Plan Information

The Optima Health Plan is a referral-less HMO plan in which you can choose a primary care physician (PCP) to coordinate your healthcare needs. You can depend on your PCP for routine medical assistance and guidance when seeking care within the Optima Health network. You are not required to obtain referrals for specialist care. If you need to see a specialist, your PCP may coordinate your care or you can make your own appointment. You can find summary of benefits, and other supporting benefits documents in the plan documents section.

Key Features

Comprehensive benefits

The Optima Health Plan includes medical, dental, vision, hearing and prescription drugs for one low premium and preventive care is covered at 100%.

Low copayments on doctor and specialist visits

Save on your doctor and specialist visit copayment when you access care through a SQCN provider.

Coverage for Out of Area Dependent Children

Optima Health offers out of area dependent children access to care outside of the Optima Health service area. Download the Out of Area Dependent Form

Low deductibles

Pay low annual medical deductibles of $150 for individual and $300 for family, and for most services the deductible may not apply.

No referrals required

Our plan, also referred as Vantage, is a referral-less HMO plan in which you choose a primary care physician who will coordinate your healthcare needs. Whenever you need to see a specialist, you don’t need to obtain a referral from your primary care physician.

Disease management with financial incentives

Receive financial incentives when you enroll in disease management programs for asthma/COPD, diabetes, or hypertension.

Access to top-quality providers

Our network features more than 26,0001 providers across Virginia including in-network access to 100% of hospitals in Hampton Roads2 and access to Sentara Medical Group (SMG), Sentara Quality Care Network (SQCN), Riverside Health System and other top-quality providers in the region.

Dedicated Member Services

Our dedicated Member Services can help you understand benefits, find the right doctor, and more.

For any further questions, please contact your dedicated Member Services team.

Plan Documents

You can find helpful information about your Optima Health plan below.

1 Sentara Health Plans, Inc. Provider Database, 2018

2 Provider Network Penetration, January 1, 2019