Our tiered network design offers lower–cost options that allow you to choose what works best for your clients.
Direct network plans include the full network of over 37,0001 doctors and facilities, in a two-tier structure to maximize cost savings. Members can save money when they get services from a Tier 1 doctor or facility.
Optima Direct Features
- core product offering for Small Group and an option for Mid-Market and Large Groups
- tier 1 includes all participating doctors and facilities except those in tier 2 and tier 2 includes Mary Washington Healthcare
- plans are available throughout the entire Optima Health service area
- Direct plans for HMO, POS, and PPO (Small Group only) product lines
- wide range of Gold, Silver, and Bronze level plans for ACA Small Group
- Health Savings Account (HSA) and Health Reimbursement Account (HRA) spending account options
- generous discounts on health and wellness services3
- comprehensive Health Management Programs
- Emergency Travel Assistance3
- free preventive care services when received from an in-network doctor or facility4
- virtual consults accessible from our website or the Optima health mobile app
1 Sentara Health Plans, Inc., Provider Status Report, 2021, available at optimahealth.com/find-doctors-drugs-and-facilities
2 May only be available in certain Product Lines, depending on group size
3 Value-Added services; not a covered benefit
4 Office Visit copayment or coinsurance may apply
2 May only be available in certain Product Lines, depending on group size
3 Value-Added services; not a covered benefit
4 Office Visit copayment or coinsurance may apply
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