Medical Loss Ratio Rebates for 2021 Tax Year

Federal law requires that we spend a certain percentage of fully insured plan premiums on medical care. If we spend less during the three-year lookback period, we refund that money back to our customers.

Based on our preliminary assessment, we anticipate that all Optima Health Plan (HMO) regulatory large group clients—fully insured groups with 51 or more total employees—who paid premiums in 2021 will receive a premium rebate check from us. In addition, Individual & Family Plan subscribers who paid premiums in 2021 will receive rebate checks from us.

At this time, we do not anticipate rebates for our Optima Health Insurance Company (PPO) regulatory large groups clients or any regulatory small groups, as a larger percentage of premiums was spent on healthcare services for 2021.

We will continue to provide updates as we complete our analysis to meet the September 30 deadline to issue the rebate checks.

BusinessEDGE® Updates

On July 7, 2022 we launched a campaign to support the recent expansion of our BusinessEDGE® plans, to include 5-250 enrolled employees, with market outreach and shared resources for brokers and employers.

Please check out the BusinessEDGE Broker resource page to stay up to date on new resources, video, and FAQs.

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