Key Takeaways
- Virginia mini-COBRA applies to employers with fewer than 20 employees
- Virginia mini-COBRA provides up to 12 months of continuation coverage
- Small group health plans (2-50 employees) have guaranteed issue protections
- Virginia requires mental health parity in group health plans
- HIPAA portability requirements apply to group health coverage
Virginia Group Health Insurance & COBRA
Virginia has specific regulations for group health insurance to ensure employees have access to and continuation of coverage.
Federal COBRA Overview
Federal COBRA applies to larger employers:
| COBRA Element | Federal Requirement |
|---|---|
| Employer Size | 20 or more employees |
| Duration | 18-36 months |
| Premium | Up to 102% of total premium |
| Qualifying Events | Termination, reduction in hours, divorce, death |
Virginia Mini-COBRA
Virginia provides mini-COBRA for smaller employers:
Mini-COBRA Requirements
| Element | Virginia Requirement |
|---|---|
| Employer Size | Fewer than 20 employees |
| Duration | Up to 12 months |
| Premium | Up to 102% of total premium |
| Qualifying Events | Similar to federal COBRA |
Qualifying Events
- Termination (except for gross misconduct)
- Reduction in work hours
- Divorce or legal separation
- Death of covered employee
- Dependent child losing eligibility
Exam Tip: Virginia mini-COBRA provides 12 months of continuation coverage vs. 18-36 months under federal COBRA.
Election and Notice Requirements
Employer Obligations
| Obligation | Requirement |
|---|---|
| Notify Insurer | Within 30 days of qualifying event |
| Provide Notice | Election notice to qualified beneficiaries |
| Maintain Coverage | During election period |
Employee/Beneficiary Rights
| Element | Requirement |
|---|---|
| Election Period | 60 days from notice or loss of coverage |
| Retroactive Coverage | Coverage is continuous |
| First Payment | Within 45 days of election |
Small Group Health Insurance
Virginia regulates small group health insurance (2-50 employees):
Guaranteed Issue
| Requirement | Description |
|---|---|
| Acceptance | Must accept all small employers |
| Pre-existing Conditions | Cannot exclude (ACA requirement) |
| Rating | Community rating with limited variations |
Guaranteed Renewal
Small group plans must renew unless:
- Non-payment of premium
- Fraud or material misrepresentation
- Failure to comply with plan provisions
- Insurer exits market (with proper notice)
Mental Health Parity
Virginia requires mental health parity:
Parity Requirements
| Element | Must Equal Medical/Surgical |
|---|---|
| Deductibles | Same or integrated |
| Copayments | Equal cost-sharing |
| Day Limits | No more restrictive |
| Visit Limits | No more restrictive |
| Preauthorization | No more burdensome |
Covered Conditions
- Mental health disorders
- Substance use disorders
- Behavioral health conditions
- Serious mental illness
HIPAA Portability
Virginia enforces HIPAA requirements:
Certificate of Creditable Coverage
| Element | Requirement |
|---|---|
| Timing | Upon loss of coverage |
| Content | Dates of coverage, type |
| Purpose | Reduce waiting periods for new coverage |
Portability Benefits
- Credit for prior continuous coverage
- Reduces new plan exclusion periods
- 63-day break rule applies
How long does Virginia mini-COBRA provide continuation coverage?
Which employers are subject to Virginia mini-COBRA requirements?
Under Virginia small group health insurance rules, insurers must:
What does Virginia's mental health parity law require for group health plans?
How long does a qualified beneficiary have to elect Virginia mini-COBRA coverage?