Please Watch the Enrollment Video First
Hi my name is Lisa Boswell I'm a senior client executive with Optima health and lead Account Manager for the Norfolk Airport Authority medical plan we know we are in unusual times and we would normally be there in person to take you through this presentation today you'll be listening to Gwen Arnold who will take you through a short presentation that will give you an overview of your 2020 medical plan options and key features when as your senior client specialist who works with your account year-round we have many resources to make you to make sure you have everything you need for open enrollment in addition to today's video we will post frequently asked questions and other planned documents and provide information on how you may reach Member Services by phone and by email we are excited to continue to be your medical plan carrier for the upcoming plan year and we thank you for choosing Optima health hi I'm Quinn Arnold the senior client specialist with optima health as Lisa mentioned these are unusual times and we truly wish we could be there in person to conduct these sessions however we've worked extra hard to bring you a great virtual open enrollment experience like many we're using new tools and technology to make this happen we hope you'll take a moment to view the brief video which goes over your upcoming plan options as well as the upcoming plan changes if you have any questions once you've viewed the video please refer to the frequently asked questions document or feel free to contact our Member Services we look forward to a time when we can be there in person and we thank you for choosing Optima health once you enter the passcode you'll be prompted to watch a 15 minute open enrollment video if someone still has questions they can check out the FAQ s contact member services or your human resources team will structure the presentation today to let you learn a little bit more about Optima health learn about our large network of doctors and hospitals learn about your plan choices and the great extras included and finally we'll go over what you can expect next and where to find more information if you need it there are no pre-existing condition exclusions on any of your optima plans we have a strong local network and no referrals are required to see a specialist our After Hours nurse line is available for triage advice or to direct you to the care you may need your Employee Assistance Program is available for all employees even if you're not enrolled in our plan we will discuss the EAP program our virtual office visits the emergency travel assistance program as well as other features of our plans more in depth later in the presentation now let's go over the local part of our network here close to home we have all the major hospital systems in our network Riverside health system including the facility and Riverside physicians all of the centerra facilities and physicians in the area Children's Hospital of the Kings daughters Bon Secour and more there are over 33,000 providers in our network across the Commonwealth of Virginia and into northeastern North Carolina the Optima Health website has an online search tool where you can look up doctors and facilities your Optima health plans are open access again this means you do not need a referral to see a specialist Optima Health encourages but does not require you to select a primary care physician the Optima Health Network includes a broad network throughout Virginia in northeastern North Carolina beyond Virginia in northeastern North Carolina optima health uses a national network partner called PHCs this will be used for dependent children who reside out of area such as those away at college your plans are structured so that dependent children residing out of the area will have the in-network level of benefits when seeking care from a provider who participates with PHCs the PHCs logo will be on the back of the ID card with all of your plans any true emergency situation regardless of the network provider or your location is treated as an in-network event your plans will also include emergency travel assistance this part of your plan covers you when you are traveling more than 100 miles away from home and need assistance with any unforeseen events on your trip now that you know about the providers in the network let's go over the plans active employees have three plans to choose from you'll want to review the plan options to see what's most appealing to you the equity managed 3,000 plan does not cover services out of network unless emergent however two of the benefit plans the point of service plans include in and out of network benefits features of your plan include co-payments deductibles and coinsurance remember of co-payment is a flat predictable dollar amount you pay when you seek care and coinsurance is a percentage of the negotiated rate you pay a deductible is the amount you pay first before your plan starts to pick up coverage Optima health again encourages a PCP selection but we do not require it a PCP relationship is great for a routine checkup preventive screenings and for helping you maintain and improve your health with all the Optima health plans you do not need a referral from your PCP to see a specialist and if you choose one of the equity plan options you can pair that with the health savings account from health equity we will cover these three options briefly and we will go over some of the key features of these plans the full details of these plans are found in the summary of benefits posted on the website where you access this video please note that preventive care is covered in full for all of the options so first we'll talk about the medical benefits and in the next slide we'll cover prescription drug benefits let's review the plan options all plans have a contract your deductible with the traditional point of service 1000 plan there is $1,000 per individual and 2000 for family deductible your more frequently used services such as doctors visits are covered at flat affordable co-payments ranging from twenty five to fifty dollars depending on which service you are seeking when you use a service that is listed as a co-payment the deductible does not come into play you just pay that co-payment if you see after deductible then you must pay the deductible first before the plan coverage begins the deductible is on a contract to your basis and will reset every July 1 so now let's look at those equity plans with the health savings account option these plans are qualified plans to go with the health savings account if you choose one of these options you will first meet the contract your deductible and then the plan will cover a hundred percent of the negotiated rate for medical services you will continue to pay prescription drug co-payments until you reach your maximum out-of-pocket all plans have an annual out-of-pocket maximum think of this feature as a financial protection if all the co-payments and coinsurance you pay in a given plan year hit this amount the plan begins paying a hundred percent and you need to not pay any more so for example if you are a single person under the point of service one thousand and all of your co-payments and coinsurance amount hit forty five hundred this is the most you will pay for the plan here just like the deductible feature the out of pocket maximum resets each plan year now let's cover prescription