Virginia SB 95: Health insurance; coverage for essential health benefits, preventive services.

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2020 SESSION

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CHAPTER 1160 

An Act to amend and reenact �� 38.2-3438, 38.2-3442, and 
38.2-3451 of the Code of Virginia, relating to health insurance; essential 
health benefits; preventive services. 

[S 95] 

Approved April 11, 2020 

Be it enacted by the General Assembly of Virginia:

1. That �� 38.2-3438, 38.2-3442, and 38.2-3451 of the Code of 
Virginia are amended and reenacted as follows:

� 38.2-3438. Definitions.

As used this article, unless the context requires a different 
meaning:

"Child" means a son, daughter, stepchild, adopted 
child, including a child placed for adoption, foster child, or any other 
child eligible for coverage under the health benefit plan.

"Covered benefits" or "benefits" means 
those health care services to which an individual is entitled under the terms 
of a health benefit plan.

"Covered person" means a policyholder, subscriber, 
enrollee, participant, or other individual covered by a health benefit plan.

"Dependent" means the spouse or child of an eligible 
employee, subject to the applicable terms of the policy, contract, or plan 
covering the eligible employee.

"Emergency medical condition" means a medical 
condition manifesting itself by acute symptoms of sufficient severity, 
including severe pain, so that a prudent layperson, who possesses an average 
knowledge of health and medicine, could reasonably expect the absence of 
immediate medical attention to result in (i) serious jeopardy to the mental or 
physical health of the individual, (ii) danger of serious impairment to bodily 
functions, (iii) serious dysfunction of any bodily organ or part, or (iv) in 
the case of a pregnant woman, serious jeopardy to the health of the fetus.

"Emergency services" means with respect to an 
emergency medical condition: (i) a medical screening examination as required 
under � 1867 of the Social Security Act (42 U.S.C. � 1395dd) that is within the 
capability of the emergency department of a hospital, including ancillary 
services routinely available to the emergency department to evaluate such 
emergency medical condition and (ii) such further medical examination and 
treatment, to the extent they are within the capabilities of the staff and 
facilities available at the hospital, as are required under � 1867 of the 
Social Security Act (42 U.S.C. � 1395dd (e)(3)) to stabilize the patient.

"ERISA" means the Employee Retirement Income 
Security Act of 1974.

"Essential health benefits" include the following 
general categories and the items and services covered within the categories in 
accordance with regulations issued pursuant to the PPACA as of January 1, 
2019: (i) ambulatory patient services; (ii) emergency services; (iii) 
hospitalization; (iv) laboratory services; (v) maternity and newborn care; (vi) 
mental health and substance abuse disorder services,