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

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.

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.

Employer News 3rd Quarter August 2021

A quarterly newsletter about your health plan benefits.

Balance Billing Protection

Effective January 1, 2021, all fully insured groups and self-insured groups who opt-in are protected from balance billing or “surprise 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. The effective date for participation can be January 1 of any year or the first day of the group health plan’s plan year.

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

MLR Rebate Update: Member Rosters Now Available

Based on our preliminary assessment, we anticipate that as an Optima Health regulatory large group client who paid premiums in 2020, you will receive a premium rebate check from us. We are continuing to work toward the September 30 deadline to issue your rebate check and will send a final communication update closer to this deadline.

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.

Employer News 2nd Quarter May 2021

A quarterly newsletter about your health plan benefits.

State Continuation Under the American Rescue Plan Act

The American Rescue Plan Act (ARP) provides for full premium subsidy for COBRA and for State continuation of coverage programs for periods of coverage between April 1, 2021 and September 30, 2021 for Assistance Eligible Individuals.

COVID-19 Coverage Extension May 31

Thank you for choosing Optima Health. We hope you are enjoying the start of the spring season. It has now been a year since the pandemic began in the United States and we want to continue putting our members first. We previously announced that we would extend COVID-19 coverage for Optima Health members through April 30. We are now extending COVID-19 coverage through May 31, 20211 for the following:

2021 Affordable Care Act Taxes and Fees

Recent legislative changes have affected the ACA-mandated taxes and fees for 2021.

Good News Regarding Patient First

We are happy to announce that we have reached an agreement with Patient First. We recently told you that we are negotiating with Patient First to keep their centers in our network for our Commercial, Individual, and Medicaid members. Our goal in these negotiations has been to keep healthcare costs for our members low while being fair to providers.

1095 Documents for 2020 Tax Year

For the 2020 tax year, Optima Health mailed 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.

Employer News 1st Quarter February 2021

A quarterly newsletter about your health plan benefits.

COVID-19 Vaccine Availability at Pharmacies

As you know, vaccine distributions are well underway in Virginia. In addition to the current locations, multiple pharmacies will also soon receive vaccines to distribute.

COVID-19 Vaccine Availability

Now that the COVID-19 vaccine has been approved, we plan to continue updating Optima Health members about how and when they can receive one.

Coverage of the COVID-19 Vaccine

As we previously shared with you, the Food and Drug Administration (FDA) has approved COVID-19 vaccines from Pfizer Inc./BioNTech and Moderna.

COVID-19 Vaccine: What You Need to Know

As you may be aware, the Food and Drug Administration (FDA) has approved a COVID-19 vaccine for individuals 16 years of age and older from Pfizer Inc./BioNTech and plans to approve a vaccine from Moderna for individuals 18 years of age and older soon. 

We're Thankful for You

Optima Health understands that this year’s holiday season will be different due to the pandemic. COVID-19 has put a strain on families and forced us to practice social distancing with loved ones. While the safest way to celebrate is only with those in your household, we understand that many will continue with their normal holiday plans of visiting family and friends.

Employer News 4th Quarter November 2020

A quarterly newsletter about your health plan benefits.