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MEDIA INQUIRIES

Information Resources Division: 804-371-9141 sccinfo@scc.virginia.gov

 

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RICHMOND – Many Virginians will soon be protected against surprise medical billing thanks to a new law that takes effect January 1, 2021. Surprise billing – or balance billing – occurs when patients enrolled in managed care health insurance plans receive bills for more than their plan’s cost-sharing amounts (such as deductibles, coinsurance and co-pays) directly from medical service providers who do not participate in the plan’s network of providers – often referred to as “out-of-network” providers. The new law protects individuals from balance billing for emergency services, as well as non-emergency laboratory and professional services including surgery, anesthesia, pathology, radiology and hospitalist services.

Starting January 1, individuals enrolled in either fully insured managed care health insurance plans issued in Virginia or the state employee health benefit plan cannot be balance billed successfully by an out-of-network provider for emergency services. Additionally, out-of-network providers cannot balance bill these individuals for certain non-emergency services during a scheduled procedure at an in-network hospital or other health care facility.

Although the new balance billing law does not apply to self-funded group health plans and certain other self-funded plans, those plans may opt in so that the law’s protections apply to their enrollees. These plans are known as elective group health plans. More than 200 elective group health plans have already opted in beginning January 1, 2021. A list of plans that have chosen to opt in is available on the State Corporation Commission’s (SCC) Bureau of Insurance (Bureau) website at Search Elective Group Health Plans | Balance Billing (virginia.gov).

Plans that wish to opt into the balance billing protections beginning at a later date can find the application on the Bureau’s website at Virginia SCC - Balance Billing. To opt in, these groups or their third-party administrators must complete and submit an online application at least 30 days before either the beginning of their plan year or January 1 of any subsequent year.

The new law works, in part, by requiring insurers and providers to resolve balance billing disputes – rather than the provider simply sending the consumer a balance billing. When a consumer is treated by an out-of-network health care provider for services covered by the new law, the provider will submit the claim to the consumer’s insurer or health plan. The insurer or health plan will pay the provider a “commercially reasonable amount” that is based on payments for the same or similar services in a similar geographic area, thereby eliminating any balance payment by the consumer to the provider for services rendered.

If they cannot agree on the amount due, the provider and the insurer or health plan may begin a claims resolution process. As part of that process, the insurer and out-of-network provider must first try to agree on a payment amount. If they cannot agree, one of the parties may request that an arbitrator determine the final payment amount and resolve disputes. Arbitrators must report their final decision to both arbitrating parties and to the Bureau using the Arbitrator Decision Reporting Form, which is available on the Bureau’s website at Virginia SCC - Balance Billing.

The Bureau is currently accepting applications for individuals interested in serving as arbitrators for balance billing disputes. Arbitrators should have training and experience in arbitration or dispute resolution and matters related to medical or health care services. For more information, including an application and a list of approved arbitrators, visit Virginia SCC - Balance Billing.

Additionally, the new law requires health care facilities and medical providers to notify consumers about balance billing protection for out-of-network services. Among other things, these notifications must inform consumers how to determine if they are protected from surprise billing, when they can be balance billed, and what to do if they are billed too much. Providers must notify consumers (on their websites or otherwise) about which networks they participate in; refund to consumers any overpaid amounts within 30 business days; provide to consumers a notice of their rights under the balance billing law, and refrain from asking consumers to limit or give up their rights under the balance billing law.

Managed care health insurance plans regulated by the Bureau also must notify enrollees regarding if and when they are subject to balance billing, as well as notify enrollees of their rights under the new law. If an enrollee is subject to balance billing, the new law requires that their financial responsibility must be based on what they would pay an in-network provider or in-network facility in their area.

If health care providers have a pattern of violations under the new law without attempting corrective action, they are subject to fines or other measures by the Virginia Board of Medicine or the Virginia Commissioner of Health. Similarly, insurance companies that are found to engage in a pattern of violations of the new law are subject to fines or other sanctions by the SCC.

For more information, contact the Virginia Bureau of Insurance toll-free at 1-877-310-6560 or visit scc.virginia.gov. Questions related to the arbitrator application, requests to arbitrate, or questions regarding the self-funded opt-in process may be emailed to BBVA@scc.virginia.gov. Consumer questions and complaints about balance billing may be emailed to BureauofInsurance@scc.virginia.gov

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Contact: Katha Treanor, 804-371-9141

RICHMOND – New insurance coverage options will soon be available to Medicare-eligible Virginians under the age of 65.

