<--Brightcove Video 6204186070001 Goes Here
On behalf of the whole team at Optima Health, we want to thank you for being a valued member. This presentation will guide you through your benefit options for the coming year.
You’re encouraged to view this presentation which will take about 15 minutes. For most people, this presentation should answer all your questions. After viewing this video, if you still have questions you can call or email our friendly customer service representatives in Virginia Beach.
You will learn more about your plan options as we go through this presentation. So, let’s get started.
We’ll structure our 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 plan options. Optima Health has 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 to all employees, even if you are 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 of the major hospital systems in our network – Riverside Health System – including the facility and Riverside physicians, all of the Sentara facilities and physicians in the area, Children’s Hospital of The Kings Daughters, Bon Secours and more. There are over 33,000 providers in our networks 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 new Optima Health plans are “open access”. This means you DO NOT need to have 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 and northeastern North Carolina.
Beyond Virginia and 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 the 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 and the network, let’s go over the plans.
Active employees have three plans to choose from. You’ll want to review the plan choices to see what’s most appealing to you.
The two Vantage (HMO) plans, do not have any out of network coverage available unless it is a true medical emergency. The Point-of-service plans provide in AND out-of-network benefit. Plans include copayments, deductibles and coinsurance.
Remember – a copayment is a flat, predictable dollar amount you pay when you seek care and coinsurance is a percentage of the negotiated rate that you pay. A deductible is the amount you pay first – before the plan starts to pick up coverage.
Optima Health encourages a PCP selection, but does not require it. A PCP relationship is great for routine check-ups, preventive screenings and for helping you maintain and improve your health. With all of the Optima Health plans, you do NOT need a referral from your primary care physician to go to see a specialist.
We will cover these three options briefly and we will go over some of the key features of the plans. The full details of all of these plans are found in the Summary of Benefits posted on the website where you accessed this video. Please note that Preventive care is covered in full for all of the plan options.
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 calendar year deductible. Your more frequently used services such as doctor visits are covered at flat, affordable copayment ranging from $30 to $60 depending on which service your seeking.
When you use a service that is listed as a copayment, the deductible does NOT come into play – you just pay that copayment. If you see “after deductible”, then you must pay the deductible first, before the plan coverage begins. The deductible is on a CALENDAR YEAR basis and will re-set every January 1st.
All plans have an annual Out of Pocket Maximum. Think of this feature as financial protection. If all of the copayments and coinsurances you pay in a given plan year, hit this amount, the plan begins paying at 100% and you do not pay for the rest of the plan year. For example, if you are a single person under the Point of Service 250/30/60 plan, your copayments and coinsurance amounts hit $5,000, that is the most you would pay for that plan year. 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 standard formulary and the formulary is divided into 4 tiers.
The Vantage & Point of Service plans include coverage where you pay copayments for the prescription drugs once you’ve met your plan year deductible of $150/$300. The copayments once your deductible is satisfied are $15, $40, $50 and 20% with a max copay of $200 for Tier 1, 2, 3, and 4 respectively. The mail order (or 90 day supply) costs $30, $80, or $100. 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 HSA Plan includes coverage where you pay copayments for the prescription drugs once you’ve met your plan year deductible. As you are working toward 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 copay amount. For a listing of preventive drugs, you can refer to Optimahealth.com and our prescription drug listing.
Here’s some important information to remember: Visit optimahealth.com to check which tiers your drugs are on. If the cost of the drug is less than the copayment, you will only pay the cost of the drug. Mail order provides a convenient way to save money especially on the Vantage & Point of Service plans. Optima Health uses OPTUM RX for mail order – so if you see this name, you’ll know this is part of your Optima Health benefits.
Plan changes for the 2021 plan year include Balance billing, Vision Therapy, Applied Behavior Analysis (ABA) & Formula and enteral products. The full details of these changes are found in the Summary of Benefits posted on the website where you accessed this video.
Your plans all include health and wellness features to help you on the road to better health.
Virtual Office visits - we will discuss more in detail shortly. Employee Assistance Program (3 visits for all, regardless of whether you are enrolled in the Plan.) Treatment Cost Calculator. MyLife MyPlan Wellness Programs & Services –Optimahealth.com/MLMP. Gym Network 360 Discounts. Emergency Travel Assistance through Assist America (when an emergency arises and you are more than 100 miles from home.)
