What You'll Lose in Virginia
Virginia has consumer protections that: Comparable Federal Rule for AHPs?

Ensure fair insurance premiums for small groups: Plans must offer standard and essential products with strict limits on:

  • How much insurers can charge sicker groups

    •  Premiums for similar employers can only vary by +/-20% from an average rate for all small employers based on health-status or claims experience

    •  Limits on other rating factors: Use of industry and group size is prohibited

  • How much insurers can increase an employer's premiums when an employee gets sick

    •  Renewal rating follows same rules as initial rates

 

 

No


 

 



No

Ensure access to independent review:

  • Consumers can demand independent external review of claims denials

 

No

Ensure appropriate access to care. Insurers must:

  • Cover emergency services that a “prudent layperson” thought necessary

  • Cover transitional care from a provider who leaves a network

  • Cover non-formulary prescription drugs in certain situations

  • Offer point-of-service option

  • Allow direct access to OB-GYNs

  • Cover cancer clinical trials


 

No

No

No

No

No

No

Ensure marketing protections:

  • Insurers must follow detailed requirements for marketing materials


 

No

Ensure health plans cover important benefits, such as:

  • Mental health parity that goes beyond federal requirements

  • Mammography screening

  • Minimum mastectomy stays

  • Colorectal cancer screening

  • Cervical cancer screening

  • Well-child care*

  • Diabetes supplies and education

  • Prompt payment rules

 

 

No

No

No

No

No

No

No

No (Self-funded AHPs exempt)

Ensure appropriate oversight of insurers:

  • State handles complaints from consumers & providers

  • State investigates, oversees, enforces rules (including financial penalties)

 

No


No$

Prevent failures and ensure payment of claims:

  • Insurers must maintain financial surpluses that grow with size of insurer

  • State oversees corrective action once insurer ears minimum standards

  • State acts quickly to seize assets to pay claims

 

No ($2M cap)

No

No

 

Promote access for the uninsured:

  • Mini-COBRA rules for small employers with fewer than 20 employees

 

No

*DeNotes a mandatory offer requirement