Effective July 1, 2010, Virginia Code 38.2-3541 was amended to extend Continuation of Coverage from 90 days to 12 months. In addition, groups with 20 or more eligible employees will no longer have a Continuation option. Plans with 20 or more eligibles will have individual conversion policies available to members who lose coverage under the group plan.
The amended code also requires the employer to provide each employee written notice regarding availability of the applicable options as well as the procedures and timeframes for obtaining Continuation or Conversion of the group policy. This notice must be provided within 14 days of the employer’s knowledge of the employee’s loss of eligibility under the group policy.
- For a Vantage, POS or POSA, including Design Vantage and Equity Vantage, in order for a member to be eligible for Continuation or Conversion coverage (depending on which the group has selected), they must exhaust COBRA benefits if applicable. (Group sizes under 20 are ineligible for COBRA)
- For Plus plans including FourSight, Design Plus and Equity Plus, members do not have to exhaust COBRA before they move to Continuation or Conversion coverage.
- Continuation or Conversion plans are not available to members enrolled in self-funded, Medicare or Medicaid plans.
Subscriber application and payment for the Continuation policy shall be made to the employer within 31 days after the issuance of the written notice but may not exceed 60 days following the date of the termination of the member’s eligibility. The premium on the policy shall be at the employer’s customary rate and is payable monthly to the employer during the twelve-month period. The policy shall extend coverage to any family members covered under the group policy at the time of termination.
If a subscriber moves to Conversion, they must enroll in the same type plan (HMO, POS, or PPO). Dependents covered under the group plan at the time of Conversion are also eligible for coverage. Once enrolled, only adopted children and/or newborns are eligible for addition to Conversion coverage. Payment of premium is due to the health plan by the end of the month or they may be subject to cancellation for non-payment of premium. There is no time limit on how long a member can remain on Conversion; however a break in coverage is not allowed.
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