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RICHMOND – Many Virginians will have protection from surprise medical bills beginning January 1, 2021. Individuals enrolled in fully insured managed care plans in Virginia and state employees will benefit from a new law adopted by the 2020 Session of the Virginia General Assembly to curb balance billing.

Surprise billing – or balance billing – occurs when patients enrolled in managed care health insurance plans receive bills for more than their plan’s cost-sharing amounts directly from medical service providers who do not participate in a managed care plan’s network of providers – often referred to as “out-of-network” providers.

The new law may extend to individuals covered under private insurance they purchase on their own or through their employer. Individuals whose primary coverage is through the state employee health benefit plan and those covered through a health benefit plan purchased through cannot be balance billed for situations covered under the new law. Approximately 40 percent of individuals who receive their health insurance through their employer will have this protection under their fully insured plan. The remaining 60 percent have coverage through a self-funded ERISA or other arrangement where their employer provides benefits that are administered by a third party, which could be a health insurance company. Most of these health plans will have the option to become elective group health plans by choosing to provide these protections for their employees.

For the same protection to apply to individuals enrolled in elective group plans, the plans must choose to opt in by completing and submitting an online application to the State Corporation Commission’s (SCC) Bureau of Insurance (Bureau) at They have until December 2, 2020, to do so for protection to be effective on January 1, 2021. Applications submitted after that date may be effective at a later date. 

Plans that opt in will be listed on the Bureau’s website with other information provided by the Bureau regarding balancing billing. Health plans and healthcare providers can go to Balance Billing under the Regulated Industries tab on the Bureau’s website at Consumer information regarding balancing billing is available by going to Balance Billing Protections under the Consumers tab on the Bureau’s website.

Under the new law, health care facilities and other providers must provide patients with notifications that address how you are protected, when you can be balance billed, and what to do if you are billed too much. Health insurers regulated by the Bureau also must provide notification to enrollees regarding whether they are subject to balance billing and under what circumstances.

Individuals enrolled in plans covered under the new law or plans that have opted into the new law cannot be billed amounts above their cost-share responsibility by an out-of-network provider for emergency services or for certain non-emergency services – including surgery, anesthesia, pathology, radiology and hospitalist service – during a scheduled procedure at an in-network hospital or other health care facility.

If a consumer is treated by an out-of-network health care provider for services covered by the new law, the provider will submit the claim to the consumer’s insurer or health plan. The insurer or health plan will pay the provider a “commercially reasonable amount” that is based on payments for the same or similar services in a similar geographic area, thereby eliminating any balance payment by the consumer to the provider for services rendered.

The Bureau will make available on its website a data set that may be used to determine “commercially reasonable” payment amounts to providers. The data utilizes Virginia’s All-Payer Claims Database as an independent source of claims payment information.

As part of the claims resolution process under the balance billing law, the insurer and provider must first try to agree on a payment amount. If they cannot, one of the parties may request arbitration. Applications for individuals interested in becoming arbitrators will soon be available on the Bureau’s website along with instructions for applying. The Bureau’s website will offer a list of approved arbitrators from which parties entering arbitration may choose.

If health care providers have a pattern of violations under the new law without attempting corrective action, they are subject to fines or other remedies by the Virginia Board of Medicine or the Virginia Commissioner of Health. Similarly, insurance companies that are found to engage in a pattern of violations of the new law are subject to fines or other remedies by the SCC. Neither insurance companies nor health care providers may use arbitration as a general business practice for resolving claims payments.

For more information, contact the Virginia Bureau of Insurance toll-free at 1-877-310-6560 or visit its website at Questions related to the arbitrator application, requests to arbitrate, or questions regarding the self-funded opt-in process may be emailed to Consumer questions and complaints about balance billing may be emailed to

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Contact: Katha Treanor, 804-371-9141

Case Number INS-2020-00136

RICHMOND – Many consumers will soon shop for health care coverage during the open enrollment period for the 2021 health insurance marketplace through This open enrollment period for plans under the federal Affordable Care Act (ACA) runs from November 1 through December 15, 2020. After this date, consumers may only buy an ACA-compliant health insurance plan if special enrollment conditions apply to them.

Special enrollment periods (SEP) are available for people who may have recently lost their employer-sponsored health insurance coverage or have had a qualifying life event such as a household change. To learn more, visit's SEP page.

