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Numerous state and federal laws make it easier for people with pre-existing conditions to get or keep health insurance, or to change from one health plan to another. A federal law, known as the Health Insurance Portability and Accountability Act (HIPAA) sets national standards for all health plans. In addition, states can pass different reforms for the health plans they regulate (fully insured group health plans and individual health plans), so your protections may vary if you leave Virginia. Virginia has expanded protections for certain kinds of health insurance beyond what federal law requires. Neither federal nor state laws protect your access to health insurance in all circumstances. So please read this guide carefully.

The following information summarizes how federal and state laws do — or do not — protect you as a Virginia resident.

How am I protected?
In Virginia, as in many other states, your health insurance options are somewhat dependent on your health status. Even if you are sick, however, the laws protect you in the following ways.

• Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.

• All health plans in Virginia must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new health plan will begin to pay for care for that condition. Generally, if you join a new plan your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage.

• All Virginia residents are guaranteed the right to buy an individual health plan from either Trigon Blue Cross Blue Shield or CareFirst Blue Cross Blue Shield, depending on where you live. This is called guaranteed issue.

• If you are federally eligible, you are guaranteed the right to buy any individual health plan that an insurance company sells in Virginia. However, an insurance company may charge you significantly higher premiums due to your health status, age, or other factors.

• Your health insurance cannot be canceled because you get sick. Most health insurance is guaranteed renewable.

• If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA continuation coverage or state continuation coverage. It can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition. There are limits on what you can be charged for this coverage.

• If you lose your fully insured group health insurance and meet other qualifications, you may be able to buy individual coverage under a conversion policy. However, there are few limits on what you can be charged for a conversion policy and the benefits may be less generous than your previous group coverage.

• If you are a small employer buying a group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. This is called guaranteed issue.

• If you are purchasing a small group standardized plan, there are limits on what you can be charged because of the health status, claim experience, and other characteristics of those in your group. Most small group plans, however, do not have similar limits on the premiums that can be charged.

• If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. The Virginia Medicaid program offers free health coverage for pregnant women, families with children, and elderly and disabled individuals with very low incomes. The Children’s Medical Security Insurance Plan offers free or subsidized health insurance for some children who are not eligible for Medicaid.