Virginia Health Insurance

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Facts and Figures

Place in State
Health Report Card 20^th
Insured 6,672,639
Uninsured 987,900
Insurance
Carriers 15
Number of
Primary Care Physicians 14440
Number of
Hospitals 90
Average Cost of
Health Insurance* $988

Breakdown of Insureds

Employer-sponsored health insurance 67%
Private plans 5%
Medicaid 12%
Medicare 14%
Others 2%

Insurance Carriers

Aetna
Anthem Blue Cross and Blue Shield of Virginia
Assurant Health (Formerly Fortis)
CareFirst BlueCross BlueShield
Celtic
Golden Rule
Kaiser Permanente of the Mid-Atlantic States
Optima Health Insurance Company Health Insurance
Principal Life
Security Life
Standard Security Life Health Insurance
UNICARE

State Health Report Card

Smoking went down from 21.4 percent to 18.5 percent among adults in the past ten years. There are more than 1.1 million adult smokers in the state. Obesity went up from 18.2 percent to 26.4 percent among adults in the last ten years. There are more than 1.6 million obese adults living in Virginia. Diabetes rose from 6.9 percent to 8.7 percent among adults in past five years. There are now more than 535,000 adults living with diabetes in the state. Binge drinking among adults went up from 13.6 percent to 15.3 percent in the past year. Children living in poverty went down from 14.8 percent to 12.3 percent among those 18 and under in the past year

Virginia Health Insurance Laws and Regulations

Virginia health insurance plans must be sold with a guaranteed renewability clause. With this clause, policyholders can renew their coverage as many times they want to as long as they pay their premiums on time and do not violate any terms of their contract. Furthermore, health insurance companies cannot cancel a subscriber’s coverage on the grounds that he gets sick or injured. Virginia health insurance plans can exclude coverage for a pre-existing condition for up to 12 months. The waiting period you’ve spent with one plan may be carried over to another plan should you wish to switch policies. However, insurers can permanently exclude coverage for a pre-existing condition through an “elimination rider.” Applicants should be aware when buying a new policy. Except for Blue Cross Blue Shield, health insurance companies in the state can deny an applicant’s request for coverage based on any factor they care to use. With limited regulatory controls, the cost of health insurance can vary greatly based on the applicant’s risk factors. Small businesses with two to fifty employees operating in the state are qualified to purchase group health coverage, and have the option of selecting one of two standardized health plans in addition to other plans the insurers offer. They can also purchase group health plans being offered to other small businesses in the state. To prevent group health plans from being terminated, small businesses are required to meet certain conditions like having a minimum level of employee participation and a minimum employer contribution to employee premiums. Virginia health insurance quotes for group coverage can vary according to the risk factors of its members. However, small group health plans cannot be cancelled due to a member’s health condition. Self-employed workers in Virginia cannot purchase group health plans unless they have at least one other employee. However, they can purchase an individual health coverage, which has the advantage of being able to deduct a portion of its premiums from tax liability.

Heath Care Reform

With the new health care law, children under the age of 26 can choose to stay under their parent’s Virginia health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In Virginia, 62,846 young adults have insurance coverage through this provision as of June 2011.

The new health care law allowed 84,977 Medicare policyholders in Virginia to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 81,535 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plans when they hit the donut hole. An average of $600 per person or a total of $48,949,685 was saved in Virginia.

Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 982 individuals in Virginia have benefited from this new law.

When looking at Virginia health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. The 2,024,000 private policyholders in Virginia will get greater value for their premium payments because of this 80/20 rule.

Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all Virginia health insurance with no deductibles or co-pays. In 2011, more than 837,645 Medicare subscribers and 1,519,000 individuals with private policies received such services in Virginia.

Under the new law, insurance companies are no longer allowed to impose an annual dollar limit – a cap on the yearly spending for your benefits, or a lifetime dollar limit – a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 2,974,000 Virginia residents have benefited from this law.

If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of Virginia received a total of $1 million.

All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In Virginia, 155 community health centers received a total of $53.3 million to fund these improvements.

In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. Virginia has already received a total of $20 million to support its policies, programs, and communities to help its residents lead healthier lives.

State Government Insurance Programs Offered

Medicaid

804-786-6145

Medicaid offers coverage to low-income individuals and families who cannot pay for their medical care. Applicants for this program should meet financial and other eligibility requirements. Benefits for this program include physician services, inpatient hospital, outpatient services, home health services, dental & vision, laboratory & x-ray, ambulatory surgery centers, non-emergency transportation, nursing, family planning, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program services, Medicare Premium Assistance, Eligibility: 1. Must be U.S. citizens or legal residents living in Virginia. 2. Must not exceed income limits. Children aged 0-18 years: 150% of the federal poverty level (FPL). Pregnant women: 200% of the FPL. Aged, and disabled: 64% of the FPL with assets not exceeding $1,500 for singles and 83% of the FPL with assets not exceeding $2,250 for couples. Workers with disabilities: 250% of the FPL, with assets not exceeding $10,580. Must be 16-64 years old, disabled, and employed.

Family Access to Medical Insurance Security (FAMIS)

866-873-2647 888-221-1590 (TDD)

Family Access to Medical Insurance Security or FAMIS offers health coverage for children under 19 years who belong to families with moderate incomes. Services covered include doctor visits, hospital visits, tests and x-rays, prescription medicine, emergency care, well-baby checkups, vaccinations, vision care, dental care, and mental healthcare. Eligibility: 1. Must be a U.S. citizen or qualified resident living in Virginia. 2. Must be under 19 years. 3. Income must not exceed 200% of the federal poverty level (FPL). 4. Must have gone at least four months without health insurance. 5. Must not be eligible for any state employee health insurance plan, or FAMIS Plus.

Every Women’s Life

866-395-4968 866-864-8204

Breast and Cervical Cancer Early Detection Program (Every Woman’s Life) in Virginia offers screening, diagnostics, and other related care to qualified low-income women. Benefits for this program include clinical breast exams, mammograms, breast and cervical cancer screenings, Pap tests, pelvic exams, and many more. Coverage for breast and cervical cancer treatment is possible through Medicaid. Eligibility: 1. Must be U.S. citizens or qualified residents living in Virginia. 2. Must not exceed 200% of the FPL. 3. Must be uninsured or have an insurance plan that doesn’t cover breast or cervical cancer screenings; must not be eligible for Medicaid. 4. Must be between 40 and 64 years old. Women between 18 and 39 years can qualify for the tests but may have to pay for them.

Virginia Medicare

800-633-4227

Medicare is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.

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