News

For up-to-date information related to COVID-19 coverage, please view our COVID-19 site.  Looking for a previous newsletter? Contact brokernews@optimahealth.com

New Training Opportunities and Small Group News

New to working with Optima Health? Need a refresher? Optima Health is excited to offer multiple Q&A opportunities to equip you to be successful. These sessions will include an overview of the Broker portal and eBroker, our employer quoting tool.

Consolidated Appropriations Act (CAA) RxDC Reporting

Optima Health continues to review the requirements under the Consolidated Appropriations Act (CAA). We are on track to meet these deliverables according to the required timelines with the first report due no later than December 27, 2022.

Medical Loss Ratio Rebates for 2021 Tax Year Update

Based on our final assessment, only Individual & Family Plan subscribers who paid premiums in 2021 will receive rebate checks from us.

Inova is Joining Our Network

We are pleased to announce that effective September 1, 2022, Optima Health includes all Inova® Health System hospitals, facilities, physician practices, and providers as in-network for our commercial group and Individual & Family Plan members.

Medical Loss Ratio Rebates for 2021 Tax Year

Federal law requires that we spend a certain percentage of fully insured plan premiums on medical care. If we spend less during the three-year lookback period, we refund that money back to our customers.

Exciting Vendor Changes

Optima Health continuously looks for ways to improve benefits and services and increase cost efficiencies for its employer groups and members. As a result of these efforts, we have made the strategic decision to change our pharmacy benefit manager (PBM) from OptumRx® to Express Scripts (ESI) and our vision services vendor from Eyemed to VSP Vision Care (VSP) for all lines of business, effective January 1, 2023 (regardless of the group’s effective date).

New Broker Resource Center is Live

The all-new Broker Resource Center is live on VirginiaPremier.com. This website, designed to help maximize your sales efforts, offers plan documents, a search tool to locate providers, member benefits, covered medication, and more!

New Virginia Premier Broker Portal is Coming This Summer

You asked for it. We answered! Optima Health brokers licensed to sell Virginia Premier memberships will soon have access to an all-new Broker Portal and Broker Resource Hub.

Machine-readable Files Available Soon

The machine-readable file (MRF) requirement under the Transparency in Coverage (TiC) rules goes into effect July 1, 2022. This part of the rule requires that insurers and self-funded group health plans must begin to publicly post machine-readable files with detailed information on the costs of covered services and prescription drugs.

ID Card Replacement System Maintenance

We will be performing a regular maintenance update to the system used to order replacement ID cards. The system will be temporarily down May 6 through May 20.