Key Takeaways
- Virginia requires a 10-day free look period for individual health insurance policies
- Pre-existing condition exclusions are prohibited in individual and small group markets under ACA
- Virginia requires coverage for essential health benefits in qualified health plans
- Mental health parity is required for health insurance policies
- Virginia operates a state-federal partnership health insurance marketplace
Virginia Health Insurance Policy Requirements
Virginia has comprehensive health insurance regulations that work in conjunction with federal requirements. Understanding these state-specific rules is essential for the licensing exam.
Regulatory Structure
Virginia health coverage is regulated by the Bureau of Insurance:
| Coverage Type | Regulator |
|---|---|
| Individual Health | Bureau of Insurance |
| Group Health | Bureau of Insurance |
| HMOs | Bureau of Insurance |
| Self-Funded Plans | Federal (ERISA) |
Free Look Period
Virginia provides a 10-day free look period for individual health insurance:
- Policyholder can return for full premium refund
- Begins when policy is delivered
- Applies to individual health policies
- Same as life insurance (except for seniors)
Required Coverage
Virginia mandates coverage for numerous benefits:
Essential Health Benefits
All individual and small group plans must cover:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorders
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive and wellness services
- Pediatric services (including dental and vision)
Exam Tip: Virginia follows the federal essential health benefits requirements for individual and small group plans.
Mental Health Parity
Virginia requires mental health parity in health insurance:
- Mental health benefits equal to medical benefits
- Same copays, deductibles, and limits
- Covers mental illness and substance use
- Applies to group and individual plans
Covered Conditions
- Serious mental illness
- Substance use disorders
- Behavioral health conditions
- Eating disorders
Pre-Existing Condition Protections
Virginia follows ACA rules on pre-existing conditions:
| Market Segment | Pre-Existing Condition Exclusions |
|---|---|
| Individual | Prohibited |
| Small Group | Prohibited |
| Large Group | Limited by federal law |
| Medicare Supplement | Special rules apply |
Health Insurance Marketplace
Virginia operates a state-federal partnership marketplace:
Key Features
- Uses HealthCare.gov platform
- State handles plan management
- Federal government handles enrollment
- Premium tax credits available
- Plans categorized by metal tiers
Metal Tiers
| Tier | Actuarial Value |
|---|---|
| Bronze | 60% |
| Silver | 70% |
| Gold | 80% |
| Platinum | 90% |
Guaranteed Issue and Renewal
Virginia requires:
Guaranteed Issue
- Insurers must accept all applicants
- Cannot deny coverage based on health status
- Applies to individual and small group markets
Guaranteed Renewal
- Insurers cannot cancel coverage except for:
- Non-payment of premium
- Fraud or misrepresentation
- Plan discontinuation (with notice)
How long is the free look period for individual health insurance policies in Virginia?
What type of health insurance marketplace does Virginia operate?