Generate/ERILOGO1.gif About ERI Disclaimer

Virginia - Compensation & Benefit Legislation

VIRGINIA - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverages within the State.

 

VIRGINIA - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of birth of adopted children is included in state's newborn health care mandate.

 

Preventive care for children: yes, to age 6.

 

(Virginia Code Ann. Sections 38.2-3409, 38.2-3411, 38.2-3411.1, 38.2-3411.2, 38.2-3414, 38.2-3414.1, 38.2-3418)

 

VIRGINIA - ALCOHOLISM & DRUG ABUSE

Mandatory coverage.

 

Minimum yearly inpatient coverage: 20 days for adults, 25 days for children.

 

Minimum yearly outpatient coverage: 20 visits.

 

Minimum lifetime coverage: No less than lifetime maximum for physical illnesses with 50% or more coinsurance for outpatient visits after the first 5 visits.

 

(Virginia Code Ann. Section 38.2-3412.1)

 

VIRGINIA - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: No. Follows FUTA.

 

VIRGINIA - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

VIRGINIA - COORDINATION OF BENEFITS

State reports no statutory requirements.

 

VIRGINIA - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

  

VIRGINIA - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

State has no statutory requirements.

 

VIRGINIA - GROUP HEALTH CODE ADDITIONS (MANDATED)

Alcoholism, Drug Abuse, and Mental Health Treatments: Limits on coverage for alcoholism, drug abuse, and mental health treatments must not be more restrictive than for other illnesses. Accident or sickness policies providing alcoholism and mental health treatments on an expense incurred basis for an insured individual or a family member of the covered individual must provide coverage for inpatient as well as outpatient mental health and substance abuse services. Inpatient substance abuse or mental health care must be provided for a minimum period of 20 visits per policy or contract year for an adult and for a minimum of 25 days per policy or contract year for a child or adolescent. Medication management visits must be covered in the same manner as those for the treatment of physical illnesses. (S490, 1996) (Virginia Code Ann. Section 38.2-3412.1.)

 

Child Health: Insurers must offer policy holders coverage for child health supervision services including periodic examination of physical and emotional status. (Virginia Code Ann. Section 38.2-3411.1.)

 

Cost Sharing Provisions: Health care policies (HMOs included), which require participants to pay a specified percentage of the cost of covered services, must calculate an amount payable based upon and not to exceed the total, actual amount paid or payable to the provider for services. (S919, 1997) (Virginia Code Ann. Section 38.2-3407.3.)

 

Coverage Continuation and Conversion: Group policies must provide continuation rights for employees whose coverage is terminated under the policy for themselves and their dependents. (Virginia Code Ann. Section 38.2-3541.)

 

Diabetes Coverage: Any issuer of individual or group hospital, medical, or major medical plans, or any HMO, must provide coverage for diabetes. Required coverage includes benefits for equipment, supplies, and outpatient self-management training and education, including medical nutrition therapy, for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and noninsulin using diabetes, if prescribed by a health care professional. (Virginia Code Ann. Section 38.2-3418.8)

 

To qualify for coverage, outpatient self-management education must be provided by a health care professional. (Virginia Code Ann. Section 38.2-3418.8)

 

Insurer may not impose any copayment, fee, or condition for receipt of these benefits that is not equally imposed upon all individuals in the same benefit category. (Virginia Code Ann. Section 38.2-3418.8)

 

Insurance plans for state employees must provide coverage for equipment, supplies, and outpatient self-management training for diabetes. (Virginia Code Ann. Section 2.1-20.1)

 

Genetic Information: Expiring July 1, 1998, genetic information must not be used to terminate any plan. Genetic information concerning individuals or members of their families must be kept confidential, unless the individuals have given written authorization for disclosure. (Virginia Code Ann. Sections 38.2-613; 38.2-508.4.)

 

Handicapped Dependents: Coverage for dependent children cannot terminate while a person is incapable of employment due to mental retardation or physical handicap and chiefly dependent on the insured. (Virginia Code Ann. Section 38.2-3411.)

