2019 Second Quarter Updates

Thank you for choosing Optima Health to be the provider for your company's health insurance plan.

We understand the importance of regularly communicating updates with you and wanted to make you aware of the following:

  • Effective April 1, 2019 for new and renewing groups: HealthEquity®, our integrated partner for our Equity Health Savings Account plans, has also become the administrator for our Design Health Reimbursement Account (HRA) plans. Customer transitions are being closely coordinated with each broker/consultant beginning with April 1, 2019 anniversaries. All future implementations will receive this new integrated experience.
  • Effective April 3, 2019 for all fully insured employer groups and Individual & Family Plan members: if a request for pre-authorization or a benefits claim is denied for services related to cancer treatment, a member, or a provider on the member's behalf, may file a request for an external appeal. Members will not have to use the Optima Health internal appeal process first and may submit requests for external appeals to the Virginia State Corporation Commission's Bureau of Insurance. All denial letters will include specific instructions on how to request an external appeal. Subscribers on fully insured group and individual product plans will receive a notice in the mail within the next 15 days.
  • Effective July 1, 2019 for new and renewing groups: monitoring of clinical patient information (such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other condition-specific data; medication adherence monitoring; and interactive video conferencing) are covered by the Optima Health telemedicine services benefit, if services are available through the provider.

If you have any questions, please contact your Optima Health representative.

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