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Virginia Health Insurance (VA)
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Virginia (VA)
Individual Health Insurance Regulations
Learn more about Virginia Individual Health Insurance
Although insurance regulations in the State of Virginia provide for individual health insurance policies to be medically underwritten, Anthem Blue Cross Blue Shield of Virginia and CareFirst Blue Cross Blue Shield of Virginia do offer some individual health policies on a guarantee issue basis. Individuals applying for guarantee issue products may not be declined as a result of their health status. Medically underwritten policies require that the insurer be provided an opportunity to assess both past and present medical history of the applicant. By utilizing the process of medical underwriting, the carrier may opt to do one of the following (1) provide coverage per the terms of the health plan (2) offer modified coverage with specific limitations and exclusions or (3) deny coverage based upon the applicant’s health history. The State of Virginia allows the use of elimination riders which, when used, will modify coverage to eliminate or exclude coverage of specific medical conditions. At the discretion of the health insurance carrier, the elimination rider may be incorporated into the policy as either a temporary or permanent exclusion of coverage. Insurance regulations also provide the carrier a 12 month look back, 12 month exclusionary period limit on pre-existing conditions. Credit for prior medical insurance is only required for persons qualified for this waiver under federal HIPAA regulations.
Virginia (VA)
Small Group Health Insurance Regulations
The State of Virginia defines a small group as a group of employees numbering from 2 – 50. Pursuant to the federal Health Insurance Portability and Accountability Act of 1996, medical coverage for groups of this size must be written on a guarantee issue basis. This prohibits insurance carriers from declining coverage to a group or individual employee based upon their past or present medical history. For those applying to a group health plan, credit for prior coverage must be given. Applicants lacking prior creditable coverage are subject to a 6 month look back, 12 month exclusionary period for pre-existing conditions by the carrier. Virginia insurance regulations allow for small group rates to be medically underwritten. Any insurance company offering small group health plans in the state must offer some standardized plans. These plans are identical in benefits, regardless of the insurance carrier, but rates can vary from one insurance company to the next by no more than 25%. For all other health plans offered by that company, the plans may be medically underwritten with no rate restrictions.
Virginia COBRA and Continuation Coverage
The State of Virginia offers a mini-COBRA regulation which applies to groups of 2 -19. State regulations mandate that individuals may opt to continue their group benefits for a period of ninety days from the date of termination of benefits provided that they have suffered a qualifying event and that they had received benefits under the group plan for a minimum of ninety days prior to the termination of those benefits. Payment for continuation coverage is the sole responsibility of the COBRA beneficiary and must be paid in its entirety prior to termination of the group health plan benefits. Employees of larger groups are protected under federal COBRA regulations, allowing them to remain insured under the group plan for 18 months. For those persons exhausting their COBRA option, conversion plans are available, or they may enroll in the state high-risk health pool.
Additional Virginia Resources
- Family Access to Medical Insurance Security (FAMIS)
FAMIS is a state and federally sponsored program whose focus is to assist families provide medical insurance to their children. - Virginia Department of Social Services
The Virginia Department of Social Services administers the state’s Medicaid Program, offering assistance to medically indigent children and pregnant women, low income families, the aged, blind and disabled and those in need of long term care. - Virginia Department of Health
Dedicated to protecting and promoting the health of its residents, the Virginia Department of Health offers a wealth of health related information as well as many useful consumer links. - Virginia Insurance Counseling and Assistance Program (VICAP)
State sponsored program that offers unbiased and confidential assistance for medical and long-tem care insurance questions and problems.
VA Medical Insurance Statistics
Total Population: 7,454,000
With Health Insurance: 6,443,000 / 86.4%
Without Health Insurance: 1,011,000 / 13.86%
*According to 2005 CPS Reports / U.S. Census Bureau
Note: The percentage of Virginia residents without health insurance has decreased .8% since 2004.
Virginia Bureau of Insurance
Phone: 800-552-7945
The Virginia Bureau of Insurance regulates, licenses, investigates and examines insurance companies, agencies and agents throughout the state.
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