§ 38.2-3407.11:2. Standing referral for cancer patients.
A. Each (i) insurer proposing to issue individual or group accident andsickness insurance policies providing hospital, medical and surgical or majormedical coverage on an expense incurred basis, (ii) corporation providingindividual or group accident and sickness subscription contracts, and (iii)health maintenance organization providing a health care plan for health careservices, whose policies, contracts or plans, including any certificate orevidence of coverage issued in connection with such policies, contracts orplans, shall have a procedure in place to permit any individual coveredthereunder who has been diagnosed with cancer to have a standing referral toa board-certified physician in pain management or oncologist who isauthorized to provide services under such policy, contract or plan and hasbeen selected by the cancer patient.
B. The board-certified physician in pain management or oncologist shallconsult on a regular basis, as required under the terms of the policy,contract or plan, by telephone or through written communication, with theprimary care physician and any oncologist providing care to the patientconcerning the plan of pain management for the patient. Further, this sectionshall not be construed to authorize the board-certified physician in painmanagement or oncologist to direct the patient to other health care services.
C. Nothing contained herein shall prohibit an insurer, corporation, or healthmaintenance organization from requiring a participating board-certifiedphysician in pain management or oncologist to provide written notification tothe cancer patient's primary care physician of any visit to him. Suchnotification may include a description of the health care services renderedat the time of the visit.
D. Each insurer, corporation or health maintenance organization subject tothe provisions of this section shall inform subscribers, in writing, withinthe policy or evidence of coverage of the provisions of this section.
E. The requirements of this section shall apply to all insurance policies,contracts, and plans delivered, issued for delivery, reissued, renewed, orextended or at any time when any term of any such policy, contract, or planis changed or any premium adjustment is made. The provisions of this sectionshall not apply to short-term travel or accident-only policies, to short-termnonrenewable policies of not more than six months' duration, or policies orcontracts issued to persons eligible under Title XVIII of the Social SecurityAct, known as Medicare, or any other similar coverage under state or federalgovernmental plans.
§ 38.2-3407.11:2. Standing referral for cancer patients.
A. Each (i) insurer proposing to issue individual or group accident andsickness insurance policies providing hospital, medical and surgical or majormedical coverage on an expense incurred basis, (ii) corporation providingindividual or group accident and sickness subscription contracts, and (iii)health maintenance organization providing a health care plan for health careservices, whose policies, contracts or plans, including any certificate orevidence of coverage issued in connection with such policies, contracts orplans, shall have a procedure in place to permit any individual coveredthereunder who has been diagnosed with cancer to have a standing referral toa board-certified physician in pain management or oncologist who isauthorized to provide services under such policy, contract or plan and hasbeen selected by the cancer patient.
B. The board-certified physician in pain management or oncologist shallconsult on a regular basis, as required under the terms of the policy,contract or plan, by telephone or through written communication, with theprimary care physician and any oncologist providing care to the patientconcerning the plan of pain management for the patient. Further, this sectionshall not be construed to authorize the board-certified physician in painmanagement or oncologist to direct the patient to other health care services.
C. Nothing contained herein shall prohibit an insurer, corporation, or healthmaintenance organization from requiring a participating board-certifiedphysician in pain management or oncologist to provide written notification tothe cancer patient's primary care physician of any visit to him. Suchnotification may include a description of the health care services renderedat the time of the visit.
D. Each insurer, corporation or health maintenance organization subject tothe provisions of this section shall inform subscribers, in writing, withinthe policy or evidence of coverage of the provisions of this section.
E. The requirements of this section shall apply to all insurance policies,contracts, and plans delivered, issued for delivery, reissued, renewed, orextended or at any time when any term of any such policy, contract, or planis changed or any premium adjustment is made. The provisions of this sectionshall not apply to short-term travel or accident-only policies, to short-termnonrenewable policies of not more than six months' duration, or policies orcontracts issued to persons eligible under Title XVIII of the Social SecurityAct, known as Medicare, or any other similar coverage under state or federalgovernmental plans.
§ 38.2-3407.11:2. Standing referral for cancer patients.
A. Each (i) insurer proposing to issue individual or group accident andsickness insurance policies providing hospital, medical and surgical or majormedical coverage on an expense incurred basis, (ii) corporation providingindividual or group accident and sickness subscription contracts, and (iii)health maintenance organization providing a health care plan for health careservices, whose policies, contracts or plans, including any certificate orevidence of coverage issued in connection with such policies, contracts orplans, shall have a procedure in place to permit any individual coveredthereunder who has been diagnosed with cancer to have a standing referral toa board-certified physician in pain management or oncologist who isauthorized to provide services under such policy, contract or plan and hasbeen selected by the cancer patient.
B. The board-certified physician in pain management or oncologist shallconsult on a regular basis, as required under the terms of the policy,contract or plan, by telephone or through written communication, with theprimary care physician and any oncologist providing care to the patientconcerning the plan of pain management for the patient. Further, this sectionshall not be construed to authorize the board-certified physician in painmanagement or oncologist to direct the patient to other health care services.
C. Nothing contained herein shall prohibit an insurer, corporation, or healthmaintenance organization from requiring a participating board-certifiedphysician in pain management or oncologist to provide written notification tothe cancer patient's primary care physician of any visit to him. Suchnotification may include a description of the health care services renderedat the time of the visit.
D. Each insurer, corporation or health maintenance organization subject tothe provisions of this section shall inform subscribers, in writing, withinthe policy or evidence of coverage of the provisions of this section.
E. The requirements of this section shall apply to all insurance policies,contracts, and plans delivered, issued for delivery, reissued, renewed, orextended or at any time when any term of any such policy, contract, or planis changed or any premium adjustment is made. The provisions of this sectionshall not apply to short-term travel or accident-only policies, to short-termnonrenewable policies of not more than six months' duration, or policies orcontracts issued to persons eligible under Title XVIII of the Social SecurityAct, known as Medicare, or any other similar coverage under state or federalgovernmental plans.