“For 2021 and again in 2022, enrollment and eligibility by Virginians will continue on, the federal health insurance platform. Virginia’s transition to a state-based system – the Virginia Health Benefit Exchange – will be ready by plan year 2023,” said Victoria Savoy, director of the Virginia Health Benefit Exchange.

The Virginia Exchange was created by the 2020 Virginia General Assembly to be operated as a new division within the State Corporation Commission (SCC). It will be an online marketplace where qualified individuals can shop for, compare and enroll in health insurance coverage. Additionally, the Virginia Exchange will create a small employer program where eligible employees of qualified small employers will be able to enroll in coverage.   

Whether you are thinking about changing plans or purchasing a new health insurance plan, the SCC encourages Virginians to review their coverage needs and thoroughly explore all their options. “Not all health plans are created alike, and some are not insurance,” said Virginia Insurance Commissioner Scott A. White. He encourages Virginians to fully understand the coverage, costs and protections before they sign up for any health plan. “Understand enrollment periods, what ACA-compliant plans must cover and where to turn for legitimate information. If you have questions, the Bureau of Insurance can help.”

Consumer protection laws govern some types of health coverage, such as plans purchased through an employer or through the health insurance marketplace. Other types of plans such as health care sharing ministries and discount plans might be less expensive than health insurance plans subject to the ACA, but they are not insurance and do not offer the same protections as ACA-compliant plans.

Short-term, limited-duration health insurance plans are not available through the health insurance marketplace, but they are regulated health insurance plans. While they may, in some cases, be less expensive than plans offered through the health insurance marketplace, they often cover less than ACA-compliant marketplace plans; may deny eligibility for coverage or exclude services because of pre-existing conditions, and may apply dollar limits on the amount they will pay.

Whether shopping for health insurance on or off the exchange, the Bureau of Insurance and the Virginia Health Benefit Exchange encourage Virginians to carefully consider what health care services you and your family will need before you sign up for any health insurance plan. Ask yourself:

  • Are anticipated services covered and are there any limits on coverage under each health care coverage option being considered? 
  • Are doctors and medications my family needs covered by the plan being considered? 
  • What are the monthly premiums and costs that coincide with using health services such as co-pays, co-insurance and deductibles? 

Especially during open enrollment, keep the following in mind:

  • In Virginia, is the official website to enroll in ACA plans.
  • For free help understanding your options, find an application assister (navigator and certified application counselor) at
  • Ask for details of any health plan in writing – including cost and coverage – and make sure you understand what you are purchasing.
  • Look for a disclosure indicating whether the health plan complies with the ACA.
  • The open enrollment period for the 2021 health insurance marketplace ends December 15, 2020. Anyone who contacts you to sell individual health insurance plans through an "enrollment period" outside of that is not selling an ACA-compliant policy.
  • Do not provide personal information or send money in response to unsolicited calls or emails.
  • To verify that an insurance agent, agency or company is licensed in Virginia, visit the Bureau’s website at
  • Be wary of telemarketers from the "national enrollment center," "national healthcare center," or other official-sounding name. The marketplace will not call to sell you health insurance.

For more information, contact the Virginia Bureau of Insurance toll-free at 1-877-310-6560 or visit its website at Use the online comparison tool to compare plans. To learn more about the new Virginia Exchange, visit

Free translation services are available. Call the Exchange hotline at 1-833-740-1364 or the hotline at 1-800-318-2596 for assistance.


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Contact: Katha Treanor, 804-371-9141

RICHMOND – Ensuring licensed agents, brokers and producers comply with Virginia insurance laws and regulations – while at the same time reducing their costs and regulatory burden whenever possible – are important to the State Corporation Commission’s (SCC) Bureau of Insurance (Bureau).

Early next year, the Bureau will introduce a new $10 insurance license renewal application processing fee per line of authority and, at the same time, significantly reduce existing processing fees for certain types of licenses. These reductions are possible thanks to greater operational efficiencies and collection of the new insurance license renewal application processing fee.

