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Health insurance protects you from financial loss stemming from accidents or illness. In any given year, Virginia's Bureau of Insurance aids Virginians in getting back more than $10 million in insurance refunds, benefits payments and changed claim determinations. As a Virginia health insurance consumer, you need to understand the health insurance policies available to you-and what those policies cover and do not cover-in order to choose the one best suited to your own needs.
Getting Smart About Health Insurance Coverage
Becoming informed about Virginia health insurance is the first step to acquiring the health insurance coverage you need. But you must also use common sense and "get smart" about health insurance to make the best possible purchasing decision.
Following are some tips to help you get the Virginia health insurance policy you need at the right price:
Your Coverage Options
Two different health insurance categories generally offer Virginia health and medical insurance: group and individual. Typically, an employer offers its employees Virginia health insurance through a group plan, whereas a Virginian purchasing a health care plan on his or her own from an agent or company purchases an individual health plan.
The types of Virginia health insurance policies available include traditional or managed-care plans. Traditional plans generally allow you to choose your own health care provider, but require you to pay for medical services yourself and then file for reimbursement. These plans include such coverages as basic health, major medical, hospital confinement, disability, specified disease, short term health and limited benefit insurance. Speak with a Virginia health insurer to determine if you need any of these types of coverages and should purchase a traditional health insurance plan.
Managed-care plans use their own networks of health care providers from whom you must choose-and you must stay within that network in order to be reimbursed for medical expenses. Managed-care plans are typically cheaper than traditional plans, but may not cover certain medical expenses and procedures. The most common types of managed-care plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point-of-Service plans (POS). Once again, you should contact a Virginia health insurance provider to determine the differences between these coverages and which type of Virginia health insurance you need.
Know Your Rights and Responsibilities
Every Virginian has the following rights according to state law when purchasing Virginia health insurance:
Certain responsibilities are also associated with obtaining and maintaining health insurance in Virginia. These include:
Keep informed on updates in Virginia law regarding your health care rights and responsibilities to help ensure the health care coverage you expect when you need it most. Stay in contact with your Virginia health insurance agent, as he or she can answer any questions you may have about your policy, including changes in your health care coverage.
Discount Health Care Plans
Discount health care plans, which often promise huge discounts on medical care, are not real health insurance plans. Virginia health insurance purchasers need to understand that these plans offer discounts for medical services from hospitals and doctors-but, unlike health insurance coverage, the consumer is still personally responsible for all medical bills incurred.
These plans usually charge members a membership fee for a list of participating discount health care providers. However, they are not regulated by the Virginia Bureau of Insurance, so the consumer protections available to purchasers of health insurance plans do not extend to purchasers of discount health plans. Beware if you are considering purchasing one of these plans; you may have no recourse if involved in a dispute with a Virginia discount health provider. You may, however, file a complaint about a discount plan marketed in Virginia by calling the Virginia Department of Consumer Affairs at 800-552-9963, or visiting their Web site at www.vdacs.state.va.us.
For Additional Information
If you have additional questions about Virginia health insurance, contact the Virginia Bureau of Insurance toll free at 877-310-6560, or log on to their Web site at www.state.va.us/scc/division/boi/index.htm.
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