The plan also includes Virtual Visits through MDLIVE. Telemedicine services are covered under your plan and can be accessed through your smart phone, tablet or computer. Board certified doctors can diagnose minor illnesses and can write prescriptions when necessary.
You will pay a $15 copayment if you enroll in the Vantage or Point of service plan. You will pay $39 fee if you enroll in the Equity Vantage (HDHP) until your deductible has been met.
Optima Health includes MyLife MyPlan – a suite of online resources that includes a variety of educational videos, materials and tools for your health and wellness support. Included in MyLife My Plan are items such as: An interactive Digital Health Assistant (DHA.)A Personal Health Assessment. Reminders for preventive screenings. A Diabetes Prevention Program. Individual Self-Paced Programs such as Yoga, Tai Chi, Meditation, or smoking cessation.
Included in your plan are valuable discounts for chiropractic care, acupuncture or massage therapy services provided through American Specialty Health providers, vision discounts through participating EyeMed vision providers, and hearing aid discounts through Epic.
If you are a current member and have not done so already, or if you are new to Optima Health, you’ll want to register online at Optima Health.com. You’ll be able to check on 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 MDLIVE virtual visit benefit, view claims, view your ID cards, search for prescription drugs or doctors and more.
Optima Health would like to keep you up-to-date on COVID-19 related health news. We have created a dedicated landing page for our members with COVID-19 resources. Please visit www.optimahealth.com/covid-19 and click on the ‘For Members’ tab for the latest information.
What’s next?
If you are not making any changes, you are not required to log in. If you are making changes to your enrollment, remember there is a dedicated team during open enrollment through Employee Family Protection. All updates must be must be entered no later than November 20th.
Now that you’ve viewed our short presentation, you might still have some questions. We encourage you to reach out to Employee Family Protection (EFP), Optima Health member services or your Benefits 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@optimahealth.com. If you decide to send an email, be sure to mention the name of your employer so we can help you with your specific benefit information.
If you have questions about who can enroll, when you can enroll or how – those questions can be directed to the Employee Family Protection enrollment team during open enrollment at 855-938-1331, from 8am – 7pm Monday through Friday.
Thank you!
You’re encouraged to view this presentation which will take about 15 minutes. For most people, this presentation should answer all your questions. After viewing this video, if you still have questions you can call or email our friendly customer service representatives in Virginia Beach.
You will learn more about your plan options as we go through this presentation. So, let’s get started.
We’ll structure our 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 plan options. Optima Health has 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 to all employees, even if you are 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 of the major hospital systems in our network – Riverside Health System – including the facility and Riverside physicians, all of the Sentara facilities and physicians in the area, Children’s Hospital of The Kings Daughters, Bon Secours and more. There are over 33,000 providers in our networks 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 new Optima Health plans are “open access”. This means you DO NOT need to have 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 and northeastern North Carolina.
Beyond Virginia and 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 the 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 and the network, let’s go over the plans.
Active employees have three plans to choose from. You’ll want to review the plan choices to see what’s most appealing to you.
The two Vantage (HMO) plans, do not have any out of network coverage available unless it is a true medical emergency. The Point-of-service plans provide in AND out-of-network benefit. Plans include copayments, deductibles and coinsurance.
Remember – a copayment is a flat, predictable dollar amount you pay when you seek care and coinsurance is a percentage of the negotiated rate that you pay. A deductible is the amount you pay first – before the plan starts to pick up coverage.
Optima Health encourages a PCP selection, but does not require it. A PCP relationship is great for routine check-ups, preventive screenings and for helping you maintain and improve your health. With all of the Optima Health plans, you do NOT need a referral from your primary care physician to go to see a specialist.
We will cover these three options briefly and we will go over some of the key features of the plans. The full details of all of these plans are found in the Summary of Benefits posted on the website where you accessed this video. Please note that Preventive care is covered in full for all of the plan options.
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 calendar year deductible. Your more frequently used services such as doctor visits are covered at flat, affordable copayment ranging from $30 to $60 depending on which service your seeking.
When you use a service that is listed as a copayment, the deductible does NOT come into play – you just pay that copayment. If you see “after deductible”, then you must pay the deductible first, before the plan coverage begins. The deductible is on a CALENDAR YEAR basis and will re-set every January 1st.
