Frequently Asked Questions about Group Health Insurance in Virginia

I will be leaving my job in a couple of weeks and I am worried about my health insurance. Is there any way I can keep my group insurance coverage?

If you are leaving a job, The Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) requires group health plans sponsored by employers with 20 or more employees to offer continuation of coverage for you and your dependents for 18 months or longer, depending on the qualifying event. You would be responsible for the entire premium, both the portion you paid as an employee and the employer's contribution, as well as an administrative fee.

You may also be able to continue the group coverage for an additional 90 days. Or, you may be able to convert your group coverage to an individual coverage. Your group certificate or EOC will indicate the options available to you.

Why are premiums on a conversion policy so expensive?

Conversion is made without evidence of insurability and, therefore must cover those who would otherwise be uninsurable. Because the claims experience for these types of policies is generally much higher, substantial premiums are often required to cover the risk.

I heard about a law that allows you to take your medical coverage with you when you change jobs. Is this true?

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you do not actually take your exact plan of health benefits with you, but you are credited with the time you were covered under your previous group policy under your new benefit plan. To receive this credit, you must meet the criteria for an "eligible individual." Virginia law provides for credit towards any preexisting condition waiting period in your new benefit plan for the amount of time you were covered by your prior group or individual health plan if you do not have greater than a 63-day break in coverage. Also, the new carrier must offer you the insurance coverage without your having to medically qualify for the coverage as long as you are an "eligible individual." For a more detailed explanation concerning HIPAA and the criteria for an "eligible individual," please contact the Bureau of Insurance.

I'm having a problem with my employer's self-funded (self-insured) health plan. Can you help?

Self-insured group health plans (or self-funded plans) are set up by employers to pay the health claims of its employees. The employer assumes the risk of providing the benefits and paying the claims. A self-insured plan is not subject to the regulatory authority of the Bureau of Insurance. Self-insured plans are subject to the Federal Employee Retirement Income Security Act of 1974 (ERISA).

The U.S. Department of Labor is the federal government agency responsible for handling matters involving self-insured plans. If you cannot receive satisfaction from dealing directly with the plan sponsor (usually the employer) or with the plan administrator, you may contact the U. S. Department of Labor for guidance. The address is:

U. S. Department of Labor
Frances Perkins Building
200 Constitution Avenue, NW
Washington, DC 20210
1-866-487-2365
www.dol.gov