Reminder: Important change in lab services network
Effective January 1, 2025, Sentara Health Plans has contracted with Quest Diagnostics® (Quest) to provide laboratory services in both our Virginia and Florida markets.
Quest is one of the world’s leading providers of diagnostic testing information services. Like Sentara Health Plans, they have a shared mission to provide access to high-quality, affordable, and equitable healthcare with an unparalleled consumer experience. Quest is a committed partner, one who can support Sentara Health Plans to deliver the best possible laboratory services to our members by providing solutions and support in advanced testing, scientific and clinical excellence, medical insights, and member satisfaction.
Quest will now be a network option for all employer group plans, Individual & Family Plans, Medicare Advantage and D-SNP (Dual Eligible Special Needs Plans) products outside of Hampton Roads, and for select self-funded groups within Hampton Roads. For our members, Quest has over 2,400 patient service centers nationwide, including nearly 50 locations within Virginia.
Sentara Reference Labs will remain in-network for all employer group plans, Individual & Family Plans, Medicare Advantage and D-SNP products statewide.
For additional details, please reference these frequently asked questions.
Also, effective January 1, 2025, LabCorp no longer provides services to Sentara Health Plans members and their patient service centers are not in-network to utilize as draw sites.
Transform health choices into tangible rewards: Sentara well-being rewards program
Thousands of members across Sentara Health Plans are transforming healthy choices into tangible rewards. Sentara Well-being Rewards is a voluntary incentive program designed to encourage participation in healthy behaviors to improve and maintain well-being. By completing healthy activities, eligible members can earn up to $250 annually. Sentara Well-being Rewards is available for subscribers in Individual & Family Health Plans in addition to subscribers in fully insured small group, mid-market, and large group* plans.
Powered by our partnership with WebMD® Health Services, the Sentara Well-being Rewards program offers a flexible and inclusive solution for employers to help their workforce join in activities that lead to better health outcomes.
If you have any questions, please refer to our Sentara Well-being Rewards frequently asked questions or contact your Sentara Health Plans representative.
*There are a few fully insured large group exceptions.
CareCentrix services have transitioned to Sentara Health Plans as of April 1, 2025
Although this transition may require members to change to a new home infusion company, these services will benefit member health outcomes by:
- Providing a more seamless process to receive services.
- Coordinating members’ care with their care manager and doctor.
- Allowing care managers and doctors to coordinate care more easily.
- Allowing all departments to make immediate updates to care plans when needed.
If members need to confirm their home infusion provider is still in network, they can search at sentarahealthplans.com/findadoc.
Health coaching automatically transitioned to Sentara Health Plans. Members didn’t need to take any action. Case managers will call members to review their current care plan and ensure healthcare needs are addressed. This change will increase the health outcomes of members by:
- Coordinating members’ care with their case manager and doctor.
- Allowing one point of contact for members’ authorization and case management needs.
- Allowing immediate updates to care plans by all departments at the health plan.
If a member needs to speak to a case manager regarding their condition before hearing from us, they can call member services at the number listed on the back of their member ID card.
Zelis payments network: Accessing commission activity
As you may know, the platform for automatic deposit commission payouts recently changed to the Zelis Payments Network. We apologize for any delays or inconvenience you may have experienced during this transition. As a reminder, your commission statement details are available in the eBroker portal. To access statement details, sign in to your eBroker account, select the Commission section in the left-hand navigation menu, and click Commission Activity.
For more detailed steps on how to access commission activity, please review the reference below:
If you have questions or concerns please email brokerinquirymailbox@sentara.com.
2024 Medical Loss Ratio Update
MLR reporting for calendar year 2024 recently concluded, and we wanted to share that Sentara Health Plans satisfied the mandate requirements and will not be required to issue a rebate to any of our employer groups or Individual & Family Health Plans members.
The Affordable Care Act (ACA) enacted a Medical Loss Ratio (MLR) mandate, which requires insurers selling policies to individuals or small groups to spend at least 80 percent of premiums on direct medical care and efforts to improve the quality of care. Insurers selling to large groups (usually 51 or more employees) must spend 85 percent of premiums on care and quality improvement.
We met the MLR requirements set forth through the ACA, while continuing to focus on providing quality health plans for our members. We strive to develop comprehensive programs that improve the health of our members in an effort to manage overall healthcare costs.
