Optima Health Vantage Plan Information
The Optima Health Vantage HMO Plan is a plan choice in the Greater Hampton Roads area. This option is available to Commonwealth of Virginia and The Local Choice employees where an employer has selected Optima Health as a plan offering. It’s one of the lowest cost comprehensive plans available to you. With the Optima Health Vantage Plan, members may receive services at participating providers in the Optima Health Vantage network throughout Virginia and North Carolina. The plan is an open-access style plan where members are not required to select a primary care physician (PCP) and they do not need referrals for specialist care. Optima health encourages, but does not require a PCP relationship. PCPs can help members with routine medical care and provide guidance when seeking specialist care within the broad Optima Health network of over 35,000 providers. You can find summary of benefits and other supporting benefits documents in the plan documents section.
Key Features
Comprehensive benefits
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
Access care through a physician designated as Tier 1 for the COVA and TLC benefit program and pay as little as a $5 or $10 copayment per visit.
Coverage for out-of-area dependent children
Out-of-area dependent children can also have coverage. Download the Out of Area Dependent Form
Low deductibles
Annual medical deductibles of $150 for individual and $300 for family, and for most services the deductible may not apply.
No referrals required
You are not required to select a primary care physician (PCP) and you do not need referrals for specialist care. Optima health encourages, but does not require a PCP relationship.
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
Optima Health Vantage network features more than 35,0001 top quality providers all across Virginia and northeastern North Carolina.
Dedicated Member Services
A Virginia-based Member Services team just for you. Contact the team for any of your health plan questions.
For any further questions, please contact your dedicated Member Services team.
Optima Health Vantage Plan Documents
Commonwealth of Virginia (COVA) Employees:
- 2021 Benefits Brochure - COVA
- 2020 Benefits Brochure - COVA
- Disease Management Incentive Program
- Dominion National Dental Summary of Benefits
- Evidence of Coverage - COVA
- Emergency Travel Assistance
- Frequently Asked Questions
- MDLIVE Virtual Care
- 2021 Benefit Summary - COVA
- 2020 Benefit Summary - COVA
- 2021 Summary of Benefits and Coverage - COVA
- 2020 Summary of Benefits and Coverage - COVA
- Transition of Care Assessment
- Vision Summary of Benefits
- Out of Area (OOA) Dependent Form - COVA
The Local Choice (TLC) Employees:
- 2020 Benefits Brochure - TLC
- Disease Management Incentive Program
- Dominion National Dental Summary of Benefits
- Emergency Travel Assistance
- Frequently Asked Questions
- MDLIVE Virtual Care
- 2021 Summary of Benefits & Coverage - TLC
- 2020 Summary of Benefits & Coverage - TLC
- 2021 Benefit Summary - TLC
- 2020 Benefit Summary - TLC (07-01-20)
- 2020 Benefit Summary - TLC (10-01-20)
- Transition of Care Assessment
- Vision Summary of Benefits
- Out of Area (OOA) Dependent Form - TLC
- Evidence of Coverage (EOC) Sample - TLC
1 Sentara Health Plans, Inc., Provider Status Report, 2020, available at optimahealth.com/find-doctors-drugs-and-facilities