Features and Support Services

We offer a variety of features and services to help keep you and your family healthy.

Disease Management Programs with Incentives

Members who are managing the following chronic health conditions: asthma/chronic obstructive pulmonary disease (COPD), diabetes, and hypertension may be eligible to earn financial incentives by joining our Disease Management programs. Members can receive a waived medical deductible of $150 or $300 depending on single or family enrollment and get a waived copay for prescription drug Tier 1 and Tier 2 medications for their condition. Employees with chronic conditions can apply by completing the transition of care assessment. These programs offer support and guidance to better manage these conditions and include care plan development, provider coordination and more.

Obesity and Weight Management

At-risk members who are ready to reduce their chances of developing obesity-related, chronic diseases are invited to participate in our digitally-delivered intensive behavioral counseling program. Within 16 weeks, previous participants in the program have lost an average of 4-5% of their body weight.

Bariatric Surgery

Members who are eligible for bariatric surgery may qualify for reduced inpatient or outpatient copayments upon completion of required program criteria. Download the Bariatric Surgery Flyer.

Partners in Pregnancy

Our Partners in Pregnancy, and Healthy Babies programs include maternity support and NICU case management. These no charge programs provide guidance, support and education to all interested expectant moms. Financial incentives are available upon completion of program criteria. View the Partners in Pregnancy Flyer.

Out-of-Area Dependent Program

Do you have dependents in your household? The Out of Area (OOA) Dependent Program offers enrolled dependent children access to care outside of the Optima Health service area. When enrolled dependent children access care outside of the Optima Health service area, they will be able to receive covered services from PHCS/Multiplan providers at the in-network benefit level. Pre-Authorization still applies when necessary. Download the Out of Area (OOA) Dependent Form

Emergency Travel Assistance

As part of your Optima Health Plan your get free emergency travel assistance1 that can handle and resolve your medical and travel emergencies. You, and any dependents on your Optima Health Plan, are covered whenever traveling 100 miles or more away from your permanent residence, or in another country.

1Not a covered benefit.