Effective January 1, 2021, individuals will be able to enroll in Medicare Supplement (also known as Medigap) plans if they are:

  • Under age 65 and live in Virginia
  • Eligible for Medicare by reason of disability, and
  • Either enrolled in or will be enrolled in Medicare Parts A and B by the effective date of coverage.

Medigap is sold by private companies and helps fill coverage gaps in original Medicare. A Medigap policy can pay for copayments, coinsurance and deductibles for covered services. In some cases, it can also pay for services that original Medicare doesn’t cover, such as medical care when traveling outside the U.S.

A new law passed by the 2020 Virginia General Assembly requires each insurer, health service plan and health maintenance organization that issues Medigap plans in Virginia to offer the option to buy at least one of its Medigap plans to individuals who meet the above criteria for eligibility.

The Medigap plans are guaranteed for eligible individuals. In other words, the insurer must issue and maintain coverage as long as premiums are paid on the policy or certificate. In addition, insurers cannot exclude benefits based on pre-existing conditions under certain circumstances.

Enrollment periods may vary depending on your circumstances and eligibility. To learn more, contact companies that sell Medigap policies in Virginia or visit the State Corporation Commission’s (SCC) Bureau of Insurance (Bureau) website at Virginia SCC - Tips, Guides & Publications and select Medicare Supplement.

In Virginia, individuals have a 30-day “free look” period for a Medigap policy that allows them to return the policy for a full premium refund within 30 days of purchase if not satisfied.

Upon turning 65, individuals who have purchased a Medigap policy under the pre-65 coverage option, will receive a new six-month open enrollment period and can purchase any of the standardized Medigap plans, which may offer a wider choice of plans and lower premiums.

For more information about Medigap plans, a list of insurance companies that sell Medigap policies to disabled Medicare-eligible individuals under age 65, and a list of premiums, visit the Bureau of Insurance website at Virginia SCC - Tips, Guides & Publications and select Medicare Supplement. For questions, contact the Bureau toll-free at 1-877-310-6560, in Richmond at 804-371-9691 or by email at BureauofInsurance@scc.virginia.gov.

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Contact: Katha Treanor, 804-371-9141

RICHMOND – Changes in licensing, fees and continuing education due dates for insurance agents in Virginia will take effect January 1, 2021.

The State Corporation Commission’s (SCC) Bureau of Insurance (Bureau) is changing the duration of agent licenses from a perpetual basis to a biennial basis based on their birth month and year. The changes will impact approximately 332,000 individuals and agencies holding 340,000 insurance agent licenses in Virginia. The switch to biennial license renewals allows the Bureau to more regularly receive up-to-date contact and other license-related information from agents, such as criminal history and disciplinary actions.

Beginning January 1, 2021, license renewal fees will be $10 every two years per line of authority for all insurance license types.

Continuing education (CE) due dates also will change. Currently, the Bureau uses a static date for resident insurance agents licensed in Virginia to complete CE requirements. As of January 1, CE due dates will align with each resident agent’s individual license renewal date. The number of hours required for CE has not changed but the $22 continuance fee has been eliminated effective January 1, 2021.

In addition, new Virginia licensees who live in the Commonwealth will be fingerprinted for state and federal background checks. This requirement does not pertain to license renewal applications.

These changes, as provided by Virginia law, have been in the works for more than two years and are among the biggest changes impacting Virginia insurance agent licensing in more than 30 years. These changes are intended to benefit both licensees as well as the Bureau’s oversight of the licensing process. Among other things, the changes are designed to create greater efficiencies and transparency by ensuring that agent information is updated regularly and to coordinate an agent’s license date with their CE due date. They are also designed to identify license applicants with criminal histories outside of Virginia.

 “One of the Bureau’s top priorities is making the insurance licensing process as uniform as possible with national regulatory standards,” said the Bureau’s Agent Licensing Manager Richard Tozer. “Implementing license renewal, aligning CE with the license renewal date, and fingerprinting will ensure we will meet that goal.”

“This has been an incredibly complex project and the Bureau truly appreciates the amount of input provided by industry stakeholders,” said Deputy Commissioner Mike Beavers of the Bureau’s Agent Regulation Division. “This project will increase the Bureau’s ability to communicate with agents through the collection of updated email and other contact information.”

