reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part I - General › Section 1VAC55-20-80 - Plan assets

Current through Register Vol. 40, No. 24, July 15, 2024
A. The assets of
				  the health benefits program, together with all appropriations, contributions
				  and other payments, shall be deposited in the employee health insurance fund(s)
				  (the "health insurance fund(s)") from which payments for claims, premiums or
				  other contributions, cost containment and administrative expenses shall be
				  withdrawn from time to time.
B. The
				  health insurance fund for state employees shall be maintained separate and
				  apart from the health insurance fund for retirees of the state eligible for
				  Medicare and from the health insurance fund for local employees. All such funds
				  shall be maintained for the exclusive benefit of the employees participating
				  currently in the respective health insurance plans.
C. The department may designate with the
				  approval of the Department of the Treasury one or more insurance companies,
				  banks or any such similar institution as a direct recipient of premiums or
				  other contributions for part or all coverage under the health benefits program
				  from local and state employers.
D.
				  The assets of the fund shall be held for the sole benefit of the employee
				  health insurance fund and to that end, employees participating in the health
				  benefits program.
Any interest on unused balances in the fund shall revert
					 back to the credit of the fund. The State Treasurer shall charge reasonable
					 fees to recover the actual costs of investing the assets held in the
					 fund.
Statutory Authority
§§ 2.2-1204 and 2.2-2818 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part I - General › Section 1VAC55-20-100 - No presumption of right

Current through Register Vol. 40, No. 24, July 15, 2024
These regulations and the health benefits program herein
					 established shall not be deemed to constitute a contract of employment between
					 any participating employer and any participant. No participant in the program
					 shall acquire any right to be retained in the employer's employ by virtue of
					 the program, nor, upon the participant's dismissal or voluntary termination of
					 employment, shall the participant have any interest in any assets of the
					 program other than as may be specifically provided herein.
Furthermore, these regulations and the health benefits
					 program herein established shall in no event confer upon any participant any
					 rights, duties or responsibilities other than those granted herein. The
					 Commonwealth of Virginia specifically reserves the right to amend, modify or
					 terminate, inclusive of eligibility, coverage and contributions provisions, the
					 health benefits program or any plan or plans comprising all or part of the
					 program, as they may relate to any active or retired
					 participant.
Statutory Authority
§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part I - General › Section 1VAC55-20-110 - Authority to withhold revenues

Current through Register Vol. 40, No. 24, July 15, 2024
In the event of default by any employer participating in
					 the health insurance program authorized by § 2.2-1204 of the Code of Virginia
					 in the remittance of premiums or other fees and costs of the program, the State
					 Comptroller is hereby authorized to pay such premiums and costs and to recover
					 such payments from any funds appropriated and payable by the Commonwealth to
					 the employer for any purpose. The State Comptroller shall make such payments,
					 and recover an equivalent amount if possible, from an employer's appropriated
					 funds upon receipt of notice from the director of the department that such
					 payments are due and unpaid from the employer.
Statutory Authority
§§ 2.2-1204 and 2.2-2818 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part II - Rights and Duties of the Department › Section 1VAC55-20-130 - Develop health benefits program

Current through Register Vol. 40, No. 24, July 15, 2024
A. The department shall develop a health
				  benefits program which shall be flexible in its form and content so as to
				  accommodate a structure which permits the creation of multiple accident and
				  health plans. The department, however, may offer a single health insurance plan
				  if it determines that that is the most effective use of plan resources. The
				  department has full authority to make changes in plan terms including, but not
				  limited to, benefits and contributions, or to change underwriters and
				  administrators as it deems appropriate.
B. The department shall supplement these
				  regulations by providing administrative guidance through the Health Insurance
				  Manual, Local Administrative Manual, Flexible Benefits Administrative Manual,
				  memoranda, and other communications.
Statutory Authority
§§ 2.2-1204 and 2.2-2818 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part II - Rights and Duties of the Department › Section 1VAC55-20-140 - Underwriting

