Mandatory Health Insurance

The Affordable Care Act mandates that beginning January 1, 2014, every individual will be required to purchase “qualified” health insurance. Those who do not comply will be subject to tax penalties up to $695 per year. The federal government will offer subsidies for individuals with incomes up to 400% of the poverty level. These subsidies will be available through state-based health insurance exchanges, where individuals and small business owners can purchase coverage that meets federal requirements.

Businesses with more than 50 full-time equivalent employees (those who work 30 hours or more per week) will be required to provide qualified health insurance or pay a tax penalty for employees who buy individual insurance. They will also be required to offer coverage to employees’ dependents starting in 2015. The IRS defines a dependent as an employee’s child who is under the age of 26. Spouses are not considered dependents.

A Virginia State Health Insurance Exchange

Under the Affordable Care Act, every state will have a health care exchange, which will serve as a marketplace for individuals and small business employers to shop for insurance coverage and learn about and apply for subsides that will help them pay for the cost of their health plans. The exchanges are being created in order to provide a more organized and competitive way to purchase health insurance. Consumers will be able to see several different options and compare rates and coverage details via the online resource.

The Affordable Care Act gives states the option of establishing their own health insurance exchanges, or letting the Department of Health and Human Services (HHS) operate a “federally facilitated” exchange in their state. Eighteen states and the District of Columbia plan to operate a state run exchange in 2014. Virginia is not among this group.

On December 14, 2012, Governor Bob McDonnell (R) informed federal officials that Virginia would not continue to plan for a state-based health benefits exchange, stating a lack of clear direction about the control and flexibility afforded at the state level to efficiently and effectively run the exchange. As a result, the federal government will assume full responsibility for running a health insurance exchange in Virginia beginning in 2014, unless the state forms a partnership agreement for a hybrid exchange.

“If Virginians are faced with running a costly, heavily regulated bureaucratic exchange without clear direction from Washington, then it is in the best interest of our taxpayers to let Washington manage an exchange at this time,” McDonnell said. “We would like the ability to control our health insurance marketplace, and will continue dialogue with the federal government to clearly understand the logistics of this option before making a decision.”

 Health Insurance Premium Increases

Under the Affordable Care Act, the cost of insuring older Americans is being passed onto our youth. A requirement on age rating states that health insurers cannot charge older adults more than three times what younger adults are charged. This mandate means that insurance for the elderly will be funded by increased premiums for younger adults. In fact, most consumers can expect a premium increase on their birthday every year from age 21 through 63. And if you smoke, health insurance companies will have the ability to charge 50 percent more for your coverage. The good news: women and individuals with pre-existing conditions will not be charged more for coverage.

Discounts for Wellness Programs and Smoking Cessation

While wellness program incentives have been around for several years, a new regulation in health care reform allows employers to provide discounts to protect employees who are unable to participate in certain wellness programs. Companies will be required to offer alternatives to employees whose physical conditions make it unreasonably difficult to participate. Participating in a wellness program could offer a 20-30 percent discount off health coverage. And quitting smoking could yield a 50 percent discount.

Optima Health is Your Resource

The coming year will be one of changes and challenges in the health insurance industry. We’ve been working for nearly two years to prepare for health care reform and are well equipped to guide employers and individuals through the process. We’re working with leaders in the community and throughout the industry to ensure a smooth transition into 2014. Our role is to help you make informed decisions regarding the impact of health care reform on your situation. Let us know if you have a question about health care reform. If we can’t answer it, we’ll find someone who can!

The option provides dental insurance products that can be purchased at the same time as health insurance products for small employer groups. This preferred pricing dental program will provide a 5% discount off dental insurance rates from Delta Dental only when partnered with an Optima Health product. With a target quote availability date of July 1, 2013, the program will be offered exclusively for Optima Health customers when purchasing a medical plan.

“Optima Health is excited to partner with Delta Dental and offer these preferred pricing dental packages for our small group employers,” said Michael Dudley, president of Optima Health. “This arrangement is a win-win partnership offering the member a robust network of providers, a convenient solution for brokers, and lower dental premiums for employers,” added Dudley.