Insurance agents will be able to complete the license renewal process online in conjunction with their CE requirements 90 days prior to their license expiration date. Going forward, if an agent fails to complete their license renewal and/or CE requirements by their license renewal date, they will have a 12-month period in which to seek reinstatement of their license rather than having to retake the license examination or be fingerprinted.

Under the new licensing process, the first agent renewals will be due beginning in February 2022, with the remaining agent license renewals taking place over the next 24 months. The Bureau anticipates an average of 14,000 license renewals each month.

Beginning in 2021, insurance agencies will renew their licenses by May 1 of each odd year.

The Bureau has worked closely with the Virginia Insurance Continuing Education Board to coordinate implementation of the new processes for CE requirements.

For questions, contact the Bureau of Insurance Agent Licensing Section at BOILicenseRenewal@scc.virginia.gov or call 804-371-9631 or visit its website at scc.virginia.gov/pages/2021-Agent-Licensing-Changes.

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Contact: Katha Treanor, 804-371-9141

RICHMOND – Beginning January 1, 2021, fingerprinting will be among the requirements for individuals living in Virginia who are interested in becoming licensed insurance agents in the Commonwealth. Fingerprinting will be conducted using “live scan” technology, which digitally captures and transmits the fingerprints to the Virginia State Police and the Federal Bureau of Investigation (FBI) for background checks.

The new requirement is the result of legislation passed by the 2019 Virginia General Assembly that requires the submission of fingerprints with applications for resident insurance licenses. This requirement, however, does not pertain to license renewal applications.

The State Corporation Commission’s (SCC) Bureau of Insurance (Bureau) has contracted with Fieldprint, which provides a complete electronic fingerprinting process from collection through transmission to the FBI. Used by several other state agencies in the Commonwealth, Fieldprint is authorized to send fingerprints to the FBI.

For insurance license applications requiring fingerprinting, the process is simple:

  • Create a secure user account on Fieldprint’s website by going to http://fieldprintvirginia.com/, and use Fieldprint Code “FPVABOICHRR” to ensure that the results from the fingerprint review are provided to the Bureau of Insurance.
  • Enter all demographic information required by the Commonwealth of Virginia and the FBI to conduct a fingerprint-based background check.
  • Search for a fingerprinting location at one of Fieldprint’s 46 locations across Virginia or elsewhere in the United States and schedule a 10-minute appointment at a date and time that fits your schedule.
  • When you arrive to be fingerprinted, bring your appointment number and two forms of valid identification such as a driver’s license or passport. Your fingerprints are collected electronically by Fieldprint’s trained technicians and are electronically transmitted to the Virginia State Police and FBI for a background check. The results are then sent to the Bureau of Insurance for review.

The fingerprinting cost is $35.72 which includes fees required by the Virginia State Police and FBI. Applicants can pay the fee by credit card when setting up their appointment with Fieldprint. Companies and agencies that wish to set up an account to pay for their employees may contact the Fieldprint Customer Service Team at 877-614-4364 or customerservice@fieldprint.com.

If an applicant does not have any criminal history, the results should be available within 24-48 hours. For individuals who have a criminal history requiring research, a final decision may take up to 60 days.

Applicants must submit their application for an insurance license within 90 days of submitting their fingerprints to Fieldprint. When applying for another insurance license, fingerprinting is not required if the applicant previously submitted fingerprints within the last 12 months and the applicant is currently licensed as an insurance agent.

The new fingerprinting requirements are among numerous changes for insurance agents in Virginia that become effective January 1, 2021. The changes, which include the switch from perpetual agent licenses to biennial license renewal, fee changes, and changes regarding continuing education (CE) due dates, are designed to create greater efficiencies and transparency by ensuring that agent information is updated regularly and to coordinate an agent’s license date with their CE due date. The changes also are designed to identify license applicants with criminal histories outside of Virginia.

For questions, contact the Bureau of Insurance Agent Licensing Section at AgentLicensing@scc.virginia.gov or call 804-371-9631.

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Contact: Katha Treanor, 804-371-9141

RICHMOND – The 2020 Atlantic hurricane season may be over, but the State Corporation Commission’s (SCC) Bureau of Insurance (Bureau) cautions Virginians not to let their guard down when it comes to the threat of floods. Heavy rains, saturated soil, melting snow and ice, broken dams and a lack of vegetation due to wildfires, development or other causes are just a few factors that can contribute to flooding.

