State employees eligible for the health benefits program may enroll in a statewide health plan, regional plan, or if living or working in the Northern Virginia area only, a regional health maintenance organization (HMO). Full-time employees pay the employee portion of the total monthly premium, with the state paying the remainder of the cost, and their premiums are deducted from paychecks before taxes are paid. For current monthly premiums, visit the DHRM Web site at http://www.dhrm.virginia.gov/hbenefits/employeestoc.html. Click on rates. Employees can also contact the Human Resources Benefits Section and request the rates.
Coverage for new employees begins on the first day of the month following the hire date (except for those employees hired on the 1st of the month). New employees must make their health insurance elections within 30 days of their date of hire. Changes to health plans may be made outside of the 30-day initial enrollment period; this time is known as Open Enrollment. Open Enrollment is usually held in April or May each year, and changes become effective on July 1st. In addition to the initial enrollment and Open Enrollment periods, employees may make changes within 60 days of a Qualifying Mid-Year Event (QME). Information on what constitutes a QME and what documentation is required can be found at http://www.dhrm.virginia.gov/hbenefits/employeestoc.html.
The Commonwealth of Virginia offers three plans: COVA Care, COVA HealthAware, and the COVA HDHP (High Deductible Health Plan). They are administered on a plan year that begins on July 1 and ends on June 30 of the following year. For in-depth descriptions of each plan including optional buy-ups documentation can be found at http://www.dhrm.virginia.gov/hbenefits/employeestoc.html.
The COVA Care plan has four separate benefit components: medical, dental, outpatient prescription drug, and behavioral health with the Employee Assistance Program (EAP), each administered by Anthem Blue Cross and Blue Shield with the exception of dental which is administered by Delta Dental. Some covered services are subject to a plan year deductible, co-insurance, or co-payments.
You may also select, at an extra cost to you, additional options that offer enhanced coverage for dental, out-of-network, vision, and hearing services.
Medical Benefits: Anthem Blue Cross and Blue Shield administers the medical benefits under COVA Care. We highly recommend that you coordinate your care through a primary care provider (PCP), but you are not required to have a PCP to use your medical benefits under COVA Care. You have medical coverage as long as you use an in-network provider. There is no out-of-network coverage (except for an emergency) unless you choose the Out-of-Network option.
However, you may also access care within the United States through the Blue Card PPO® network, and worldwide through the BlueCard Worldwide® network. The Anthem Virginia network includes hospitals, primary care physicians and specialists statewide. For the most current list of Anthem network hospitals and physicians, go to www.anthem.com. Click on the “Find a Doctor” link.
Behavioral Health and Employee Assistance Program (EAP): Anthem EAP provides your behavioral health and EAP benefits under COVA Care. We recommend that you contact them at 1-855-223-9277 or visit www.anthemeap.com so that your care can be authorized in advance. An Anthem EAP participating provider works with a care manager to ensure that the services you receive are covered under your plan. When you self-refer to a non-network provider, you are responsible for making sure the services you receive are medically necessary for your condition. There is no out-of-network coverage (except for an emergency) unless you choose the Out-of-Network option.
The EAP offers up to four visits at no cost to you and members of your household for counseling in such areas as mental health, substance abuse, work and family issues, and financial or legal matters.
Dental: Delta Dental of Virginia administers dental coverage for the COVA Care plan, including diagnostic and preventive care. The Expanded Dental option covers, at an additional cost, primary care services such as fillings and root canals, orthodontic services, and major restorative services such as crowns, bridgework, implants, and dentures.
You may use either an in-network or out-of-network dentist, but you may pay more if you use an out-of-network dentist. To see if your dentist is in the Delta Premier network, or to search for a participating dentist, visit the Delta Dental Web site at: www.deltadentalva.com. Click on “Find a Dentist” and select the Delta Premier program. You also may call Delta Dental at 1-888-335-8296 for assistance.
Prescription Drugs: Your COVA Care health plan provides an outpatient prescription drug benefit, administered by Anthem Blue Cross and Blue Shield, divides your prescriptions into four categories (tiers) based primarily on their cost. The first tier is typically generic drugs; the second tier generally includes low-cost to medium-cost brand name drugs; the third tier consists of higher-cost brand name drugs; and the forth tier consists of specialty drugs, typically, the highest cost brand name drugs used to treat complex and rare conditions. You may also save money by using the Express Scripts home delivery service for a 90-day supply of a maintenance prescription. If a brand name drug is requested when a generic equivalent is available, you pay the brand co-payment plus the difference between the cost of the brand and the generic drug.
You may use either a network or non-network pharmacy. However, you will pay more at a non-network pharmacy. To find a participating pharmacy, please call 1-800-355-8279.
