Benefits and Forms

The documents and information below are for use by Optima Community Complete (HMO SNP) members. Please select the documents for the year in which you are currently enrolled.

Benefit Information

Complaints, Coverage Decisions, and Appeals

If you are a member of Optima Community Complete (HMO SNP) and you have a concern about your health plan, the quality of your care or your coverage for certain services, you may follow an established process to resolve your concern. You cannot be disenrolled from our plan or penalized in any way if you make a complaint, request a coverage decision, or file an appeal.

Who to Contact

Information about the number of Appeals, Grievances & Exceptions filed with Optima Community Complete:

Optima Community Complete
Appeals Department
P.O. Box 62876
Virginia Beach, VA 23466-2876
Fax: 757-687-6232 or Toll-free Fax: 1-866-472-3920
TTY: VA Relay Service 1-800-828-1140 or 711

Other Documents and Forms

Forms for a member to give another person the right to have access to his/her confidential protected health information from Optima Medicare and information on disenrollment.


1 Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change from one year to the next.