It is important to note that Virginia's insurance laws require that most health insurance plans, including Managed Care Health Insurance Plans (MCHIPs): 1) provide certain benefits, known as mandated benefits, in each and every individual or group contract they offer in Virginia; and 2) offer and make available to you, as an individual policyholder, or your employer, if you have group coverage, the option to purchase certain benefits known as mandated offers of coverage. Mandates apply only to Virginia-issued contracts or policies.

If you wish to read any of the specific mandated benefit or mandated offer statutes, simply click on the code citation below.

Each of the links below are provided and controlled by the Commonwealth of Virginia's Legislative Information System. You will be leaving the SCC site when accessing these links.

Mandated Benefits

§38.2-3408 Reimbursement for services provided by certain practitioners other than physicians

§38.2-3409 Coverage for dependent children

§38.2-3410 Terms "physician" and "doctor" to include dentist

§38.2-3411 Coverage of newborn children

§38.2-3411.2 Coverage of adopted children required

§38.2-3411.3 Coverage for Childhood Immunizations

§38.2-3411.4 Coverage for infant hearing screening and related diagnostics

§38.2-3412.1 Coverage for mental health and substance abuse services

§38.2-3412.1:01 Coverage for biologically based mental illness

§38.2-3414.1 Coverage for postpartum services

§38.2-3415 Exclusion or reduction of benefits for certain causes prohibited

§38.2-3416 Insurer required to offer conversion policy or group coverage

§38.2-3418 Coverage for victims of rape and incest

§38.2-3418.1 Coverage for mammograms

§38.2-3418.1:2 Coverage for pap smears

§38.2-3418.2 Coverage of procedures involving bones and joints

§38.2-3418.3 Coverage for hemophilia and congenital bleeding disorders

§38.2-3418.4 Coverage for reconstructive breast surgery

§38.2-3418.5 Coverage for early intervention services

§38.2-3418.6 Minimal hospital stays mastectomy, certain lymph node dissection patients

§38.2-3418.7 Coverage for PSA (prostate-specific antigen) testing

§38.2-3418.7:1 Coverage for Colorectal Cancer Screenings

§38.2-3418.8 Coverage for clinical trials for treatment studies on cancer

§38.2-3418.9 Minimum hospital stays for hysterectomy

§38.2-3418.10 Coverage for diabetes

§38.2-3418.11 Coverage for hospice care

§38.2-3418.12 Coverage for Hospitalization and Anethesia for dental procedures

§38.2-3418.14 Coverage for Lymphedema

§38.2-3418.16 Coverage for telemedicine services

§38.2-3418.17 Coverage for autism spectrum disorder

Mandated Offers of Coverage

§38.2-3411.1 Coverage for child health supervision services

§38.2-3414 Optional coverage for obstetrical services

§38.2-3417 Deductible and coinsurance options required

§38.2-3418.13 Coverage for Morbid Obesity

§38.2-3418.15 Coverage for prosthetic devices and components (applicable to policies issued or renewed on and after January 1, 2010)

Special Information Regarding Coverage Issued by Small Employers

Small employers may purchase "basic health insurance coverage" for their employees, subject to the provisions in Virginia Code §38.2-3406.1 and §38.2-3406.2, under which coverage may be excluded for one or more of the mandated benefits and mandated offers described above, except such coverage must include the mandates prescribed by §38.2-3418.1 (Coverage for mammograms), §38.2-3418.1:2 (Coverage for pap smears), §38.2-3418.7 (Coverage for PSA testing), and §38.2-3418.7:1 (Coverage for colorectal cancer screening). In addition, to the extent that health care services covered by these policies or subscription contracts may be legally rendered by a health care provider listed in §38.2-3408, the "basic health insurance coverage" product must allow for the reimbursement of such covered services when rendered by such a provider. Policies providing "basic health insurance coverage" may be offered by insurers or health services plans. They may not be offered by health maintenance organizations.

You may contact The Office of the Managed Care Ombudsman for detailed information about these mandates or you may refer to Title 38.2 of the Code of Virginia.