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  3. Optima Medicare
  4. Documents and Forms for Medicare Plans

Documents and Forms for Medicare Plans

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We found the following documents that match your search:

Benefits and Coverage

  • 2022 Optima Medicare Prime (HMO) - Annual Notice of Changes PDF, 724 KB Last Updated: 10/1/2021
  • 2022 Optima Medicare Prime (HMO) - Annual Notice of ChangesPDF, 732 KB Last Updated: 10/1/2021
  • 2022 Optima Medicare Value (HMO) - Annual Notice of ChangesPDF, 655 KB Last Updated: 10/1/2021
  • 2022 Optima Medicare Value (HMO) - Annual Notice of ChangesPDF, 438 KB Last Updated: 10/13/2021
  • 2022 Optima Medicare Salute (HMO) - Annual Notice of ChangesPDF, 678 KB Last Updated: 10/1/2021
  • 2022 Optima Medicare Prime (HMO) - Annual Notice of ChangesPDF, 717 KB Last Updated: 10/1/2021
  • 2022 Optima Medicare Value (HMO) - Annual Notice of ChangesPDF, 525 KB Last Updated: 10/13/2021
  • 2022 Optima Medicare Prime (HMO) - Annual Notice of ChangesPDF, 706 KB Last Updated: 10/1/2021
  • 2022 Optima Medicare Value (HMO) - Annual Notice of ChangesPDF, 725 KB Last Updated: 10/1/2021
  • 2022 Optima Community Complete (HMO D-SNP) - Annual Notice of ChangesPDF, 731 KB Last Updated: 10/1/2021
  • 2022 Optima Medicare Prime (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/13/2021
  • 2022 Optima Medicare Prime (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/13/2021
  • 2022 Optima Medicare Prime (HMO) - Evidence of CoveragePDF, 3 MB Last Updated: 10/13/2021
  • 2022 Optima Medicare Prime (HMO) - Evidence of CoveragePDF, 3 MB Last Updated: 10/13/2021
  • 2022 Optima Medicare Value (HMO) - Evidence of CoveragePDF, 3 MB Last Updated: 10/13/2021
  • 2022 Optima Medicare Value (HMO) - Evidence of CoveragePDF, 3 MB Last Updated: 10/13/2021
  • 2022 Optima Medicare Value (HMO) - Evidence of CoveragePDF, 3 MB Last Updated: 10/13/2021
  • 2022 Optima Medicare Value (HMO) - Evidence of CoveragePDF, 3 MB Last Updated: 10/13/2021
  • 2022 Optima Medicare Salute (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/19/2021
  • 2022 Optima Medicare Value (HMO) - Evidence of CoveragePDF, 3 MB Last Updated: 10/13/2021
  • 2022 Optima Medicare Value (HMO) - Evidence of CoveragePDF, 3 MB Last Updated: 10/13/2021
  • 2022 Optima Community Complete (HMO D-SNP) - Evidence of CoveragePDF, 3 MB Last Updated: 10/1/2021
  • 2022 Optima Medicare Prime/Value (HMO) - Summary of BenefitsPDF, 1 MB Last Updated: 10/1/2021
  • 2022 Optima Medicare Prime/Value (HMO) - Summary of BenefitsPDF, 1 MB Last Updated: 10/1/2021
  • 2022 Optima Medicare Prime/Value (HMO) - Summary of BenefitsPDF, 1 MB Last Updated: 10/1/2021
  • 2022 Optima Medicare Prime/Value (HMO) - Summary of BenefitsPDF, 1 MB Last Updated: 10/1/2021
  • 2022 Optima Medicare Value (HMO) - Summary of BenefitsPDF, 1 MB Last Updated: 10/1/2021
  • 2022 Optima Medicare Value (HMO) - Summary of BenefitsPDF, 1 MB Last Updated: 10/1/2021
  • 2022 Optima Medicare Salute (HMO) - Summary of BenefitsPDF, 1 MB Last Updated: 10/1/2021
  • 2022 Optima Community Complete (HMO D-SNP) - Summary of BenefitsPDF, 1 MB Last Updated: 10/1/2021
  • 2022 Optima Medicare (HMO) - Extra Help Plan PremiumPDF, 37 KB Last Updated: 10/1/2021
  • 2023 Optima Medicare Prime (HMO) - Annual Notice of Changes PDF, 694 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Prime (HMO) - Annual Notice of ChangesPDF, 695 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Value (HMO) - Annual Notice of ChangesPDF, 708 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Value (HMO) - Annual Notice of ChangesPDF, 702 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Value (HMO) - Annual Notice of Changes PDF, 678 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Value (HMO) - Annual Notice of ChangesPDF, 675 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Salute (HMO) - Annual Notice of ChangesPDF, 637 KB Last Updated: 10/1/2022
  • 2023 Optima Community Complete (HMO D-SNP) - Annual Notice of ChangesPDF, 670 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Prime (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/15/2022
  • 2023 Optima Medicare Prime (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/15/2022
  • 2023 Optima Medicare Value (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/15/2022
  • 2023 Optima Medicare Value (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/15/2022
  • 2023 Optima Medicare Value (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/15/2022
  • 2023 Optima Medicare Value (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/15/2022
  • 2023 Optima Medicare Value (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/15/2022
  • 2023 Optima Medicare Value (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/15/2022
  • 2023 Optima Medicare Savings (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/15/2022
  • 2023 Optima Medicare Salute (HMO) - Evidence of CoveragePDF, 2 MB Last Updated: 10/15/2022
  • 2023 Optima Medicare Engage - Diabetes and Heart (HMO C-SNP) - Evidence of CoveragePDF, 2 MB Last Updated: 10/15/2022
  • 2023 Optima Community Complete (HMO D-SNP) - Evidence of CoveragePDF, 3 MB Last Updated: 10/15/2022
  • 2023 Optima Medicare Prime/Value (HMO) - Summary of BenefitsPDF, 1017 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Prime/Value (HMO) - Summary of BenefitsPDF, 1017 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Prime/Value (HMO) - Summary of BenefitsPDF, 1008 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Value (HMO) - Summary of BenefitsPDF, 1006 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Value (HMO) - Summary of BenefitsPDF, 1005 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Value (HMO) - Summary of BenefitsPDF, 1004 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Value (HMO) - Summary of BenefitsPDF, 1004 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Value (HMO) - Summary of BenefitsPDF, 1004 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Value (HMO) - Summary of BenefitsPDF, 1004 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Value (HMO) - Summary of Benefits (Vietnamese)PDF, 2 MB Last Updated: 11/11/2022
  • 2023 Optima Medicare Value (HMO) - Summary of Benefits (Spanish)PDF, 2 MB Last Updated: 11/11/2022
  • 2023 Optima Medicare Savings (HMO) - Summary of BenefitsPDF, 945 KB Last Updated: 10/1/2022
  • 2023 Optima Medicare Salute (HMO) - Summary of BenefitsPDF, 1 MB Last Updated: 10/1/2022
  • 2023 Optima Medicare Engage - Diabetes and Heart (HMO C-SNP) - Summary of BenefitsPDF, 1007 KB Last Updated: 10/1/2022
  • 2023 Optima Community Complete (HMO D-SNP) - Summary of BenefitsPDF, 969 KB Last Updated: 10/1/2022
  • 2023 Optima Community Complete (HMO D-SNP) - Summary of Benefits (Spanish)PDF, 2 MB Last Updated: 11/11/2022
  • 2023 Optima Community Complete (HMO D-SNP) - Summary of Benefits (Vietnamese)PDF, 2 MB Last Updated: 11/11/2022
  • 2023 Optima Medicare (HMO) - Extra Help Plan PremiumPDF, 50 KB Last Updated: 10/14/2022

