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Employer News 3rd Quarter August 2022

A quarterly newsletter about your health plan benefits.

Medical Loss Ratio Rebates for 2021 Tax Year

Based on our final assessment, we will not issue rebates for our regulatory fully insured small and large group clients for plan year 2021.

Inova is Joining Our Network

We are pleased to announce that effective September 1, 2022, Optima Health includes all Inova® Health System hospitals, facilities, physician practices, and providers as in-network for our commercial group and Individual & Family Plan members.

Exciting Vendor Changes

Optima Health continuously looks for ways to improve benefits and services and increase cost efficiencies for its employer groups and members. As a result of these efforts, we have made the strategic decision to change our pharmacy benefit manager (PBM) 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).

Employer News 2nd Quarter June 2022

A quarterly newsletter about your health plan benefits.

Machine-readable Files Available Soon

The machine-readable file (MRF) requirement under the Transparency in Coverage (TiC) rules goes into effect July 1, 2022. This part of the rule requires that insurers and self-funded group health plans must begin to publicly post machine-readable files with detailed information on the costs of covered services and prescription drugs.

Employer News 1st Quarter February 2022

A quarterly newsletter about your health plan benefits.

Win with the Optima Health Mobile App

We love how easy it is to use the helpful features on our mobile app—and we know your employees covered by an Optima Health plan will enjoy the convenience of access to their member ID card, virtual consults, and more—right from their phone.

1095 Documents for 2021 Tax Year

For the 2021 tax year, Optima Health will mail 1095-B tax form to all individuals covered by our fully insured health plans, including employer-sponsored and Individual & Family Plans sold off the Health Insurance Marketplace.

2022 ACA PCORI Fees

For 2022, the Patient-Centered Outcomes Research Institute (PCORI) fee is $2.79 per covered member per year. The fee has been extended through 2029.

Balance Billing Protection

Effective January 1, 2021, all fully insured groups and elective (self-insured) groups who chose to opt-in received protection through the balance billing law under Virginia legislation.

Balance Billing Protection Updates in 2022

In January 2021, a Virginia balance billing law was passed to protect fully insured health plan members from receiving an unexpected balance bill from an out-of-network provider for emergency services and for some non-emergency services administered by out-of-network providers at in-network facilities.

Important Changes Regarding Valley Health

Our members’ healthcare is important to us and one of our goals is to keep you informed about changes that could affect them.

Employer News 4th Quarter November 2021

A quarterly newsletter about your health plan benefits.

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.

Optima Health Named One of the Best-Performing Health Plans in Virginia

Optima Health Plan earned four out of five stars and “accredited” status from the National Committee for Quality Assurance (NCQA)’s annual review.

Optima Health Partners with CareCentrix

As a valued partner of Optima Health, we wanted to share that we have contracted with CareCentrix to manage post-acute care (PAC) services for our commercial members including all group sizes and Individual Product, effective October 1, 2021.