38.2-3418.10 - Coverage for diabetes.
§ 38.2-3418.10. Coverage for diabetes.
A. Each insurer proposing to issue an individual or group hospital policy ormajor medical policy in this Commonwealth, each corporation proposing toissue an individual or group hospital, medical or major medical subscriptioncontract, and each health maintenance organization providing a health careplan for health care services shall provide coverage for diabetes as providedin this section.
B. Such coverage shall include benefits for equipment, supplies and in-personoutpatient self-management training and education, including medicalnutrition therapy, for the treatment of insulin-dependent diabetes,insulin-using diabetes, gestational diabetes and noninsulin-using diabetes ifprescribed by a health care professional legally authorized to prescribe suchitems under law. As used herein, the terms "equipment" and "supplies"shall not be considered durable medical equipment.
C. To qualify for coverage under this section, diabetes in-person outpatientself-management training and education shall be provided by a certified,registered or licensed health care professional. A managed care healthinsurance plan, as defined in Chapter 58 (§ 38.2-5800 et seq.) of this title,may require such health care professional to be a member of the plan'sprovider network; provided that such network includes sufficient health careprofessionals who are qualified by specific education, experience, andcredentials to provide the covered benefits described in this section.
D. No insurer, corporation, or health maintenance organization shall imposeupon any person receiving benefits pursuant to this section any copayment,fee or condition that is not equally imposed upon all individuals in the samebenefit category, nor shall any insurer, corporation or health maintenanceorganization impose any policy-year or calendar-year dollar or durationalbenefit limitations or maximums for benefits or services provided under thissection.
E. The requirements of this section shall apply to all insurance policies,contracts and plans delivered, issued for delivery, reissued, or extended onand after July 1, 2000, or at any time thereafter when any term of thepolicy, contract or plan is changed or any premium adjustment is made.
F. This section shall not apply to short-term travel, accident only, limitedor specified disease, or individual conversion policies or contracts, nor topolicies or contracts designed for issuance to persons eligible for coverageunder Title XVIII of the Social Security Act, known as Medicare, or any othersimilar coverage under state or federal governmental plans.
(1999, c. 35; 2000, cc. 1025, 1060.)