drugs your prescription benefits include our open formulary and the formulary is divided into four tiers the point of service plan includes flat co-payments for your prescription drugs at ten thirty fifty dollars and twenty percent with a max copay of two fifty four tiers one two three and 4 respectively the mail-order or 90 days supply costs $25 $75 or one hundred and twenty five dollars note that 90-day supplies are not available for specialty medications and this is because these drugs often require special handling and more frequent monitoring by your doctor the equity plans with HSA include coverage where you pay co-payments for your prescription drugs once you've met your plan your deductible as you are working towards meeting your deductible you can pay for your drugs through your health savings account any medications that are considered preventive in nature get to bypass the deductible and are covered at a hundred percent for a listing of preventive drugs you can refer to Optima health calm and our prescription drug listing so here's some more important information to remember visit optima health.com to check which tears your drugs are in if the cost of the drug is less than the co-payment you will only pay the cost of the drug mail-order provides a convenient way to save money especially on the traditional point of service plan optima health uses Optima EX for mail order so if you see this name you'll know that it's part of your Optima health benefits if you decide to choose one of the equity plans coupled with health savings account your savings account will be administered by health equity if you already have an HSA open with a financial institution you have the option to transfer your account to health equity you may wish to consider moving your account to health equity for the best integrated experience with your health plan your 2020 employee cost share per pay period based on your plan design and your enrollment tier is as follows your plans all include health and wellness features to help you on the road to better health virtual office visits the Employee Assistance Program a treatment cost calculator my life my plan wellness programs and services gym network 360 discounts and emergency travel assistance through assist America so let's review each and further detail the plans also include virtual visits through empty live telemedicine services are covered under your plan and can be accessed through your smartphone tablet or computer board-certified doctors can diagnose minor illnesses and can write prescriptions when necessary if you are enrolled in the Optima POS 1000 plan you will pay a ten dollar co-payment if you are enrolled in one of the equity plans and you have not met your annual deductible yet the allowable charge for this service is $39 all your plans include an Employee Assistance Program for all employees regardless of whether you were enrolled in our health you or any member of your household are entitled to three free visits per presenting issue with a caring solution-focused counselor the treatment cost calculator provides the cost for over 350 of our most commonly performed procedures when you log into the tool it is providing real-time data and projects your out-of-pocket costs based on where you are within your deductible or out-of-pocket maximum Optima health includes my life my plan a suite of online resources that include a variety of educational videos materials and tools for your health and wellness support included in my life my plan are items such as an interactive digital health assistant who can emulate a life coach a personal health assessment reminders for preventive screenings a diabetes prevention program an individual self-paced program such as yoga tai chi meditation or smoking cessation included in your plan are valuable discounts for chiropractic acupuncture or massage therapy services provided through American specialty health providers vision discounts through participating IMed Vision providers and hearing aid discounts provided through epic also included in your plan are valuable discounts through our gym network 360 program through this program discounts are available on gym memberships and you can access weight-loss and healthy eating programs the emergency travel assistance program provided by assist America covers you in the event of an emergency when you are traveling farther than a hundred miles from your home it provides services such as medical consultation evaluation and referral hospital admission assistance emergency medical evacuation medical repatriation care for minor children while you were hospitalized and many more valuable services please refer to your benefit information guide for more information if you're a current member and have not already done so or if you are new to Optima health you'll want to register online at Optima health com you will be able to check all aspects of your plan you can find your benefit summaries and important documents you can print ID cards view claims and plan balances find providers and much more you can find more information and can access these valuable tools and resources on our website next you'll want to take us on the go by downloading the Optima health mobile app our mobile app is easy to use you can access your MD live virtual visit benefit view claims view your ID cards search for prescription drugs or doctors and more a great feature of health equity is the integration with all of your Optima health tools you can have your HSA information at your fingertips through your member portal and/or your mobile app through this feature you can check your balance and transactions in real time you can also pay providers directly from your HSA account Optima health would like to keep you up to date on kovat 19 related health news we've created a dedicated landing page for our members with kovat 19 resources please visit Optima health.com forward slash kovat - 19 and click on the for members tab for the latest information employee next steps if you are not making any changes you are not required to complete a new application simply sign and date the green benefit enrollment payroll deduction form provided by Norfolk Airport Authority and return it to human resources keep in mind that an out-of-area dependent form is required to be updated annually if you are making changes to your enrollment please submit a new application to reflect the changes as well as the green benefit enrollment payroll deduction form and return that to human resources now that you viewed our short presentation you might still have some questions we encourage you to check out the FAQ so we prepared or to reach out to Optima Health member service team to help you thank you for choosing Optima health you'll have plenty of resources to help you through your enrollment and decision period here at Optima health you can call us even before you're a member and we will help you understand your plan options and answer any questions you might have you can email us at members at Optima health comm if you decide to send an email please be sure to mention the name of your employer so we can help with your specific benefit information if you have any questions about who can enroll when you can enroll or how those questions can be directed to your employer.
Download our FAQs or these other helpful resources:
Still Have Questions?
Call member services at 1-877-552-7401 or TTY 711.