Provider Directories

  • 2022 Optima Medicare (HMO) - Printable Provider and Pharmacy DirectoryPDF Last Updated: 2/22/2023This link will open a new browser tab or window. This link will open a new browser tab or window.
  • 2022 Optima Community Complete (HMO D-SNP) - Printable Provider and Pharmacy DirectoryPDF Last Updated: 2/22/2023This link will open a new browser tab or window. This link will open a new browser tab or window.
  • 2022 Optima Community Complete (HMO D-SNP) - Printable Provider and Pharmacy Directory (Large Print)PDF Last Updated: 2/22/2023This link will open a new browser tab or window. This link will open a new browser tab or window.
  • 2022 Optima Medicare (HMO) - Provider Directory SearchThis link will open a new browser tab or window. This link will open a new browser tab or window.
  • 2022 Optima Community Complete (HMO D-SNP) - Provider Directory SearchThis link will open a new browser tab or window. This link will open a new browser tab or window.
  • Find a Dentist This link will open a new browser tab or window.
  • 2023 Optima Medicare HMO Provider Directory SearchThis link will open a new browser tab or window and takes you to a website that is not owned or operated by Optima Health. This link will open a new browser tab or window.
  • 2023 Optima Medicare Engage - Diabetes and Heart (HMO C-SNP) Provider Directory SearchThis link will open a new browser tab or window and takes you to a website that is not owned or operated by Optima Health. This link will open a new browser tab or window.
  • 2023 Optima Community Complete (HMO D-SNP) Provider Directory SearchThis link will open a new browser tab or window and takes you to a website that is not owned or operated by Optima Health. This link will open a new browser tab or window.
  • 2023 Optima Medicare (HMO) - Printable Provider and Pharmacy DirectoryPDF Last Updated: 2/22/2023This link will open a new browser tab or window. This link will open a new browser tab or window.
  • 2023 Optima Medicare Salute (HMO) - Printable Provider DirectoryPDF Last Updated: 2/22/2023This link will open a new browser tab or window. This link will open a new browser tab or window.
  • 2023 Optima Community Complete (HMO D-SNP) - Printable Provider and Pharmacy DirectoryPDF Last Updated: 2/22/2023This link will open a new browser tab or window. This link will open a new browser tab or window.
  • Find a Dentist This link will open a new browser tab or window.

