State employees eligible for the health benefits program may enroll in a statewide health 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. Part-time classified/university employees who work at least 20 hours, but less than 32 hours, per week (or salaried employees in similar positions in legislative, judicial and independent agencies) pay the total premium, which may be deducted from their paychecks on a pre-tax basis. View the current monthly premiums (pdf). You can also contact your Benefits Administrator and request the rates.
Coverage always begins on the first of a month and ends at the end of a month. Most requests received within 30 days and by the end of the month are effective the first of the next month. There are two exceptions: coverage for a newborn or adopted child, and when a family member loses eligibility as a dependent.
The Commonwealth of Virginia offers three plans, COVA Care, COVA Connect, and the COVA HDHP (High Deductible Health Plan) throughout Virginia. They are administered on a plan year that begins July 1 and ends June 30 of the next year.
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 a different company. Some covered services are subject to a plan year deductible, coinsurance or copayments. 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.
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 also may 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. Provider Directory
Behavioral Health and Employee Assistance Program (EAP)
ValueOptions provides your behavioral health and EAP benefits under COVA Care. We recommend that you call ValueOptions at 1-866-725-0602 so that your care can be authorized in advance. A ValueOptions 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 or members of your household for counseling in such areas as mental health, substance abuse, work and family issues, financial or legal matters.
Delta Dental of Virginia provides dental coverage for the COVA Care plan, including diagnostic and preventive care, and primary dental services such as fillings and root canals.
The Expanded Dental option covers orthodontic services and offers enhanced coverage for 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 DeltaPremier 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 DeltaPremier program. You also may call Delta Dental at 1-888-335-8296 for assistance.
Medco Health Solutions, Inc., administers the outpatient prescription drug program for the COVA Care plan. This plan provides insurance coverage for most medically necessary outpatient prescription drugs through the use of participating pharmacies. Prescription drugs are divided into four tiers or categories, and you pay the appropriate prescription co-payment by tier. In general, the first tier covers generic drugs, which are usually the least expensive. The second tier includes lower cost brand name drugs. The third tier is higher cost brand name drugs and may include newly introduced drugs. The fourth tier covers specialty drugs which typically consist of the highest cost brand name drugs used to treat complex and rare conditions. You can find more information about the prescription drug program, as well as which tier specific prescriptions will be under by visiting Medco's website at www.medcohealth.com . You may also contact Member Services at 1-800-355-8279 for assistance.
NOTE: Some drugs require prior authorization.
Optional health insurance coverage may be added to the COVA Care Basic plan as follows:
- Out-of-Network: 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 ValueOptions, Inc. 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.
- Expanded Dental Benefit: This option allows you to add Complex Restorative and Orthodontic benefits to your basic dental benefits under Delta Dental.
- Vision, Hearing and Expanded Dental: This option includes a routine eye exam once every 12 months. The participant pays the specialist co-payment to the eye doctor. Vision coverage also pays a portion for the eyeglass frames and lenses or it will pay a portion for contact lenses. To reduce the out-of-pocket expense, it is best to choose an Anthem Blue Cross Blue Shield optician, optometrist or ophthalmologist. This option also includes routine hearing benefits once every 48 months. The participant pays the specialist co-pay for the visit for the hearing exam. Hearing coverage will pay a portion for hearing aid(s) and other related hearing aid services such as selection and fitting. This option also includes the Expanded Dental benefit, which is summarized above.
- Out-of-Network and Expanded Dental: This option provides you with the benefit of Out-of-Network privileges with the additional benefit of Expanded Dental, both of which are summarized above.
- Out-of-Network, Vision, Hearing and Expanded Dental: This choice provides you with the benefit of all options, as summarized previously.
The COVA Connect plan has four separate benefit components: medical, outpatient prescription drug and behavioral health with the Employee Assistance Program (EAP) each administered by Optima Health and dental benefits are administered by Delta Dental. Some covered services are subject to a plan year deductible, coinsurance or copayments. 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. They are the same as COVA Care, please see above.
The COVA HDHP (High Deductible Health Plan) 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 full 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. More Information
COVA HDHP Provider Directory
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 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.