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.

Optima Health has contracted with CareCentrix to manage post-acute care (PAC) services for all commercial members, including all group sizes and Individual Product, effective October 1, 2021. CareCentrix will manage authorization requests for members admitted to skilled nursing or inpatient rehabilitation facilities, support care coordination, and provide nurse coaching for members after an acute care hospital or PAC facility discharge. SQCN members and those with certain diagnoses are excluded from this program.

Commercial Group Updates

Benefit Change Sheets and Small Group and BusinessEDGE® Plan Guides are available. We will add Large Group once we receive the Virginia Bureau of Insurance approval for our 2022 Large Group plans. In addition, we created an online order form to easily request printed copies.

Optima Health sunsetted the BusinessEDGE eliteTM plans, as of June 1, 2021. Any group currently enrolled in a BusinessEDGE elite plan will remain until the end of their contract date.

Optima Health is sunsetting its OptimaSelect® plans in Charlottesville, as of December 31, 2021. Any group currently enrolled in an OptimaSelect plan will remain until the end of their contract date. Groups will be automatically renewed into a similar OptimaDirect® plan.

The annual ACA Small Group Special Enrollment Period for both new and renewing business with a January 1, 2022 effective date runs from November 15, 2021–December 15, 2021. During this time, any groups can enroll or renew with no employee minimum participation requirement, provided the completed enrollment is submitted to Optima Health during the Special Enrollment Period. Remember, Optima Health never holds ACA small groups to a minimum employer contribution responsibility.

Effective January 1, 2022, the Broker Rewards Program will award 25 points per subscriber for new business, and five points per subscriber for retention business in the Small, Mid-Market, and BusinessEDGE markets.

Individual Product Updates

The 2022 Individual & Family Plan Guide will be available once we receive QHP sign off on our 2022 OptimaFit® plans.

CMS extended the annual Open Enrollment Period for Individual & Family plans for 2022. This year, the enrollment period, both on and off the Exchange, runs from November 1, 2021 through January 15, 2022. Member effective dates depend on when they enroll:

  • enroll/active and passive renewal: November 1–December 15;
  • effective date is January 1, 2022 • enroll/active renewal: December 16–January 15; effective date is February 1, 2022

CMS is offering Marketplace Pre-Enrollment Webinars to QHP agents and brokers. View the CMS webinar dates and topics.

Optima Health is offering Enhanced Direct Enrollment. Both On- and Off-Exchange new and renewing individuals can easily apply for coverage, update their income and contact information, and change their coverage from optimahealth.com.

Optima Health is sunsetting its OptimaFit Select plans in Charlottesville and Rockingham, as of December 31, 2021. OptimaFit Direct and Catastrophic plans are offered throughout the Individual & Family service area. Members will be automatically renewed into a similar OptimaFit Direct plan, effective January 1, 2022.

Optima Health will not offer Adult Preventive Vision with its Individual & Family Plans, effective January 1, 2022. Pediatric Vision, an essential health benefit under the ACA, will continue to be covered.

Starting November 1, 2021, Optima Health is offering brokers a cash bonus of $200 for each new member and $100 for each renewing member for Individual & Family Plans. No maximum family size or minimum membership is required.