Virginia health insurance tips


Virginia insurance law and regulation

The Virginia Bureau of Insurance Web site contains a link to the complete text of the state’s insurance laws and regulations.

The state insurance department can be reached by telephone at(804) 371-9741 or by mail at P.O. Box 1157, Richmond VA 23218. The state children’s health insurance plan (CHIP) Web site is CHIP of Virginia.

News that affects your health insurance and planning

January 24, 2021 – Virginia’s law prohibiting health plans from covering abortions is closer to being repealed after the state Senate SB1276. The current state law conflicts with federal law requiring this coverage.

January 22, 2021 – Two bills proposing to allow parents to exempt children from vaccination from corona virus vaccination requirements for religious reasons will not advance in the legislature. Under current law, the State Health Commissioner may require immediate immunization of all persons in case of an epidemic of any disease of public health importance for which a vaccine exists except for a person to whose health the administration of a vaccine would be detrimental as certified in writing by a Virginia physician.

June 3, 2019 – Status of alternative non-ACA health plans: Virginia does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market. Virginia limits the sale of short-term coverage more strictly than the federal government. A maximum policy of 6 months is allowed.

May 23, 2019 – So far this year 280,000 uninsured Virginians were added to the state’s expanded Medicaid program. By year end, a total of 360,000 are expected to be covered. Some Republican lawmakers in the state are reportedly unhappy with the rapid progress and slow implementation of cost control measures. A new state law imposes a work requirement on Medicaid recipients. The requirement may be implemented within two years. Since many Medicaid recipients work part time or in short term jobs, Freedom Benefits recommends that if employers provide health insurance to these part time employees who are Medicaid recipients, it should be a type of insurance that does not include minimum essential benefits and therefore does not undermine the Medicaid coverage. Most mini-med plans linked from this web site would be suitable for that purpose.

May 8, 2019 – Average monthly insurance premiums on the Virginia exchange are expected to reach $796 in 2019, more than double the average premium in 2016. Data is reported by the Virginia Bureau of Insurance. As a result, enrollment is declining. While overall level of uninsured in Virginia has remained about the same at about 1 in 10, more people are opting for lower cost limited benefit plans like those listed at Freedom Benefits.

March 19, 2019 – The state’s 40 mental health centers are now all offering walk-in mental evaluations. Governor Northam said“Every person in Virginia should be able to access quality public behavioral health services, no matter who they are, how much money they make, or their insurance status. Virginia’s Community Service Boards are the front line providers of mental health treatment, and when someone is in urgent need of clinical services, it is important that they receive care in a timely manner. Same Day Access removes many of the barriers to mental health care and helps individuals get treatment wherever they may live in the Commonwealth.”

January 1, 2019 – As a result of Medicaid expansion approved by Virginia legislature bi-partisan action, more than 200,000 Virginians who were uninsured in 2018 are now insured for 2019. Coverage will be expanded further for another 200,000 uninsured Virginians.

The history of health care planning in Virginia (Information is outdated and links may be expired)

2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at(800) 609-0683.

7/26/2013 Affordable Smart Term Life Insurance is now available to most Virginia residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.

4/10/2013 Virginia Tech students were overcharged for health insurance due to fraud by the company selected to run the school’s student health insurance plan, according to a grand jury indictment unsealed in federal court in Abingdon VA today.

3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.

2/15/2012 The cost for specific health care services can be easily estimated and compared using Virginia’s “Health Care Prices” online report. We recommend that consumers use this service and discuss prices with medical providers before agreeing to a plan of treatment. Consumers have been reluctant to discuss price with their medical providers partly because they lacked information about pricing of medical services. Implementation of health reform means that more consumers are on the hook for a larger portion of their own health expenses. The state hopes that this reporting service will help empower consumers to negotiate pricing and payment terms with their medical providers.

2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Anthem Health Plans of Virginia, and Optima Health Plan are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.

1/12/2012 Value Access Guarantee is no longer available in Virginia.

7/10/2011  The U.S. Center for Consumer Information and Insurance Oversight announced that Virginia lacks proper resources or authority in the small-group market to effectively review large rate increases as required by federal law. The federal government will temporarily take over the task of reviewing small business health insurance rate increases that are more than 10%.

2/7/2011 The state’s pre-existing condition insurance plan (PCIP) monthly premium rates (per person):

Plan/Age Band
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods. PCIP applicants who are approved to participate in PCIP can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses. Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the amount the plan pays for your care. If you apply for PCIP coverage on the government Web site, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed. Note that your premium may increase if you age into a higher rate tier, or if PCIP adjusts its premiums to any changes in the commercial market.

1/30/2011 Patients with health insurance and a credit card now have access to VIP treatment when care is needed at a hospital emergency room. Riverside Regional Medical Center in Newport News and Family Health Clinic at the Crossings in Hopewelljoined the growing list of hospitals that allows patients to use InQuickER, a reservation system that books appointments and reduces waiting time in the emergency room. The reservation system makes check-in easier by recording your insurance and payment information in advance. The service costs $15 to $25. Of course the nature unpredictable medical emergencies mean that the service cannot absolutely guarantee that you’ll be seen immediately at your appointment time, but you get a full refund if not treated within 15 minutes after arrival. The InQuickER service works in conjunction with any of the private health insurance plans listed here at but is not available to uninsured patients.

12/16/2010 Virginia Department of Medical Assistance Services officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.

In its initial federal grant request for the insurance exchange project, the Virginia Department of Medical Assistance Services said that it would: 1) Establish task forces in six key areas, Medicaid Reform, Insurance Market Reform and Exchanges, Delivery and Payment Reform, Capacity, Technology, and Purchasers, via the Virginia Health Reform Initiative (VHRI). VHRI has been established within the Office of the Secretary of Health and Human Resources. VHRI Advisory Council members represent leaders from the legislature, health care delivery, health care policy, health insurance, and the business community, and 2) Provide options on the planning, research, development, and implementation issues on how an Exchange’s governance, financial operations and oversight, and technical infrastructure.

The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.

5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Virginia is now available at Freedom Benefits.

3/24/2010 Virginia enacted a new saying that no Virginian can be required to purchase insurance. Additional legal action against the federal government’s health care reform law is expected in the near future.

3/18/2010 Five of the state’s largest health insurance companies received state approval to raise premium rates an average of 14% beginning April 1 or May 1. The rate increases for Humana, Prudential, Golden Rule, Anthem and Optima and are primarily attributable to increases in utilization or the rate at which members elect to use expensive services like MRIs, CAT scans and other technology intensive diagnostic procedures.  Prudential experienced an even higher rate of increased claims but the state will require the insurer to recoup the costs though other methods like limiting benefits or allocating the costs to future rate increases to other types of health plan members instead.