All plans have an annual Out of Pocket Maximum. Think of this feature as financial protection. If all of the copayments and coinsurances you pay in a given plan year, hit this amount, the plan begins paying at 100% and you do not pay for the rest of the plan year. For example, if you are a single person under the Point of Service 250/30/60 plan, your copayments and coinsurance amounts hit $5,000, that is the most you would pay for that plan year. 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 standard formulary and the formulary is divided into 4 tiers.
The Vantage & Point of Service plans include coverage where you pay copayments for the prescription drugs once you’ve met your plan year deductible of $150/$300. The copayments once your deductible is satisfied are $15, $40, $50 and 20% with a max copay of $200 for Tier 1, 2, 3, and 4 respectively. The mail order (or 90 day supply) costs $30, $80, or $100. 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 HSA Plan includes coverage where you pay copayments for the prescription drugs once you’ve met your plan year deductible. As you are working toward 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 copay amount. For a listing of preventive drugs, you can refer to Optimahealth.com and our prescription drug listing.
Here’s some important information to remember: Visit optimahealth.com to check which tiers your drugs are on. If the cost of the drug is less than the copayment, you will only pay the cost of the drug. Mail order provides a convenient way to save money especially on the Vantage & Point of Service plans. Optima Health uses OPTUM RX for mail order – so if you see this name, you’ll know this is part of your Optima Health benefits.
Plan changes for the 2021 plan year include Balance billing, Vision Therapy, Applied Behavior Analysis (ABA) & Formula and enteral products. The full details of these changes are found in the Summary of Benefits posted on the website where you accessed this video.
Your plans all include health and wellness features to help you on the road to better health.
Virtual Office visits - we will discuss more in detail shortly. Employee Assistance Program (3 visits for all, regardless of whether you are enrolled in the Plan.) Treatment Cost Calculator. MyLife MyPlan Wellness Programs & Services –Optimahealth.com/MLMP. Gym Network 360 Discounts. Emergency Travel Assistance through Assist America (when an emergency arises and you are more than 100 miles from home.)
The plan also includes Virtual Visits through MDLIVE. Telemedicine services are covered under your plan and can be accessed through your smart phone, tablet or computer. Board certified doctors can diagnose minor illnesses and can write prescriptions when necessary.
You will pay a $15 copayment if you enroll in the Vantage or Point of service plan. You will pay $39 fee if you enroll in the Equity Vantage (HDHP) until your deductible has been met.
Optima Health includes MyLife MyPlan – a suite of online resources that includes a variety of educational videos, materials and tools for your health and wellness support. Included in MyLife My Plan are items such as: An interactive Digital Health Assistant (DHA.)A Personal Health Assessment. Reminders for preventive screenings. A Diabetes Prevention Program. Individual Self-Paced Programs such as Yoga, Tai Chi, Meditation, or smoking cessation.
Included in your plan are valuable discounts for chiropractic care, acupuncture or massage therapy services provided through American Specialty Health providers, vision discounts through participating EyeMed vision providers, and hearing aid discounts through Epic.
If you are a current member and have not done so already, or if you are new to Optima Health, you’ll want to register online at Optima Health.com. You’ll be able to check on 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 MDLIVE virtual visit benefit, view claims, view your ID cards, search for prescription drugs or doctors and more.
Optima Health would like to keep you up-to-date on COVID-19 related health news. We have created a dedicated landing page for our members with COVID-19 resources. Please visit www.optimahealth.com/covid-19 and click on the ‘For Members’ tab for the latest information.
What’s next?
If you are not making any changes, you are not required to log in. If you are making changes to your enrollment, remember there is a dedicated team during open enrollment through Employee Family Protection. All updates must be must be entered no later than November 20th.
Now that you’ve viewed our short presentation, you might still have some questions. We encourage you to reach out to Employee Family Protection (EFP), Optima Health member services or your Benefits 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@optimahealth.com. If you decide to send an email, be sure to mention the name of your employer so we can help you with your specific benefit information.
If you have questions about who can enroll, when you can enroll or how – those questions can be directed to the Employee Family Protection enrollment team during open enrollment at 855-938-1331, from 8am – 7pm Monday through Friday.
Thank you!