Sentara statement on DOJ investigation

“In 2017, there were historic market disruptions and 350,000 people in Virginia were at risk of losing ACA coverage. At the request of federal and state policymakers, we worked with regulators to help fill a potential gap in coverage in a short period of time. We quickly formulated rates based on sound actuarial principles, the best data available, and with the support from one of the nation’s preeminent actuarial firms. Our rates complied with all relevant state and federal laws and rules and were repeatedly approved by regulators.

Under the law, insurance companies like Sentara Health Plans (formerly Optima Health) do not keep excess premiums, they must be rebated back to consumers. Sentara was fully compliant with the law and issued over $98 million in rebates to Virginia policyholders for the 2018 plan alone, in accordance with ACA regulations. The allegations of wrongdoing are without merit.

Far from a profitable endeavor, even today, Sentara’s participation in the ACA market has driven substantial losses without government support or assistance, in 2024 alone.  Despite these risks, Sentara has stayed in the market because providing health coverage to those who need it is central to our mission. This complaint could have a chilling effect by driving small insurers like Sentara out of the ACA market entirely – limiting options and driving up costs for consumers.

The facts are on our side, and we will carefully review any complaint that is filed and make clear that we complied with all applicable laws and regulations while we worked to fulfill our not-for-profit mission.”

-Attributed to Mike Kafka, Sentara Spokesperson

Additional information is available here:  https://www.sentara.com/there-for-virginia