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听听or contact your听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.
You are eligible for coverage if you are a:
- Full-time, classified employee
Full-time classified employees are scheduled to work at least 30 hours per week. - Part-time, classified employee
Eligible if scheduled to work at least 20 hours per week - 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.听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听- to cover yourself only;
- Employee Plus One听- to cover yourself and one eligible dependent; and
- Family听- to cover yourself and two or more 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听听on the DHRM website.
You are eligible for coverage if you are a:
- Full-time, classified employee
Full-time classified employees are scheduled to work at least 30 hours per week. - Part-time, classified employee
Eligible if scheduled to work at least 20 hours per week - 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.听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听- to cover yourself only;
- Employee Plus One听- to cover yourself and one eligible dependent; and
- Family听- to cover yourself and two or more 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听听on the DHRM website.
The Commonwealth offers听five basic plan options听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听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听statewide and regional plans听may be found on the听.
COVA Care听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:听Anthem
Prescription Drug:听Anthem Pharmacy
Dental Benefits:听Delta Dental of Virginia
COVA HealthAware听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:听Aetna
Prescription Drug:听Anthem Pharmacy
Dental Benefits:听Delta Dental of Virginia
罢丑别听COVA HDHP听(High Deductible Health Plan)听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:听Anthem
Prescription Drug:听Anthem Pharmacy
Dental Benefits:听Delta Dental of Virginia
罢丑别听Kaiser Permanente HMO听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听听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:听Includes certain cities, counties and zip codes where you live or work in Virginia, Maryland and the District of Columbia.
Dental:听
Optima Health Vantage HMO听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)听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
TRICARE Supplement听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.
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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听Benefits Specialist
听
Remember, the Final Decision is Yours!
If you have questions, contact your agency Benefits Administrator.听Once you have submitted a valid election and the election takes effect, it is binding and may not be changed.听When adding dependents to coverage, supporting documentation is required that provides proof of eligibility.
- 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听pre-tax basis.
- Health Care Premiums are subject to change every听July 1.
听
To find your premium amount, visit the听, or contact your听Benefits Specialist.
Premium Rewards Program:
罢丑别听听program allows an employee/retiree who is enrolled in COVA Care or COVA HealthAware to reduce their monthly premium by听$17听per month ($34 when combined with enrolled spouse) if they fulfill the requirements to earn a reward.
Health Care Coverage听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.
听
Flexible Spending Accounts (FSA)听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.
Log into听听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听Cardinal Employee ID, which should have been emailed to you from Cardinal. If you need to retrieve it again, follow听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 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.
听
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听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.
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听Benefits Specialist
听
Remember, the Final Decision is Yours!
If you have questions, contact your agency Benefits Administrator.听Once you have submitted a valid election and the election takes effect, it is binding and may not be changed.听When adding dependents to coverage, supporting documentation is required that provides proof of eligibility.
- 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听pre-tax basis.
- Health Care Premiums are subject to change every听July 1.
听
To find your premium amount, visit the听, or contact your听Benefits Specialist.
Premium Rewards Program:
罢丑别听听program allows an employee/retiree who is enrolled in COVA Care or COVA HealthAware to reduce their monthly premium by听$17听per month ($34 when combined with enrolled spouse) if they fulfill the requirements to earn a reward.
Health Care Coverage听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.
听
Flexible Spending Accounts (FSA)听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.
Log into听听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听Cardinal Employee ID, which should have been emailed to you from Cardinal. If you need to retrieve it again, follow听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 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.
听
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听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.
Cardinal Employee 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.
Additional Resources
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:
听
- 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.
听
Once enrolled, be sure to visit your health plan's website to find multiple resources to help you live a healthier lifestyle, including听assistance with long-term conditions,听pregnancy,听health coaching听and听cost savings.
听
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.
听
- Maternity Management听- Expectant mothers who enroll within the first 16 weeks of pregnancy, actively participate and complete a 28- week health assessment can earn a听copay waiver or HRA contribution, depending on the plan.
- Disease Management听-听Diabetes, Asthma/ COPD and Hypertension Management听- 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听certain drugs or supplies at no cost.
The Employee Assistance Program supports employee听mental and emotional health听by providing confidential assistance and referral services for employees enrolled in a health plan who are experiencing personal, family, marital, or substance abuse problems.
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.
听
- SmartShopper听- COVA Care and COVA HDHP
- Informed Rewards听- COVA HealthAware
| Topic | Details |
|---|---|
| General Questions | Contact your Benefits Specialist |
| COVA Care | Medical, Vision, Hearing & Behavioral Health:听Anthem |
| Prescription Drug:听Anthem Pharmacy | |
|
Dental Benefits:听Delta Dental of Virginia |
|
| COVA HealthAware |
Medical, Vision, Hearing & Behavioral Health:听Aetna |
|
Prescription Drug:听Anthem Pharmacy |
|
| Dental Benefits:听Delta Dental of Virginia | |
| COVA HDHP | Medical, Vision, Hearing & Behavioral Health:听Anthem |
| Prescription Drug:听Anthem Pharmacy | |
| Dental Benefits:听Delta Dental of Virginia | |
| Kaiser Permanente HMO | |
| Dental:听 | |
| Optima Health Vantage | Medical, Prescription Drug, Dental, Vision and Behavioral Health |
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:
听
- 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.
听
Once enrolled, be sure to visit your health plan's website to find multiple resources to help you live a healthier lifestyle, including听assistance with long-term conditions,听pregnancy,听health coaching听and听cost savings.
听
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.
听
- Maternity Management听- Expectant mothers who enroll within the first 16 weeks of pregnancy, actively participate and complete a 28- week health assessment can earn a听copay waiver or HRA contribution, depending on the plan.
- Disease Management听-听Diabetes, Asthma/ COPD and Hypertension Management听- 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听certain drugs or supplies at no cost.
The Employee Assistance Program supports employee听mental and emotional health听by providing confidential assistance and referral services for employees enrolled in a health plan who are experiencing personal, family, marital, or substance abuse problems.
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.
听
- SmartShopper听- COVA Care and COVA HDHP
- Informed Rewards听- COVA HealthAware
| Topic | Details |
|---|---|
| General Questions | Contact your Benefits Specialist |
| COVA Care | Medical, Vision, Hearing & Behavioral Health:听Anthem |
| Prescription Drug:听Anthem Pharmacy | |
|
Dental Benefits:听Delta Dental of Virginia |
|
| COVA HealthAware |
Medical, Vision, Hearing & Behavioral Health:听Aetna |
|
Prescription Drug:听Anthem Pharmacy |
|
| Dental Benefits:听Delta Dental of Virginia | |
| COVA HDHP | Medical, Vision, Hearing & Behavioral Health:听Anthem |
| Prescription Drug:听Anthem Pharmacy | |
| Dental Benefits:听Delta Dental of Virginia | |
| Kaiser Permanente HMO | |
| Dental:听 | |
| Optima Health Vantage | Medical, Prescription Drug, Dental, Vision and Behavioral Health |