Current through Register Vol. 40, No. 24, July 15, 2024
At the department's discretion, the program may either be
					 created and maintained on a self-funded basis or procured from an insurance
					 company licensed to do business in the Commonwealth of Virginia, or a
					 combination of both. In addition, the department is authorized to contract with
					 any third party providers for any and all services which may be necessary to
					 design, administer, communicate or fund the health benefits
					 program.
Statutory Authority
§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part II - Rights and Duties of the Department › Section 1VAC55-20-150 - Employer application

Current through Register Vol. 40, No. 24, July 15, 2024
The department shall develop a form on which local
					 employers may apply for participation in the health benefits program and make
					 available such form to local employers joining such program. The department
					 will advise local employers on questions pertaining to the application. Among
					 other items the department may deem necessary, the application may
					 include:
1. Information regarding the
				  political subdivision such as the governing body, individuals or offices
				  responsible to provide, receive and remit information to the department and the
				  method by which information can or will be transmitted.
2. Information regarding the total number of
				  employees and those employees currently covered, those who will immediately
				  become eligible, and those whose participation is anticipated. This information
				  can include but is not limited to demographic data such as the age and sex of
				  employees, geographic location of residence and employment, dependent status,
				  and information concerning employment responsibilities.
3. Information regarding past premiums,
				  claims and enrollment experience, contribution history, financial arrangements
				  with prior underwriters and the types of plans or benefits provided being
				  offered within the five years prior to making the application.
Statutory Authority
§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part II - Rights and Duties of the Department › Section 1VAC55-20-160 - Establishing contribution rates and accounting for contributions and claims

Current through Register Vol. 40, No. 24, July 15, 2024
A. The department
				  shall establish one or more pools for establishing contribution rates and for
				  accounting for claims and contributions for state employees and participating
				  local employers. The plan for local employers shall be rated separately from
				  the plan established for state employees. There are hereby authorized pools
				  based on geographic and demographic characteristics and employment
				  relationships. Such pools may include but shall not be limited to:
1. Active state employees, including retirees
				  under age 65 and not eligible for Medicare;
2. Active local employees (excluding
				  separately rated employees of public school systems);
3. Active employees of public school
				  systems;
4. Retired state employees
				  over age 65 and retired state employees eligible for Medicare;
5. Retired local employees (excluding
				  separately rated employees of public school systems);
6. Retired employees of public school
				  systems; and
7. Active employees
				  whose employer does not sponsor a health insurance plan.
Participating employers shall make applicable contributions
					 to the employee health insurance fund.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part II - Rights and Duties of the Department › Section 1VAC55-20-170 - Information to local employers

Current through Register Vol. 40, No. 24, July 15, 2024
The department will provide guidance and support to local
					 administrators in the adoption, implementation and administration of the health
					 benefits program.
The department shall furnish local employers with any and
					 all information necessary for any reports the local employer is required to
					 file with any federal or state agency as well as any information necessary for
					 meeting the qualification or nondiscrimination rules under the Internal Revenue
					 Code which may be applicable to such plans.
Statutory Authority
§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part II - Rights and Duties of the Department › Section 1VAC55-20-180 - Information to local employees

Current through Register Vol. 40, No. 24, July 15, 2024
The department shall inform local employees when their
					 coverage terminates by reason of nonpayment of premiums for the local employee
					 group by the local employer. The form of the first notice shall be a notice in
					 a newspaper of general circulation in the locality of the local employer. Such
					 notice shall be prospective with respect to the date of termination. The form
					 of the second notice shall be a letter to each contract holder at the contract
					 holder's address of record.
Statutory Authority
§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part II - Rights and Duties of the Department › Section 1VAC55-20-190 - Confidentiality

Current through Register Vol. 40, No. 24, July 15, 2024
The department will not disclose identifiable individual
					 health data without the consent of the individual being provided coverage. The
					 department may rely on the representations of any parent or guardian regarding
					 such parent's or guardian's consent to the release of information regarding a
					 child of such parent or any other person to which such guardianship shall
					 apply. Data may be compiled into statistical reports provided that the identity
					 of individual persons is not ascertainable by the reader or disclosed by the
					 department.
Statutory Authority
§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part II - Rights and Duties of the Department › Section 1VAC55-20-200 - Reports

