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Optima Health Employers

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Medical Loss Ratio Rebates for 2020 Tax Year

Optima Health is issuing rebate checks for our Individual & Family Plan subscribers and regulatory fully insured large groups who had coverage for at least part of 2020.

Learn About MLR Rebates
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Balance Billing Protection

Effective January 1, 2021, all fully insured groups and self-insured groups who opt-in are protected from balance billing by the new balance billing law under Virginia legislation.  Elective (level-funded or self-funded) Group Health Plans must submit the opt-in form at least 30 days in advance of the effective date of the election to participate (January 1 of any year or the first day of the group health plan's plan year).

The new law prevents certain balance billing, but does not apply to all health plans.  Please refer to the compliance notice for more information.

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Find Doctors, Drugs and Facilities

Use our online search tools to find doctors and other health care providers, care facilities, and covered prescription medications.

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Strengthening Organizations by Supporting Employees

Learn more about Optima Employee Assistance Program (EAP).

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News


Reminder on Action Required for Balance Billing Protection

As a courtesy to our self-funded groups, we would like to remind you that beginning January 1, 2021, many Virginians covered under health insurance plans have protection from “surprise billing” or balance billing.

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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.

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