Virginia Health Insurance ( Powerpoint)

Module 1: Introduction to Health Insurance in Virginia

• Overview of Virginia’s health insurance market.
• The role of state and federal regulations (Affordable Care Act, Medicaid, CHIP, etc.).
• Key terms and definitions: premiums, deductibles, copays, coinsurance, etc.
• The Virginia Health Benefit Exchange: Individual and family health insurance marketplace.

Module 2: Public Health Insurance Programs in Virginia

• Medicaid in Virginia:
  • Medicaid eligibility and application process.
  • Medicaid expansion under the Affordable Care Act (ACA).
  • Services covered by Medicaid in Virginia.
  • Managed Care Medicaid and Fee-for-Service Medicaid.
• Children’s Health Insurance Program (CHIP) – FAMIS:
  • Overview of FAMIS (Family Access to Medical Insurance Security).
  • Eligibility requirements for children and pregnant women.
  • Services covered by FAMIS and application process.
• Medicare:
  • Eligibility for Medicare and coverage options.
  • Medicare Part A, B, C, and D.
  • Medigap (Medicare Supplement) policies in Virginia.

Module 3: Private Health Insurance Plans

• Individual and family plans available through the Virginia Health Insurance Marketplace.
• Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Exclusive Provider Organizations (EPOs).
• Short-term health insurance plans.
• Catastrophic health plans for individuals under 30.

Module 4: Employer-Sponsored Health Insurance in Virginia

• Types of employer-sponsored plans (fully-insured vs. self-insured).
• Virginia’s small group and large group health insurance regulations.
• Employer mandates under the ACA.
• Continuation of coverage under COBRA (Consolidated Omnibus Budget Reconciliation Act) and Virginia’s Mini-COBRA.

Module 5: Compliance and Regulations for Insurers and Employers

• Virginia Bureau of Insurance’s role in overseeing health insurance compliance.
• Requirements for providing essential health benefits.
• State-specific mandates: mental health parity, coverage for preventive services, and more.
• Health insurance appeals process and dispute resolution.

Module 6: Consumer Protections and Rights in Virginia

• The Virginia Health Insurance Consumer Assistance Program (CICAP).
• Understanding open enrollment and special enrollment periods.
• How to appeal denied claims and coverage decisions.
• Virginia’s protections against surprise medical bills.

Module 7: Navigating the Enrollment Process

• Key dates for open enrollment and special enrollment periods.
• How to use the Virginia Health Benefit Exchange.
• Tools and resources for choosing the right health plan.
• Assistance programs for low-income individuals.

Module 8: Health Insurance Costs and Financial Assistance

• Understanding premiums, deductibles, copays, and out-of-pocket limits.
• Federal subsidies available under the ACA for marketplace plans.
• Virginia’s premium assistance programs for low-income residents.
• Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs).

Module 9: Future Trends in Health Insurance

• Legislative changes impacting Virginia’s health insurance market.
• The impact of telemedicine and digital health services.
• Innovations in health plan offerings and integrated care models.
• The role of health insurance in addressing health disparities in Virginia.