Health Insurance

What is a deductible?

A deductible is the amount of money that must be spent out of pocket before the insurance will pay for any expenses.

What is a copay?

A copay is the fixed dollar amount you pay for some covered services.

What is a health reimbursement account (HRA) that is included in the COVA HealthAware plan?

The health reimbursement account (HRA) is funded by the Commonwealth of Virginia to help pay your out-of-pocket medical costs and annual deductible for covered services.

What is the out of pocket expense limit?

The out of pocket expense limit is the amount of money that is paid out of pocket for certain allowable covered medical and behavioral health expenses during the plan year. Deductibles, copayments, coinsurances all count towards the out of pocket expense limit. Once the limit is reached, covered expenses are paid in full for the rest of the plan year.

What is the health insurance plan year?

The plan year runs on a fiscal year. The fiscal year is July 1 through June 30.

What if I have a pre-existing medical condition?

Pre-existing conditions are covered under the health plan. There is no waiting period before services are covered for pre-existing conditions.

Do I need a referral to see a certain medical professional?

A referral is not necessary under the health insurance plans; however, some medical professionals may require a referral before providing any services.

How do I add or drop a dependent?

You may add or drop dependents within 60 days of the qualifying life event. Qualifying events may include marriage, birth, death, divorce and change in employment status. Only the dependents that are affected by the event may be added/removed. Other changes to your plan must be made during the open enrollment period.

When is the open enrollment period for health insurance?

Open enrollment usually occurs in the spring, mid-April to mid-May. Changes during open enrollment take effect on July 1.

How long can my child stay on my health insurance plan?

Dependent children may be covered to the end of the year in which he/she turns 26.

How do I change my address with the health insurance provider?

To ensure that all individuals receive information properly and efficiently, be sure that your address is correct in MyMadison. A Human Resources Benefits Coordinator will run a weekly query that pulls all address changes made in MyMadison and will then update the state health insurance system with the new address.

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