Broker Information

Resources for Brokers

Optima Health is working hard to respond to the impacts of COVID-19 on your business. We are committed to providing you with important updates, while ensuring that your clients/employees get the care they need during this unprecedented time.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act

The Coronavirus Aid, Relief, and Economic Security (CARES) Act allocated $350 billion to help small businesses keep workers employed amid the pandemic and economic downturn. Known as the Paycheck Protection Program, the initiative provides 100% federally guaranteed loans to small businesses. Learn more about how these programs can assist you at the links below.

As part of the CARES application, employers must provide copies of invoices showing paid health insurance premiums. Optima Health employer groups with access to our secure Employer Portal can view and download current and historical billing statements.

Employers who do not currently have access should complete and submit our Confidentiality Agreement and Portal User Profile Form to request an account. Be sure to check the box at the top of the form to “View Billing Statements.”

Once the account has been established, employers can sign in and select Billing Statements on the left-hand navigation pane under “Payments and Billing” to view their statements.

Note: Optima Health is providing this to brokers and employers for informational purposes only. The information posted on our website is not intended to provide compliance, tax, or legal advice, or to be relied upon for these purposes. Brokers and employers should be advised to consult with legal and tax experts to understand how the Act will affect their individual or business circumstances.

COBRA Relief and Guidance Deadlines Extended

The U.S. Department of Labor (DOL) and IRS have extended election timeframes for special enrollment periods and the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) plans. This includes an extension for plan participants to elect to receive coverage under COBRA and the timeframe participants have to file claims or submit appeals. Until the end of the COVID-19 national emergency, the typical deadlines and timeframes will be disregarded for the following:

  • The 30-day period to request special enrollment for loss of coverage, or adding a new dependent
  • The date for employers to provide COBRA election notices
  • The 60-day election period for COBRA
  • The Premium due date, usually 45 days after election, for COBRA
  • Timely filing dates for claims for covered services under group health plans
  • The date within which claimants may file and complete internal and external appeals

For more information, please visit the U.S. Department of Labor website.

IRS Guidelines

According to new IRS guidelines, during the period between January 1, 2020 and December 31, 2020, an employer offering fully insured or self-funded health plan coverage may amend one or more of its cafeteria health plans to allow employees to do the following on a prospective basis:

  • Choose to make a new election for employer-sponsored health coverage if they initially declined
  • Revoke an existing election and make a new election to enroll in different health coverage sponsored by the same employer (e.g., switching from a PPO to an HMO plan)
  • Completely revoke an existing election for employer-sponsored health coverage and attest in writing that they are enrolled, or will immediately enroll in other health coverage
  • Revoke an election, make a new election, or decrease or increase an existing election regarding a health flexible spending account (FSA)

There is also increased flexibility with FSA grace periods for plan years ending in 2020 to apply unused FSA money to medical care expenses incurred through December 31, 2020.

High Deductible Health Plan (HDHP) COVID-19 Testing and Treatment

Recent federal guidance provides a temporary safe harbor for HDHPs to cover COVID-19 treatment, testing and related expenses, and telehealth services prior to a plan deductible or with a reduced deductible without disqualifying the member from making Health Savings Account (HSA) contributions. This safe harbor applies to reimbursements of expenses incurred on or after January 1, 2020.

Employers should check with their legal resources or tax consultants for complete details. You can also view the detailed notice from the IRS.

Optima Health Broker Webinar - April, 2020

We recently held a broker webinar about Optima Health and COVID-19. You can watch a replay of it now.

View the Video

News


2020 Affordable Care Act Taxes and Fees

Recent legislative changes have affected the ACA-mandated taxes and fees for 2020.

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COVID-19 Extended Coverage

In order to help remove barriers to care and provide safe options for our members during the COVID-19 crisis, Optima Health committed to expanded coverage. All out-of-pocket member costs associated with COVID-19 diagnostic testing will be covered through the duration of the pandemic.

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