New Product Overview

As part of our easy to do business with philosophy, we regularly evaluate our product offerings to ensure we offer innovative and comprehensive plan designs at a competitive price point.

This year, we are pleased to include the following additions to our portfolio:

Available for groups effective December 1, 2018:

BusinessEDGE® elite is a new level-funded option exclusively for Small Groups with 10–50 total employees and a minimum of 10 enrolled. These unique plans have the same deductibles and max out-of-pocket amounts as 12-month plans, but they accumulate over an 18-month period. Members can save money on their out-of-pocket healthcare expenses, and employers enjoy the convenience of a locked-in rate for 18 months.

Available for new and renewing groups effective January 1, 2019:

OptimaDirect® plans offer the full Optima Health network of over 26,000 providers, in a two-tiered in-network structure. Members save money when they utilize services from a Tier 1 doctor or facility. OptimaDirect is the core product offering for Small Group (1-50 total employees), and is an option for groups with 51 or more total employees.

OptimaSelect® plans provide a low-cost health insurance solution for businesses and individuals who get services from a regionalized group of providers. The network includes Sentara and SQCN doctors and facilities statewide, as well as other key clinically integrated networks. OptimaSelect is offered as an option for all employer groups in the Charlottesville area.

OptimaFit® Direct and OptimaFit Select plans are available for Individual & Family Plan members. OptimaFit Direct is the core product offering and OptimaFit Select is an option for members in the Charlottesville and Rockingham areas.

The Out-of-Area Dependent Program is being offered as a core benefit on all Mid-Market, Large Group, BusinessEDGE, and BusinessEDGE elite HMO and POS plans. Dependent children who live outside of the Optima Health service area can visit PHCS/Multiplan physicians and pay their plan’s in-network deductibles, coinsurance, and copayment amounts as applicable.

Pharmacy Updates

  • Equity HSA plans and Design HRA plans have additional pharmacy options, including coinsurance-only cost-share amounts on all tiers. These options are available for Mid-Market and Large Groups.
  • A Standard (closed) Formulary is now available as an option for Mid-Market Groups (51 or more total and 150 or fewer eligible employees). It is currently an option for Large Groups.

BusinessEDGE Equity HSA plans have a pharmacy option that includes the preventive drug benefit before the medical deductible is met (already an option on fully insured Equity HSA plans for Mid-Market and Large Groups).