The Bureau reminds Virginians that homeowners, renters and commercial insurance policies typically do not cover damage or loss caused by a flood event. “Floods can happen anywhere and anytime,” said Virginia Insurance Commissioner Scott A. White. “Even a few inches of water can cause extensive damage to your home and its contents.”

White encourages Virginians to assess their flood risk and protect themselves financially before the waters start to rise. If you live in a floodplain near a river, or if you live near the coast, it is especially important to consider purchasing separate flood insurance for your home. However, keep in mind that even low-risk communities can experience flooding.

Although homeowners, renters and commercial insurance policies issued in Virginia typically do not provide coverage for damage to your home, business and belongings caused by floods, the federal government does sell insurance for direct flood and flood-related damage through the National Flood Insurance Program (NFIP). This federally backed flood insurance is available to homeowners, renters and business owners, and offers separate coverage for structures and contents. “There is usually a 30-day waiting period before a new flood insurance policy takes effect, so the time to plan is now,” White said.

For more information about flood insurance, contact your insurance agent or the NFIP at 1-800-427-4661 or FloodSmart@FEMA.DHS.gov or visit floodsmart.gov. Some private insurers also offer their own flood insurance policies, so check with your insurance agent about the availability of a private flood insurance policy. In either case, ask whether your flood policy provides coverage for your personal property.

Virginians also should consider whether their auto insurance covers flood damage to their vehicles. Unlike homeowners insurance, auto insurance generally covers damage caused by flooding. However, the policyholder must have other-than-collision (also known as comprehensive) coverage on their vehicle. This coverage pays for damage to a vehicle from such things as fire, water, hail, vandalism, glass breakage, wind and falling objects.

The SCC’s Bureau of Insurance offers consumer guides regarding homeowners and auto insurance and disaster-related property insurance claims. For copies of the guides or other publications offered by the Bureau of Insurance or answers to your insurance questions, contact the Bureau of Insurance Property and Casualty Consumer Services Section at 804-371-9185 in Richmond or toll-free at 1-877-310-6560. Copies of the consumer insurance guides are also available on the Bureau’s website at scc.virginia.gov/pages/Insurance.


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Contact: Katha Treanor, 804-371-9141

RICHMOND – The Advisory Committee for the Virginia Health Benefit Exchange (Advisory Committee) will hold its inaugural meeting virtually at 1 p.m. on December 7. The Advisory Committee was established to advise and provide recommendations to the Virginia Health Benefit Exchange (Exchange) in carrying out Exchange purposes and duties. The Exchange was created by the 2020 Virginia General Assembly to be an online marketplace where qualified individuals can shop for, compare and enroll in health insurance coverage. The Exchange also provides a small employer program where eligible employees of qualified small employers will be able to enroll in coverage.

The Advisory Committee includes five members appointed by the Governor, five members appointed by the State Corporation Commission (Commission) and five ex-officio members. As part of this inaugural meeting, the members of the Advisory Committee will elect a chair and vice-chair as well as discuss associated committee procedural matters, goals and objectives of the committee and the upcoming state-based exchange platform development project.

The meeting begins at 1 p.m. on Monday, December 7, and will be webcast at https://scc.virginia.gov/pages/Webcasting.  If anyone from the public wishes to comment during the meeting, they must pre-register with the SCC by 5 p.m. on Thursday, December 3, as further provided below. Public witnesses will be called by SCC staff on December 7 in the order in which they registered.

To comment during the meeting, public witnesses must pre-register by 5 p.m. on Thursday, December 3, as follows:

  • Complete the form associated with the meeting date on the webcast page at the address noted above, and email to ExchangeDivision@scc.virginia.gov, or
  • Call the SCC at 804-371-1532 during normal business hours (8:15 a.m. – 5 p.m.) and provide the name and phone number the Commission should dial to reach you during the meeting.

For additional information about the Exchange, visit scc.virginia.gov/pages/Health-Benefit-Exchange-(6).

