Coverage and Plan Updates

We’d like you to know about a few important changes we’ve made to some of the health insurance plans we offer. 

Cost Sharing

Effective March 12, 2020, and until further notice, cost-sharing for all FAMIS covered services and drugs will be waived. This means FAMIS members do not have to pay anything to receive covered care or medications.

State Fair Hearing and Appeal Processes

During the Virginia State of Emergency, there will be several changes to Medicaid’s State Fair Hearing and Virginia Premier appeals processes, offering members more flexibility.

Virginia Premier Medicaid

Appeals will be processed as long as the Medicaid member or applicant gives appropriate verbal authorization of legal representation even if the paperwork for the appointment of representation is incomplete.

If the plan receives no verbal or written authorization for representation, the appeal will move forward with communications limited to the Medicaid member or applicant.

Virginia State Medicaid

All State Fair Hearings with the Department of Medical Assistance Services (DMAS) will be conducted by telephone. DMAS will also grant requests to reschedule hearings.

Appeals may be submitted to DMAS via e-mail at Appeals@DMAS.Virginia.Gov. Additionally, State Fair Hearing decisions may not be issued within the normal timeframe, depending on the length of the emergency.

Virginia Premier Medicare

There will be no time limits for filing an appeal during the Virginia State of Emergency. Similarly, if an appeal is missing information, we will continue to process it as a complete appeal and there will be no time limit for you to provide the missing information to us. However, if the request includes an incomplete Appointment of Representative form, then we will only be able to communicate information about the appeal with the member. Learn more about Virginia Premier’s appeals process for Medicare members.

Virginia Premier Medicaid Members Receiving Consumer-directed Services and their Attendants

Virginia Premier Medicaid members receiving consumer-directed services and their attendants are now eligible to receive the COVID-19 vaccine. This includes the following types of care:

  • Personal care
  • Respite services
  • Companion services

Visit the Virginia Department of Health’s website to pre-register for the vaccine. You can also call the vaccine hotline at 877-829-4682 if you prefer to speak with someone by phone.

Fairfax County is using its own registration site. If you live in Fairfax County, you can use the county’s website to pre-register for a vaccine.

We want you to be prepared for the vaccine. Here are some frequently asked questions:

  • Will it work? There are three vaccines available now. They are all highly effective at preventing serious illness and hospital admissions from COVID-19.
  • How do I get a vaccine? Once you pre-register, you will receive updates when you are able to schedule an appointment to receive a vaccine.
  • What does it cost? There is no cost for anyone to receive a vaccine.
  • What should I expect when I get a vaccine? Depending on the type of vaccine you receive, you will need one or two doses to ensure you are protected from COVID-19. You do not need to bring a government-issued ID and cannot be turned away for not having ID. However, you should bring some form of ID if possible, to make sure the right person receives the vaccine.