Virginia Health Insurance

When starting any important task, it can be very helpful to first understand the legal framework that might affect your ability to succeed.  This is particularly true when shopping for health insurance, and in a state like Virginia your knowledge of the relevant regulatory guidelines in force can make a huge difference in finding a good deal.  To help you with this process, we offer the following summary of Virginia’s current health insurance regulations.

• Every company that offers health insurance in Virginia is required by law to include a guaranteed-renewability clause in each policy sold.  This means that, as long as you’ve kept to the terms of your contract, you will always have the option of renewing your coverage each time it is due to expire.  In addition, your insurer cannot ever cancel your health coverage on the grounds that you have become ill.
• Insurance companies in Virginia are permitted to declare certain pre-existing conditions as being exempt from coverage by any new policy they sell for up to twelve months.  Virginia defines “pre-existing condition” as any health issue that was diagnosed or treated within the year prior to your policy’s start date.  While you are permitted to credit any exclusion period you’ve already had to endure toward your new policy’s exclusions, insurers are also allowed to include an “elimination rider” in an new policy, designating a pre-existing health condition as being permanently outside the scope of that policy.  This practice is not currently subject to significant legal controls, so please be aware when buying new coverage.
• The only company in Virginia that cannot refuse to sell you health insurance is Blue Cross Blue Shield.  Every other insurer is free to accept or reject any application for coverage that they receive, on any grounds they care to use.  The cost of any policy they do sell is also not subject to significant regulatory controls, so (depending on factors like health and age) two people with identical coverage may end up paying very different amounts.
• Small businesses operating in Virginia are automatically granted access to group health coverage, and may choose between two standardized plans in addition to whatever else insurers might offer.  Companies with no more than fifty employees (and at least two) are also legally entitled to choose any group health policy that is already being offered to other Virginia-based small businesses.
• Group health coverage enjoyed by small businesses in Virginia can vary in cost based on the age, health, and family history of the insured employees, and may also come with certain other strings attached.  There may be a mandatory employer contribution to employee premiums, for example, or the employees may need to maintain a certain baseline level of participation in the company health plan.  Failing to meet the requirements of the group policy could potentially mean the termination of coverage for the entire company.
• Self-employed workers in Virginia who have no other employees are not permitted to purchase group health coverage the way a larger enterprise could.  On the other hand, those who choose to purchase individual health coverage may be able to deduct a large portion of its premiums from their tax liability.

The relatively lax regulations enjoyed by Virginia’s health insurance companies can make it seem difficult to find a good deal on coverage here, but fortunately the insurance market is often competitive enough to give you some degree of advantage in this process.  Once you’ve decided on the kind of health plan you’re looking for, you’re halfway there.  Chances are good that, if you’re willing to look, there’s an insurer ready to offer you a good deal on your chosen coverage.

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