Provider Network

As part of a not-for-profit, integrated delivery system, Optima Health has a unique approach to provider contracting.

With more than 26,000 providers and facilities across Virginia, our committed, high-quality network includes the Optima Health statewide networks, PHCS®, MDLIVE®, EyeMed, and American Specialty Health®.

Key clinically integrated networks within the Optima Health provider network offer members the benefit of new models of care from a custom care team, to deliver the right care, in the right place, at the right time.

The percentage of providers with a favorable impression of Optima Health is 93%.
— Optima Health Customer Service Monthly Report Cards, May 2018.

Search for doctors, drugs and facilities within our network to see the options you get when you choose Optima Health.

OptimaDirect® and OptimaSelect® Networks

Our new network designs offer lower cost options that allow you to choose what works best for your employees and your budget

Direct network plans include the full network of over 26,0001 doctors and facilities, in a two-tier structure to maximize cost savings. Members can save money when they get services from a Tier 1 doctor or facility.

Select network plans utilize local doctors and facilities within key clinically integrated networks, to provide high-quality and efficient care. Members can save more if they get services from a regionalized group of doctors and facilities.

Select and Direct At–A–Glance Comparison Chart

OptimaDirect OptimaSelect
Who can buy
  • Core product offering for Small Group
  • Option for Mid-Market and Large Groups
  • Option for all employer groups
Where plans are available
  • Entire Optima Health service area
  • Charlottesville area only
Product Lines available
  • HMO
  • POS
  • PPO (Small Group only)
  • HMO only
Spending Account Options2
  • Health Savings Account (HSA)
  • Health Reimbursement Account (HRA)
  • Health Savings Account (HSA)
  • Health Reimbursement Account (HRA)
In–Network Coverage
  • Tier 1: All participating doctors and facilities except those in Tier 2
  • Tier 2: University of Virginia Health System and Mary Washington Healthcare
  • Sentara Quality Care Network (SQCN) and Sentara Healthcare statewide
  • Children’s Hospital of the King’s Daughters
  • Tidewater Physicians Multispecialty Group
  • Eastern Virginia Medical School
  • All participating oral surgeons
  • Other physician groups in Virginia
Out–of–Network Coverage
  • POS and PPO plans
  • Emergency care only for HMO plans
  • Emergency care only
Features and Benefits
  • All 10 Essential Health Benefits
  • Wide range of Gold, Silver, and Bronze level plans
  • Generous discounts on health and wellness services3
  • Comprehensive Health Management Programs
  • Emergency Travel Assistance4
  • Free preventive care services when received from an in-network doctor or facility4
  • Video Visits with MDLIVE®
  • All 10 Essential Health Benefits
  • Wide range of Gold, Silver, and Bronze level plans
  • Generous discounts on health and wellness services3
  • Comprehensive Health Management Programs
  • Emergency Travel Assistance4
  • Free preventive care services when received from an in-network doctor or facility4
  • Video Visits with MDLIVE®

The Service Area

2019 Select and Direct Network Map - Individual & Family Plans
Download a printable PDF version of this map

More Information

For more information, get detailed plan information from a local broker.

If you are already an Optima Health member, please contact your broker or Optima Health representative for more information.

1 Sentara Health Plans, Inc. Provider Database, 2018
2 May only be available in certain Product Lines, depending on group size
3 Value-Added services; not a covered benefit
4 Office Visit copayment or coinsurance may apply

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