The partnership between Optima Health and Delta Dental offers a valuable option to small groups looking for the convenience of bundled medical/dental arrangements, cost savings and access to the largest dental networks in the Commonwealth. The preferred pricing dental program is offered for employer groups with 2-99 eligible employees.

“This is a unique opportunity for two Virginia companies to join together to provide a whole health solution for Virginians,” said Dyke Davies, COO, Delta Dental of Virginia.  “Delta Dental looks forward to working with Optima Health to provide the kinds of flexible and cost effective benefits small business employers are seeking.”

Submitted by Susan Tweed, PhD, RN, health educator at Optima Health, on the health benefits of yoga. Susan has been practicing yoga since her early 20

Yoga has changed my life in many ways. It has helped my body stay flexible and strong and my mind become more compassionate and accepting of others.

The postures are only one part of yoga. Sometimes I take classes and other times I use a video at home or just practice some of the postures in my everyday life…like balance postures waiting in line in the grocery store.

What are some of the health benefits you can expect from a regular yoga practice?

Increased Body Awareness
You will begin to have an increased awareness of your own body. Over time, this will increase your level of comfort in your own body and can lead to improved posture and greater self-confidence.

Increased Mental Calmness
Yoga exercises, or asanas, are intensely physical. Concentrating closely on how and what you body is doing has the effect of bringing a calmness to the mind. Most yoga classes introduce you to the mediation techniques, which help calm the mind.

Stress Reduction
Physical activity is good for relieving stress. When you are focusing on your yoga practice, your daily troubles seem to melt away. This provides a break from your stressors, and helps you put things into perspective. Yoga emphasizes being in the moment which can also help relieve stress, as you learn not to dwell on past events or anticipate the future.

Increased Flexibility
By stretching in new ways you will become more flexible, bringing greater range of motion to muscles and joints.

Increased Strength
Many yoga poses require you to support the weight of your own body in new ways. In Tree Pose you balance on one leg and Downward Facing Dog requires you to support yourself with your arms. Yoga is often done slowly and purposefully which also increases strength.

Better Breathing
Most of us breathe very shallowly and don’t give much thought to how we breathe. Yoga breathing exercises focus the attention on the breath which benefits the entire body.

Pain Prevention
Many people who suffer from back pain spend a lot of time sitting at a computer or driving a car. Increased flexibility and strength can help prevent the causes of some types of back pain.

Susan Tweed has spent the last 36 years making a difference in the lives of others. Read Family History Inspires, a personal essay on how her family history inspired her to become a nurse.

Visit Optima Health for additional yoga information.

Terrina Thomas, Director of Health and Preventive Services, Optima Health.

I don’t know about you but right about 2:30 p.m. each day, I start to hear the faintest chant of my name coming from the downstairs of my building! No wait, maybe it is coming from my stomach and echoing from the vending machine downstairs. At any rate, if I haven’t remembered to bring a bag of grapes or granola bar from home, I find myself standing in the glow of the vending machine trying to make a good choice while my stomach calls out for something to eat. It isn’t always easy to make a good choice but I really try hard. Fortunately for me and others who find themselves in the same position, Optima Health and the rest of the Sentara office buildings have created a “Healthy Edge Choice” program that labels all of the healthier items in our machines. So even though I am snacking from the vending machine, I can make better choices.

How to make healthy choices?

But what happens when you are at a vending machine that isn’t conveniently labeled to help with your decision making? What are some items that you should consider over others that won’t undo your good choices from the rest of the day? I suggest that you “PACT” by choosing pretzels, animal crackers, chewing gum and trail mix over the potato chips, corn chips, donuts, and cakes. Your PACT choices will satisfy your craving for salt or sweets but do it in a way that won’t leave you with snacker remorse in an hour!

