​2019 Second Quarter Updates

We want to keep our valued broker partners up to date on changes that may affect your clients.

The following updates apply to employer group plans:

  • Effective April 1, 2019 for new and renewing groups: HealthEquity®, our integrated partner for our Equity Health Savings Account plans, has also become the administrator for our Design Health Reimbursement Account (HRA) plans. Customer transitions are being closely coordinated with each broker/consultant beginning with April 1, 2019 anniversaries. All future implementations will receive this new integrated experience.
  • Effective April 3, 2019 for all fully insured employer groups and Individual & Family Plan members: if a request for pre-authorization or a benefits claim is denied for services related to cancer treatment, a member, or a provider on the member’s behalf, may file a request for an external appeal. Members will not have to use the Optima Health internal appeal process first and may submit requests for external appeals to the Virginia State Corporation Commission’s Bureau of Insurance. All denial letters will include specific instructions on how to request an external appeal. Subscribers on fully insured group and individual product plans will receive a notice in the mail within the next 15 days.
  • Effective July 1, 2019 for new and renewing groups: monitoring of clinical patient information (such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other condition-specific data; medication adherence monitoring; and interactive video conferencing) are covered by the Optima Health telemedicine services benefit, if services are available through the provider.

In addition, qualified subscribers and their covered spouses enrolled in an OptimaFit® Individual & Family Plan have until September 30, 2019 to enroll in the Health Management Incentive Program and earn up to $400 each.

If you have any questions, please contact your Optima Health representative.