Current through Register Vol. 40, No. 24, July 15, 2024
The department, on an annual basis, shall provide a report
					 to the General Assembly. Such report shall discuss the overall objectives of
					 the health benefits program, including enrollment, income and expense,
					 participation by local employers and additional matters of general
					 concern.
Statutory Authority
§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part III - Local Employer Participation › Section 1VAC55-20-220 - Eligible employers

Current through Register Vol. 40, No. 24, July 15, 2024
Pursuant to § 2.1-20.1:02 of the Code of Virginia, local
					 employers may, by making proper application and complying with this chapter,
					 participate in the health benefits program.
Statutory Authority
§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part III - Local Employer Participation › Section 1VAC55-20-230 - Entrance into the health benefits program

Current through Register Vol. 40, No. 24, July 15, 2024
A. Any local employer desiring to participate
				  in the health benefits program shall complete an employer application provided
				  by the department and execute an adoption agreement acknowledging the rights,
				  duties and responsibilities of the department and the local employer.
As a condition of participation, the department may require
					 the local employer to complete the application in its entirety and deliver it
					 to the department no less than 120 days prior to the effective date of coverage
					 under the health benefits program. The application shall include the
					 designation of a local administrator and include a list of other individuals
					 whose responsibilities may be such that the department may have cause to
					 contact them.
The application of a local employer may be withdrawn
					 without penalty any time within the first 30 days after the department's
					 delivery of rates to the employer. A 15-day extension will be available upon
					 written request by the employer. Thereafter, the department may levy a
					 processing charge not to exceed $500 to cover the cost of processing the
					 application.
B. Except in
				  unusual circumstances to be determined by the department, the completion of any
				  waiting periods will not be required of employees of local employers joining
				  the program at the time of a local employer's initial participation.
C. Local employers may include in the program
				  their active employees, or their active employees and their retirees. Local
				  employers may not elect to cover only retirees. If the local employer wishes to
				  provide benefits to their Medicare-eligible retirees it must also provide
				  coverage for non-Medicare retirees. The local employer's beneficiaries
				  qualified under the Consolidated Omnibus Budget Reconciliation Act of 1985
				  (COBRA) or similar legislation may also participate in the program. Coverage
				  will not be available to a new employee unless the employee is on the payroll a
				  minimum of 16 calendar days.
Statutory Authority: § 2.2-2818 of the Code of
						Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part III - Local Employer Participation › Section 1VAC55-20-250 - Enrollment

Current through Register Vol. 40, No. 24, July 15, 2024
The local employer is responsible for providing local
					 employees with enrollment forms for participation in the health benefits
					 program. Such forms shall be provided to the local employer by the department
					 or its designee. It is the responsibility of the local employer to provide
					 information to local employees concerning the benefits offered in each of the
					 plans comprising the health benefits program at such time and in such manner
					 that it can be expected that the local employee can make an informed decision
					 regarding the types of coverage that are being offered.
The local employer is responsible for ensuring that
					 enrollment forms for participation made by local employees are fully completed
					 on a timely basis, signed and certified. No later than 30 days prior to the
					 effective date of coverage, the local employer shall forward the enrollment
					 forms to the department or its designee, as may be appropriate. The department
					 shall be responsible for notifying the local employer as to the location and
					 manner of delivery of all such local employee enrollment forms. Further, the
					 local employer shall be responsible for reporting any changes in benefit
					 coverage in a manner similar to the reporting of an initial application with
					 the department having the ability to waive the 30-day notice
					 requirement.
Statutory Authority
§§ 2.2-1204 and 2.2-2818 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part III - Local Employer Participation › Section 1VAC55-20-260 - Minimum local employer contributions

