Health Insurance

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

A copay is the fixed dollar amount you pay for some covered services.
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.
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.
The plan year runs on a fiscal year. The fiscal year is July 1 through June 30.
Pre-existing conditions are covered under the health plan. There is no waiting period before services are covered for pre-existing conditions.
A referral is not necessary under the health insurance plans; however, some medical professionals may require a referral before providing any services.
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.
Open enrollment occurs in the spring typically within the month of May. Changes during open enrollment take effect on July 1.
Dependent children may be covered to the end of the calendar year of which they turn age 26.
To ensure that all individuals receive information properly and efficiently, be sure that your address is correct in MyMadison. This information will be reported to the state Cardinal health insurance system.

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