We thank you for your continued support. If you have any questions, please contact your Sentara Health Plans representative.
Would you rather? Members can designate their communications preferences!
We continue to encourage Sentara Health Plans members to sign in to their profiles and visit our master preference center, where they can tell us how they want to receive their communications, including paperless options and texts. Members will be reminded about their choices below on various health plan materials:
Sign in to set your preferences — Elect to go paperless, receive our texts, and more.
Here’s how to do it:
- Sign in to the member portal at member.sentarahealthplans.com/sign-in.
- Select Profile from the drop-down menu on the top right of your screen to see the choices for Email and Go Paperless and Phone Numbers and Text Notifications.
We are excited to continue to enhance member communications options and encourage them to share their preferences with us.
New Quoting Tools
An enhancement to enable flexibility in the census template to support the quoting tool, which no longer requires a specific template.
If you have any questions, please reach out to your Sentara Health Plans representative.
New Comprehensive Partnership with J&A Racing
Sentara will now serve as the title partner for the iconic Sentara Shamrock Half Marathon in Virginia Beach as well as the Sentara Crawlin' Crab Half Marathon Weekend in Hampton. Sentara will also become the presenting partner for the additional seven race weekends hosted by J&A Racing.
This three-year partnership marks a significant milestone for both organizations, as it brings together two local entities that are committed to promoting health and wellness in the community. Sentara's support will help enhance the race experience for participants and spectators alike, while also showcasing their dedication to improving the well-being of individuals across the region.
In addition to serving as the title partner for the Sentara Shamrock Half Marathon, Sentara Crawlin' Crab Half Marathon and presenting partner in the additional seven race weekends, Sentara will play an active role at all J&A Racing events, offering support services, health-focused activities, and engagement opportunities that reflect their commitment to community wellness. Their presence at these events will further solidify their commitment to promoting wellness and community engagement.
The Sentara Crawlin' Crab Half Marathon is scheduled for October 4-5, 2025, and the Sentara Shamrock Half Marathon will take place on March 22, 2026. For more information and to register for any of the upcoming races, visit www.jandaracing.com.
We hope to see you and your clients at the finish line!
Employer Group
This partnership brings Sentara Health Plans to your Employee Navigator for a seamless and integrated enrollment process. But don’t just take it from us, hear what one of our broker partners had to say:
“This platform integration helps us do a better job at supporting our mutual clients and improving the experience along the way. The impact this has to our small boutique agency is monumental in efficiency for our customers and delivering a quality program.”
- Christina M. Brunner, Sterling Benefits Holdings, LLC
If you are interested in this integration or have any questions, please reach out to your Sentara Health Plans representative or ensupport@sentara.com.
Need to set up an Employee Navigator account? Learn how here.
Learn more
*Employee Navigator is a third-party platform that requires a subscription to utilize their services. No additional cost from Sentara Health Plans.
Individual & Family Health Plans (IFP)
Stay tuned to Broker Buzz or marketplace.virginia.gov for updates as they become available
The Centers for Medicare and Medicaid Services (CMS) released the Marketplace Integrity and Affordability Proposed Rule that proposes standards for the health insurance marketplaces that provide Individual & Family Health Plan coverage through the Affordable Care Act (ACA). This year’s proposed rule includes the following:
- Shortening the Open Enrollment Period from November 1 through December 15.
- Adding verification requirements for 75% of special enrollment periods.
- Prohibiting passive re-enrollment for individuals with $0 net premiums.
- Eliminating the SEP for households with income under 150% FPL.
Read the entire proposed rule here.
We will continue to follow these proposed updates and keep you posted as we learn how any new legislative changes will impact how we do business.
Did you know?
Did you know that Summer Solstice, the longest day of 2025, took place on June 20? Which area of Virginia enjoyed the most sunlight on Summer Solstice?
A. Hampton Roads
B. Northern Virginia
C. Roanoke
D. Richmond
E. All of Virginia had the same amount of sunlight
B. Northern Virginia
Northern Virginia will experienced 14 hours and 53 minutes of sunlight on Summer Solstice this year! That’s 12 more minutes than Hampton Roads, 10 more minutes than Roanoke, and 8 more minutes than Richmond. No matter where you were in Virginia, we hope you had plenty of time to enjoy the sunshine and replenish your Vitamin D levels. As always, don’t forget your sunscreen!
Souce: timeanddate.com