Action Required: Balance Billing Protection

Attention Brokers — As a courtesy to our self-funded groups we would like to remind you that beginning January 1, 2021 many Virginians covered under health insurance plans will have protection from "surprise billing" or balance billing.

If an Elective (self-funded) Group Health Plan would like to offer this protection to their employees, they must opt-in to this balance billing law at least 30 days prior to their effective date. The effective date must be either January 1 or the first day of your plan year. For January 1, 2021 groups or any group that would like the balance billing protection to become effective January 1, 2021, the deadline for submission is December 2, 2020.

For more information, please see the explanation of effective dates and deadlines on the SCC website under Elective Group Health Plans. To opt-in to the balance billing law, the group must complete and submit the Elective Group Health Plan Opt-In form located on the SCC website. The following steps will help the group navigate the site and fill out the form. If they have any questions about how to fill out the form or about their health plan benefits they should contact their Optima Health representative directly:

  1. Click the top right button that says "Add Elective Group Health Plan."
  2. Complete each field of the application with information about your health plan.
  3. In the "Opt-In Effective Duration" section, you may select "Auto Renewal" for this process to renew annually or "One Year" if you’d prefer to complete the form each year.
  4. In the "Third Party Administrator Information and Contact" sections, enter Noel Wharton, 4417 Corporation Lane Virginia Beach VA 23462, 757-552-8910, balancebilling@sentara.com.
  5. Complete the Attestation and Submit.
  6. Email healthplans@sentara.com to notify the Optima Health team of their opt-in status.

The group can track the status of their election on the Elective Group Health Plan Search Page. Please note the following status designations that currently appear on the SCC website:

  1. When a form is received, it is placed in a ‘Submitted’ status.
  2. Once a form is approved by the BOI it is placed in a ‘Pending’ status until the group’s effective date.
  3. On their effective date, plans will be placed in an ‘Active’ status.
  4. For plans that provide a Termination Date, the plan is placed in ‘Expired’ status when that date is reached.

If the group would like to change opt-in information, terminate from the opt-in, or make a change to previously submitted information they must complete and submit the Elective Group Opt-In Change Termination form.

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