News

For 2025, the Patient-Centered Outcomes Research Institute (PCORI) fee is $3.47 per covered member per year. This is a $0.25 increase from 2024.

For the 2024 tax year, Sentara Health Plans 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.

The e3 Web Enrollment tool has a new update! Brokers with access to this tool can now print or order ID cards for members.

Sentara Health Plans introduces the Sentara Well-Being Rewards program, an intentionally designed opportunity for fully insured groups to optimize the health and well-being of their workforce.

Even though Open Enrollment has closed, your clients who experience Qualifying Life Events are eligible for a Special Enrollment Period and can get health coverage with us anytime throughout the year.

For the 2023 tax year, Sentara Health Plans 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.

On October 23, 2023, Piedmont announced it is withdrawing its Individual & Family health plan offerings for 2024.

Optima Health continues to review the requirements under the Consolidated Appropriations Act (CAA).

As you may have heard, Optima Health will change its branding and become Sentara Health Plans as we enter 2024. As we work toward unification with our parent company, Sentara Health, we will update you on our progress toward this goal.

Shopping and enrolling for Individual & Family Plans is going to look different for Virginians this year. Virginia's Insurance Marketplace, the new state-based health benefit exchange, is launching during Open Enrollment for the 2024 plan year. This will replace healthcare.gov for Virginia residents.

Our competitive compensation is designed to enhance broker earnings in addition to our Broker Rewards program and bonuses.

We're excited to announce that your new eBroker experience launched April 10!

Optima Health has continuously monitored the spread of COVID-19 to keep brokers, employers, and members informed of the latest developments and how these changes could affect their health plan.

We are excited to share with you that Bon Secours Health System will remain as part of the Optima Health provider network.

Optima Health is always looking for ways to celebrate local businesses and recognize your impact on our community.

For the 2022 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.

Valley Health is now in-network for all Optima Health products, including Medicare and Medicaid members and the addition of commercial and individual products. Valley Health returning to our network will enhance healthcare options for commercial and individual product members who access care in Winchester, Luray, Front Royal, Woodstock, and two locations in West Virginia including Berkeley and Romney.

A summary of the latest updates for Optima Health Brokers for 2023.

New to working with Optima Health? Need a refresher? Optima Health is excited to offer multiple Q&A opportunities to equip you to be successful. These sessions will include an overview of the Broker portal and eBroker, our employer quoting tool.

Optima Health continues to review the requirements under the Consolidated Appropriations Act (CAA). We are on track to meet these deliverables according to the required timelines with the first report due no later than December 27, 2022.

Based on our final assessment, only Individual & Family Plan subscribers who paid premiums in 2021 will receive rebate checks from us.

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.

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).

You asked for it. We answered! Optima Health brokers licensed to sell Virginia Premier memberships will soon have access to an all-new Broker Portal and Broker Resource Hub.

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.

The all-new Broker Resource Center is live on VirginiaPremier.com. This website, designed to help maximize your sales efforts, offers plan documents, a search tool to locate providers, member benefits, covered medication, and more!

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.

Open Enrollment is underway, and we have the resources available to better serve you and your employer groups.

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.