The new $10 renewal fee goes into effect January 1, 2021, for all insurance license types, and accompanies the Bureau’s move to biennial license renewals. Previously, insurance licenses in Virginia were issued in perpetuity. The switch to biennial license renewals brings the Bureau into line with what most other state insurance departments are doing and allows the Bureau to more regularly receive up-to-date contact and other information from agents, such as criminal history and disciplinary actions.  

Certain fee reductions will also take effect January 1, 2021. Currently, the Bureau assesses different application processing fees for certain types of licenses. The fee reduction not only will reduce the amounts paid by these licensees, but also will simplify those payments by establishing a $15 uniform license application processing fee for licenses issued by the Bureau’s Agent Licensing Section. Application processing fees for consultant, surplus lines and viatical settlement brokers will be reduced from $50 to $15 per line of authority. In addition, the public adjuster application processing fee will be reduced from $250 to $15, and the application processing fee for title settlement agent registrations will be reduced from $100 for business entities and $35 for individuals, respectively, to $15.

“The fee reductions reflect the Bureau’s continued commitment to reducing costs for the insurance industry,” said Agent Licensing Manager Richard Tozer. “The past few months have been incredibly challenging for the insurance industry due to COVID-19, and the Bureau is pleased to support insurance agents with these fee reductions to help them keep operating during a pandemic and beyond.”

For questions, contact the Bureau of Insurance Agent Licensing Section at 804-371-9631 or visit its website at

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Contact: Katha Treanor, 804-371-9141

RICHMOND – As the coronavirus pandemic lingers, so does the potential for coronavirus-related investment schemes. Scammers may take advantage of the situation to offer business opportunities for supposed miracle cures or purported innovative technologies to unsuspecting investors.

The State Corporation Commission’s (SCC) Division of Securities and Retail Franchising (Division), along with other securities regulators, are working to prevent coronavirus-related scams. The Division encourages Virginians to use caution when presented with investment opportunities touting products and services related to the coronavirus pandemic.

“COVID-19-related schemes, like many other types of scams, often follow the headlines and prey on people’s fears and uncertainty,” said Division Director Ron Thomas. “Regardless of the type of investment scam, the red flags that an offer may be fraudulent are often the same.”

Thomas encourages Virginians to beware of unsolicited calls, emails or texts, or social media posts and other online promotions regarding investment opportunities that claim to be raising money for companies promising new health care products that can detect, treat or cure the coronavirus. These opportunities may include offers to invest in medical technology or healthcare companies by purchasing membership units in general or limited partnerships, stock, or other investment vehicles, such as private placement offerings, initial coin offerings or other cryptocurrency-related investments, or crowdfunding.

Thomas also urges Virginians to use caution when presented with investment opportunities promising high yield returns with little or no risk, or that offer trendy, complex or exotic investments. “Every investment opportunity carries some degree of risk that you could lose your money,” he said. He recommends using caution when considering investments that refer to returns as “passive income” or “cash flow” and promise to pay returns on a monthly basis.

“Before handing over your hard-earned money, research the investment and the person or company offering it and know where your money is going, how it will be used and how you can get it back,” Thomas said. He offers the following tips when considering any investment opportunity:

  • Do not invest money you cannot afford to lose.
  • Do your research. Ask for details about an investment opportunity and read the fine print. Ask about the risks and fees involved. Never invest in something you do not fully understand.
  • Always verify that an investment and the person offering it are licensed or registered by the appropriate securities regulator. In Virginia, you can find out by contacting the Division of Securities and Retail Franchising in Richmond at 804-371-9051 or toll-free at 1-800-552-7945.
  • Resist high-pressure sales tactics or “can’t miss” opportunities.
  • Be wary of participating in a general partnership or joint venture if you have no specific experience, knowledge or education in the industry sector – which is often the healthcare industry for coronavirus-related frauds – and would have to rely on others’ expertise.
  • Think twice before considering “research reports” or promotions claiming that the products or services of publicly traded companies can prevent, detect or cure coronavirus and that the stock of these companies will dramatically increase in value as a result.
  • Don’t always believe what you see. Con artists are often good at producing professional-looking websites boasting current productivity levels and profits with photos of vaccine or medical equipment production sites. These easily can be faked.

