Virginia Individual Health Insurance

Health insurance is a valuable safety net that no person or family should be without. For those considering Virginia individual health insurance, the possibilities are endless, as there are often literally hundreds of plans to choose from. There are laws and regulations in Virginia surrounding these individual health insurance policies that you should be aware of, in order to make a more informed decision.

Eligibility: How Am I Evaluated?

Virginia individual health insurance applications are reviewed based on factors determined by the insurer. There are no Virginia laws that regulate how an application should be reviewed. Additionally, an applicant can be denied coverage for any reason, as there are no Virginia regulations regarding who should or should not be granted coverage. The only exception to this is for those who are applying for health insurance from CareFirst BlueCross BlueShield (northern Virginia) or Anthem BlueCross BlueShield (other parts of Virginia). These policies will be sold to you regardless of your health status.

In accordance with HIPPA Group-to-Individual Portability Coverage regulations, Virginia guarantees issuance of health insurance from all private insurers to HIPPA eligible consumers. There is, however, no limit on what you can be charged for guaranteed issued policies from these insurers.

Virginia Guaranteed Benefits & Pre-Existing Conditions

The state of Virginia does not require insurers to carry standardized policies; however, there are certain benefits that every provider is required to cover for every customer, including mammograms and postpartum care.

Under Virginia law, an insurer cannot impose exclusion periods or elimination riders to policies that are guaranteed issued to HIPPA eligible consumers. For non-HIPPA eligible customers, the insurer may add a pre-existing condition to your policy's elimination rider, which will allow them to avoid covering bills stemming from the condition for the life of your policy. They can also impose a 12 month exclusion period on pre-existing conditions and are allowed a look back period of 12 months prior to your application to determine what should be deemed a pre-existing condition. Furthermore, any claim made within the first 2 years of your policy relating to a specific condition can be denied if it is determined that the condition should have been named as a pre-existing condition. The insurer is once again allowed a look back period of 12 months prior to your application for this purpose.

Virginia Individual Health Insurance Premiums

Your Virginia individual health insurance premiums can be determined based on a number of different individual factors and there are no limits on how high your premiums can go because of these factors. Your premiums can also be increased when your policy is renewed, based on your insurers discretion.

Finally, your insurance policy cannot be cancelled by your insurer because of declining health or the amount of claims made against the policy. You are guaranteed the opportunity to renew your policy, no matter what your health status may be at the time. However, you must also be willing to accept any premium increases imposed by the insurer to make up for these increased risk factors.