Current through Register Vol. 40, No. 24, July 15, 2024
A. The department shall require, as a
				  condition of local employer participation in the health benefits program, that
				  a local employer pay a minimum portion of the plan contribution attributable to
				  an active local employee's coverage. Contributions toward the cost of retiree
				  coverage are permitted but not required. Unless otherwise specified in a local
				  employer's adoption agreement, participating local employers shall contribute,
				  at a minimum, 80% of the cost of single coverage, and 20% of the cost of
				  dependent coverage as a condition of participation. In the event that an
				  employer enrolls 75% or more of all eligible employees, the employer will not
				  be required to contribute the above amounts towards the cost of dependent
				  coverage.
B. Local employers
				  allowing part-time employees to participate in the program must contribute a
				  minimum of 50% of the amount they contribute toward active employee coverage
				  (at all membership levels) on behalf of their participating part-time
				  employees.
For purposes of this section, amounts contributed on behalf
					 of an employee who has requested a reduction in salary pursuant to a plan
					 qualified under § 125 of the Internal Revenue Code (Tax Treatment of Cafeteria
					 Plans) will not be counted as an employer contribution.
Statutory Authority
§§ 2.2-1204 and 2.2-2818 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part III - Local Employer Participation › Section 1VAC55-20-270 - Selection of plans

Current through Register Vol. 40, No. 24, July 15, 2024
Local employers electing to participate in the health
					 benefits program must, as a condition of participation, agree to offer
					 exclusively one or more plans constituting such program. Notwithstanding the
					 above, a local employer, with the approval of the department may offer another
					 accident or health plan provided that such other plan does not duplicate the
					 coverage offered by the health benefits program. Such permission shall not be
					 unreasonably withheld.
Local employers participating in the health benefits
					 program who desire to offer a health maintenance organization (HMO) must offer
					 the HMOs included in the health benefits program and only those
					 HMOs.
Statutory Authority
§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part III - Local Employer Participation › Section 1VAC55-20-280 - Commencement of local employer participation

Current through Register Vol. 40, No. 24, July 15, 2024
Local employers may join initially at any time upon the
					 timely submission of an employer application, but, thereafter, renewals must be
					 as of July 1 of each year. Local school boards may have an October 1 renewal,
					 if they so elect. Initial participation by a local employer at any time other
					 than on July 1 (October 1) may be for the short plan year ending on the June 30
					 (September 30) following initial participation.
There shall be no specified time for local employee
					 enrollment coincident with the local employer's initial participation in the
					 health benefits program provided the department or its designee shall have
					 knowledge of the local employee elections at least 30 days prior to the
					 effective date of coverage. Thereafter the open enrollment period for local
					 employees shall take place during the month of April or May of each year with
					 the effective date of coverage then being July 1 of such
					 year.
Statutory Authority: § 2.2-2818 of the Code of
						Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part III - Local Employer Participation › Section 1VAC55-20-290 - Reparticipation of local employers

Current through Register Vol. 40, No. 24, July 15, 2024
Local employers having withdrawn from the health benefits
					 program may reenter the program only with the consent of the department, and
					 only on the July 1 (October 1 for school boards) following the timely
					 submission of an employer application. The July 1 (October 1) effective date
					 may be waived for local employers who have been away from the program for more
					 than three years. Employees of local employers seeking reparticipation may be
					 required to serve a waiting period.
Department consent shall not be granted until all pending
					 contributions, penalties and other assessments have been paid by a local
					 employer and there is no outstanding litigation pending between the department
					 and the local employer. A pending appeal will not prohibit a local employer
					 from reparticipating in the health benefits program.
Statutory Authority: § 2.2-2818 of the Code of
						Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part III - Local Employer Participation › Section 1VAC55-20-300 - Ceasing participation in the health benefits program

Current through Register Vol. 40, No. 24, July 15, 2024
A local employer who desires to terminate participation in
					 the health benefits program may do so at any time, as of the last day of any
					 calendar month, with three months notice to the department. The local employer
					 shall be obligated to pay any and all contributions otherwise required through
					 the date of termination of participation and interest related thereto.
					 Additionally, a terminating local employer shall be responsible for any adverse
					 experience adjustment which may apply with respect to the year termination
					 occurred and any prior year within which the terminating local employer
					 participated in the program.
Upon the local employer's cessation of participation in the
					 program, all of the local employers' participants, including retirees,
					 dependents of retirees and COBRA beneficiaries will cease to be covered under
					 the program.
Statutory Authority
§§ 2.2-1204 and 2.2-2818 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part III - Local Employer Participation › Section 1VAC55-20-310 - Compliance

