What's New for 2023
A summary of the latest updates for Optima Health Brokers for 2023.
Our pharmacy benefit manager (PBM) is changing from OptumRx® to Express Scripts (ESI) and our vision services vendor from Eyemed to VSP Vision Care (VSP) for all lines of business, effective January 1, 2023, regardless of the group’s effective date.
Inova® Health System is now in-network for commercial group and individual & family plan members. The addition of this Northern Virginia-area provider network enables Optima Health to provide statewide in-network coverage.
Ovia Health offers maternity and family benefits to support women in their reproductive health, pregnancy, and parenthood journeys. The app-based programs provide unlimited support from health coaches, clinical health pathways and wellness programs, personalized health insights, early identification of high-risk triggers, and critical alerts and real-time intervention. Members can download the Ovia Fertility, Ovia Pregnancy, and Ovia Parenting apps from the App Store or Google Play.
Sales Area Expansion
Commercial group and Individual & Family Plans are now available in Northern Virginia. Enrollment is open now for a plan effective date on or after January 1, 2023.
Individual & Family Plans are now available statewide for January 1, 2023 plan effective dates, with the exception of Frederick County, Winchester City, Giles County, Montgomery County, Pulaski County, and Radford City.
Commercial Group Updates
The annual ACA Small Group Special Enrollment Period for both new and renewing business with a January 1, 2023 effective date runs from November 15, 2022–December 15, 2022. During this time, any ACA group 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 requirement.
In addition to the cash bonus programs, 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. Earn up to 25,000 points per group for the fully insured Large Group new business sales.
Individual Product Updates
The annual Open Enrollment Period for Individual & Family plans for 2023, both on and off the Exchange, runs from November 1, 2022 through January 15, 2023. Member effective dates depend on when they enroll:
- enroll/active and passive renewal: November 1–December 15; effective date is January 1, 2023
- enroll/active renewal: December 16–January 15; effective date is February 1, 2023
Optima Health offers 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® Catastrophic Plans, as of December 31, 2022. OptimaFit Direct and our new Standard plans are offered throughout the Individual & Family service area. Members will be automatically renewed into a similar OptimaFit Direct plan, effective January 1, 2023.
In addition to doubling the commission for Individual & Family Plan new sales and renewals, Optima Health is offering brokers a cash bonus of $200 for each new member and $100 for each renewing member. No maximum family size or minimum membership is required. The member must still be enrolled at the start of the next quarter. The bonus will be paid out at the end of first quarter.
CAA Gag Clause Prohibition Compliance Attestation
We're Moving and Other Important Updates
Resources to Help You Prepare for Virginia's Insurance Marketplace
2023 Individual & Family Plan Commissions and a New Bonus Opportunity