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Contact: Katha Treanor, 804-371-9141

RICHMOND – With the holiday season quickly approaching, there is no time like the present to review your insurance coverage. Dry pine needles, icy streets and sidewalks, busy kitchens, and overworked outlets are just a few of the seasonal hazards that can impact your financial well-being without adequate insurance coverage. In order to keep spirits bright, the State Corporation Commission’s (SCC) Bureau of Insurance reminds Virginians to check with their insurance agent or company to ensure they have the appropriate amount of insurance coverage in the event of an illness, theft, or mishap.

“The ongoing COVID-19 pandemic makes it more critical than ever to plan ahead this year,” said Virginia Insurance Commissioner Scott A. White. “Make sure your insurance coverage is up-to-date so you can minimize any financial damage.”

Take a close look at each of your insurance policies to ensure you know exactly what is – and is not – covered. What about stolen gifts, decorations, or other items from your home or vehicle? A guest suffering an injury at your residence? A fire on the premises? Understand any deductibles or coverage limits that may apply.

What’s more, COVID-19 creates several additional considerations for policyholders:

  • Complying with local, state, and/or national restrictions regarding the number of people who may gather at one time;
  • Minimizing the risk of transmission by wearing masks, using hand soap and hand sanitizer frequently, and encouraging the sick to stay home;
  • Understanding how COVID-19, specifically, is addressed by your homeowner’s, renter’s, health, and life insurance policies.

In addition to reviewing your policies, you can also be proactive by keeping your auto insurance company’s contact information and a copy of your insurance card with you when you drive, staying alert of local weather forecasts, and bringing health insurance information – like identification cards and contact details for family members – with you while traveling. Also check that your coverage extends to seasonal activities like skiing, snowboarding, and snowmobiling.

Last, make an early New Year’s resolution to update your home inventory. This will help you ensure your homeowners or renter's policy provides enough coverage for your belongings. It can facilitate the recovery process if you experience loss or damage and have to file an insurance claim. Separate coverage may be needed for high-cost items such as jewelry, art or electronics. The National Association of Insurance Commissioners' free smartphone app — myHome Scr.APP.book — makes creating a home inventory quick and easy. This app is available through the App Store and Google Play.

For information about a variety of insurance-related topics specifically for consumers, contact the Virginia Bureau of Insurance in Richmond at (804) 371-9741 or toll-free at 1-877-310-6560 or visit its website at scc.virginia.gov/pages/Insurance. Additional information also may be found on the InsureU portion of the National Association of Insurance Commissioners website at www.insureuonline.org.

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Contact: Ford Carson, 804-371-9141

RICHMOND – Fast-moving and often weighing more than 100 pounds, a deer in the roadway poses a threat to even the most careful driver. Mating season and migration contribute to a dramatic uptick in vehicle-deer collisions during the fall, especially in Virginia, which is among the states with the highest risk of these types of collisions. For this reason, the State Corporation Commission’s (SCC) Bureau of Insurance reminds drivers to stay alert, particularly when traveling during darker times of the day.

“November is the peak month for insurance claims related to vehicle collisions with deer,” said Virginia Insurance Commissioner Scott White. “Contact your insurance agent or company to determine if your policy provides coverage for this type of loss.”

Damage caused to your vehicle as a result of a collision with a deer or other animal typically are covered under the optional “other-than-collision” (also known as “comprehensive”) portion of your automobile policy. Some of the coverages provided by “other-than-collision” coverage are damage resulting from theft, collision with an animal, wind, hail and flood, as well as fire and vandalism. Keep in mind that if you have a liability-only policy, your policy does not cover your vehicle for damage resulting from an accident involving a deer or any other object.

The best way, of course, to avoid a collision with a deer altogether is to slow down and stay alert. If a collision is inevitable, however, you should stay in your lane and brake as carefully as possible. Though jarring, a collision with a deer is often safer for the driver – and for surrounding drivers – than swerving sharply and potentially hitting something else. Additionally, a collision with a deer is typically covered by the comprehensive portion of an insurance policy; whereas a collision caused by swerving – into a tree, for example – would instead typically be covered by the collision portion of the policy. Also, if you swerve and go into a ditch or hit a tree, your insurer may consider you to be at fault, which could cause your premium to increase.

Should you collide with a deer, notify law enforcement and your insurance company as soon as possible. Take pictures of the incident scene and any vehicle damage in the event you file an insurance claim. Don’t assume that your vehicle is safe to drive. Check for leaking fluid, tire damage, broken lights and other damage. When in doubt, call a tow truck.

