this Commonwealth shallcontain any provision providing for subrogation of any person's right torecovery for personal injuries from a third person.
B. No such contract, subscription contract or health services plan shallcontain any provision requiring the beneficiary of any such contract or planto sign any agreement to pay back to any company issuing such a contract orcreating a health services plan any benefits paid pursuant to the terms ofsuch contract or plan from the proceeds of a recovery by such a beneficiaryfrom any other source; provided, that this provision shall not prohibit anexclusion of benefits paid or payable under workers' compensation laws orfederal or state programs, nor shall this provision prohibit coordination ofbenefits provisions when there are two or more such accident and sicknessinsurance contracts or plans providing for the payment of the same benefits.Coordination of benefits provisions may not operate to reduce benefitsbecause of any benefits paid, payable, or provided by any liability insurancecontract or any benefits paid, payable, or provided by any medical expense ormedical payments insurance provided in conjunction with liability coverage.
C. No insurance contract providing hospital, medical, surgical and similar orrelated benefits, and no subscription contract or health services plandelivered or issued for delivery or providing for payment of benefits to oron behalf of persons residing in or employed in this Commonwealth shallcontain any provision limiting, restricting, or prohibiting a physician fromdisclosing fully all medical treatment options to patients whether or notsuch treatment options are (i) experimental or covered services, (ii)services that the health insurer will not authorize, or (iii) the costs ofthe treatment will be borne by the health insurer or the patient tofacilitate an informed decision by the patient, if the physician determinesthat such an option is in the best interest of the patient. For the purposesof this subsection, "medical treatment options" means any alternative orexperimental therapeutic, psychiatric, medical treatment or procedure, healthcare service, drug, or remedy.
D. Whenever benefits paid or payable under workers' compensation are excludedfrom coverage under the terms of any such contract, subscription contract orhealth services plan, the issuer thereof shall not exclude coverage for anymedical condition pursuant to such exclusion if (i) an award of the Workers'Compensation Commission pursuant to § 65.2-704 denies compensation benefitsrelating to such medical condition and no request for review of such award ismade pursuant to and within the time prescribed by § 65.2-705 or (ii) anaward of the Workers' Compensation Commission, after review by the fullCommission pursuant to § 65.2-705, denies compensation benefits relating tosuch medical condition. Following the entry of a workers' compensation awardpursuant to clause (i) or (ii) having the effect of prohibiting theapplication of any such exclusion, the issuer shall immediately providecoverage for such medical condition to the extent otherwise covered under thecontract, subscription contract or health services plan. If, upon appeal tothe Court of Appeals or the Supreme Court, such medical condition is held tobe compensable under the Virginia Workers' Compensation Act (Title 65.2), theissuer may recover from the applicable employer or workers' compensationinsurance carrier the costs of coverage for medical conditions found to becompensable under the Act.
(1973, c. 28, § 38.1-342.2; 1979, c. 341; 1986, c. 562; 1988, c. 840; 1989,c. 487; 1994, c. 609; 1995, c. 68; 2004, c. 675.)
§ 38.2-3405. Certain subrogation provisions and limitations upon recovery inhospital, medical, etc., policies forbidden; limitations on disclosure ofmedical treatment options prohibited.
A. No insurance contract providing hospital, medical, surgical and similar orrelated benefits, and no subscription contract or health services plandelivered or issued for delivery or providing for payment of benefits to oron behalf of persons residing in or employed in this Commonwealth shallcontain any provision providing for subrogation of any person's right torecovery for personal injuries from a third person.
B. No such contract, subscription contract or health services plan shallcontain any provision requiring the beneficiary of any such contract or planto sign any agreement to pay back to any company issuing such a contract orcreating a health services plan any benefits paid pursuant to the terms ofsuch contract or plan from the proceeds of a recovery by such a beneficiaryfrom any other source; provided, that this provision shall not prohibit anexclusion of benefits paid or payable under workers' compensation laws orfederal or state programs, nor shall this provision prohibit coordination ofbenefits provisions when there are two or more such accident and sicknessinsurance contracts or plans providing for the payment of the same benefits.Coordination of benefits provisions may not operate to reduce benefitsbecause of any benefits paid, payable, or provided by any liability insurancecontract or any benefits paid, payable, or provided by any medical expense ormedical payments insurance provided in conjunction with liability coverage.
C. No insurance contract providing hospital, medical, surgical and similar orrelated benefits, and no subscription contract or health services plandelivered or issued for delivery or providing for payment of benefits to oron behalf of persons residing in or employed in this Commonwealth shallcontain any provision limiting, restricting, or prohibiting a physician fromdisclosing fully all medical treatment options to patients whether or notsuch treatment options are (i) experimental or covered services, (ii)services that the health insurer will not authorize, or (iii) the costs ofthe treatment will be borne by the health insurer or the patient tofacilitate an informed decision by the patient, if the physician determinesthat such an option is in the best interest of the patient. For the purposesof this subsection, "medical treatment options" means any alternative orexperimental therapeutic, psychiatric, medical treatment or procedure, healthcare service, drug, or remedy.
D. Whenever benefits paid or payable under workers' compensation are excludedfrom coverage under the terms of any such contract, subscription contract orhealth services plan, the issuer thereof shall not exclude coverage for anymedical condition pursuant to such exclusion if (i) an award of the Workers'Compensation Commission pursuant to § 65.2-704 denies compensation benefitsrelating to such medical condition and no request for review of such award ismade pursuant to and within the time prescribed by § 65.2-705 or (ii) anaward of the Workers' Compensation Commission, after review by the fullCommission pursuant to § 65.2-705, denies compensation benefits relating tosuch medical condition. Following the entry of a workers' compensation awardpursuant to clause (i) or (ii) having the effect of prohibiting theapplication of any such exclusion, the issuer shall immediately providecoverage for such medical condition to the extent otherwise covered under thecontract, subscription contract or health services plan. If, upon appeal tothe Court of Appeals or the Supreme Court, such medical condition is held tobe compensable under the Virginia Workers' Compensation Act (Title 65.2), theissuer may recover from the applicable employer or workers' compensationinsurance carrier the costs of coverage for medical conditions found to becompensable under the Act.
(1973, c. 28, § 38.1-342.2; 1979, c. 341; 1986, c. 562; 1988, c. 840; 1989,c. 487; 1994, c. 609; 1995, c. 68; 2004, c. 675.)
