Optima Health Vantage Plan Information
The Optima Health Vantage HMO Plan is a plan choice in the Greater Hampton Roads area 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 30,000 providers. You can find summary of benefits and other supporting benefits documents in the plan documents section.
Key Features
Comprehensive benefits
The Optima Health Vantage 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 copayments when you access care through a physician designated as Tier 1 for the COVA and TLC benefit program.
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
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.
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 32,5001 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, Tidewater Physicians Multispecialty Group and other top-quality providers in the region.
Dedicated Member Services
Our dedicated, Virginia-based Member Services team can help you understand benefits, find the right doctor, and more.
For any further questions, please contact your dedicated Member Services team.
Optima Health Vantage Plan Documents
Commonwealth of Virginia (COVA) Employees:
- Benefits Brochure - COVA
- Dominion National Dental Summary of Benefits
- Evidence of Coverage - COVA
- Emergency Travel Assistance
- Frequently Asked Questions
- MDLIVE ID Card Carrier
- Summary of Benefits - COVA
- 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:
- Benefits Brochure - TLC
- Dominion National Dental Summary of Benefits
- Emergency Travel Assistance
- Frequently Asked Questions
- MDLIVE ID Card Carrier
- Tiered Summary of Benefits - TLC
- Optima Vantage Summary of Benefits - TLC (07/01/20)
- Optima Vantage Summary of Benefits - 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 Database, 2020
2 Provider Network Penetration, January 1, 2020