 

Health Maintenance Organizations: Patient Access to Emergency Services: HMOs must provide access to medical care on a 24-hour basis or must provide phone access to care on a 24-hour basis by allowing the availability of a physician or licensed health care professional who can direct a member to prompt medical care in the event of an emergency. HMOs must reimburse a hospital emergency facility and a provider for medical screening and stabilization services; for care authorized, directed, or referred by a primary care physician, and for care necessitated because an HMO fails to have access to care on a 24-hour basis. HMOs must have descriptions of procedures members need to follow when obtaining emergency care. (H2062, 1997) (Virginia Code Ann. Section 38.2-4312.3.)

 

Hospitalization: "Essential" and "standard" health care policies must include 365 days of inpatient hospitalization for each covered individual during a 12-month period. During the 365-day period, hospitalization benefits must continue until the day the maximum amount of benefit has been reached or until the day on which the covered person is no longer an inpatient. (H2786, 1997) (Virginia Code Ann. Section 9-298, 38.2-3431.)

 

Mammography Screening: Insurers must offer policyholders coverage for mammography screening. Coverage must provide a mammogram to individuals age 35 to 39, biennial mammograms to individuals age 40 to 49, and annual mammograms to individuals age 50 and over. Mammography screening must be ordered by a health care professional, performed by a registered technologist, interpreted by a qualified radiologist, and performed by a certified health care professional. A copy of a mammogram must be sent to the health care practitioner who prescribed the procedure. (S431, 1996) (Virginia Code Ann. Section 38.2-3418.1.)

 

Maternity: Insurers must offer group policyholders coverage of inpatient obstetrical services under terms no less favorable than for physical illness generally. (Virginia Code Ann. Sections 38.2-3414, 38.2-3409.) Insurers (HMOs included) which provide benefits for obstetrical services also must provide coverage for post partum services. Post partum coverage must include provisions for inpatient care and for a home visit or visits in accordance with standard medical guidelines. Guideline changes must be incorporated into health care plans within 6 months of their publication. (H87, 1996) (Virginia Code Ann. Section 38.2-3414.1.)

 

Newborns: Policies providing family coverage must provide benefits for newborns from the moment of birth for injury or sickness including treatment of medically diagnosed congenital defects and birth abnormalities. (Virginia Code Ann. Section 38.2-3411.)

 

Obstetricians and Gynecologists: Group health policies (HMOs included) must provide females 13 years old and over with benefits for direct access to authorized obstetricians or gynecologists of an individual's selection. Prior authorizations from primary care physicians are not required. (H442, 1997) (Virginia Code Ann. Section 38.2-3407.10.)

 

Pap Smears: Group health insurers, including HMOs, must provide coverage for annual pap smears. (S432, 1996) (Virginia Code Ann. Section 38.2-3418.1:2.)

 

Policies for Small Employers: Policies covering less than 50 persons who have been without accident and sickness insurance for at least 12 months immediately preceding the effective date of the policy are not subject to mandates relating to providers or to treatment of mental, emotional, or nervous disorders, including alcoholism and drug abuse. Such policies must cover at least 30 days of inpatient treatment per year; prenatal care, including one visit per month during the first two trimesters of pregnancy, two per month in the seventh and eighth months, and one per week thereafter; obstetrical care, including physicians' services, delivery room, and necessary hospital services; well baby and well child care including seven physical examinations between birth and two years of age and annual exams thereafter until age six; and a basic level of primary and preventive care for other covered persons, including at least two physician visits per year. (Virginia Code Ann. Section 38.2-3425.) Small employer carriers shall offer to all primary small employers that elect to be covered, at least an "essential" and a "standard" health benefit plan. (Virginia Code Ann. Section 38.2-3431D.) Such coverage shall be offered to all eligible employees of the small employer and their dependents. No employees or their dependents may be excluded or charged additional premiums because of health status. (Virginia Code Ann. Section 38.2-3432C.) Small employers are employers actively engaged in business that, on at least 50 percent of its working days during the preceding year, employed less than 100 eligible employees and not less than two unrelated eligible employees, the majority of whom work in Virginia. Primary small employers are the same as small employers, but employ no more than 25 eligible employees and not less than 2 unrelated eligible employees, and include affiliated companies that are eligible to file a combined tax return.(H700, 1996) (Virginia Code Ann. Sections 38.2-3431; 38.2-3431B.) Small employer market premium and disclosure provisions are applicable to health maintenance organizations. (H1715, 1995) Small employers must maintain their size classifications until the earlier of the plan anniversary date or one year following the date upon which an employer no longer meets the eligibility requirements as a small employer. (H2786, 1997) (Virginia Code Ann. Sections 9-298, 38.2-3431.)