Current through Register Vol. 40, No. 24, July 15, 2024
The department shall oversee the local employers and state
					 agencies and shall assist the employees thereof in the pursuit of all rights
					 and benefits. The department shall hold the employee harmless for any errors
					 made by local employers and state agencies. The cost of any such errors, where
					 applicable, shall be borne by the local employer or state agency, and not the
					 employee.
Nothing in this chapter shall affect the rights of any
					 local employee to bring a cause of action against a local employer for action
					 taken hereunder with respect to such local employer's willful disregard of this
					 chapter. In the event a local employee brings a cause of action against the
					 department due to a local employer's willful disregard for the requirements of
					 this chapter, the local employer as a condition of initial participation in the
					 program shall reimburse the department for any such settlement required by a
					 court of law.
Statutory Authority
§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part IV - Employee Participation › Section 1VAC55-20-320 - Eligible employees

Current through Register Vol. 40, No. 24, July 15, 2024
A. State
				  employees.
1. Full-time salaried, classified
				  employees and faculty as defined in
				  1VAC55-20-20 are eligible for
				  membership in the health benefits program. A full-time salaried employee is one
				  who is scheduled to work at least 32 hours per week or carries a faculty
				  teaching load considered to be full time at his institution.
2. Certain full-time employees in auxiliary
				  enterprises (such as food services, bookstores, laundry services, etc.) at the
				  University of Virginia, Virginia Military Institute and the College of William
				  and Mary as well as other state institutions of higher learning are also
				  considered state employees even though they do not receive a salaried state
				  paycheck. The Athletic Department of Virginia Polytechnic Institute and State
				  University is an example of a local auxiliary whose members are eligible for
				  the program.
3. Certain full-time
				  employees of the Medical College of Virginia Hospital Authority are eligible
				  for the program as long as they are on the authority's payroll and were
				  enrolled in the program on November 1, 1996. They may have payroll deductions
				  for health benefits premiums even if they rotate to the Veterans'
				  Administration Hospital or other acute care facility.
4. Other employees identified in the Code of
				  Virginia as eligible for the program.
5. Classified positions include employees who
				  are fully covered by the Virginia Personnel Act, employees excluded from the
				  Virginia Personnel Act by subdivision 16 of § 2.2-2905 of the Code of Virginia,
				  and employees on a restricted appointment. A restricted appointment is a
				  classified appointment to a position that is funded at least 10% from gifts,
				  grants, donations, or other sources that are not identifiable as continuing in
				  nature. An employee on a restricted appointment must receive a state paycheck
				  in order to be eligible.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part IV - Employee Participation › Section 1VAC55-20-330 - Enrollment form or enrollment action

Current through Register Vol. 40, No. 24, July 15, 2024
A. No coverage is available unless an
				  employee files an enrollment form or takes an equivalent enrollment action. No
				  changes in coverage are effective unless an employee files an enrollment form
				  or takes an equivalent enrollment action. Employees alone are responsible for
				  knowing when an enrollment action is required, for taking the action, and for
				  certifying that the information conveyed is complete and true.
B. The employer is responsible for checking
				  that the employee fills in the form completely and accurately. The employer
				  will certify each enrollment form in the space provided on the form.
C. The effective date of coverage shall be
				  determined from the date the enrollment form is stamped as received by a
				  designee of the department or the date of the equivalent enrollment action.
				  This is generally the first of the month following receipt.
Except as noted here, coverage elections including those
					 made by new employees are made on a prospective basis, that is, effective the
					 first of the month following the receipt of the election form or enrollment
					 action. However, if the receipt of the form or the date of the enrollment
					 action is the first of the month, then the effective date will be the first of
					 the month. Additionally, if an election form or enrollment action is received
					 from a new employee on the first business day of the month, coverage for the
					 new employee will commence on the first day of that month (see
					 1VAC55-20-370 ). Coverage elections
					 made on account of a newborn, adoption or placement for adoption are effective
					 the date the child is born, adopted or placed for adoption, as long as the
					 employee makes the coverage election within 31 days of the event. Coverage
					 terminations are effective the end of the month following receipt of an
					 election notice, except for terminations that are required by the plan.
					 Coverage terminations required by the plan are effective the end of the month
					 that the event takes place. Examples of coverage terminations required by the
					 plan are such things as a divorce, termination of employment or a dependent
					 child losing eligibility.
Statutory Authority: § 2.2-2818 of the Code of
						Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part IV - Employee Participation › Section 1VAC55-20-340 - Payment of contributions

