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Health Insurance
The Local Choice
The Local Choice Health Benefits Program was created exclusively for local governments, authorities, school divisions, constitutional officers, groups designated by the General Assembly, and political subdivisions of the Commonwealth of Virginia.  
 
The Local Choice Slide Show

Available Options (Active Employees and Pre-65 Retirees)
Effective July 1, 2015
 
Key Advantage 250
Key Advantage 500
High Deductible Health Plan
Kaiser Permanente HMO

Enrollment:
Enrollment Form

Key Advantage (250 & 500)- Statewide Plans:
Administered by Anthem Blue Cross Blue Shield

Medical & Routine Vision Services
Key Advantage plans are preferred Provider Organization (PPO) plans and provide comprehensive medical, preventive care, wellness benefits, immunizations and routine vision benefits (through Blue Vision).

Specialist referrals are not required. Admission to a hospital for an inpatient stay must be approved in advance, or within 48 hours in the case of an emergency or birth of a child. While members receive the highest level of benefits when visiting an in-network provider, Key Advantage plans also provide out-of-network coverage for covered medical services with additional deductibles and/or coinsurance.

These plans also allow for medical care when traveling outside Virginia through the Blue Card program.

Dental Services
Preventive, primary and major restorative dental benefits with orthodontia are provided. You are not required to use an in-network provider for dental. However, members pay less when using an in-network dentist. Non-network providers may bill the balance to members for charges in excess of the negotiated discounts. Dental services are provided by Delta Dental through an agreement with Anthem.

TLC-Delta Dental Coverage Summary


Behavioral Health Services
As with medical services, members receive the highest level of benefits when visiting an in-network provider for behavioral health services. All Key Advantage plans offer out-of-network behavioral health services with additional deductibles and/or coinsurance. Prior authorization of benefits is not required but is highly recommended. Members should contact Anthem to confirm that the service is medically necessary to avoid deductibles and coinsurance for services received outside the network.

Outpatient Prescription Drug Benefits
The TLC plan is a mandatory generic drug program administered by Anthem. If members receive a brand-name drug when a generic equivalent is available they are responsible for the applicable brand copayment plus the difference between the allowable charge for the generic equivalent and the brand name drug.
Prescription drugs are divided into three co-payment tiers, depending upon the type of drug. 
  • First Tier- Typically generic drugs $10 co-pay for up to a 34 day supply
  • Second Tier- Lower cost brand drugs $30 co-pay for up to a 34 day supply
  • Third Tier- Higher cost brand drugs $35 co-pay for up to a 34 day supply

Home Delivery is also available through the outpatient prescription drug benefit. You can receive up to a 90-day supply through the mail at two times the co-pay of a 34-day supply.

Summaries of Benefits and Coverage (SBC's)

Key Advantage 250

Key Advantage 500

High Deductible Health Plan (HDHP)- Statewide Plan:
The HDHP is a PPO plan that includes medical, behavioral health and EAP, prescription drugs and dental benefits.There is a separate deductible for the dental benefits.

Preventive medical care is covered with no deductible or coinsurance. All other covered medical, behavioral health, and prescription services are subject to the $2,800 employee and $5,600 family plan year deductible and 80/20 coinsurance.

Routine vision benefits are not available under this plan. Dental services are provided by Delta Dental through an agreement with Anthem.

The HDHP provides only in-network coverage except in the event of a life-threatening emergency.

Summary of Benefits and Coverage (SBC)

High Deductible Health Plan

Kaiser Permanente- HMO (Regional Plan):
Kaiser Permanente offers a regional HMO plan in Northern Virginia, Fredericksburg, Washington D.C., and parts of Maryland. The regional HMO is only available in certain areas. A detailed outline of the service area and benefits may be found in the Kaiser HMO benefits summary. Mental illness and substance abuse, EAP, prescription drug and dental coverage are included in the Kaiser plan. Dental Coverage provided by Dominion Dental.

Kaiser Dental Coverage Summary


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