For up-to-date information related to COVID-19 coverage, please view our COVID-19 site.  Looking for a previous newsletter? Contact

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.

Medical Loss Ratio Rebates Fall Update

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.

FDA Approves First COVID-19 Vaccine for Individuals 16 and Older

On August 23, the U.S. Food and Drug Administration (FDA) announced the Pfizer-BioNTech (now known as Comirnaty) vaccine has received full FDA approval for the prevention of COVID-19 in people 16 and older by meeting the FDA’s standards for safety, effectiveness, and manufacturing quality.

New Business Quoting and Enrollment

In our constant pursuit to improve the customer experience, Optima Health is excited to announce a new eBroker experience coming this Fall.

MLR Rebate Update: Member Rosters Now Available

Based on our preliminary assessment, we anticipate that all Optima Health regulatory large group clients—fully insured groups with 51 or more total employees—who paid premiums in 2020 will receive a premium rebate check from us. We are continuing to work toward the September 30 deadline to issue the rebate checks to these groups and will send a final communication update closer to this deadline.

Sales and Rewards Opportunities

You can earn Broker Rewards points1 when you renew your Optima Health groups.

Two Weeks Left to Earn up to 500 Points

You have until June 30 to sell new Small Group contracts and be in the running to earn Top Performer Rewards points!

Reminder on Action Required for Balance Billing Protection

As a courtesy to our self-funded groups, we have been sending reminders to our business partners that beginning January 1, 2021, many Virginians covered under health insurance plans have protection from “surprise billing” or balance billing.

COVID-19 100% Coverage Ending June 30

Thank you for choosing Optima Health. As you know, in an effort to support our clients and members, Optima Health began providing 100% coverage for many services related to the COVID-19 pandemic. We previously announced that we would extend coverage through May 31, 2021 for select services and have decided to extend coverage through June 30, 2021.

Marketing Campaign to Support BusinessEDGE® Plans

Beginning in June, we are launching a strategic marketing campaign to increase awareness of our BusinessEDGE® product offerings.