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

COVID-19 100% Coverage Ending June 30

Thank you for choosing Optima Health. As you know, in an effort to support our clients and members, Optima Health began providing 100% coverage for many services related to the COVID-19 pandemic. We previously announced that we would extend coverage through May 31, 2021 for select services and have decided to extend coverage through June 30, 2021.

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.

Win with the Optima Health Mobile App

We love how easy it is to use the helpful features on our mobile app—and we know our members will enjoy the convenience of access to their member ID card, virtual consults, and more—right from their phone.

1095 Documents for 2021 Tax Year

For the 2021 tax year, Optima Health will mail 1095-B tax form to all individuals covered by our fully insured health plans, including employer-sponsored and Individual & Family Plans sold off the Health Insurance Marketplace.

2022 ACA PCORI Fees

For 2022, the Patient-Centered Outcomes Research Institute (PCORI) fee is $2.79 per covered member per year. The fee has been extended through 2029.

Open Enrollment Resources and Rewards

Open Enrollment is underway, and we have the resources available to better serve you and your employer groups.

Balance Billing Protection in 2022

In January 2021, a Virginia balance billing law was passed to protect fully insured health plan members from receiving an unexpected balance bill from an out-of-network provider for emergency services and for some non-emergency services administered by out-of-network providers at in-network facilities. Elective (self-funded) group health plans were also eligible to opt-in to this Virginia balance billing law.

New Broker Rewards Program Incentive for 2022

For 2022, we’re making it simple to earn Rewards points1 in our Small, Mid-Market and BusinessEDGE® markets.