Administrative Code

Virginia Administrative Code
6/30/2022

Part V. Benefits Plans

1VAC55-20-450. Basic plan.

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 employees upon enrollment. The department shall denote a self-funded plan as the "basic plan," which is required by code to be available throughout the state and shall provide the basis for all employer contributions.

Statutory Authority

§§ 2.2-1204 and 2.2-2818 of the Code of Virginia.

Historical Notes

Derived from VR525-01-02 § 5.1, eff. November 21, 1990; amended, Virginia Register Volume 20, Issue 20, eff. July 16, 2004.

1VAC55-20-460. Alternative health benefit plans.

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 retirees have the same enrollment options as active employees.

Retirees must enroll in a plan within 31 days of separation for retirement. A separating state employee who defers retirement will not be eligible to enroll in a retiree medical plan when the former employee seeks retirement benefits.

Statutory Authority

§ 2.2-2818 of the Code of Virginia.

Historical Notes

Derived from VR525-01-02 § 5.2, eff. November 21, 1990; amended, Virginia Register Volume 20, Issue 20, eff. July 16, 2004; Volume 30, Issue 14, eff. April 24, 2014.

1VAC55-20-470. Benefits coverage.

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 department's contractors.

B. The benefit provisions of the contract documents are contained in the contract booklets or member handbooks distributed to employees by their benefits administrators.

C. The benefits administrators have copies of the contract booklets and member handbooks for all plans offered by that employer. By appointment, any employee or citizen may inspect the entire contract or contracts at the offices of the department.

Statutory Authority

§§ 2.1-20.1 and 2.1-20.1:02 of the Code of Virginia.

Historical Notes

Derived from VR525-01-02 § 5.3, eff. November 21, 1990.

1VAC55-20-480. Department discretion.

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.

Historical Notes

Derived from VR525-01-02 § 5.4, eff. November 21, 1990.

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