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Active employees shall pay their portion, if any, of contributions through
				  payroll deduction.
B. State
				  retirees will have their contributions deducted from VRS or other retirement
				  system. If the retirement payment is not sufficient to pay the entire
				  contribution, they may pay their contributions directly to the department's
				  designee. There may be an administrative fee for direct payment. Such fee may
				  be waived by the department if payment is made monthly by bank draft.
A credit toward the cost of coverage is made by the
					 Commonwealth on behalf of retired state employees as provided in § 51.1-1400 of
					 the Code of Virginia.
C.
				  Retired employees of local employers shall pay contributions by either of two
				  methods. The retired employee may authorize contributions to be deducted from
				  the retiree's pension payment, whether it be through the VRS or otherwise.
				  Alternatively, if the employer so provides, the retiree may pay his
				  contribution to the employer who shall be responsible for remitting the
				  contributions to the department or its designee. In either case the employer is
				  responsible for collecting and submitting the premium to the plan at the time
				  that the active premium is submitted.
Statutory Authority
§§ 2.2-1204 and 2.2-2818 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part IV - Employee Participation › Section 1VAC55-20-350 - Membership

Current through Register Vol. 40, No. 24, July 15, 2024
A. Type of
				  membership. Participants have a choice of three types of membership under the
				  program:
1. Single (employee only). If a
				  participant chooses employee only membership, the health benefits program does
				  not cover the employee's dependents (spouse or children). A woman with single
				  membership under the program does have maternity coverage. However, the newborn
				  child is covered only for routine hospital nursery care, unless the mother
				  changes to dual or family membership within 31 days of the date of
				  birth.
2. Dual (employee and one
				  eligible dependent).
3. Family
				  membership (employee and two or more eligible dependents).
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part IV - Employee Participation › Section 1VAC55-20-360 - Choice of plans

Current through Register Vol. 40, No. 24, July 15, 2024
A. During the
				  annual open enrollment period, state employees and non-Medicare retirees
				  eligible to participate in the health benefits program have a choice of
				  enrolling in any plan offered by their employer, which may often include an
				  alternative health benefits plan offered by the department. To be eligible for
				  membership in the health benefits program, the employee or retiree must live or
				  work within the service area of the particular plan.
B. Employees of participating local employers
				  have a choice of enrolling in the plans offered by their respective employers.
				  Local employers have the option of requiring that employees live within the
				  service area of the plan the employee chooses to join or of allowing employees
				  to join a plan if they live or work in the service area.
C. An enrollment action will not be accepted
				  outside of open enrollment except for an employee who experiences a qualifying
				  mid-year event.
D. The employer's
				  contribution toward coverage, if any, shall be determined by the employer
				  except with respect to the minimum contribution rate applicable to local
				  employers.
Statutory Authority
§§ 2.2-1204 and 2.2-2818 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part IV - Employee Participation › Section 1VAC55-20-370 - Effective date of coverage

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  General. Coverage and changes in coverage or membership are generally
				  prospective, effective on the first day of the month following the month in
				  which the enrollment action is received by the department's designee.
B. Date coverage begins. Coverage begins on
				  the first day of the first full month of employment following the receipt of
				  the employee's enrollment action. Employees who begin work on the first working
				  day of the month are considered employed effective the first of the month.
				  Thus, if an employee submits the completed enrollment action on or prior to the
				  first working day of the month, coverage will be effective the first of the
				  month in which employment commenced.
C. Exceptions. With prior approval from the
				  department, coverage may be allowed to commence on an earlier date in limited
				  circumstances when prior coverage is unavailable; for example, a new employee
				  who has moved out of the service area of an HMO.
Statutory Authority: § 2.2-2818 of the Code of
						Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part IV - Employee Participation › Section 1VAC55-20-380 - Leaves of absence