If you work in a building that has vending machines, you may consider working with your management to have your vending machine vendor offer a minimum of 25 percent healthy items that are priced lower than the non-healthy alternatives. As I mentioned before, Sentara Healthcare has successfully made changes to their machines and contrary to what others may say, folks still use the vending machines and are happy that those healthier items are identified for them.

Pack your own snacks.

One other solution to the vending machine is to bring healthy snacks from home. I find that if I take the time to bring a snack from home a couple of things happen. First, I don’t eat something that I don’t really want to eat but I do it anyway because my stomach overrules my brain. Second, I don’t spent $0.95 on a bag of chips that probably only cost $0.25 to produce. Finally, I don’t waste time going to the machine and standing there trying to decide what to buy. So the solution of snacks from home saves me time, money and regret.

Bringing snacks from home may take some planning, if you work in an area that you can keep items at your desk, then pick up an extra box of snacks during your weekend grocery store trip and you will have it all week. If you cannot keep snacks at your workplace, then consider buying something then bringing it with you daily. I personally will buy grapes and individually package them in 5 snack bags so I just grab one from the refrigerator each morning when I head out the door. Bananas are good for this too. If your afternoon craving is for salty foods, you can do the same thing with pretzels or nuts.

Next time you find yourself basking in the glow of the vending machines at work, remember to take a step back, choose wisely then make a plan for the rest of the week. You are definitely worth it!

What do you do to make healthy snack choices? Submit a comment and share your thoughts.

Michael M. Dudley, Optima Health President and Chief Executive Officer (back row) pictured with newest Quarter Century Club members:  Front row (l-r): Tracye Watts, Sharon Cooper-Lewis, Katherine Longmire, Lorna Shelton; Back row (l-r): Lorrie O’Neal, Leslie Routon, Tamla Pandolf, Theresa Hubbard, Belinda Winslow, Kathren McCartney, Malinda Grandchamp

Optima Health has welcomed 11 new members into their exclusive Quarter Century Club. Membership for this elite club is reserved for employees reaching 25 or more years of service within the Sentara Healthcare system. Most of the employees reaching this 25-year milestone have a decorated career with expertise in a variety of clinical and administrative areas throughout Sentara and Optima Health.

Senior leadership and supervisors recognized each employee’s professional accomplishments, shared anecdotal stories and fun memories, and offered club members best wishes for another 25 years.

Congratulations and welcome to the Quarter Century Club!

Learn more about Optima Health and Sentara employment opportunities.

Optima Health Blog Talk Radio will explore how you can use technology to your advantage and find needed information from your health plan. Join us on Thursday, December 6th (12:30 p.m.- 1:00 p.m.) when Angela Donovan, Web Content Consultant with Optima Health, shares tips on how to use technology to your advantage.

If you miss a broadcast, you can listen to previous shows at your convenience.

Will an incentive-based wellness program motivate employees to get and stay healthy? Employers have been asking this question as they see an increase in their health insurance costs. The cost-effectiveness of health-incentive programs can vary and it takes time before a company sees a return on investment. The key is to use this program as an investment towards saving money long-term.

 Aon Hewitt, in partnership with Rush Health, reports that employee-sponsored wellness programs are on the rise.  Two out of five employers surveyed offer their employees incentives for their participation and completion of lifestyle modification programs like weight loss or smoking cessation.

 Sentara Healthcare, in partnership with Optima Health, implemented an employee wellness program, Mission: Health, demonstrating a five-year savings of $4 million. Sentara leaders believed they could significantly cut costs if employees were encouraged to better manage their chronic diseases by offering additional monetary incentives; and it worked.  

 Optima Health offers employers an easy way to implement a cost-effective, incentive-based wellness program by offering several reward programs: Optima Rewards, Optima Design Rewards, and Optima Design RxDed Rewards.  These programs help employers encourage their employees to engage in healthy activities.  It allows an employee to earn their way to lower out-of-pocket healthcare expenses.  It’s an incentive that makes sense, unlike cash that could be spent for anything including the very behavior the employee is attempting to change. 

