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Virginia Health Insurance
Health insurance is an important precaution when it comes to insuring your financial future. Protecting your family against the occurrence of illness or injury should be your top priority; however a suitable health policy can relieve your financial woes caused by these events. When purchasing health coverage, you should evaluate all potential risks and its effect on your finances. In the U.S., approximately 47 million people are uninsured, majority of whom are working families. These families, especially children, have to bear the dire consequences of not owning proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to these individuals.
Virginia is the 20ndth healthiest state to live in and obtain health coverage, according to the America's Health 2008 Rankings. The state was on 22nd and 21st position in 2007 and 2006 respectively. Despite strong public funding, the major challenges faced by Virginia’s healthcare system include high infant mortality rate, high geographic disparity, increasing percentage of children in poverty and the high rate of uninsured population. The state of Virginia, with more than seven million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced coverage to the uninsurable residents of Virginia who meet specific eligibility requirements of age and income.
The Virginia Bureau of Insurance manages and supervises all kinds of insurance sold through private-market health insurers as well as public health coverage programs. Despite the state’s positive health features, approximately 14.2% of the state’s population is still uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 37.3% of Virginia’s uninsured residents come under the above 200% FPL category.
Buying health coverage can be quite intimidating and perplexing; however, with the help of a licensed health insurance agent/broker, you can choose a proper health insurance plan with benefits that are perfect for your family.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of Virginia. These regulations apply to all insurance companies offering individual or family health insurance in Virginia:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 12 months |
Look Back Period | 12 months |
Look Back Standard | Prudent person |
Mandatory Benefits | Cancer screening for women including breast cancer screening and cervical cancer screening, mastectomy stay - 48 hours for a radical or modified radical mastectomy and 24 hours for a mastectomy or partial mastectomy, reconstructive surgery after mastectomy, direct access to OB/GYNs, maternity care |
Market Rate Restrictions | None |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of Virginia. These regulations apply to all insurance companies offering small group health insurance in Virginia:
| Small Group Size | 2-50 |
Employee Qualifications | Owner can count as an employee |
Guaranteed Issue | Yes |
Premium Rating Factors | No Rating Restrictions |
Rate Adjustment Factors | 25% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of Virginia. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
| Mini-Cobra Option | No |
Eligible Group Sizes | NA |
Extension of Benefits Period - Standard | NA |
Extension of Benefits Period - Disabled | NA |
Maximum Premium Increase | NA |
State Legislation Reference | NA |
Additional Notes | NA |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of Virginia to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Virginia does not have a high risk pool for its residents who cannot obtain private health insurance due to pre-existing conditions.
Children’s Health Insurance Program
Through shared funding from the federal government, the State of Virginia provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | Family Access to Medical Insurance Security (FAMIS) |
Website | |
Phone Number | 866-873-2647 |
Apply Online | Yes |
Age Limits | Under 19 |
Insurance Carrier | CareNet, Optima, Anthem, VA Premier, Amerigroup |
Length of Coverage | 12 months |
Residency Requirements | Virginia resident, U.S. citizen, legal qualified alien |
Other Eligibility Requirements | To qualify, you child should not have had health insurance in the past 4 months (some exceptions apply); should not be eligible for any Virginia state employee health insurance plan; and should not eligible for FAMIS Plus (also known as Medicaid). The FAMIS income limit is 200% of the FPL |
Pre-Existing Condition Exclusions | None |
Cost | There are no monthly premiums or deductibles required. Parents pay $2 - $5 co-pays for most services. |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Virginia:
| Governing Agency | Department of Medical Assistance Services |
Website | |
Phone Number | 800-552-3431 |
Residency Requirements | Virginia residents, U.S. citizens |
Federal Poverty Line Income Limits | Pregnant women, infants and children up to 133% FPL |
Additional Resources
Virginia Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Virginia’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Virginia: At-A-Glance
Provides exclusive health data of Virginia. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
