Individual and Family Plan Updates for 2021
Open Enrollment for 2021 starts November 1, and we want to make you aware of a few important updates to our Individual & Family Plans as you begin selling and renewing OptimaFit® plans for 2021. All updates take effect January 1, 2021 unless otherwise noted.
Expanded Service Area
OptimaFit® Direct plans are now available to individuals who reside in the greater Richmond area. OptimaFit Select plans will continue to be available only to residents in the Charlottesville and Rockingham areas.
Recently, Virginia Premier became part of Sentara Healthcare, who also owns Optima Health. Because Virginia Premier and Optima Health are both part of Sentara Healthcare, Optima Health was able to simplify the coverage search for these individuals and automatically renew Virginia Premier members into an Optima Health plan for coverage beginning January 1, 2021.
View renewal letters for Optima Health and Virginia Premier members
OptimaFit Direct Individual & Family Plans will have the following change to its network design:
- Tier 1: All Optima Health participating providers except those listed in Tier 2
- Tier 2: University of Virginia Health System (UVA) and Mary Washington Healthcare doctors and facilities
Note: Prior to January 1, 2021, UVA is in Tier 1 and Virginia Commonwealth University Health System is in Tier 2.
This change aligns the OptimaFit Direct network with our current Direct network configuration for employer-sponsored health plans.
To find out if a specific doctor, specialist, or facility is in network and which tier applies, members should always use the Find-a-Doc tool on our website or call member services at the number listed on the back of their member ID card before using services.
If you have any questions, please contact your Optima Health representative.