Additionally, Thomas encourages Virginians to report suspected fraudulent COVID-19 or other investment opportunities by contacting the Division of Securities and Retail Franchising at the numbers above or by visiting its website at For more information, visit the North American Securities Administrators Association’s website at


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Contact: Katha Treanor, 804-371-9141

Richmond - The Virginia Health Benefit Exchange continues preparations for the November 1 open enrollment period for 2021 health plans. The Virginia Exchange will operate on the federal exchange – – for 2021.

The Virginia Health Benefit Exchange was created by the 2020 Virginia General Assembly to be operated as a new division within the State Corporation Commission (SCC). It is expected to transition to a full state-based exchange by plan year 2023.

This month and throughout the transition, the Virginia Exchange will perform consumer outreach and education activities and offer consumer assistance. Last month the SCC appointed Victoria I. Savoy to direct the division.

A 15-member advisory committee is in place to advise and provide recommendations to the Commission and the director in carrying out the purposes and duties of the exchange.

The five members named by the Commission are:

  • Doug Gray - Virginia Associations of Health Plans
  • Lee Biedrycki – BeneFinder, an insurance agency
  • Sabrina Corlette – Georgetown University Health Policy Institute
  • Scott N. Castro – Medical Society of Virginia
  • Kenn Penn – ChamberSolutions (part of Virginia Chamber of Commerce)

The five members named by the Governor on September 4 are:

  • Chiquita Brooks-LaSure – Manatt Health Strategies
  • Elizabeth Cunningham – Virginia Legal Aid Society
  • Ikeita Cantu Hinojosa – formerly of D.C. Health Benefit Exchange Authority
  • Starla Kiser – Dickenson County Behavioral Health Services
  • Jane Norwood Kusiak – Virginia Health Care Foundation (board of advisors)

The five non-voting ex-officio members (or their designees) identified by statute are:

  • Scott White – Commissioner of Insurance
  • Karen Kimsey – Department of Medical Assistance Services Director
  • M. Norman Oliver – State Health Commissioner
  • Duke Storen – Commissioner of the Department of Social Services
  • Daniel Carey – Secretary of Health and Human Resources

The Virginia Exchange will be an online marketplace where qualified individuals can shop for, compare and enroll in health insurance coverage. Additionally, through the marketplace, small business employers may enroll eligible employees directly through qualified health plan issuers, qualified dental plan issuers, or licensed agents as established by the Virginia Exchange.


Contact: Ken Schrad, 804-371-9858

RICHMOND – Rail Safety Week – the annual, nationwide campaign to raise awareness of the need for rail safety education – will appear differently this year amid the COVID-19 pandemic. The State Corporation Commission (SCC) and others will observe the entire week (September 21-27) digitally.

SCC Rail Safety Manager Renee Salmon and VA Operation Lifesaver Coordinator Tracey Lamb agree that the goal is the same: to address head-on the need for rail safety awareness to combat the statistic that either a person or vehicle is hit by a train every three hours in the U.S., as reported by Operation Lifesaver, Inc. (OLI).

Although in-person events will not be possible this year, the SCC plans to share potentially life-saving information on its website and social media pages. OLI has assigned each day of Rail Safety Week its own safety theme:

  • Monday – Proclamations, Media Outreach;
  • Tuesday – Law Enforcement Partnerships;
  • Wednesday – Crossing Safety, Professional Drivers;
  • Thursday – Commuter and Transit Safety;
  • Friday – Wear Red for Rail Safety;
  • Saturday – Trespass Prevention;
  • Sunday – Photographer Safety.

“Rail safety is much more than just a single tip or slogan,” said Salmon. “It’s a set of guidelines for different groups of people, including children, first responders, media professionals, photographers, personal and professional drivers, and more.”

OLI is encouraged by a 76% decrease in nationwide collisions at U.S. highway-rail grade crossings over the past 40 years. “But there’s still more rail safety awareness work to do,” said Lamb.

This year’s digital focus is perhaps most appropriate for photographer safety, the seventh and final day of Rail Safety Week. Photo shoots and ‘selfies’ on train tracks may be tempting for posting on social media, but both activities are dangerous and illegal.

Both Lamb and Salmon acknowledge the same rail safety awareness statistic: “Trains can take a mile or more to come to a complete stop and overhang the track by at least three feet. Please never put yourself – or your clients – in harm’s way, and remember that people mimic your behavior when they see your photos on the web,” Lamb said.

