Common Questions
This section contains answers to frequently asked questions on a variety of topics. Select a topic or question below, or simply scroll down to read all of the questions and answers.
Important note: Answers to common questions are general guidelines for health plans offered by Optima Health. While most answers apply to all plans offered by Optima Health, there may be some slight differences. Please refer to your member materials or contact us for information on your specific health plan.
Enrollment
What documentation is required to begin the underwriting process?
Do you offer electronic enrollment?
Can I email enrollment files to the plan?
What is the average turnaround time required to determine a group subscriber's eligibility or underwriting status?
How do I obtain a group quote?
Products and Coverage
What products do you offer?
How are health plan members kept informed?
How do pre-existing conditions impact coverage?
What qualifies as creditable coverage?
What health and wellness programs do you offer members?
When traveling, can my employees receive coverage out of the area?
How do you accomodate members located outside of Hampton Roads?
I have an employee out on disability. How long am I required to keep him on the group health insurance policy?
Contact Information
Who are the appropriate contacts for large and small, peninsula and southside business?
Release of Information
What is a Release of Information and why is it required? 
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Enrollment
What documentation is required to begin the underwriting process?
The following is required for small groups:
· Employer group application
· Complete employee application for every employee who is applying for coverage
· Waivers for eligible employees who are not electing coverage
· Virginia Employment Commission (VEC), declaration letter or other required eligibility documentation
· Proof of prior coverage
Do you offer electronic enrollment?
No, not at this time.
Can I email enrollment files to the plan?
No. For security and privacy reasons we ask that all enrollment documents be sent directly to Optima Health by US mail or by fax.
What is the average turnaround time required to determine a group or subscriber’s eligibility or underwriting status?
Allow five business days for small group underwriting.
How do I obtain a group quote?
Simply Request a Quote.
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Products and Coverage
What products do you offer?
Optima Health provides a full range of network-based healthcare coverage products for large and small groups - including Optima Select HMO, Optima Advantage Point-of-Service, Optima Premier PPO and Optima Direct Open Access plans.
· Plans for Large Groups
We define large groups as employer groups with 100 or more eligible employees. Our standard HMO, POS and PPO plan designs and funding arrangements may be offered, or they may be customized depending on the size, needs and resources of the group.
· Plans for Small Businesses
Small businesses are defined as companies with two to 99 eligible employees. Plans are available with a range of coverage levels, deductibles and copays.
*Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, and Optima Health Group, Inc. Optima HMO products, related Patient Optional Point-of-Service products, Point-of-Service products, and Open Access products are underwritten by Optima Health Plan. Optima Preferred Provider Organization products are underwritten by Optima Health Insurance Company. Self-funded plans are administered by Sentara Health Plans, Inc.
How are health plan members kept informed?
All plan members receive:
· Member ID Cards mailed to the home address on record.
· Benefit Information Guides, usually distributed by the employer prior to enrollment.
· Coverage documents mailed to the home address on record.
In addition, members may receive:
· Benefit News member newsletter
· Healthy Edge newsletter
· Benefit Information Guides
· Direct mail
How do pre-existing conditions impact coverage?
Coverage for pre-existing conditions is usually provided after a waiting period has been satisfied. Health plans typically reduce the waiting period if the covered member(s) can prove creditable coverage. A Certificate of Creditable Coverage is the document indicating that the member(s) were previously covered under another health plan and had no more than a 63-day break in coverage. Pregnancy is not considered a pre-existing condition.
What qualifies as creditable coverage?
Most group health insurance (including government or church plan), individual health insurance, Medicare, Medicaid, military-sponsored healthcare (TRICARE), a program of Indian Health Service, a state health benefits risk pool, the Federal Employee Health Benefits Program (FEHBP), a public health plan as defined in the federal HIPAA regulations, and any health benefits plan under section 5(e) of the Peace Corps Act.
What health and wellness programs do you offer members?
Health and wellness programs include Eating for Life, Healthy Heart and Smoking Cessation. In addition, we offer condition and disease management programs. Online programs, such as the Healthcare Advisor, EAP online and a health information library are available to our members. Contact your account representative for more information on our many offerings.
When traveling, can my employees receive coverage out of the area?
Certain Optima Health products give members the option of receiving covered services out of the area through a national carrier. Also, Optima Health provides coverage for emergency care out of the area. Contact your insurance broker or Optima Health account representative for more information.
How do you accommodate members located outside of Hampton Roads?
In most cases these employees can be covered through Optima Health’s out-of-area PPO. In the case of minors, our out-of-area dependent rider is available. Contact your insurance broker or Optima Health account representative for more information.
I have an employee out on disability. How long am I required to keep him on the group health insurance policy?
A full-time, active employee who has not worked for a time period due to illness or injury (disability) may continue to be covered under the group’s health plan for up to six months.
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Contact Information
Who are the appropriate contacts for large & small, peninsula and southside business?
Contact Us.
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Release of Information
What is a Release of Information and why is it required?
Federal and state privacy laws require us to have on file a Release of Information/Authorization of Designated Agent form whenever anyone other than the member needs to obtain and/or change the member’s health information. This form must be signed, witnessed and returned in order for it to be in effect.
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