Virginia Health Insurance Rights and Responsibilities

Here are some of your rights and responsibilities regarding health insurance in Virginia.

• Insurance companies cannot unfairly discriminate concerning rates and coverage;
• Claims must be paid promptly and fairly;
• Consumers have a right to access certain information collected by insurance companies if coverage is refused, coverage is terminated, coverage differs from what was originally applied for, or premiums are higher than what was quoted you at the time of application;
• When you buy insurance, you have the right to:
  • Receive a copy of the insurance policy, certificate governing your coverage, or evidence of coverage;
  • Receive copies of all forms and applications signed by you or your agent;
  • Appeal any denied claims.

When buying insurance, you are responsible for:

• Reading and understanding any explanation of benefits forms sent by your insurance company;
• Making sure your application is accurately completed, even if the agent or someone else completed it for you;
• Knowing what your policy covers and excludes;
• Paying your premiums, even while involved in a dispute with your company; and
• Paying any deductibles, coinsurance, or co-payments, outlined in your policy, certificate or EOC.

Insurance Rules to Live By

• Know the name of your insurance company and policy number.
• Read your policy.
• Be sure your agent is licensed.
• Get a receipt if you pay by cash.
• Read the application before you sign it.