 Essentially, an employer decides which healthy activities they want to fund per employee, and Optima Health does the rest. Healthy activities include a personal health assessment, online exercise and nutrition planner, and engagement with a health coach. Upon completion, reward dollars are deposited onto a debit card or into Health Reimbursement Arrangement (HRA) account. These incentive dollars may be used to help with eligible out-of-pocket medical expenses.

Employers and employees benefit in several ways including:

•  Reducing the employer’s overall insurance premium by giving employees a way to earn extra dollars to cover their out-of-pocket medical costs;
•  Engaging employees and helping them pay attention to service costs will most likely guide them to make better healthcare purchasing decisions; and
•  Reducing employee healthcare usage and expense by participating in activities to manage and improve their health.

We all make choices, and many of those directly affect the quality and longevity of our lives. Optima Rewards, Optima Design Rewards, and Optima Design RxDed Rewards are programs that offer employers an easy way to encourage employees to make healthier choices that will help keep medical costs down. Employers considering wellness programs should check with their insurance carrier about available options. 

For additional information about Employer Resources, visit Optima Health.

Individuals who own their own business or their employer doesn’t offer health insurance are familiar with the process of buying health insurance. It can be a daunting task and oftentimes you can feel very alone in the process.

It’s not as scary as you think it is. Brokers and/or agents are available to assist you through the process. Or, you can talk directly to a representative from an insurance plan. Doing some research up front and identifying your health insurance needs will help the process much smoother.

One of the first eye-openers for most is the cost of individual insurance policies. When your employer sponsors your health insurance they typically pay a portion of the cost, so you are shielded from the true cost of the plan. When purchasing insurance on your own, you are bearing the full cost of the plan.

Don’t let that scare you. Have a budget in mind, know your healthcare spending habits, and try to project your future healthcare costs. These three things will help tremendously when making your decision.

Join Optima Health Blog Talk Radio on Thursday, November 15^th when we focus on “Unveiling the Secrets of Individual Health Insurance.” Our expert is Kathy McVey, Manager of Consumer Products. She’ll explore all the ins and outs of buying an individual insurance plan.

Show airs from 12:30-1:00 p.m. but if you miss it, don’t distress, you can listen at your convenience by downloading the archived show from Optima Health.

The November 1st show of Optima Health Blog Talk Radio discusses simple ways to stay on track, manage any health conditions you may have, and live a healthy lifestyle. Thomas will share her personal challenges to managing her health and ways that you can utilize the programs that are offered by your health insurance plan to help you maintain good health.

The show airs at 12:30-1:00 p.m. on Optima Health Blog Talk Radio.  Join us by logging on and tuning in. If you aren’t able to listen live on air day, download and listen at your convenience by visiting our Optima Health website.

Remember, the program is hosted by Priscilla Monti, Optima Health’s client and broker relations specialist and former Hampton Roads’ TV reporter. Check it out and see if you can glean some new tips on helping improve and maintain your health!

Governors Tim Kaine (l) and George Allen (r)

Optima Health was a sponsor of the Hampton Roads Chamber of Commerce Senatorial Luncheon Forum held October 18 at Norfolk Waterside Marriott in Norfolk. The luncheon was attended by more than 800 local business leaders who were eager to learn about Senate race details.

Who will control the United States Senate in 2013?  The nation’s eyes are on Virginia, as two of our former Governors compete for a seat that may dictate the course of public policy for years to come. The Senate race between Republican George Allen and Democrat Tim Kaine is seen by the nation’s political experts as a battle between two popular leaders who are attempting to convince the Commonwealth that their respective fiscal and social policies are in line with our diverse electorate.

Governors Allen and Kaine answered questions and assured the audience that  Virginia’s voice would be heard in Washington.

Optima Health is proud to be an event sponsor in an effort to better understand the needs of the businesses and consumers in our community. We will continue to provide Virginians quality health plans at affordable prices.

For more information about health plan options for you, your family or business, visit optimahealth.com