38.2-3418.5 - Coverage for early intervention services.
§ 38.2-3418.5. Coverage for early intervention services.
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing toissue individual or group accident and sickness insurance policies providinghospital, medical and surgical, or major medical coverage on anexpense-incurred basis; each corporation providing individual or groupaccident and sickness subscription contracts; and each health maintenanceorganization providing a health care plan for health care services shallprovide coverage for medically necessary early intervention services undersuch policy, contract or plan delivered, issued for delivery or renewed inthis Commonwealth on and after July 1, 1998. Such coverage shall be limitedto a benefit of $5,000 per insured or member per policy or calendar year and,except as set forth in subsection C, shall be subject to such dollar limits,deductibles and coinsurance factors as are no less favorable than forphysical illness generally.
B. For the purpose of this section, "early intervention services" meansmedically necessary speech and language therapy, occupational therapy,physical therapy and assistive technology services and devices for dependentsfrom birth to age three who are certified by the Department of BehavioralHealth and Developmental Services as eligible for services under Part H ofthe Individuals with Disabilities Education Act (20 U.S.C. § 1471 et seq.)."Medically necessary early intervention services for the populationcertified by the Department of Behavioral Health and Developmental Services"shall mean those services designed to help an individual attain or retain thecapability to function age-appropriately within his environment, and shallinclude services that enhance functional ability without effecting a cure.
C. The cost of early intervention services shall not be applied to anycontractual provision limiting the total amount of coverage paid by theinsurer, corporation or health maintenance organization to or on behalf ofthe insured or member during the insured's or member's lifetime.
D. "Financial costs," as used in this section, shall mean any copayment,coinsurance, or deductible in the policy or plan. Financial costs may be paidthrough the use of federal Part H program funds, state general funds, orlocal government funds appropriated to implement Part H services for familieswho may refuse the use of their insurance to pay for early interventionservices due to a financial cost.
E. The provisions of this section shall not apply to short-term travel,accident only, limited or specified disease policies, policies or contractsdesigned for issuance to persons eligible for coverage under Title XVIII ofthe Social Security Act, known as Medicare, or any other similar coverageunder state or governmental plans or to short-term nonrenewable policies ofnot more than six months' duration.
(1998, c. 625; 2009, cc. 813, 840.)