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Benefits:Health Care

The following is a general description of the Commonwealth of Virginia's State Health Benefits Program eligibility and enrollment information for employees. It is not intended to replace member handbooks and other plan documents. For more detailed information or clarification, visit the DHRM website at www.dhrm.virginia.gov or contact your Benefits Team. Participation in the State Health Benefits Program is subject to current program provisions, state and federal laws and regulations, and plan availability. The Commonwealth reserves the right to change your enrollment to ensure compliance.



WHO CAN BE COVERED

Classified Employees and Faculty Are Eligible

You are eligible for coverage if you are a:

  1. Full-time, classified employee
    Full-time classified employees are scheduled to work at least 30 hours per week.
  2. Part-time, classified employee
    Eligible if scheduled to work at least 20 hours per week
  3. Regular, full-time or part-time faculty member
    Carries a faculty teaching load considered to be full time at the institution.

State plan members may be covered under only one state contract. A U.S. citizen, U.S. resident alien, U.S. national or resident of Canada or Mexico may be covered as a dependent. The Office of Health Benefits will review enrollment requests for non-U.S. citizens.

Types of health plan membership include:

  • Employee Single - to cover yourself only;
  • Employee Plus One - to cover yourself and one eligible dependent; and
  • Family - to cover yourself and two or more eligible dependents.

Eligible Dependents

  • The employee's legal spouse
  • The employee's children
    • Under the health benefits program, the following eligible children may be covered to the end of the calendar year in which they turn age 26 (the plan's limiting age). The age requirement may be waived for adult incapacitated children.
      • Natural or adopted children and children placed for adoption
      • Stepchildren.
      • Other unmarried children when a court has issued a final order naming the employee (and/or the employee's legal spouse) to assume sole permanent custody, if the certain requirements are met.
      • Adult incapacitated children.

You must provide proof of a dependent's eligibility any time you add a dependent to your health plan. If it is determined that a person is covered in error, the plan has the right to take corrective action. Members who cover ineligible persons may be removed from the program for a period of up to three years.

For more information, see the Eligibility Chart on the DHRM website.



COVERAGE & PLAN OPTIONS

Overview

The Commonwealth offers five basic plan options to state employees and non-Medicare retirees. Statewide plans include COVA Care, COVA HealthAware and COVA HDHP (High Deductible Health Plan). The Kaiser Permanente HMO plan is offered in certain Northern and Central Virginia zip codes and Optima Health Vantage HMO plan offered in Hampton Roads.

All plans offer these benefits:

  • Medical
  • Outpatient prescription drug
  • Preventive dental
  • Behavioral health, and
  • Employee assistance program (EAP) services

Some covered services are subject to a plan year deductible, coinsurance or copayments. In-network wellness and preventive care services are available at no cost to members. In addition, some statewide plans allow you to purchase at an extra cost enhanced coverage such as expanded dental, out-of-network and vision & hearing.

Information on statewide and regional plans may be found on the DHRM web site.

COVA Care

COVA Care is a statewide PPO plan with medical, behavioral health and employee assistance program (EAP) services administered by Anthem Blue Cross and Blue Shield. Anthem Pharmacy delivered by IngenioRx administers the outpatient prescription drug benefits and Delta Dental of Virginia administers dental benefits. For medical and behavioral health, there is no out-of-network coverage, except for an emergency, unless you choose the Out-of-Network option. You may select this option, as well as Expanded Dental, and Vision & Hearing, at an extra cost.

Medical, Vision, Hearing & Behavioral Health
Anthem: www.anthem.com/cova

Prescription Drug
Anthem Pharmacy: www.anthem.com

Dental Benefits
Delta Dental of Virginia: www.deltadentalva.com

Learn More

COVA HealthAware

COVA HealthAware is a statewide consumer-driven health plan (CDHP) that includes medical, behavioral health and employee assistance program (EAP) services administered by Aetna. Anthem Pharmacy delivered by IngenioRx administers the outpatient prescription drug benefits and Delta Dental of Virginia administers dental benefits. The plan includes in-network annual preventive services such as dental, vision & hearing exams paid at 100 percent, and out-of-network coverage. Aetna's network also provides coverage throughout the U.S. and worldwide. You may purchase expanded coverage for dental benefits, or vision benefits for lenses and frames, at an additional cost.

Medical, Vision, Hearing & Behavioral Health
Aetna: www.covahealthaware.com

Prescription Drug
Anthem Pharmacy: www.anthem.com

Dental Benefits
Delta Dental of Virginia: www.deltadentalva.com

Learn More

COVA HDHP

The COVA HDHP (High Deductible Health Plan) is a 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 medical, behavioral health and employee assistance program (EAP) services are administered by Anthem Blue Cross and Blue Shield. Anthem Pharmacy delivered by IngenioRx administers the outpatient prescription drug benefits and Delta Dental of Virginia administers dental benefits.

