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General Assembly Update: Optima Health and Tax Rebates

October 2, 2019 by David Toscano

WATCH YOUR MAILBOX!

Local residents should watch their mailboxes carefully in the next several weeks because about 2.7 million eligible taxpayers will receive a one-time refund from the Commonwealth as the result of action the General Assembly took last spring.

STATE TAX REBATES

Those eligible should receive $110 if they filed state taxes individually, or $220 if they filed jointly. The check should arrive by October 15. So, if you see a letter from the Department of Taxation – OPEN IT! If you have questions, visit the Virginia Department of Taxation’s website at https://www.tax.virginia.gov/news/2019-virginia-tax-relief-refund or call 804.367.8031.

PREMIUM REBATES FROM OPTIMA

Another rebate for residents in our area may soon be coming from Optima Health as the result of actions by a local advocacy group, Charlottesville for Reasonable Health Insurance (CRHI) (https://www.facebook.com/groups/142730106368938/) and the state Bureau of Insurance (BOI), with a little nudge from yours truly. Under requirements of the Affordable Care Act (ACA), insurance providers are required to spend 80¢ out of every dollar in premiums collected on healthcare claims and quality improvements (in policy parlance, this is called Medical Loss Ratio – MLR).

In 2018, largely in response to uncertainty in the insurance markets brought on by the Trump Administration’s efforts to undermine the ACA, Anthem left our local market, leaving Optima as the only provider in the individual marketplace.

Optima tripled its rates locally in 2018, with the result that Charlottesville had the highest rate hike in the country. CRHI formed shortly thereafter and began to pressure the company and the BOI for information and a reduction in rates. They worked with Senator Deeds and me to pass legislation in the last session to provide the BOI with tools to limit wide variances in premium rates between different geographic markets in the Commonwealth in future years, and to codify BOI’s authority to review premium rates and call for rate adjustments or rebates to consumers when they are overcharged. An analysis revealed that in 2018, Optima spent only half of the premiums it collected on medical claims, well below the law’s 80% requirement, and must therefore send partial rebates to its subscribers. Protecting consumers will hopefully continue to be an important concern of state lawmakers in the years ahead.

Rebates in 2019 will be sent to subscribers who were enrolled in the Optima Plan in 2018. They will take the form of checks or premium credits, and may differ depending on the amounts subscribers paid. According to projections from the Kaiser Family Foundation, about 144,000 Virginia subscribers in the individual market qualify for about $111.3 million in rebates. The state BOI projects the average rebate-per-subscriber to be $660.00, but cautions that these are estimates; some policyholders in some areas may receive different amounts. Since Charlottesville had among the highest rates in the states, it is possible that subscribers here may receive more than the average statewide rebate amount. Another good outcome from CRHI’s ongoing advocacy – according to The Daily Progress, Optima 2020 rates will now be among the lowest in the state.

If you have any questions regarding Optima Health’s rebates, please contact the company directly for more information: toll-free at 1-866-514-5916 or by email at MLRrebate@sentara.com.

David

A more detailed analysis on health care policy can be found in my forthcoming book, Great States Don’t Just Happen: The Role of Politics, Policy, and Personalities in Shaping Virginia and the Nation.

Filed Under: General Assembly 2019 Tagged With: Affordable Care Act - Virginia, Affordable Health Care, Virginia Health Insurance Marketplace

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Archive: Press Releases

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Statement on President Trump’s Decision to Exit the Paris Climate Accord
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