 

Pre-existing Conditions: Health care policies must not limit, deny, or exclude coverage for conditions which occur within a 12-month period following an individual's effective date of newly secured coverage. Conditions included in this coverage are those which are manifest in such a manner as to cause an ordinarily prudent person to seek diagnosis, care, or treatment, or those for which medical advice, diagnosis, care, or treatment was recommended or received within 12 months of the effective date of coverage. (H700, 1996) (Virginia Code Ann. Section 38.2-3431.)

 

Pregnancy: Policies must cover costs of pregnancy resulting from an act of rape reported to the police within seven days after the incident The reporting requirement is extended to 180 days in cases of rape or incest involving a female under age 13. (Virginia Code Ann. Section 38.2-3418.)

 

Prescription Drugs: Health care policies (HMOs included, which provide coverage for prescription drugs on an outpatient basis, must offer and make available coverage for prescribed drugs or devices approved by the FDA for use as contraceptives. (H1233, 1997) (Virginia Code Ann. Section 38.2-3407.5:1.)

 

Providers: Health are policies must provide reimbursement or services which may be legally performed by licensed chiropractors, optometrists, opticians, professional counselors, psychologists, clinical social workers, podiatrists, physical therapists, chiropodists, clinical nurse specialists (rendering mental health services), audiologists, speech pathologists, and certified nurse midwives. (H1360, 1997) (Virginia Code Ann. Section 38.2-3408.) Pharmacies and ancillary Service Providers: Individuals may select non-participating providers who have notified the insurer, HMO, or corporation providing health care subscription contracts of their agreement to accept reimbursement at participating provider rates. (H2304, 1995)

 

VIRGINIA - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

 

VIRGINIA - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: No.

 

Percent of employees who must elect coverage (if employees pay part of premium): No statutory requirements.

 

Percent of employees who must be covered if employer pays all of premium: 100%

 

Minimum number of employees in group plan: State has no statutory requirements.

 

Employer prohibited as beneficiary: Yes.

 

Grace period (days): 31.

 

Mandatory conversion: Yes.

 

Other provisions: Insurer may not deny or limit coverage based on death resulting from AIDS.

 

(Virginia Code Ann. Sections 38.2-3100.1, 38.2-3320, 38.2-3325, 38.2-3332; Virginia Insurance Reg. 34 (May 1, 1990))

 

VIRGINIA - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Columbus Day (or 2nd Monday in October), Thanksgiving. Other: Any day appointed by the Governor or President. If any holiday falls on Sunday, following Monday is a holiday; if any holiday falls on Saturday, preceding Friday is a holiday. (Virginia Code Ann. Sections 2.1-21, 2.1-21.1, 2.1-21.2, 2.1-24, 2.1-24.1, 2.1-25 through 2.1-27, 2.1-27.2, 2.1-27.3, 2.1-27.8)

 

VIRGINIA - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

VIRGINIA - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: Violator is guilty of a Class 4 misdemeanor.

 

Other Requirements: Employee must give employer reasonable notice. Employer cannot force employee to use vacation or sick leave for jury duty. (Virginia Code Ann. Section 18.2-465.1.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: Yes, unless employee is the defendant in a criminal case.

 

Remedies and Penalties: Violator is guilty of a Class 4 misdemeanor.

 

Other Requirements: Employee must give employer reasonable notice. Employer cannot force employee to use vacation or sick leave for witness duty

 

VIRGINIA - LEAVES OF ABSENCE

State reports no statutory requirements.

 

See U.S. Federal Family and Medical Leave Act

 

VIRGINIA - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

VIRGINIA - MANDATED PROVIDERS

Optometrists, chiropractors, dentists, psychologists, podiatrists, and social workers. Mandatory coverage for chiropodists, opticians, professional counselors, physical therapists, audiologists, speech pathologists, and clinical mental health nurses. Direct access to an obstetrician/gynecologist is mandatory. (Virginia Code Ann. Sections 38.2-3407.11, 38.2-3408, 38.2-3410)

 

VIRGINIA - MENTAL HEALTH CARE

Mandatory coverage.

