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

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.

Important Changes Regarding Valley Health

Our members’ healthcare is important to us and one of our goals is to keep you informed about changes that could affect them.

Reminder on Action Required: Balance Billing Protection

As a courtesy to our self-funded groups, we will be sending reminders to our business partners that beginning January 1, 2021, many Virginians covered under health insurance plans will have protection from “surprise billing” or balance billing.

Optima Health Named One of the Best-Performing Health Plans in Virginia

Optima Health Plan earned four out of five stars and “accredited” status from the National Committee for Quality Assurance (NCQA)’s annual review.

2022 Plan Updates

Optima Health is partnering with FocusCare to offer members in-home assessments and preventive screenings at no cost, for Medicare, Medicaid, and ACA Individual and Small Group members. We formerly offered this program through another vendor, Matrix.