About Individual Health Insurance in VA
Purchasing individual health insurance that is sold in the state of Virginia may depend on an individual's health status. However, there are certain instances where an insurer cannot deny health insurance coverage. This is because of a combination of state and federal laws such as the Code of Virginia and HIPAA. An insurer is required to sell an individual policy to all "eligible individuals" in the state.
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Health Insurers
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All health insurers in the state of Virginia are free to impose limitations or pre-existing exclusions on health insurance polices. Health insurers will use an individual's current health and health history when reviewing an application for health insurance. The only exceptions are the health insurers Anthem BlueCross & BlueShield and CareFirst BlueChoice.
Anthem BlueCross & Blue Shield
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This is one health insurer in the state of Virginia that will sell an individual health insurance policy regardless of the health status of the applicant. A policy from this company currently imposes a 12-month pre-existing exclusion period before coverage starts.
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CareFirst BlueChoice
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This is another insurer that will not deny coverage for an individual health insurance policy based on the health status of an applicant. This company has a 10-month pre-existing period that it imposes on an individual health insurance policy before coverage starts.
HIPAA
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Individuals that are eligible for HIPAA or the Health Insurance Portability and Accountability Act cannot be denied health insurance coverage. A HIPAA-eligible individual needs to have at least 18 months of continuous coverage such as a group health plan or COBRA. An individual that has is HIPAA eligible is also exempted from any pre-existing exclusion from an insurer.
Family Coverage
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Health insurers in the state of Virginia are not required to provide family coverage on an individual health insurance policy. This includes an health insurance policy for an individual that is eligible for HIPAA. However, an insurer must offer an individual policy for each family member who is eligible under HIPAA.
Dependent Children
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Newborns and children who have been adopted are covered by a parent's individual health insurance policy automatically. Coverage is provided for the first 31 days. The child will need to be enrolled on the health insurance policy to continue coverage.
Disabled Children
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Children who are disabled are permitted to stay on their parents individual health insurance policy after dependent coverage usually ends. Proof of disability needs to be provided to an insurer within 31 days after dependent coverage ends. Parents may be required to send periodic proof to an insurer up to three times a year.
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