38.2-3411.1 - Coverage for child health supervision services.
§ 38.2-3411.1. Coverage for child health supervision services.
A. Every individual or group accident and sickness insurance policy,subscription contract providing coverage under a health services plan, orevidence of coverage of a health care plan delivered or issued for deliveryin the Commonwealth or renewed, reissued, or extended if already issued,shall offer and make available coverage under such policy or plan for childhealth supervision services to provide for the periodic examination ofchildren covered under such policy or plan.
B. As used in this section, the term "child health supervision services"means the periodic review of a child's physical and emotional status by alicensed and qualified physician or pursuant to a physician's supervision. Areview shall include but not be limited to a history, complete physicalexamination, developmental assessment, anticipatory guidance, appropriateimmunizations, and laboratory tests in keeping with prevailing medicalstandards.
C. Each such policy or plan, offering and making available such coverage,shall, at a minimum, provide benefits for child health supervision servicesat approximately the following age intervals: birth, two months, four months,six months, nine months, twelve months, fifteen months, eighteen months, twoyears, three years, four years, five years, and six years. A policy or planmay provide that child health supervision services which are rendered duringa periodic review shall only be covered to the extent that such services areprovided by or under the supervision of a single physician during the courseof one visit.
D. Benefits for coverage for child health supervision services shall beexempt from any copayment, coinsurance, deductible, or other dollar limitprovision in the policy or plan. Such exemption shall be expressly stated onthe policy, plan, rider, endorsement, or other attachment providing suchcoverage.
E. The premiums for such coverage shall take into consideration (i) the costof providing such coverage, (ii) cost savings realized or likely to berealized as a consequence of such coverage, (iii) a reasonable profit for theinsurer, and (iv) any other relevant information or data the Commission deemsappropriate.
F. This section shall not apply (i) to any insurer or health services planhaving fewer than 1,000 covered individuals insured or covered in Virginia orless than $500,000 in premiums in Virginia as of its last annual statement,(ii) to short-term travel or accident only policies, (iii) to short-termnonrenewable policies of not more than six months' duration, or (iv) tospecified disease, hospital indemnity or other limited benefit policiesissued to provide supplemental benefits to a policy providing primary carebenefits.
(1990, c. 901; 2000, c. 118.)