Current through Register Vol. 40, No. 24, July 15, 2024
Note: This section addresses various aspects of employee
					 leave and may or may not be applicable to a local employer.
A. Leave of absence with full pay. As long as
				  an employee is still receiving full pay, health benefits coverage continues
				  with the employer making its contribution. Nothing special must be done to
				  maintain coverage.
Local employers are not required to contribute toward
					 coverage for any part-time employee granted any type of leave of
					 absence.
B. Virginia
				  Sickness and Disability Program, Long-Term Disability (VSDP-LTD)
1. Coverage with the employer contribution
				  continues to the end of the month in which the LTD benefits begin, unless
				  benefits begin on the first day of the month, in which case the employer
				  contribution will end on the last day of the preceding month. Thereafter,
				  employees may continue coverage by paying the entire cost of the
				  coverage.
2. Employees receiving
				  LTD benefits may enroll in the State Retiree Health Benefits Program upon
				  service retirement regardless of whether they have maintained health coverage
				  in the state program provided that the individuals have been continuously
				  covered and have had no break in long-term disability benefits prior to service
				  retirement. The LTD participant has 31 days from the date of retirement to
				  enroll in the State Retiree Health Benefits Program. Coverage in the retiree
				  group begins on the first day of the first full month of retirement.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part IV - Employee Participation › Section 1VAC55-20-390 - Termination of coverage

Current through Register Vol. 40, No. 24, July 15, 2024
A. Coverage
				  ends at the end of the month in which an employee terminates the employment
				  relationship, otherwise loses group eligibility, or on the last day of the
				  month for which premiums are paid.
B. Coverage ends on the date of a
				  participant's death. Coverage for family members continues until the end of the
				  month following the month in which the participant died.
1. A surviving beneficiary may enroll in the
				  state retiree group if:
a. The dependent is
				  eligible for an annuity under the VRS death-in-service provision;
b. The employee had submitted a disability
				  retirement application naming the dependent under the survivor option before
				  his death and the employee died prior to achieving the retirement date;
				  or
c. The death was job related.
To continue coverage, the family member must apply within
					 60 days of the date the coverage would otherwise end due to the death.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part IV - Employee Participation › Section 1VAC55-20-400 - Termination of employment

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Coverage continues to the end of the month in which an employee terminates.
				  Each terminating employee may elect continuation of coverage pursuant to
				  Internal Revenue Code section 4980B and accompanying regulations.
B. Terminating employees may also have the
				  option of converting to a non-group policy. The carrier will send the employee
				  a letter offering non-group coverage. The employee will have 30 days after the
				  date of the letter to reply in order for coverage to be continuous. All
				  terminating employees will be given certificates of coverage as required by the
				  Health Insurance Portability and Accountability Act.
Statutory Authority: § 2.2-2818 of the Code of
						Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part IV - Employee Participation › Section 1VAC55-20-410 - Suspension and reinstatement

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  General.
1. Coverage generally continues
				  through the end of the month in which the suspension began. However, if the
				  suspension was effective on or before the first work day of the month, there
				  will be no coverage for that month unless the employee is reinstated in time to
				  work half of the work days in the month. For example, if a suspension is
				  effective on April 19, the employee will have coverage through the end of
				  April. If the suspension is effective April 1, the employee will have no
				  coverage in April. By the same token, if the suspension is effective April 2
				  and the employee's first workday in April is April 3, the employee will not
				  have coverage in April. If the employee is reinstated in time to work half of
				  the workdays in the month following the month in which the suspension began,
				  there will be continuous coverage.
2. If the employee is suspended pending court
				  action or pending an official investigation, the suspension may go beyond one
				  pay period. In these cases, coverage will continue to the end of the month in
				  which the suspension began. If the employee is reinstated in time to work half
				  of the workdays of the month following the month in which the suspension began,
				  there would be no break in coverage. Suspension beyond that period should be
				  handled in the same way as a leave without pay with no employer contribution.
				  The employee may remain in the group by paying monthly contributions to the
				  employer in advance. Group coverage may continue until a court decision is
				  issued or the official investigation is completed, or up to a period of 12
				  months, whichever is less.
3. If
				  the employee is reinstated with back benefits, the employer should refund the
				  employee the amount of the employer contribution during the period the employee
				  paid the full premium. Single membership should be reinstated retroactive to
				  the date the employee was removed from the group up to a limit of 60 days.
				  Retroactive dual or family membership will be available up to a maximum period
				  of 60 days. Appropriate contributions must be made to cover the retroactive
				  period. Alternatively, the family membership may begin the first full month of
				  reinstatement if the employee applies within 31 days of
				  reinstatement.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part IV - Employee Participation › Section 1VAC55-20-440 - Claims