Optional Benefits: Certain optional health insurance coverage may be added to the COVA Care (CC) plan and the COVA HealthAware (HA) plan as follows:
1. Out-of-Network (CC) – This option allows you to receive covered services at a reduced level from non-network providers—that is, providers that are not in the Anthem BlueCard PPO or Anthem Behavioral Health and Employee Assistance Program networks. The plan payment for covered services is reduced by 25%. You are responsible for any applicable deductible, co-payment or coinsurance. You also pay any balance above the allowable charge. Claim payments are made directly to the member when services are received from a non-network provider.
2. Expanded Dental Benefit (CC and HA) - This option, available from Delta Dental, allows you to add Primary Services, Complex Restorative, and Orthodontic benefits to your basic dental benefit.
3. Routine Vision and Hearing (CC) - Routine vision benefits are available from Blue View Vision. Benefits are available once every 12 months and the count begins on the date you receive your eye examination or purchase eyeglass frames or lenses. You may see a network optician, optometrist or go to a retail setting for your eye exam and for purchasing lenses and frames. Non-network benefits will apply if you visit a provider who is not in the network. COVA Care participants can find a Blue View provider by visiting www.anthem.com. Hearing coverage will pay a portion for hearing aid(s) and other related hearing aid services such as selection and fitting every 48 months. This option also includes the Expanded Dental benefit, which is summarized above.
4. Routine Vision Only (HA) – Routine vision benefits for the COVA Health Aware plan are available from Aetna. Benefits are available once every 12 months and the count begins on the date you receive your eye examination or purchase eyeglass frames or lenses. To locate a vision provider, visit www.covahealthaware.com. Note: Routine hearing benefits are included in the basic plan.
The COVA HDHP (High Deductible Health Plan) is a statewide plan. COVA HDHP is a special type of health care plan that allows you to set up a Health Savings Account (HSA). Use the tax-deductible funds you put into the HSA to help pay for medical expenses. Your HSA goes wherever you go and you are not required to “use it or lose it.” The COVA HDHP has a higher plan year deductible that must be met before the plan pays for your medical, behavioral health and prescription drug benefits. Once the deductible is met, you pay 20% coinsurance for most covered services. When two or more people are covered, the entire deductible must be met before the plan pays any expenses for any one person covered under the plan. Under the HDHP, you pay no more out of pocket for in-network services than $5,000 for one person and $10,000 for two or more people. The deductible applies to this limit. The COVA HDHP includes basic dental benefits. However, there is no out-of-network coverage for medical or behavioral health benefits. All components of this plan are administered by Anthem. Go to www.anthem.com to access the online Provider Directory.
The COVA HealthAware plan is offered to all eligible state employees. This plan includes a Health Reimbursement Arrangement, or HRA, to help you pay for plan expenses. The Commonwealth will place $600 in an HRA for an employee or $1,200 for an employee and spouse enrolled in the plan. The funds can be used to pay your deductible and other plan costs for all covered family members. You may also earn more HRA funds by completing health activities, called “Do Rights,” designed by the plan to earn up to $150 in your HRA, and your spouse can do the same. “Do Rights” include having an annual physical exam, a dental exam, a flu shot, and using one of the MyActiveHealth (www.myactivehealth.com/cova) portal trackers at least three times a month for each month in a quarter. Simply pick three of the four “Do Rights” and earn $50 for each one. Note: the funds for “Do Rights” are placed in your HRA during the quarter after you complete the activity.
COVA Care and HealthAware members may be able to reduce your monthly premiums by completing health-related activities. Completing each activity allows you to receive six months of premium rewards. The reward amount is $17 per month, and if your covered spouse participates you can double your monthly reward.
Reward Period Activity
July – December Complete an online health assessment during Open Enrollment at www.myactivehealth.com/COVA
January – June Take a Biometric Health Screening between August 1st and October 31st at your doctor’s office or a designated LabCorp facility
KAISER PERMANENTE REGIONAL HMO
Available only to employees who live or work in Northern Virginia, the Kaiser Permanente regional HMO has a service area that includes Northern Virginia, Washington, D.C. and parts of Maryland. There is no deductible for in-network services, but you must use HMO participating providers (except in an emergency) and choose a PCP for each enrolled family member. You may search by zip code on the Kaiser Web site at http://my.kaiserpermanente.org/mida/commonwealthofvirginia/ to determine if your job location or home address is in the Kaiser Permanente service area.
NOTE: All health plan deductions are mandatory pre-tax. This is accomplished by deducting the premiums before taxes are calculated, thus reducing the amount of Federal, State, and Social Security withholding.