Virginia Administrative Code

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). 2. Dual (empl…

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 t…

A. Newly eligible employees. Newly eligible employees (new hires) have up to 30 calendar days to enroll in a health plan or flexible spending account offered by the state. The 30-day countdown period begins on the first day of employment and ends 30 calendar days later. If the en…

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…

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…

(Repealed.)

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. All terminating employees will be given certificates of cov…

A. General. 1. Coverage generally continues with the state contribution 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 …

(Repealed.)

A. New employees will receive and be required to respond to a coordination of benefits (COB) inquiry letter following enrollment in the health plan. Employees should notify the plan administrator if coverage changes during employment for them or a covered dependent. If a plan par…

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.

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 empl…

The department also offers several health maintenance organization and preferred provider organization plans that 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…

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…

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.

(Repealed.)

A. The administration and underwriting of the plans shall be at the discretion of the department and may include but not be limited to self-funded arrangements, insured arrangements, administrative services arrangements, health maintenance organizations, and preferred provider or…

The department shall comply with the Virginia Public Procurement Act, Chapter 43 (§ 2.2-4300 et seq.) of Title 2.2 of the Code of Virginia, as it may relate to any services to which such Act shall apply. In an effort to stabilize the administration and maintenance of the health b…

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 con…

A. The director of the department shall be the final arbiter of any disputes arising under this chapter. The director may not redelegate this authority other than to an independent hearing officer except as provided under subsection C of this section. All disputes arising under t…

(Repealed.)

(Repealed.)

(Repealed.)

(Repealed.)

(Repealed.)

(Repealed.)

(Repealed.)

(Repealed.)

(Repealed.)

The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise: "Administrative Process Act" means Chapter 40 (§ 2.2-4000 et seq.) of Title 2.2 of the Code of Virginia. "Adopt textual matter by reference" m…

A. An agency shall provide the date of final agency action and the effective date of a regulation when filing a regulation submission package for a fast-track or final regulatory action, or other equivalent action. B. When Virginia law allows a regulation to be effective upon the…

A. Pursuant to § 2.2-4103 of the Code of Virginia, the registrar may request information in addition to the full text of a regulation for the purpose of publishing the Register and VAC. B. An agency shall respond to a request from the registrar within three business days of the r…

A. When an agency withdraws a final regulation pursuant to § 2.2-4016 of the Code of Virginia, the agency shall file a written notice of withdrawal with the registrar prior to the effective date of the regulation being withdrawn. The notice shall include: 1. The reason for the wi…

A. An agency shall notify the registrar of all omissions or errors that the agency becomes aware of in any of the information (i) submitted for publication or (ii) published in the Register or the Virginia Administrative Code. B. The notification shall be filed with the registrar…

A. A regulation may adopt textual matter by reference to all or any part of a publication or document. For the purposes of this part, a publication and a document are interchangeable. The material in the document becomes the text of the regulation and an enforceable part of the r…

A. When an agency adopts textual matter in a regulation by reference to a document, the agency shall file a copy of the referenced document with the regulation submission package. The document shall be filed in its entirety, unless the registrar has approved a request for the doc…

When incorporating material by reference, an agency shall include in the regulatory text (i) a statement that the document is incorporated by reference; (ii) the complete name of the document; (iii) the effective, issue, revision, or publication date; (iv) the version or edition,…

A. The requirements established in 1VAC7-10-150 and 1VAC7-10-160 do not apply to incorporation of textual matter by reference to material published in the Federal Register or the Code of Federal Regulations, or by reference to regulations of other Virginia agencies. Where such re…

A. An agency shall file any form that the agency intends to incorporate into or use in administering the regulation with the proposed or final, including fast-track, regulation submission package for publication in the Register pursuant to § 2.2-4031 A of the Code of Virginia. Th…

A. An agency may request an exemption from filing a form if the form (i) may be completed only online or electronically or (ii) is not in a printable format. B. The agency shall make a request for an exemption from filing by submitting a request to the registrar. The registrar wi…

When Article 2 (§ 2.2-4006 et seq.) or 6 (§ 2.2-4031 et seq.) of the Administrative Process Act or the Virginia Register Act prescribes a time period that is contingent upon publication in the Register, whether before, after, or upon publication, the day of publication shall not …

A. The provisions of this section apply when a form for a regulation is added, amended, or removed, provided that (i) the regulatory text is not changing and (ii) the change to the form is not making a substantive change to the regulation. B. An agency shall file form changes as …

A. For the purposes of § 2.2-4031 of the Code of Virginia, a form shall be considered to be published in the Virginia Register of Regulations if (i) the form is published in full, (ii) a hyperlink to the form is published, or (iii) a notice identifying where the form may be obtai…

As provided in § 2.2-4031 of the Code of Virginia, the Virginia Register of Regulations is published by posting the Register on the Virginia Code Commission's website. The portable document format (PDF) file is the official version of the Register.Statutory Authority§ 2.2-4104 of…

This section shall be used in the construction of the Virginia Administrative Code. 1. Catchlines of sections. The catchline or title of a section following the section number is intended as a description to indicate the content of the section and does not constitute part of the …

A. The registrar shall develop a manual to advise agencies regarding the form and style of regulations and the codification of regulations. B. The registrar shall provide procedures stipulating how agencies shall prepare and file with the registrar's office (i) regulations, (ii) …

An agency shall file regulations, regulation submissions packages, and requested information electronically through the Regulatory Information System, commonly known as "RIS," unless specifically approved by the registrar to file through other means.Statutory Authority§ 2.2-4104 …