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Carrier Updates

For fully insured plans with an effective date of January 1, 2021, or later, Optima Health has issued an Amendment to their employer group contracts and member Evidence of Coverage (EOC) and Certificate of Insurance (COI) legal documents.

The Amendment is already included in the contracts and member legal documents for their Individual Product and Small Group (1-50 employees) plans. The Amendment is necessary because they did not refile EOCs/COIs for 2021; Optima Health amended the latest filed version(2020) to include new state and federal requirements such as new balance-billing provisions and other changes.

Because of the timing of when the legal documents were approved, the Amendment will be distributed separately for their Mid-Market (51-150 employees) and Large (151+ employees) group employers and members. Distribution of the Amendment for Mid-Market groups with effective dates in January, February, March, and possibly April, as well as Large group employers and members with January effective dates, will begin around early May. For groups and members with effective dates after those mentioned above, the Amendment will be included in the contracts and member legal documents.

This does not affect our BusinessEDGE® and large self-funded group plan documents.

Have questions? Call us today at 866-568-9649!