Please Watch the Enrollment Video First

Video Transcript

On behalf of the whole team at Optima Health, we want to welcome you to your new benefits.

Optima Health will be your new medical plan administrator beginning January 1, 2021. Your pharmacy coverage will still be administered by OptumRx in 2021.

This presentation will guide you through your medical benefits for the coming year.

You’re encouraged to view this presentation which will take about 10 minutes.

After viewing this video, if you have questions you can check our Frequently Asked Questions, or you can call or email our friendly customer service representatives in Virginia Beach. For most people, this should answer all of your questions. In addition to these resources, there will be a series of optional interactive webinars.

We’ll learn more about your plan as we go through this presentation.

We’ll structure our presentation today to let you: Learn more a little bit more about Optima Health, Learn about our large network of doctors and hospitals, Learn about your plan choice and the great extras included with your benefits, And finally, we’ll go over what you can expect next and where to find more information if you need it.

Optima Health is a local health plan headquartered in Virginia Beach. Our goal is to improve health every day and our vision is to be the health plan of choice in the communities we serve.

We’ve been around for over 35 years and we currently serve over 800,000 members through our plans offered to employer groups, individuals and Medicare and Medicaid members.

We’re a local plan with a great network of providers here in Virginia and Northeastern North Carolina, but we also have national coverage for students and travelers.

First – let’s go over the local part of our network.

Your plan option will be based on our Point of Service network. Beyond Virginia and northeastern NC, Optima Health uses a national network partner called PHCS/MultiPlan. The PHCS logo will be on the back of the ID card.

Here close to home, we have all of the major hospital systems in our network – Riverside, all of the Sentara facilities in the area, Bon Secours, Children’s Hospital of the Kings Daughters and more. There are over 35,000 providers in our networks across the Commonwealth of Virginia and into northeastern North Carolina.

The Optima Health website has an online search tool where you can look up doctors and facilities. Your new Optima Health plans are “open access”. This means you DO NOT need to have a referral to see a specialist. Optima Health encourages, but does not require you to select a primary care physician.

With your plan, any true emergency situation– regardless of the provider’s network status or your location - is treated as an in-network event.

Your plan will also include access to a national network called PHCS. You will receive in-network benefits for covered services when you access a PHCS provider outside of the Optima Health service area. The Optima Health service area is defined as the participating network in the Commonwealth of Virginia and northeastern North Carolina.

Your plan also includes Emergency Travel Assistance. This part of your plan covers you when you are traveling more than 100 miles away from home and need assistance with any unforeseen events on your trip.

Now that you know about the providers and the network, let’s go over the plan.

The plan includes in AND out of network benefits. The plan cost-share includes copayments and coinsurance. Remember – a copayment is a flat, predictable dollar amount you pay when you seek care and coinsurance is a percentage of the negotiated rate that you pay.

As we mentioned before, Optima Health encourages a Primary Care Physician (or “PCP”) selection, but does not require it. A PCP relationship is great for routine check-ups, preventive screenings and for helping you maintain and improve your health. The plan is open access so there’s no referrals to go to see a specialist.

We’ll cover the plan briefly and we will go over some of the key features. The full details of the plan is found in the Summary of Benefits document posted on the website where you accessed this video.

The plan has no in-network deductible and more frequently utilized services such as doctor visits are covered at flat, affordable $30 or $45 copayments.

The plan also includes preventive care covered at no charge to you.

Additionally, the plan has an annual Out of Pocket Maximum. Think of this feature as a financial protection. If all of the copayments and coinsurance you pay in a given plan year hit this amount, the plan begins paying 100% and you do not pay any more for covered services. For example, if you are a single person and all of your copayments and your coinsurance amounts hit $2,300, that is the most you would pay for that year. The out of pocket maximum re-sets each plan year on January 1.

Your plan includes health and wellness features to help you on the road to better health.

Included in your plan are valuable discounts through our Gym Network 360 program that offers discounts on gym memberships, as well as access to weight loss and healthy eating programs.

Optima Health will support the City’s wellness program and additional information about the City’s program will be posted on the dedicated web page where you accessed this video.

The plan also includes Virtual Visits through MDLIVE.  Telemedicine services are covered under your plan and can be accessed through your smart phone, tablet or computer.  Board certified doctors can diagnose minor illnesses and can write prescriptions when necessary.

Let’s talk about what happens next and some key dates...

Over the next few weeks, please take some time to explore your benefits and your new Optima Health plan. Open enrollment will begin on November 2nd and end on November 13th. You have several resources for you to learn about all of the benefits the City has to offer including the dedicated web page where you found this video. You will also be able to attend a virtual Q&A session. For information about the dates and times for these sessions, please refer to the Open Enrollment information found on the web page.

Once you’ve enrolled in your benefit plan, you will receive a new health insurance ID card in December. Every covered family member in your home will receive an ID card. You’ll note that there are a lot of abbreviations on the card. We do this intentionally so that your provider will know how much to charge you. Your card will come in the mail and will include a list of the abbreviations and what they mean. Remember to present your new ID card to your doctors in January next year so that they know about your new benefits.

As you are thinking about your transition, some of you may be undergoing treatment for a condition or have an upcoming procedure scheduled. The plan offered by your employer covers pre-existing conditions – so don’t worry about changing your health insurance in the middle of your treatment. In order to make this a smooth transition for you, Optima Health will work with you and your doctor to make sure your transition process is as smooth as possible. You’ll have access to Optima Health resources to help you navigate your specific situation. We recommend that you call your doctor's office and tell them your coverage is changing to Optima Health on January 1. Your doctor can work with Optima Health Clinical Care Services team to provide clinical notes and update any authorizations necessary.

If you have specific questions about your condition or on-going course of care, please call Member Services at Optima Health to discuss your situation.

After you become a new member, you’ll want to register online at Optima You’ll be able to check on all aspects of your plan. You can do such things as find your benefit summaries, view important documents, print ID temporary cards, view claims and plan balances and find providers.

Next, you’ll want to take us on the go by downloading the Optima Health mobile app. Our mobile app is very easy to use. With the app, you can access your MDLive virtual visit benefit, view claims, view ID cards, search for doctors and access your wellness programs.

You’ll have plenty of resources to help you through your enrollment and decision period. Here at Optima Health, you can call us – even before you’re a member – and we will help you understand your plan and answer any questions you might have. You can email us at If you decide to send an email, be sure to mention the name of your employer so we can help you with your specific benefits information.

The City’s benefits consultant, USI, is also a resource for you if you have questions on any of the benefits offered by the City of Hampton.

The City of Hampton Benefits Team is also available to help answer any questions you may have specific to your employer.

Now that you’ve viewed our short presentation, you might still have some questions. We encourage you to check out the FAQs we’ve prepared and to reach out to the Optima Health member service team to help you. If you like, you can also attend a live webinar at designated times noted on the website where you accessed this video.

Thank you for choosing Optima Health!

Still Have Questions?

Call member services at 1-877-552-7401 or TTY 711.