Virginia Health Insurance

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According to the Center for Disease Control, an average of 12.5% of Virginia residents went uninsured for Virginia health insurance each year between 2001 and 2003.

Virginia Health Insurance Regulations

All individuals covered for Virginia health insurance under a group of employer health insurance plan cannot be denied or limited access to health insurance under that plan. Individuals however, can be denied access to health insurance through some Virginia health insurance companies, but all Virginia residents are guaranteed access to individual health insurance through Anthem Blue Cross Blue Shield or CareFirst Blue Cross Blue Shield depending on location. Virginia health insurance is also guaranteed renewable which means that any individual who wishes to renew existing Virginia medical insurance is guaranteed the right to do so provided the individual has not provided false information and has paid all premiums on time.

HIPAA Eligibility

HIPAA eligible individuals cannot be turned down by any Virginia health insurance company selling individual health insurance. Nor can health insurance companies impose pre-existing exclusion periods on HIPAA eligible individuals looking for health insurance.

Pre-Existing Conditions

Virginia health insurance companies (with the exception of Blue Cross Blue Shield companies) can turn down any individual for individual health insurance based on health, age or any other factor. They can also impose pre-existing exclusion periods and elimination riders. Neither pre-existing condition exclusion periods nor elimination riders can be imposed on HIPAA eligible individuals.

Elimination riders can deny coverage for any condition or body part for the duration of a Virginia health insurance plan. Virginia medical insurance policies can also have pre-existing exclusion periods which can deny coverage for a pre-existing condition for up to 12 months in the beginning of a policy. An insurer can look back 12 months prior to the beginning of coverage under the new policy and see if the individual was diagnosed, treated, advised or should have been diagnosed, treated or advised for any condition. That condition can then be considered pre-existing.

Continuous coverage under another health insurance policy prior to the new Virginia health insurance policy may credit the new policy for the pre-existing condition period. There must not be a lapse in coverage for more than 30 days.

Pregnancy

Pregnancy can be considered a pre-existing condition. Any individual who has individual Virginia health insurance with dependent coverage has automatic coverage of newborns and adopted children for the first 30 days after birth or adoption. Disabled children may remain under the policy beyond the point at which most dependents cease coverage under a standard policy.

Rates

Virginia health insurance rates vary depending on age, health and other factors. Premiums may also increase when health insurance policies are renewed.

Temporary Insurance

Some Virginia health insurance companies offer temporary health insurance. This is good for individuals who are between plans, employers or individual Virginia medical insurance policies.

Alternative Virginia Health Insurance Options

For individuals who have difficulty affording Virginia health insurance, there are some state programs that may help:

• Virginia Medicaid is available to qualifying individuals who meet the eligibility criteria.
• Virginia Children’s Medical Security Insurance Plan is designed to provide health insurance for children under 19 whose families do not qualify for Medicaid and who may not be able to afford Virginia medical insurance.

Virginia Bureau of Insurance

BOI Main Mailing Address
P.O. Box 1157
Richmond, Virginia 23218

BOI Main Number for Consumer Inquiries: 804-371-9741
BOI Ombudsman and Consumer Service Hotline: 877-310-6560
State Corporation Commission's Toll Free Number for Virginia Residents: 800-552-7945

Virginia Health Insurance Organizations

According to the Virginia Bureau of Insurance, the following is a list of Virginia health insurance companies that sell Health Maintenance Organization plans in Virginia:

• AETNA HEALTH INC.
• AMERIGROUP VIRGINIA, INC.
• CAPITALCARE, INC.
• CAREFIRST BLUECHOICE, INC.
• CIGNA DENTAL HEALTH OF VIRGINIA INC
• CIGNA HEALTHCARE MID-ATLANTIC, INC.
• CIGNA HEALTHCARE OF VIRGINIA, INC.
• DOMINION DENTAL SERVICES, INC.
• HEALTHKEEPERS, INC.
• KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC.
• MD-INDIVIDUAL PRACTICE ASSOCIATION, INC
• OPTIMA HEALTH GROUP, INC.
• OPTIMA HEALTH PLAN
• OPTIMUM CHOICE, INCORPORATED
• PENINSULA HEALTH CARE, INC.
• PIEDMONT COMMUNITY HEALTHCARE, INC.
• PRIORITY HEALTH CARE, INC.
• SOUTHERN HEALTH SERVICES, INC.
• SPECTERA VISION, INC.
• UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.
• UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.
• VIRGINIA PREMIER HEALTH PLAN, INC.

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