Virginia Health Insurance Guide

Health Insurance Resources for VA State Residents

As a resident of the Commonwealth of Virginia you can choose from a number of health insurance programs for individuals and group plans provided by private insurance companies. Virginia also offers sponsored programs to assist low-income families and children in finding affordable health care. You also have access to all federally mandated programs including Medicare and COBRA.

Virginia law does not enforce guaranteed issue. However, Virginia health insurance law requires that many health insurance plans provide mandated benefits to all holders of individual and group policies issued in the commonwealth. In addition, it requires that individual and group policy holders have the option to purchase certain mandated offers of coverage (such as prescription contraceptives, optional obstetrical services and morbid obesity).

Many of the mandated benefits are designed to specifically benefit women and children. These include but are not limited to coverage for: childhood immunization; infant hearing screening and related diagnostics, mammograms; pap smears; minimal hospital stays for mastectomy; reconstructive breast surgery; hysterectomy; and postpartum services. Other mandated benefits include coverage for: mental health and substance abuse services; colorectal cancer screening; diabetes; and hospice care. Another important mandate prohibits the exclusion or reduction of benefits or denial of renewal for certain causes once a group or individual policy has been issued, as long as the premiums are paid.

Types of Health Insurance Plans Available in Virginia
The following major medical health insurance plans are generally available in Virginia. Major medical plans cover illness and injuries, hospitalization, prescription drugs and office visits.

Managed Care Health Insurance Plans, also called MCHIPs (Managed Care Health Insurance Plans)
In Virginia, require you to select your health care providers from a network. When you stay in the network, you pay less for your services than if you go out of the network. Managed care options include Health Maintenance Organizations (HMOs), which require that you select a Primary Care Physician, who must provide referrals to see any specialists; and Preferred Provider Organizations (PPOs), which do not require a Primary Care Physician or restrict your ability to see specialists in or out of the network, although going out of network will usually result in a higher co-pay or smaller reimbursement for services. A Point of Service Plan (POS) is another type of MCHIP that gives you the option of going in or out of network but provides less coverage for out-of-network service and which usually require payment of deductibles and co-insurance for out-of-network care. Note that membership in an HMO requires that you live or work within the plan’s service area to be eligible for service.
Traditional Health Insurance
Also called Indemnity Plans, these policies allow you to go to the health care provider and hospital of your choice. You pay for the services and file for reimbursement according to your plan. These are typically the most flexible plans, but also the most expensive. Specific coverage and costs will vary depending on the plan you choose.

Alternative Health Programs in Virginia

FAMIS (Family Access to Medical Insurance Security)
FAMIS is a health insurance program designed to make health care affordable for children of eligible Virginia parents. Covered services include doctor visits, well-baby care, hospitalization, vaccinations, prescription drugs, lab tests and x-rays, dental care, emergency care, vision care and mental health care. There are no premiums or enrollment costs to eligible families. Some services including routine check-ups are free, while others may involve co-payments of $2 or $5.00.

FAMIS MOM
FAMIS MOM is a Virginia health care program that provides prenatal care to resident women who are uninsured, meet family income guidelines and do not have access to any state employee health plan.

FAMIS Select
is a third commonwealth-sponsored program that helps eligible families pay for private or employer-provided health insurance. Families are allowed to choose between covering dependent children through FAMIS or through a private or employer-provided health plan. FAMIS Select gives enrolled families up to $100 per enrolled child per month toward health insurance premiums. At least one child must be already enrolled in FAMIS before the family can enroll in FAMIS Select.

Regulating Agencies
Health insurance is regulated by the Virginia State Corporation Commission Bureau of Insurance. Since 1999, Virginia residents have had access to the Bureau of Insurance Office of Managed Care Ombudsman, whose principal function is to help Virginia consumers whose health care is provided by a Managed Care health Insurance Plan. This office is a resource for understanding and exercise rights of appeal of adverse decisions made by a consumer’s MCHIP.

Get access to Virginia health insurance quotes at einsurance.com based on your coverage needs and individual health circumstances.

Virginia Bureau of Insurance
BOI Main Mailing Address:
P.O. Box 1157
Richmond, Virginia 23218
804-371-9741

BOI Street Address:
1300 East Main Street
Richmond, Virginia 23219
www.scc.virginia.gov/division/boi/index.htm

FAMIS – Family Access to Medical Insurance Security
www.famis.org
For more information about the FAMIS programs, call toll-free:
1-866-87FAMIS (1-866-873-2647)
TDD users ONLY call, 1-888-221-1590
8:00 am to 7:00 pm, Monday - Friday
9:00 am to 12:00 noon, Saturday

Virginia Department of Medical Assistant Services – DMAS
600 East Broad Street
Richmond, Virginia 23219
www.dmas.virginia.gov

(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
www.naic.org

Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
www.iii.org