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Virginia - State Diabetes Insurance Coverage Laws

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Virginia has mandated coverage for diabetes care.

H. 1376 of 2000 - signed on 4/19/2000 - clarifies coverage for inpatient self-management, training and education; excludes coverage for durable medical equipment.

S.244 (Chapter 35 of 1999) - signed on 3/4/99, effective 7/1/99. Includes coverage for nutrition therapy. This expands HB 1399 (Chapters 35 and 386 of 1998) for coverage of state employees.

Summary of Provisions

• Requirement related to diabetes? Yes
• Diabetes Education services covered? Yes
• Medical nutritional therapy covered? Yes
• Diabetes supplies covered? Yes
• Specified supplies covered? No

According to the Virginia State legislation website:

CHAPTER 35 - An Act to amend and reenact 38.2-4319 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 38.2-3418.8. relating to accident and sickness insurance; coverage for diabetes. [S 244]; Approved March 4, 1999

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 38.2-3418.8 as follows:

38.2-3418.8. Coverage for diabetes.

A. Each insurer proposing to issue an individual or group hospital policy or major medical policy in this Commonwealth, each corporation proposing to issue an individual or group hospital, medical or major medical subscription contract, and each health maintenance organization providing a health care plan for health care services shall provide coverage for diabetes as provided in this section.

B. Such coverage shall include benefits for equipment, supplies and outpatient self-management training and education, including medical nutrition therapy, for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and noninsulin-using diabetes if prescribed by a health care professional legally authorized to prescribe such items under law.

C. To qualify for coverage under this section, diabetes outpatient self-management training and education shall be provided by a certified, registered or licensed 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.

E. The requirements of this section shall apply to all insurance policies, contracts and plans delivered, issued for delivery, reissued, or extended on and after July 1, 1999, or at any time thereafter when any term of the policy, contract or plan is changed or any premium adjustment is made.

F. This section shall not apply to short-term travel, accident only, limited or specified disease, or individual conversion policies or contracts, nor to policies or 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.