Current through Register Vol. 40, No. 24, July 15, 2024
Claims must be filed no later than the end of the calendar
					 year after the year in which the claim is incurred. Claims not filed in a
					 timely fashion will not be considered.
Statutory Authority
§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part V - Benefits Plans › Section 1VAC55-20-450 - Basic plan

Current through Register Vol. 40, No. 24, July 15, 2024
The department may provide self-funded plan(s) administered
					 by a third party administrator including, but not limited to, an exclusive
					 provider organization (EPO) and a point of service plan (POS). These plans are
					 described in the employee handbooks, which are distributed to employees upon
					 enrollment. The department shall denote a self-funded plan as the "basic plan,"
					 which is required by code to be available throughout the state and shall
					 provide the basis for all employer contributions.
Statutory Authority
§§ 2.2-1204 and 2.2-2818 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part V - Benefits Plans › Section 1VAC55-20-460 - Alternative health benefit plans

Current through Register Vol. 40, No. 24, July 15, 2024
The department also offers several health maintenance
					 organization and preferred provider organization plans which are available to
					 participants residing in the service area of the HMO or PPO. A list of these
					 plans is available upon request to the department.
Non-Medicare-eligible retirees have the same enrollment
					 options as active employees.
Retirees must enroll in a plan within 31 days of separation
					 for retirement. A separating employee who defers retirement will not be
					 eligible to enroll in a retiree medical plan when the former employee seeks
					 retirement benefits.
Statutory Authority: § 2.2-2818 of the Code of
						Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part V - Benefits Plans › Section 1VAC55-20-470 - Benefits coverage

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Interpretations of covered services will be made in the following manner,
				  listed in order of priority:
1. The contract
				  documents, including the request for proposal;
2. Member handbooks or contract
				  booklets;
3. The interpretation of
				  the department;
4. The
				  interpretation of the department's contractors.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part V - Benefits Plans › Section 1VAC55-20-480 - Department discretion

Current through Register Vol. 40, No. 24, July 15, 2024
The department reserves the right to change the plans
					 offered and benefits provided thereunder at its sole discretion based upon
					 market and department considerations.
Statutory Authority
§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.
Virginia Administrative Code › Title 1 - ADMINISTRATION › Agency 55 - DEPARTMENT OF HUMAN RESOURCE MANAGEMENT › Chapter 20 - COMMONWEALTH OF VIRGINIA HEALTH BENEFITS PROGRAM › Part V - Benefits Plans › Form - FORMS (1VAC55-20)

Current through Register Vol. 40, No. 24, July 15, 2024
Adoption
					 Agreement, T20082 (R1/02)
Commonwealth
					 of Virginia Health Benefits Program Application, T20445 (rev.
					 1/13)
Enrollment
					 Form - The Local Choice Health Benefits Program, T20911 (1/14)
General
					 Notice of Extended Coverage Rights (rev. 3/05)
Interagency
					 Transfer Invoice, Department of Accounts DA-02039 (rev. 7/86)
Commonwealth
					 of Virginia Certificate of Group Health Plan Coverage and Statement of HIPAA
					 Portability Rights (rev. 4/05)
State
					 Health Benefits Program Appeal Form (rev. 5/11)
Statutory Authority: § 2.2-2818 of the Code of
						Virginia.