Virginia Operation Lifesaver is administered by the SCC’s division of Utility and Railroad Safety, which offers education sessions virtually and can be reached at Keep an eye out for the SCC’s digital messaging during Rail Safety Week. In the meantime, check out the SCC’s full list of resources at


Contact: Ford Carson, 804-371-9141

RICHMOND – The general moratorium on utility shutoffs is extended through October 5, 2020. The State Corporation Commission (SCC) issued the order following a request from Virginia Governor Ralph S. Northam. The moratorium was originally set to end on September 16.

In a letter to the Commission on September 14, the Governor said, “My request for an extension will give the General Assembly the time they need to address this issue, finalize their budget, and complete their important work during this special session.”

In granting another extension, the Commission said it will not extend the moratorium beyond October 5, 2020. The Commission urged the Governor and General Assembly to appropriate funds for direct financial assistance to those customers who are unable to pay their bills due to the COVID-19 pandemic. The Commission said, “We hope the General Assembly uses this additional time to act on this recommendation.”

The Commission wrote, “Since we first imposed the moratorium on March 16, 2020, we have warned repeatedly that this moratorium is not sustainable indefinitely. The mounting costs of unpaid bills must eventually be paid, either by the customers in arrears or by other customers who themselves may be struggling to pay their bills. Unless the General Assembly explicitly directs that a utility's own shareholders must bear the cost of unpaid bills, those costs will almost certainly be shifted to other paying customers.”

The SCC’s latest extension order means the moratorium will have been in place for more than six months. It was originally imposed on March 16, 2020, as an emergency measure to protect customers from the immediate economic impacts of the COVID crisis.

The end of the Commission-directed moratorium on October 5 does not mean the end of protections for customers in arrears who are making a good-faith effort to pay their bills over a longer time period. Customers who enter such extended payment plans with their utilities will continue to be protected from service cut-offs even after the end of this moratorium.


Case number PUR-2020-00048 - View Additional Order on Moratorium
Contact: Ken Schrad, 804-371-9858

RICHMOND – Staying connected and having access to local emergency services and community resources is more important than ever during the COVID-19 public health emergency. The State Corporation Commission (SCC) is partnering with the Federal Communications Commission (FCC), the National Association of Regulatory Utility Commissioners and the National Association of State Utility Consumer Advocates during “National Telephone Discount Lifeline Awareness Week” September 14-18, 2020.

Lifeline, a federal program, offers a monthly discount of up to $9.25 toward phone or broadband services for eligible consumers and is available through certain local telephone and wireless companies. The goal of this nationwide outreach effort is to increase awareness about the Lifeline program and provide information to qualified participants. In addition to falling below a certain income level, you could be eligible if you participate in one of these federal assistance programs: 

  • Supplemental Nutrition Assistance Program (SNAP)
  • Medicaid
  • Supplemental Security Income (SSI)
  • Federal Public Housing Assistance (FPHA)
  • Veterans Pension and Survivors Benefit

Participants are limited to one Lifeline benefit per household. Participating companies can provide assistance with enrollment. A new option – the National Verifier ( – makes it easier for consumers to assess eligibility and sign up for Lifeline. The SCC encourages Virginians to contact companies from whom you wish to receive service since not all companies are required to offer Lifeline service.

To learn more about Lifeline and the National Verifier, and to see if you are eligible, call 1-800-234-9473 or email or visit or the FCC website at You may also contact Lean Sorini with Universal Service Administrative Co., the company that administers the Lifeline program, at 202-772-6274 or at


Contact: Katha Treanor, 804-371-9141

RICHMOND – The State Corporation Commission’s (SCC) new Virginia Health Benefit Exchange (Exchange) has awarded navigator grants to Virginia Poverty Law Center (VPLC) and Boat People SOS, Inc. (BPSOS). The grants will support the work of these organizations to help Virginians navigate, shop for and enroll in health insurance coverage through

VPLC received nearly $1.5 million in grant money. VPLC established “ENROLL Virginia!,” a statewide consortium of community-based and consumer-focused nonprofits that educates Virginians about the health insurance marketplace. BPSOS was awarded a $365,000 grant. BPSOS is a national nonprofit headquartered in Northern Virginia with a focus on serving the Asian-American community in that area.

