Frequently Asked Questions

For groups enrolling 25 or more subscribers the following is needed:

• Employer Group Health Questionnaire (EGHP)
• current plans / benefits
• census split if they have more than one plan
• current and renewing rates

For groups enrolling 2-24 subscribers the following is needed:

• all four pages of Optima Health’s application and health questionnaire (or Universal app) for each enrolling subscriber

Yes. Enrollment documents can be sent directly to Optima Health by US mail, fax, or secure email.

Please allow five business days for small group underwriting.

Simply Request a Quote.

Optima Health provides a full range of healthcare coverage products for large and small groups.

• Plans for Large Groups: We define large groups as employer groups with 151 or more eligible employees. Our standard plan designs and funding arrangements may be offered, or they may be customized depending on the size, needs and resources of the group.
• Plans for Mid-Market Groups: We define mid-market groups as employer groups with 51 to 150 eligible employees. Our standard plans are available with a range of coverage levels, deductibles and copayments.
• Plans for Small Businesses: Small businesses are defined as companies with two to 50 eligible employees. Our standard plans are available with a range of coverage levels, deductibles and copayments.

*Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, and Optima Health Group, Inc. Optima HMO products, related Patient Optional Point-of-Service products, Point-of-Service products, and Open Access products are underwritten by Optima Health Plan. Optima Preferred Provider Organization products are underwritten by Optima Health Insurance Company. Self-funded plans are administered by Sentara Health Plans, Inc.

All plan members receive:

• member ID cards mailed to the home address on record
• benefit information guides, usually distributed by the employer prior to enrollment
• coverage documents that are available online and may be mailed to the member’s home at the member’s request

In addition, members may receive:

• member newsletter
• other direct mail
• Explanation of Benefits (EOB) when care is received

A pre-existing condition is any medical condition, other than pregnancy, for which medical advice, diagnosis, care, or treatment was recommended or received within a six-month period ending on the enrollment date.

If your plan has a pre-existing condition exclusion or waiting period, you will not be covered for those specific pre-existing conditions for a period of 12 months. You may receive credit to reduce or eliminate the pre-existing condition waiting period for any creditable coverage if you were continuously covered under another health plan with no more than a 63-day break in coverage. Please refer to the Notice of Pre-Existing Condition Exclusion included with your plan documents, if applicable.

A certificate of creditable coverage is intended to help you and your dependents in case you lose or change health plan coverage.

Under a federal law known as the Health Insurance Portability and Accountability Act (HIPAA), you or your dependents may need evidence of coverage to reduce a pre-existing condition exclusion period under another plan, to help get special enrollment in another plan, or to get certain types of individual health coverage.

When you change healthcare coverage, or if you or your dependents lose coverage under a health plan, the plan sponsor is usually required to provide written certification of how long you and your dependents were covered under that plan. You or your dependents can also request a certificate of creditable coverage if one is not automatically provided to you. When you enroll in an Optima Health plan we ask that you include a copy of certificates of creditable coverage for you and your dependents so that we may ensure you receive credit for your prior coverage against any pre-existing condition exclusion periods under your Optima Health plan.

Please call member services if you have any questions about obtaining a certificate of creditable coverage. Most group health insurance (including government or church plan), individual health insurance, Medicare, Medicaid, military-sponsored healthcare (TRICARE), a program of Indian Health Service, a state health benefits risk pool, the Federal Employee Health Benefits Program (FEHBP), a public health plan as defined in the federal HIPAA regulations, and any health benefits plan under section 5(e) of the Peace Corps Act.

These health improvement programs provide information and lifestyle tips to reduce cardiovascular health risks and promote health.

• Healthy Habits Healthy You
• Eating for Life
• Tobacco Cessation
• MoveAbout Program
• Yoga and Meditation
• Health and Wellness webinar videos

To take your Personal Health Assessment and for more information about all of our health and wellness programs, visit Health and Wellness.