Free Group Health Insurance Study Guide
Virginia Accident & Health exam — Group Health Insurance.
Federal COBRA, HIPAA and the ACA are covered in the national Group Health Insurance guide. Virginia adds a state continuation law (38.2-3541), small employer definitions and group eligibility rules. This guide covers those.
State continuation (38.2-3541)
Applies only where federal COBRA doesn't.
| Item | Virginia rule |
|---|---|
| Length | 12 months, without evidence of insurability |
| Premium | The insurer's current rate plus an administrative fee of no more than 2% |
| Eligibility | Continuously insured for the 3 months just before eligibility ended. Not available after a discharge for gross misconduct. |
| Notice | The group policyholder gives written notice within 14 days of learning of the loss of eligibility |
| Election | Within 31 days after the notice, but never more than 60 days after eligibility ended |
Group rules
- Certificates: each insured gets one describing coverage, limits, beneficiaries and continuation rights (38.2-3533).
- A noncontributory plan must cover all eligible employees except those who reject it in writing (38.2-3521.1).
- Association groups must start with at least 100 persons, exist at least 5 years and be formed for purposes other than insurance (38.2-3521.1).
- Waiting periods: no more than 90 days (38.2-3452).
- Health status: it can't be used to set eligibility or charge similarly situated people more (38.2-3436).
- Students on medical leave: coverage continues up to 12 months when a doctor certifies the leave is medically necessary (38.2-3525).
- Military service: coverage ended by military service is reinstated on return without new preexisting exclusions (38.2-508.1).
- HMO extension of benefits: coverage continues for a totally disabled enrollee for at least 180 days, or until a new carrier covers the condition (14VAC5-211-130).
Small employers
- Small employer: averaged 1 to 50 employees in the past year (38.2-3431).
- Eligible employee: works 30 hours or more a week. The employer may include part-time workers.
- Small group coverage must be offered to every applying small employer and all eligible employees, with no health exclusions or surcharges (38.2-3432.2).
- An issuer that leaves a group market gives 180 days' notice and may not return for 5 years (38.2-3432.1).
Common exam traps
- State continuation: 12 months, at the rate plus up to 2%. It requires 3 months of prior coverage and doesn't apply where COBRA does.
- Notice within 14 days. Election within 31 days, with a 60-day outer limit.
- Waiting periods: at most 90 days.
- A small employer has 1–50 employees.
Practice Group Health Insurance questions All Accident & Health topics
Practice questions are study aids generated for exam preparation and are not actual exam questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules, and exam specifications with the Insurance Department and the exam administrator before relying on it.