VPLC has served as a navigator organization since the federal grant program began in 2013 to assist individuals, small employers and their employees as they look for health coverage options through the health benefit exchange and the small employer health options (SHOP) marketplace. BPSOS has served Virginians in a similar role for the past five years.

Navigators help consumers understand health insurance plan options and assist them in applying for government subsidies through the health benefit exchange. They are not affiliated with or funded by any health insurer, and their services are free of charge to the consumer. Although they are not required to be licensed, navigator individuals must complete an annual certification with the Exchange and a registration process with the Bureau of Insurance that includes updated training each year.

Virginia’s navigators have previously been funded through federal grant programs. Virginia is establishing a state-based health insurance exchange for the individual and small business markets. The Virginia Exchange will operate on the federal exchange platform – – for plan years 2021 and 2022, and is expected to transition to a full state-based exchange by plan year 2023. Beginning this fall, the Virginia Exchange will perform consumer outreach and education activities and offer consumer assistance.

“We are excited to be able to provide increased grant funding for navigators this year,” said Virginia Insurance Commissioner and Acting Exchange Director Scott White. “The navigator organizations have an excellent network designed to increase awareness about opportunities to obtain lower cost comprehensive coverage that may be available for individuals through Even if you already have coverage, make sure to review your options each open enrollment period to find the option best suited for your circumstances.” 

Navigators are available to assist Virginia residents in obtaining individual health insurance coverage during open enrollment for plan year 2021 that begins November 1, 2020, and ends on December 15, 2020. They also are available to assist residents throughout the year with post-enrollment questions and issues that arise, and special enrollment qualifications. Navigators also assist consumers throughout the year to provide information about other coverage options, such as the State Medicaid Program and FAMIS for children.

Navigators assist small employers and their employees in reviewing plan options via the SHOP marketplace. The Small Business Health Care Tax Credit is only available to employers who purchase a SHOP plan and meet other IRS requirements.

A locator tool to find free assistance from a navigator or other assister in your area can be accessed at Information and help for small employers is available at


Contact: Katha Treanor, 804-371-9141

RICHMOND – Virginians who lost their health insurance any time this year may have a new opportunity to enroll in health insurance coverage at

Millions of people nationwide have lost their employer-based health insurance due to the impact of the COVID-19 pandemic on many businesses. Normally, people who lose their insurance get a 60-day special enrollment period (SEP) to enroll in coverage on The emergency declaration by the Federal Emergency Management Agency (FEMA) enables consumers who missed their 60-day deadline to still enroll in coverage if they missed the deadline earlier this year. According to the FEMA SEP fact sheet, instead of asking whether an applicant has lost coverage within the last 60 days, the application asks whether they have lost coverage since January 1, 2020. As part of the process, applicants may need to provide proof of their loss of insurance coverage and the date that coverage ended.

The FEMA SEP has begun for the electronic application process. If someone was eligible to obtain coverage through an SEP at some point this year and failed to enroll, they may still qualify for coverage. Their coverage could begin as early as next month or even extend back to their initial date of eligibility. Additionally, enrollment during the SEP does not preclude people from receiving discounts that may be offered on their health insurance at

“Losing your job doesn’t have to mean losing your health insurance coverage,” said Virginia Insurance Commissioner Scott A. White. “Consumers impacted by COVID-19 now have another chance to enroll in quality, affordable coverage.”

The FEMA SEP is not limited to people who lost their health insurance coverage due to loss of employment. People who lost coverage any time this year – due to job loss or for other reasons – may now qualify for the FEMA SEP directly through the application process. People who experienced life changes other than job loss (for example, having a baby or moving) may also qualify, even if they missed the normal SEP deadline, if their life was affected in some way by the COVID-19 pandemic. Persons interested in obtaining coverage through the FEMA SEP should contact the call center at 800-318-2596 for more information.

In most cases, people who have not had any SEP-qualifying events since January 1, 2020, are not eligible for the FEMA SEP, but they will be able to sign up for health insurance for 2021 during the regular open enrollment period, which starts on November 1, 2020, and ends on December 15, 2020. Many people may also be eligible for Medicaid, which is open year-round, and those who need coverage may view their options at

For more information, visit or

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Contact: Katha Treanor, 804-371-9141


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