The Bureau of Insurance stands ready to assist Virginians with their questions regarding auto and many other types of insurance. For more information, call the Bureau toll-free at 1-877-310-6560 or in Richmond at 804-371-9741 or visit its website at scc.virginia.gov/pages/Insurance

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Contact: Ford Carson, 804-371-9141

RICHMOND – Many Virginians will have protection from surprise medical bills beginning January 1, 2021. Individuals enrolled in fully insured managed care plans in Virginia and state employees will benefit from a new law adopted by the 2020 Session of the Virginia General Assembly to curb balance billing.

Surprise billing – or balance billing – occurs when patients enrolled in managed care health insurance plans receive bills for more than their plan’s cost-sharing amounts directly from medical service providers who do not participate in a managed care plan’s network of providers – often referred to as “out-of-network” providers.

The new law may extend to individuals covered under private insurance they purchase on their own or through their employer. Individuals whose primary coverage is through the state employee health benefit plan and those covered through a health benefit plan purchased through HealthCare.gov cannot be balance billed for situations covered under the new law. Approximately 40 percent of individuals who receive their health insurance through their employer will have this protection under their fully insured plan. The remaining 60 percent have coverage through a self-funded ERISA or other arrangement where their employer provides benefits that are administered by a third party, which could be a health insurance company. Most of these health plans will have the option to become elective group health plans by choosing to provide these protections for their employees.

For the same protection to apply to individuals enrolled in elective group plans, the plans must choose to opt in by completing and submitting an online application to the State Corporation Commission’s (SCC) Bureau of Insurance (Bureau) at scc.virginia.gov. They have until December 2, 2020, to do so for protection to be effective on January 1, 2021. Applications submitted after that date may be effective at a later date. 

Plans that opt in will be listed on the Bureau’s website with other information provided by the Bureau regarding balancing billing. Health plans and healthcare providers can go to Balance Billing under the Regulated Industries tab on the Bureau’s website at scc.virginia.gov. Consumer information regarding balancing billing is available by going to Balance Billing Protections under the Consumers tab on the Bureau’s website.

Under the new law, health care facilities and other providers must provide patients with notifications that address how you are protected, when you can be balance billed, and what to do if you are billed too much. Health insurers regulated by the Bureau also must provide notification to enrollees regarding whether they are subject to balance billing and under what circumstances.

Individuals enrolled in plans covered under the new law or plans that have opted into the new law cannot be billed amounts above their cost-share responsibility by an out-of-network provider for emergency services or for certain non-emergency services – including surgery, anesthesia, pathology, radiology and hospitalist service – during a scheduled procedure at an in-network hospital or other health care facility.

If a consumer is treated by an out-of-network health care provider for services covered by the new law, the provider will submit the claim to the consumer’s insurer or health plan. The insurer or health plan will pay the provider a “commercially reasonable amount” that is based on payments for the same or similar services in a similar geographic area, thereby eliminating any balance payment by the consumer to the provider for services rendered.

The Bureau will make available on its website a data set that may be used to determine “commercially reasonable” payment amounts to providers. The data utilizes Virginia’s All-Payer Claims Database as an independent source of claims payment information.

As part of the claims resolution process under the balance billing law, the insurer and provider must first try to agree on a payment amount. If they cannot, one of the parties may request arbitration. Applications for individuals interested in becoming arbitrators will soon be available on the Bureau’s website along with instructions for applying. The Bureau’s website will offer a list of approved arbitrators from which parties entering arbitration may choose.

If health care providers have a pattern of violations under the new law without attempting corrective action, they are subject to fines or other remedies by the Virginia Board of Medicine or the Virginia Commissioner of Health. Similarly, insurance companies that are found to engage in a pattern of violations of the new law are subject to fines or other remedies by the SCC. Neither insurance companies nor health care providers may use arbitration as a general business practice for resolving claims payments.

For more information, contact the Virginia Bureau of Insurance toll-free at 1-877-310-6560 or visit its website at scc.virginia.gov. Questions related to the arbitrator application, requests to arbitrate, or questions regarding the self-funded opt-in process may be emailed to BBVA@scc.virginia.gov. Consumer questions and complaints about balance billing may be emailed to BureauofInsurance@scc.virginia.gov.