Medical, Vision, Hearing & Behavioral Health
Anthem: www.anthem.com/cova

Prescription Drug
Anthem Pharmacy: www.anthem.com

Dental Benefits
Delta Dental of Virginia: www.deltadentalva.com

Learn More

Kaiser Permanente HMO

The Kaiser Permanente HMO has no deductible for medical in-network services, but you must use Kaiser 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 website at http://my.kp.org/commonwealthofvirginia/ to determine if your job location or home address is in the Kaiser service area, which is required to participate in the plan.

Kaiser Service Area: Includes certain cities, counties and zip codes where you live or work in Virginia, Maryland and the District of Columbia.

Medical, Prescription Drug and Vision
http://my.kp.org/commonwealthofvirginia/

Dental
Dominion National: https://www.DominionNational.com/kaiser

Learn More

Optima Health Vantage HMO

Optima Health Vantage HMO is a regional plan option for employees who live or work in the Tidewater area. Members may receive care through any participating provider in the Optima Health Vantage network throughout Virginia and northeastern North Carolina. Optima Health encourages but does not require members to choose a primary care physician (PCP) and members do not need referrals for specialist visits. Your home address or job location must be in the Optima service area for you to participate in the plan.

Optima Health Service Area: (Primarily Hampton Roads) Includes certain cities, counties and zip codes where you live or work in greater Hampton Roads defined as: Gloucester, Hampton, James City, Mathews, Newport News, Poquoson, Williamsburg, York, Chesapeake, City of Franklin, Isle of Wight, Norfolk, Portsmouth, Southampton, Suffolk, Surry, Virginia Beach.

Medical, Prescription Drug, Dental, Vision and Behavioral Health
www.optimahealth.com/cova

Learn More

Tricare Supplement

TRICARE SUPPLEMENT is a statewide plan for military retirees.The state health benefits program offers this voluntary supplement to TRICARE and is administered for the Commonwealth by Selman & Company. Enrollment is open to state employees and early retirees who are military retirees, or the spouse of a military retiree. They must be eligible for:

  • TRICARE, the military health benefits program, and
  • The state health benefits program.
Learn More


CHOOSING A HEALTH PLAN

Before You Choose a Plan

Before You Choose a Plan:

Remember that each plan is different. It is important to consider how the plan you choose may affect you and your family. So be sure that:

  • Your health care providers are in the plan's network.
  • You check the benefit coverage for your prescriptions.
  • You consider your total out-of-pocket expenses such as deductibles and copayments.
  • You get more information by:
    • Visiting the plan administrator's web site,
    • Calling the plan's customer service number,
    • Contacting your Benefits Specialist

Remember, the Final Decision is Yours!

If you have questions, contact your agency Benefits Administrator. Once you have submitted a valid election and the election takes effect, it is binding and may not be changed. When adding dependents to coverage, supporting documentation is required that provides proof of eligibility.

About Monthly Premiums

About Your Monthly Premium:

  • Full-time employees working 30 hours or more per week receive a state premium contribution.
  • Part-time employees who work less than 30 hours per week must pay the entire cost of coverage.
  • Payroll deducted premiums are on a pre-tax basis.
  • Health Care Premiums are subject to change every July 1.

To find your premium amount, visit the DHRM website, or contact your Benefits Specialist.

Premium Rewards Program:

The Premium Rewards program allows an employee/retiree who is enrolled in COVA Care or COVA HealthAware to reduce their monthly premium by $17 per month ($34 when combined with enrolled spouse) if they fulfill the requirements to earn a reward. (Learn More)

When Enrolling

Your Election Choices

Health Care Coverage in most cases includes medical, dental, pharmacy, and behavioral health services. Certain family members who meet eligibility and rules requirements may also be covered. Supporting documentation must be provided before family members can be added.

  • Employees who enroll or fail to remove a family member who is not eligible for coverage may face disciplinary action and removal from the State Health Benefits Program for up to three years.
  • Continued coverage is available for you and covered family members who lose eligibility under the State Health Benefits Program unless you enroll in the TRICARE supplement.
  • More information about Extended Coverage (COBRA) is available on the DHRM website or from your Benefits Administrator.
  • Portability information for the TRICARE supplement is available from the plan administrator.

Flexible Spending Accounts (FSA) allow you to set aside part of your salary each pay period before taxes for eligible medical or dependent care expenses. There is a monthly pre-tax administrative fee for one or both accounts. (learn more)


How to Enroll

Log into Cardinal Employee Self Service (ESS) to review your current health benefits record, update your personal information, enroll, or make changes to your health plan and/or enroll in a FSA.

