The Optima Health Community Care Member Handbook will help you understand your Commonwealth Coordinated Care Plus (CCC Plus) benefits and how you can get help from Optima Health Community Care. This handbook is your guide to health services. It explains your health care, behavioral health, prescription drug, and long-term services and supports coverage under the CCC Plus program. It tells you the steps you can take to make your Optima Health Community Care program work for you.
Our provider network includes access to care 24 hours a day, seven days per week and includes hospitals, doctors, specialists, urgent care facilities, nursing facilities, home and community-based service providers, early intervention providers, rehabilitative therapy providers, addiction and recovery treatment services providers, home health and hospice providers, durable medical equipment providers, and other types of providers. Optima Health Community Care provides you with a choice of providers located so that you do not have to travel very far to see them. You can use our online search tool to find a primary care provider or other provider that you may need.
As an Optima Health Community Care member, you will have a dedicated Care Coordinator who can help you to understand your covered services and how to access these services when needed. Your Care Coordinator will also help you to work with your doctor and other health care professionals (such as nurses and physical therapists), to provide a health risk assessment, and develop a care plan that considers your needs and preferences. You will receive a letter from your Care Coordinator right after your effective date. This letter will give your Care Coordinator’s name and information about how to reach them. Your Care Coordinator can:
- Answer questions about your health care
- Provide assistance with appointment scheduling
- Answer questions about getting any of the services you need, for example: behavioral health services, transportation, and long-term services and supports
- Help with arranging transportation to your appointments when necessary
- Answer questions you may have about your daily health care and living needs
A care plan includes the types of health services that are needed and how you will get them. It is based on your health risk assessment. After you and your Care Coordinator complete your health risk assessment, your care team will meet with you to talk about what health and/or long-term services and supports you need and want as well as your goals and preferences. Together, you and your care team will make a personalized care plan, specific to your needs (this is also referred to as a person-centered care plan.) Your care team will work with you to update your care plan when the health services you need or choose change, and at least once per year. You can access your care plan through the Optima Health website when you sign in.
Vision services for Optima Health Community Care members are provided by EyeMed Vision Care. Vision services include diagnostic examination and optometric treatment procedures and services by ophthalmologists, optometrists, and opticians. Eyeglasses for children under age 21 will be covered. Routine refractions (vision tests) will be covered not less than once every 24 months.
To find a participating provider, call EyeMed Vision Care at 1-888-610-2268 or visit EyeMed.com . EyeMed’s hours are 9 a.m. to 8:30 p.m. Monday through Friday, and Saturdays from 9 a.m. to 5 p.m.
Dental Services are covered for members under age 21 through Smiles for Children. Contact Smiles for Children at 1-888-912-3456 or visit Smiles for Children . Cover Virginia also has information about Smiles for Children at coverva.org/programs_smiles.cfm .
Dental services for members age 21 and older are covered through in-network providers only and include:
- One annual oral exam,
- One annual cleaning, and
- One annual bitewing x-ray.
As Optima Health Community Care member, most of your outpatient drugs are covered when a prescription is written by your doctor and when you receive your drugs from a network pharmacy. Optima Health Community Care has a List of Covered Drugs that are selected by Optima Health Community Care with the help of a team of doctors and pharmacists. The Optima Health Community Care List of Covered Drugs also includes all of the drugs on the DMAS Preferred Drug List.
Sometimes prescriptions must be filled at a specialized pharmacy. Specialized pharmacies include pharmacies that supply drugs for home infusion therapy or residents of a long-term care facility, such as a nursing facility.
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Release of Medical Information Form
You should complete this form if you wish to authorize Optima Health to use or disclose your medical information to persons who may or may not directly be involved in making decisions regarding your health care. This authorization will remain in effect until the (a) date you specify; (b) two years from the date signed; or (c) the date you withdraw your permission.
There may be a time when you are unable to make health care decisions for yourself. Before that happens, you have the right to say how you want your care handled if you:
- Fill out a written form to give someone the right to make health care decisions for you if you become unable to make decisions for yourself.
- Give your doctors written instructions about how you want them to handle your health care if you become unable to make decisions for yourself.