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Contact: Katha Treanor, 804-371-9141

Case Number INS-2020-00136

RICHMOND – Many consumers will soon shop for health care coverage during the open enrollment period for the 2021 health insurance marketplace through HealthCare.gov. This open enrollment period for plans under the federal Affordable Care Act (ACA) runs from November 1 through December 15, 2020. After this date, consumers may only buy an ACA-compliant health insurance plan if special enrollment conditions apply to them.

Special enrollment periods (SEP) are available for people who may have recently lost their employer-sponsored health insurance coverage or have had a qualifying life event such as a household change. To learn more, visit HealthCare.gov's SEP page.

“For 2021 and again in 2022, enrollment and eligibility by Virginians will continue on HealthCare.gov, the federal health insurance platform. Virginia’s transition to a state-based system – the Virginia Health Benefit Exchange – will be ready by plan year 2023,” said Victoria Savoy, director of the Virginia Health Benefit Exchange.

The Virginia Exchange was created by the 2020 Virginia General Assembly to be operated as a new division within the State Corporation Commission (SCC). It will be an online marketplace where qualified individuals can shop for, compare and enroll in health insurance coverage. Additionally, the Virginia Exchange will create a small employer program where eligible employees of qualified small employers will be able to enroll in coverage.   

Whether you are thinking about changing plans or purchasing a new health insurance plan, the SCC encourages Virginians to review their coverage needs and thoroughly explore all their options. “Not all health plans are created alike, and some are not insurance,” said Virginia Insurance Commissioner Scott A. White. He encourages Virginians to fully understand the coverage, costs and protections before they sign up for any health plan. “Understand enrollment periods, what ACA-compliant plans must cover and where to turn for legitimate information. If you have questions, the Bureau of Insurance can help.”

Consumer protection laws govern some types of health coverage, such as plans purchased through an employer or through the health insurance marketplace. Other types of plans such as health care sharing ministries and discount plans might be less expensive than health insurance plans subject to the ACA, but they are not insurance and do not offer the same protections as ACA-compliant plans.

Short-term, limited-duration health insurance plans are not available through the health insurance marketplace, but they are regulated health insurance plans. While they may, in some cases, be less expensive than plans offered through the health insurance marketplace, they often cover less than ACA-compliant marketplace plans; may deny eligibility for coverage or exclude services because of pre-existing conditions, and may apply dollar limits on the amount they will pay.

Whether shopping for health insurance on or off the exchange, the Bureau of Insurance and the Virginia Health Benefit Exchange encourage Virginians to carefully consider what health care services you and your family will need before you sign up for any health insurance plan. Ask yourself:

  • Are anticipated services covered and are there any limits on coverage under each health care coverage option being considered? 
  • Are doctors and medications my family needs covered by the plan being considered? 
  • What are the monthly premiums and costs that coincide with using health services such as co-pays, co-insurance and deductibles? 

Especially during open enrollment, keep the following in mind:

  • In Virginia, HealthCare.gov is the official website to enroll in ACA plans.
  • For free help understanding your options, find an application assister (navigator and certified application counselor) at Coverva.org/assistance/.
  • Ask for details of any health plan in writing – including cost and coverage – and make sure you understand what you are purchasing.
  • Look for a disclosure indicating whether the health plan complies with the ACA.
  • The open enrollment period for the 2021 health insurance marketplace ends December 15, 2020. Anyone who contacts you to sell individual health insurance plans through an "enrollment period" outside of that is not selling an ACA-compliant policy.
  • Do not provide personal information or send money in response to unsolicited calls or emails.
  • To verify that an insurance agent, agency or company is licensed in Virginia, visit the Bureau’s website at scc.virginia.gov/boi/ConsumerInquiry/default.aspx.
  • Be wary of telemarketers from the "national enrollment center," "national healthcare center," or other official-sounding name. The marketplace will not call to sell you health insurance.

For more information, contact the Virginia Bureau of Insurance toll-free at 1-877-310-6560 or visit its website at scc.virginia.gov/pages/Insurance. Use the online comparison tool to compare plans. To learn more about the new Virginia Exchange, visit scc.virginia.gov/pages/Health-Benefit-Exchange-(6).

Free translation services are available. Call the Exchange hotline at 1-833-740-1364 or the Healthcare.gov hotline at 1-800-318-2596 for assistance.

 

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Contact: Katha Treanor, 804-371-9141

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