 

Minimum yearly inpatient coverage: 20 days for adults; 25 days for children.

 

Minimum yearly inpatient coverage: 20 visits.

 

Minimum yearly inpatient coverage: No less that lifetime maximum for physical illness, with 50% or more coinsurance for outpatient visits after the first five visits.

 

(Virginia Code Ann. Section 38.2-3412.1)

 

VIRGINIA - MINIMUM WAGE

Refer to the Federal minimum wage: $5.15 per hour (effective September 1, 1997).

 

Exemptions: Certain agriculture workers, domestics, outside sales, students, apprentices, and handicapped workers in special environments. (Virginia Code Ann. Sections, 40.1-28.9, 40.1-28.10)

 

See U.S. Minimum Wage

 

VIRGINIA - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: All new employees and rehires.

 

Exempt from reporting: No exemptions.

 

Form(s) to file: State for, W-4 form, or mutually agreeable method.

 

Filing deadline: Within 35 days of employment.

 

Employer information to be included: Name, address, and federal or state EIN.

 

Employee information to be included: Name, address, and SSN.

 

Penalty for failure to report: N/A

 

(Virginia Code Ann. Section 60.2-114.1)

 

VIRGINIA - NEWBORN CARE MANDATE

Mandated coverage.

 

Preventive care for children: Yes, to age 6. (Virginia Code Ann. Sections 38.2-3409, 38.2-3411, 38.2-3411.1, 38.2-3411.2, 38.2-3414, 38.2-3414.1, 38.2-3418)

 

VIRGINIA - OVERTIME COMPENSATION REQUIREMENTS

State reports no statutory requirements.

 

VIRGINIA - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

VIRGINIA - PRE-EXISTING CONDITIONS

For insurance plans offered to small employers, employee and eligible dependents must be covered after 12 months. (Virginia Code Ann. Section 38.2-3431)

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

VIRGINIA - PROTECTED CLASSIFICATIONS

Age:   Yes.

Race:  Yes.

Color:   Yes.

National Origin:  Yes.

Ancestry:   No specific law. State has expressed policy against discrimination.

Religion:  Yes.

Sex:   Yes.

Pregnancy:  Yes.

Sexual Harassment:   No specific law. State has expressed policy against discrimination.

 

(Va. Code Ann. Sections 2.1-116.10, 2.1-715, 2.1-716; Va. Const. art. I Section 11.)

 

VIRGINIA - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

VIRGINIA - SHORT TERM DISABILITY CODE ADDITIONS

State does not require employer or employee participation in short term disability plans.

 

VIRGINIA - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Payday.

 

Date due if employee resigns: Payday.

 

Wages: Yes.

 

Vacation Pay: No.

 

Holiday: No.

 

Sick leave: No.

 

Severance: No.

 

(Virginia Code Ann. Section 40.1-29)

 

VIRGINIA - UNEMPLOYMENT TAX

Employer Contributions:

 

 

Voluntary Contribution Provision: No.

 

(Virginia Code Ann. Sections 60.2-114, 60.2-512, 60.2-515, 60.2-526, 60.2-528, 60.2-530, 60.2-531.)

 

VIRGINIA - VACATION PAY

State has no statutory requirements.

 

VIRGINIA - VOTING TIME OFF

State reports no statutory requirements.

 

VIRGINIA - WORKERS' COMPENSATION

Private Employers: Mandatory as to employers with 3 or more employees and farm employers with more that 2 full-time employees. Elective for partners and sole proprietors. Corporate officers may reject for accidental injury only.

 

Public Employers: Mandatory coverage to all public employments, except administrative officers and employees elected or appointed for employees elected or appointed for definite terms. (Note: Governing body of county, city or town may elect coverage of its members.)

 

Exceptions: Casual employees; horticultural and farm laborers; taxi drivers and domestic servants; employees of steam railroad; employments not in usual course of employer's trade, business, or occupation, and real estate salesperson/associated brokers on commission, under independent contract, or who are not treated as employees for federal income tax purposes. (Note: Does not apply to injuries received during emergency services activities, unless it results from gross negligence.)

 

Special Coverage Provisions: Voluntary as to employers of less than 3, farm labor, and domestics. Employers may elect coverage for its independent contractor provided that independent agrees in writing. The independent contractor may have to pay for all or part of that coverage.

 

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)