Bill Text: VA HB604 | 2024 | Regular Session | Prefiled
Bill Title: Health insurance; coverage for polycystic ovary syndrome.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced) 2024-01-25 - Tabled in Labor and Commerce (18-Y 3-N) [HB604 Detail]
Download: Virginia-2024-HB604-Prefiled.html
Be it enacted by the General Assembly of Virginia:
1. That §38.2-4319 of the Code of Virginia is amended and reenacted and that the Code of Virginia is amended by adding a section numbered 38.2-3418.22 as follows:
§38.2-3418.22. Coverage for polycystic ovary syndrome.
A. Notwithstanding the provisions of §38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription contracts; and each health maintenance organization providing a health care plan for health care services shall provide coverage for the treatment of polycystic ovary syndrome under any policy, contract, or plan delivered, issued for delivery, or renewed in the Commonwealth.
B. As used in this section, "polycystic ovary syndrome" means (i) an endocrine disorder characterized by androgen excess, ovarian dysfunction that causes irregular or absent ovulation or menstruation, or polycystic ovaries, meaning ovaries that are enlarged and afflicted with multiple immature ovarian follicles or cysts or (ii) a metabolic disorder that increases the risk for comorbidities, including Type 2 diabetes, hypertension, sleep disorders, cardiovascular disease, nonalcoholic fatty liver disease, maternal-fetal health complications, stroke, and other disorders including mental health disorders and infertility.
C. Coverage shall be provided under subsection A following a diagnosis of polycystic ovary syndrome by a licensed physician or health care provider, including diagnosis by a gynecologist, endocrinologist, primary care physician, pediatrician, nurse practitioner, dermatologist, or infertility specialist. Such coverage shall include:
1. Treatment by a licensed physician or health care provider, including by a gynecologist, endocrinologist, primary care physician, pediatrician, nurse practitioner, dermatologist, or infertility specialist;
2. Treatment of hair and skin issues related to polycystic ovary syndrome, including electrolysis, laser hair removal, and acne and hair loss treatments;
3. Treatment for metabolic issues related to polycystic ovary syndrome;
4. Treatment for mental health issues related to polycystic ovary syndrome provided by a licensed or certified mental health professional; and
5. If recommended by a licensed physician or health care provider, treatment and support services related to mental health, nutrition management, metabolic health, diabetes prevention, cardiovascular disease prevention, and other lifestyle management support by health care professionals, including by a licensed dietician, nutritionist, exercise physiologist, therapist, or other health care professional.
D. No insurer, corporation, or health maintenance organization shall impose upon any person receiving benefits pursuant to this section any copayment, fee, or condition that is not equally imposed upon all individuals in the same benefit category, nor shall any insurer, corporation, or health maintenance organization impose any policy-year or calendar-year dollar or durational benefit limitations or maximums for benefits or services provided under this section.
E. The provisions of this section shall apply to any insurance policy, contract, or plan delivered, issued for delivery, reissued, or extended on or after January 1, 2025.
F. The provisions of this section shall not apply to short-term travel, accident-only, or limited or specified disease policies or contracts, contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under state or federal governmental plans, or short-term nonrenewable policies of not more than six months' duration.
§38.2-4319. Statutory construction and relationship to other laws.
A. No provisions of this title except this chapter and, insofar as they are not inconsistent with this chapter, §§38.2-100, 38.2-136, 38.2-200, 38.2-203, 38.2-209 through 38.2-213, 38.2-216, 38.2-218 through 38.2-225, 38.2-229, 38.2-232, 38.2-305, 38.2-316, 38.2-316.1, 38.2-322, 38.2-325, 38.2-326, 38.2-400, 38.2-402 through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through 38.2-629, Chapter 9 (§38.2-900 et seq.), §§ 38.2-1016.1 through 38.2-1023, 38.2-1057, and 38.2-1306.1, Article 2 (§ 38.2-1306.2 et seq.), §38.2-1315.1, and Articles 3.1 (§38.2-1316.1 et seq.), 4 (§38.2-1317 et seq.), 5 (§38.2-1322 et seq.), 5.1 (§38.2-1334.3 et seq.), and 5.2 (§38.2-1334.11 et seq.) of Chapter 13, Articles 1 (§38.2-1400 et seq.), 2 (§38.2-1412 et seq.), and 4 (§38.2-1446 et seq.) of Chapter 14, Chapter 15 (§38.2-1500 et seq.), Chapter 17 (§38.2-1700 et seq.), §§ 38.2-1800 through 38.2-1836, 38.2-3401, 38.2-3405, 38.2-3405.1, 38.2-3406.1, 38.2-3407.2 through 38.2-3407.6:1, 38.2-3407.9 through 38.2-3407.20, 38.2-3411, 38.2-3411.2, 38.2-3411.3, 38.2-3411.4, 38.2-3412.1, 38.2-3414.1, 38.2-3418.1 through 38.2-3418.19, 38.2-3418.21, 38.2-3418.22, 38.2-3419.1, and 38.2-3430.1 through 38.2-3454, Articles 8 (§38.2-3461 et seq.) and 9 (§38.2-3465 et seq.) of Chapter 34, §38.2-3500, subdivision 13 of §38.2-3503, subdivision 8 of §38.2-3504, §§38.2-3514.1, 38.2-3514.2, 38.2-3522.1 through 38.2-3523.4, 38.2-3525, 38.2-3540.1, 38.2-3540.2, 38.2-3541.2, 38.2-3542, and 38.2-3543.2, Article 5 (§38.2-3551 et seq.) of Chapter 35, Chapter 35.1 (§38.2-3556 et seq.), §38.2-3610, Chapter 52 (§38.2-5200 et seq.), Chapter 55 (§38.2-5500 et seq.), Chapter 58 (§ 38.2-5800 et seq.), Chapter 65 (§38.2-6500 et seq.), and Chapter 66 (§ 38.2-6600 et seq.) shall be applicable to any health maintenance organization granted a license under this chapter. This chapter shall not apply to an insurer or health services plan licensed and regulated in conformance with the insurance laws or Chapter 42 (§38.2-4200 et seq.) except with respect to the activities of its health maintenance organization.