Prescription Drugs

  • 2022 Optima Medicare (HMO) - Printable FormularyPDF, 2 MB Last Updated: 12/1/2022
  • 2022 Optima Medicare HMO Formulario Completo (En Español)PDF, 2 MB Last Updated: 12/1/2022
  • 2022 Optima Community Complete (HMO D-SNP) - Printable FormularyPDF, 2 MB Last Updated: 12/1/2022
  • Other Pharmacy Documents
  • Note: Prescription drug coverage is not provided under Optima Medicare Salute (HMO) plans.
  • 2022 Optima Medicare (HMO) - Printable FormularyPDF, 2 MB Last Updated: 2/1/2023
  • 2023 Optima Community Complete (HMO D-SNP) - Printable FormularyPDF, 2 MB Last Updated: 2/1/2023
  • Other Pharmacy Documents
  • Note: Prescription drug coverage is not provided under Optima Medicare Salute (HMO) plans.

Over-the-Counter Product Allowance

  • 2022 Optima Community Complete (HMO D-SNP) - Enroll By Mail
  • 2022 Optima Medicare Value/Prime (HMO) - Hampton Roads Southside - Enroll By Mail
  • 2022 Optima Medicare Value/Prime (HMO) - Hampton Roads Peninsula - Enroll By Mail
  • 2022 Optima Medicare Value/Prime (HMO) - Central/Halifax - Enroll By Mail
  • 2022 Optima Medicare Value/Prime (HMO) - Northern Virginia - Enroll By Mail
  • 2022 Optima Medicare Value (HMO) - Roanoke/Alleghany - Enroll By Mail
  • 2022 Optima Medicare Value (HMO) - Southwest - Enroll By Mail
  • 2022 Optima Medicare Salute (HMO) - Enroll By Mail
  • 2022 Optima Medicare (HMO) - Request a Change in Coverage

Other Documents

  • Star RatingsPDF, 81 KB Last Updated: 10/21/2022
  • Register an Advance Care PlanPDF, 368 KB Last Updated: 12/11/2019
  • My Advance Care Planning GuidePDF, 2 MB Last Updated: 12/11/2019
  • Designated Representative Authorization FormPDF, 149 KB Last Updated: 5/10/2022
  • Formulario para la autorizacion de un representante designadoPDF, 238 KB Last Updated: 5/10/2022

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© Optima Health 2023, PO Box 66189, Virginia Beach, Virginia 23466

Sentara Health Plans and Optima Health are trade names of Sentara Health Plans, Sentara Health Insurance Company, Sentara Health Administration, Inc., and Sentara Behavioral Health Services, Inc. Optima Health Insurance Company is an additional trade name for Sentara Health Insurance Company. Virginia Premier Health Plan is an additional trade name for Sentara Health Plans. Optima Behavioral Health is an additional trade name for Sentara Behavioral Health Services, Inc. Optima Health Maintenance Organization (HMO) products, and Point-of-Service (POS) products, are issued and underwritten by Sentara Health Plans. Optima Preferred Provider Organization (PPO) products are issued and underwritten by Sentara Health Insurance Company. Sentara Health Administration, Inc. provides administrative services to group and individual health plans but does not underwrite benefits. All Optima Health plans have benefit exclusions and limitations and terms under which the policy may be continued in force or discontinued. Medicare products are administered under an agreement with Sentara Health Plans and the Centers for Medicare and Medicaid Services (CMS.) Medicaid and FAMIS products are administered under an agreement with Sentara Health Plans and the Virginia Department of Medical Assistance Services (DMAS.)