Prohibited restrictions on in-network referrals
Va. Code Ann. § 38.2-3407.23
in effectA. As used in this section:
"Carrier" has the same meaning as provided in § 38.2-3407.15 . "Carrier" includes any entity administering a policy or plan providing health insurance coverage to state employees pursuant to § 2.2-2818 .
"Health plan" has the same meaning as provided in § 38.2-3407.15 . "Health plan" includes any policy or plan providing health insurance coverage to state employees pursuant to § 2.2-2818 .
"In-network" means a provider that has contracted with a carrier or a carrier's contractor or subcontractor to provide health care services to enrollees and be reimbursed by the carrier at a contracted rate as payment in full for the health care services, including applicable cost-sharing requirements.
B. No carrier, in the provision of individual or group accident and sickness insurance, including any health benefit plan, shall prohibit an in-network provider from referring any enrollee or specimen to any in-network clinical laboratory or in-network pathology service provider under the terms of the health plan unless such referral would constitute a violation of the Practitioner Self-Referral Act (§ 54.1-2410 et seq.) or 42 U.S.C. § 1320a-7b.
C. The Commission shall have no jurisdiction to adjudicate individual controversies arising out of this section.
2026, cc. 138 , 139 .
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://law.lis.virginia.gov/vacode/38.2-3407.23/Fetched: 10/16/2026