B. For plans administered by the Department of Medical Assistance Services that provide benefits pursuant to Title XIX or Title XXI of the Social Security Act, as amended, no provisions of this title except this chapter and, insofar as they are not inconsistent with this chapter, §§38.2-100, 38.2-136, 38.2-200, 38.2-203, 38.2-209 through 38.2-213, 38.2-216, 38.2-218 through 38.2-225, 38.2-229, 38.2-232, 38.2-322, 38.2-325, 38.2-400, 38.2-402 through 38.2-413, 38.2-500 through 38.2-515, and 38.2-600 through 38.2-629, Chapter 9 (§38.2-900 et seq.), §§38.2-1016.1 through 38.2-1023, 38.2-1057, and 38.2-1306.1, Article 2 (§38.2-1306.2 et seq.), §38.2-1315.1, Articles 3.1 (§38.2-1316.1 et seq.), 4 (§38.2-1317 et seq.), 5 (§38.2-1322 et seq.), 5.1 (§38.2-1334.3 et seq.), and 5.2 (§38.2-1334.11 et seq.) of Chapter 13, Articles 1 (§38.2-1400 et seq.), 2 (§38.2-1412 et seq.), and 4 (§38.2-1446 et seq.) of Chapter 14, §§38.2-3401, 38.2-3405, 38.2-3407.2 through 38.2-3407.5, 38.2-3407.6, 38.2-3407.6:1, 38.2-3407.9, 38.2-3407.9:01, and 38.2-3407.9:02, subdivisions E 1, 2, and 3 of §38.2-3407.10, §§38.2-3407.10:1, 38.2-3407.11, 38.2-3407.11:3, 38.2-3407.13, 38.2-3407.13:1, 38.2-3407.14, 38.2-3411.2, 38.2-3418.1, 38.2-3418.2, 38.2-3418.16, 38.2-3419.1, 38.2-3430.1 through 38.2-3437, and 38.2-3500, subdivision 13 of §38.2-3503, subdivision 8 of § 38.2-3504, §§38.2-3514.1, 38.2-3514.2, 38.2-3522.1 through 38.2-3523.4, 38.2-3525, 38.2-3540.1, 38.2-3540.2, 38.2-3541.2, 38.2-3542, and 38.2-3543.2, Chapter 52 (§38.2-5200 et seq.), Chapter 55 (§38.2-5500 et seq.), Chapter 58 (§38.2-5800 et seq.), Chapter 65 (§38.2-6500 et seq.), and Chapter 66 (§ 38.2-6600 et seq.) shall be applicable to any health maintenance organization granted a license under this chapter. This chapter shall not apply to an insurer or health services plan licensed and regulated in conformance with the insurance laws or Chapter 42 (§38.2-4200 et seq.) except with respect to the activities of its health maintenance organization.
C. Solicitation of enrollees by a licensed health maintenance organization or by its representatives shall not be construed to violate any provisions of law relating to solicitation or advertising by health professionals.
D. A licensed health maintenance organization shall not be deemed to be engaged in the unlawful practice of medicine. All health care providers associated with a health maintenance organization shall be subject to all provisions of law.
E. Notwithstanding the definition of an eligible employee as set forth in §38.2-3431, a health maintenance organization providing health care plans pursuant to §38.2-3431 shall not be required to offer coverage to or accept applications from an employee who does not reside within the health maintenance organization's service area.
F. For purposes of applying this section, "insurer" when used in a section cited in subsections A and B shall be construed to mean and include "health maintenance organizations" unless the section cited clearly applies to health maintenance organizations without such construction.
