2018 ACA Deductible/MOOP Credit

How many times have you thought, "This is crazy, almost all my small group business is on a December 1 cycle, which is also right in the middle of the busiest time of the year for all my OTHER business. I am working night and day (my staff too) just to keep up. How can I move some of this business to another time of the year so I can lighten my work load in November and December?"

Optima Health is here to help. Much like the promotion we ran last year, for 2018 any of your ACA qualified non-Optima Health December small groups may move to Optima Health with a new effective date—all with minimal impact to the members. If the group chooses, the new plan(s) may have a Calendar Year accumulation period. Optima Health can provide each group plan's members credit for deductible and maximum out-of-pocket (MOOP) already accumulated in 2018, assuming the proper documentation is submitted in time*.

For example: In 2014, Tom's Toys moved its health plan to a December 1 effective date. Tom, the owner, needs to change the plan back to its original effective date of April 1. Tom's Toys enrolls in an Optima Health plan with an April 1, 2018 effective date. The group provides Optima Health with the deductible and MOOP* amounts each member accumulated on its prior carrier's plan(s) in 2018, within 30 days following the effective date. Optima Health will credit those members their deductible and MOOP accumulations from January through the end of March. Tom's Toys will begin its new Optima Health calendar-year accumulator plan(s) on April 1, 2018. Plan renewal will be on April 1 every subsequent year.

At Optima Health we want to be Easy To Do Business With. We also want our brokers to have the flexibility they need to make the most of their portfolio.

Please contact your Optima Health representative if you have any questions.

*The Optima Health deductible and MOOP credit spreadsheet must be submitted with supporting documentation, including individual EOBs or prior carrier's deductible and MOOP report(s).