Virginia Individual Health Insurance Regulations

Like many other states, most applications for Virginia individual health insurance policies are required to go through the medical underwriting process. However, Virginia's Anthem Blue Cross Blue Shield and CareFirst Blue Cross Blue Shield in Virginia both provide policies with a guarantee issue. Consumers applying to these two health insurance plans will not be denied coverage based medical history or current level of health.

The majority of Virginia medical insurance policies go through medical underwriting allowing the insurer to take a close look at the current and past health issues of an applicant. Once the process has taken place, the insurer is in a position to offer the applicant coverage through a health plan or make an offer for coverage altered to include exclusions or limitations based on pre-existing medical conditions. These exclusions may last for a 12 month period. The insurer also has the right to decline the application due to what is uncovered during underwriting.

If the insurer decides to offer a plan for coverage, it may impose elimination riders that can be temporary or last for the lifetime of the plan. Elimination riders are a way for the insurer to offer coverage while eliminating benefits to certain conditions labeled preexisting. The state of Virginia allows insurers to review applicants' history up to 12 months prior to the application date. Applicants who qualify under the federal HIPAA regulations may receive credit for previous medical coverage.

Virginia Small Group Medical Insurance Regulations and Guarantee Issue

An employee group with two to 50 people qualifies for small group health insurance in Virginia. Virginia law states that small groups must receive coverage on a guarantee issue basis, meaning a group cannot be declined coverage due to health history or current medical conditions. Credit must also be awarded to applicants who have prior creditable coverage. Without this prior coverage, applicants may go through a six month review period in which the insurer identifies any pre-existing conditions.

All insurers who offer health insurance policies for small groups in Virginia are required to offer standardized health plans that have the same benefits from carrier to carrier. While premium rates may vary, they may not be raised more than 25% of the standard rate. Except for the standardized plans, the insurers have the right to put any application through medical underwriting process and then impose unlimited rates for premiums.

Understanding Virginia COBRA and Continuation Coverage Issues

In Virginia, small businesses with between two and 19 employees qualify for mini-COBRA, allowing employees to continue group benefits for a maximum of 90 days from the termination date as long as they have experienced an event that qualifies under the guidelines. Another qualification for mini-COBRA is that the employee must have been a part of the health coverage plan of the group for at least 90 days prior to termination. All premium payments for mini-COBRA are paid by the employee and must be paid in full before the mini-COBRA ends.

Federal COBRA applies to groups with 20 employees or more. The length of time an employee can stay insured under the employer policy through COBRA is 18 months. Once that time has passed, individuals may apply to conversion plans or apply to Virginia's high-risk health pool.

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