Your Rights under Virginia Health Insurance Law
(Copyright 2005 All Rights Reserved)
Individual Health Insurance:
Individuals, families, self employed and small business owners are having an increasingly difficult time finding health insurance. Those with pre-existing medical conditions have even more difficulty. There are a multitude of companies offering health insurance in most states and people without serious pre-existing health conditions should be able to find a health insurance plan to suit their needs and budget.
In Virginia, your ability to buy individual health coverage may depend on your health status. There are certain circumstances, however, when you must be allowed to buy individual health insurance.
In general, companies that sell individual health insurance in Virginia are free to turn you down because of your health status and other factors.
Anthem Blue Cross Blue Shield and Care First Blue Cross Blue Shield will sell individual health insurance to any Virginia resident regardless of health status.
Even if you are HIPAA eligible, (Health Insurance Portability and Accountability), insurance companies in Virginia are not required to offer you family coverage when you buy individual health insurance.
Under Virginia law, adult dependents who are physically disabled or mentally retarded are able to stay on their parents’ individual health insurance policy after they have reached the age at which the plan usually cancels dependent coverage.
If you have an expensive health condition, your individual health insurance premiums may be very high.
Your coverage cannot be canceled because you get sick. Some insurance companies sell short-term health insurance policies.
Each employer chooses whether its employees are offered a continuation policy or a conversion policy when they are no longer eligible for coverage under the employer’s fully insured plan.
Each employer chooses whether its employees are offered a conversion policy or a continuation policy when they are no longer eligible for coverage under the employer’s fully insured plan.
Virginia does not require that conversion policies provide the same or similar benefits as your old policy, as the benefits you receive from a conversion policy might be less generous than those you had through your group plan.
The Family Access to Medical Insurance Security is a state-designed program that provides health coverage to low-income children under the age of 19 who are not eligible for Medicaid and who have no health insurance.
Virginia’s Breast and Cervical Cancer Early Detection Program provides free screening services for breast and cervical cancer and follow up services to eligible women.
For more information, please visit the Bureau of Insurance, State Corporation Commission at http://www.scc.virgina.gov/division/boi/webpages/boiconsumer.htm
Group Health Insurance:
Virginia Group Health Insurance is for businesses with 2 or more employees, which can include the owner of the business. Group health insurance is regulated by both the state and federal government. The HIPAA act of 1997 determines eligibility in some cases and provides rules for individuals leaving a group plan. The group plans usually have more benefits than an individual plan because of federal requirements established by ERISA and HIPAA laws. As long as an employer meets the criteria required by the
Virginia Health Insurance Company, they cannot be turned down for insurance nor can any of the employees be turned down.
Insurance companies can impose a pre-existing medical condition waiting period if the employee was without insurance for more than 63 days prior to enrolling or if the employee did not have insurance for an 18 month period prior to enrolling.
You must be given a special opportunity to sign up for your group health plan if certain changes happen to your family.
Under Virginia law, newborns, adopted children and children placed for adoption are automatically covered under the parents’ fully insured health plan for the first 31 days, if the plan covers dependents.
Adult dependents who are physically disabled or mentally retarded are able to stay on their parents’ fully insured group health plan after they have reached the age at which the plan usually cancels dependent coverage.
When you begin a new job, your employer may require a waiting period before you can sign up for health coverage.
When you begin a new job with health insurance through an HMO, the HMO may require an affiliation period before coverage begins.
If you have to take leave from your job due to illness, the birth or adoption of a child, or to care for a seriously ill family member, you may be able to keep your group health coverage for a limited time.
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