New Users
All new users must register for Cardinal ESS with their Cardinal Employee ID, which should have been emailed to you from Cardinal. If you need to retrieve it again, follow these instructions.

Need Help?
The "Open Enrollment through Cardinal ESS Job Aid" is a step-by-step tutorial to help guide your benefit election process.


Upon Enrollment

Upon enrollment in COVA Care, COVA HealthAware, COVA HDHP, Kaiser, Optima or the Medical Flexible Spending Account, you should receive from your agency Benefits Administrator:

  • the Office of Health Benefits Notice of Privacy Practices,
  • an Extended Coverage (COBRA) General Notice,
  • a Wellness Program Notice, and
  • a Medicare Part D Notice of Creditable Coverage.

If you do not receive your notice, please contact your benefits office or visit the DHRM website to obtain a copy. Upon enrollment in the statewide health plans, you should receive a copy of the most recent member handbook which provides the details of your coverage. Upon enrollment in Kaiser, Optima or the TRICARE Supplement, you should receive an Evidence of Coverage (EOC) from the plan administrator. When enrolling in the Flexible Spending Accounts, you should receive a confirmation notice from the FSA claims administrator. You should keep the confirmation notice, along with the FSA Sourcebook, which provides detailed information on the administration of the accounts. (For more information, visit the DHRM web site.)

REMEMBER: A valid election, once submitted, is binding and may not be changed after it takes effect.

Enrollment Deadlines
Open Enrollment
Qualifying Mid-Year Events




ADDITIONAL RESOURCES

Health & Wellness Programs

Helping you on your journey to wellness with assistance for managing chronic health conditions

The Commonwealth's medical plans also include health and wellness programs available to enrolled participants and their covered family members. It's important to know that:

  • These programs are secure and confidential, in full compliance with federal and state laws,
  • These types of programs are provided to help people improve their health, and
  • Participation in these programs is voluntary.

Once enrolled, be sure to visit your health plan's website to find multiple resources to help you live a healthier lifestyle, including assistance with long-term conditions, pregnancy, health coaching and cost savings.

Health incentives programs to help with cost savings

COVA Care and COVA HealthAware members who complete certain requirements for the maternity, diabetes, asthma/COPD and hypertension management programs are rewarded with a special incentive.

  • Maternity Management - Expectant mothers who enroll within the first 16 weeks of pregnancy, actively participate and complete a 28- week health assessment can earn a copay waiver or HRA contribution, depending on the plan.
  • Disease Management - Diabetes, Asthma/ COPD and Hypertension Management - Members who enroll and work with a nurse coach, follow up with their health care provider annually, and have appropriate exams or tests may get certain drugs or supplies at no cost.
Visit the DHRM "Health & Wellness Programs" site to learn more

Employee Assistance Program (EAP)

The Employee Assistance Program supports employee mental and emotional health by providing confidential assistance and referral services for employees enrolled in a health plan who are experiencing personal, family, marital, or substance abuse problems.

Learn more

Shared Savings Incentives Program

COVA Care, COVA HDHP and COVA HealthAware members are eligible for the Shared Savings Program. These incentive programs offer cash reward to members when they shop for better-value health care services. Not every facility will bring a reward. The programs are strictly voluntary.

  • SmartShopper - COVA Care and COVA HDHP
  • Informed Rewards - COVA HealthAware
Visit the DHRM website to learn more

Contact Information

General Questions Contact your Benefits Specialist
COVA Care Medical, Vision, Hearing & Behavioral Health
Anthem: www.anthem.com/cova
Prescription Drug
Anthem Pharmacy: www.anthem.com

Dental Benefits
Delta Dental of Virginia: www.deltadentalva.com

COVA HealthAware

Medical, Vision, Hearing & Behavioral Health
Aetna: www.covahealthaware.com

Prescription Drug
Anthem Pharmacy: www.anthem.com

Dental Benefits
Delta Dental of Virginia: www.deltadentalva.com
COVA HDHP Medical, Vision, Hearing & Behavioral Health
Anthem: www.anthem.com/cova
Prescription Drug
Anthem Pharmacy: www.anthem.com
Dental Benefits
Delta Dental of Virginia: www.deltadentalva.com
Kaiser Permanente HMO

Medical, Prescription Drug and Vision
http://my.kp.org/commonwealthofvirginia/

Dental
Dominion National: https://www.DominionNational.com/kaiser
Optima Health Vantage Medical, Prescription Drug, Dental, Vision and Behavioral Health
www.optimahealth.com/cova



Cardinal Self Service

Use Cardinal Employee Self Service (ESS) to review your current health benefits record, update your personal information, enroll, or make changes to your health plan and/or enroll in a FSA.

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