2019 OptimaFit® Plan Highlights

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


Direct and Select At-A-Glance Comparison

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Direct Plan

Choose local, choose Optima Health Direct Plans

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

Coverage Area Highlights

Available both ON and OFF the Health Insurance Marketplace in:

  • Charlottesville
  • Halifax
  • Hampton Roads
  • Harrisonburg
  • Mecklenburg
  • Rockingham

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Spending Account Options

  • Health Savings Account (HSA)

In-Network Coverage

  • Tier 1: All participating doctors and facilities except those in Tier 2
  • Tier 2: Virginia Commonwealth University and Mary Washington Healthcare

View Direct Plan Provider Directory

Out-of-Network Coverage

  • Emergency Care Only.

Features and Benefits

  • Wide range of Gold, Silver, and Bronze level plans
  • Health Savings Accounts (HSAs)
  • Generous discounts on health and wellness services2
  • Comprehensive Health Management Programs
  • Emergency Travel Assistance2
  • Free preventive care services when received from an in-network doctor or facility3.
  • Video Visits with MDLIVE®
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Select Plan

Clinically integrated network for you and your family

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

Coverage Area Highlights

Available both ON and OFF the Health Insurance Marketplace in:

  • Charlottesville
  • Rockingham areas

Check my Zip Code

Spending Account Options

  • Health Savings Account (HSA)

In-Network Coverage

  • Sentara Quality Care Network (SQCN) and Sentara Healthcare statewide
  • Virginia Commonwealth University
  • Riverside Health System
  • All participating oral surgeons
  • Children’s Hospital of the King’s Daughters
  • Tidewater Physicians Multispecialty Group
  • Eastern Virginia Medical School
  • Other physician groups in Virginia

View Select Plan Provider Directory

Most doctors and facilities in UVA Health System network are not in the Select network.

Out-of-Network Coverage

  • Emergency Care Only.

Features and Benefits

  • Wide range of Gold, Silver, and Bronze level plans
  • Health Savings Accounts (HSAs)
  • Generous discounts on health and wellness services2
  • Comprehensive Health Management Programs
  • Emergency Travel Assistance2
  • Free preventive care services when received from an in-network doctor or facility3.
  • Video Visits with MDLIVE®

1Sentara Health Plans, Inc. Provider Database, 2018

2 Value-Added services; not a covered benefit

3 Office Visit copayment or coinsurance may apply


Frequently Asked Questions

Have questions? Review our Frequently Asked Questions for more details.

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Direct Plans

  • What is OptimaFit® Direct?

    OptimaFit Direct health insurance plans include the full Optima Health network of over 26,0001 doctors and facilities, in a two-tier structure. Members can maximize cost savings when you use a Tier 1 doctor or facility.

  • Who can buy an OptimaFit Direct plan?

    OptimaFit Direct is available to individuals and families throughout the Optima Health Individual Product service area, within the Commonwealth of Virginia.

  • Do OptimaFit Direct plans have different benefits from other Optima Health plans?

    No. All OptimaFit Direct plans provide coverage for the same benefits as other Optima Health plans. OptimaFit Direct plans are offered in a variety of plan designs to meet everyone’s needs and budget. You can view plan options at healthcare.gov or optimahealth.com/individual.

  • Will I lose access to any doctors or facilities when I enroll in an OptimaFit Direct plan?

    No. All OptimaFit Direct plans provide access to our full network of over 26,000 doctors and facilities. OptimaFit Direct enables members to be more actively involved in the cost of your healthcare. You can save money on out-of-pocket costs by seeking care from a Tier 1 provider.

  • Which doctors are in which tier?

    The OptimaFit Direct network is structured as follows:

    • Tier 1: All Optima Health participating providers except those listed in Tier 2
    • Tier 2: Virginia Commonwealth University and Mary Washington Healthcare doctors and facilities

    To find out which tier applies to a specific doctor, specialist, or facility, members should always use the Find a Doc tool on optimahealth.com or call Member Services at the number on the back of your member ID card before using services.

    Members can also sign in to optimahealth.com/members and use the Treatment Cost Calculator to look up estimated costs for procedures, by doctor and facility.

  • Are all OptimaFit Direct benefits and services tiered?

    No. Please refer to your plan Summary of Benefits for detailed benefit information.

  • How will doctors know that I use the OptimaFit Direct network?

    The plan name and network will be clearly marked on the front of your member ID card. When you visit a doctor or hospital for services, you should always present your member ID card.

  • What happens in an emergency situation?

    Emergency room, ambulance, and urgent care are not tiered benefits—you will pay the cost share as outlined in your Summary of Benefits. If you receive emergency room services from an out-of-network doctor or facility, you will be charged the in-network cost-share amount.

  • What happens if the care or services I need is only available from a Tier 2 doctor or hospital?

    Members will pay the Tier 2 cost share when you receive care from a Tier 2 doctor or hospital.

  • Who can I contact if I have questions about my plan?

    Members may call Member Services at the number listed on the back of your member ID card for any questions about plan benefits or if you need additional information.


Select Plans

  • What is OptimaFit® Select?

    OptimaFit Select network plans are a lower-cost alternative that utilize local doctors and facilities within key clinically integrated networks, to provide members high-quality and efficient care.

    A clinically integrated network is a physician-led collaborative of doctors, specialists, and facilities that join together to increase the quality and coordination of care at a more affordable cost.

  • Who can buy an OptimaFit Select plan?

    OptimaFit Select network plans provide a lower-cost health insurance solution for individuals who get services from a regionalized group of doctors and facilities.

    OptimaFit Select plans are available to Individual & Family plan members in the Charlottesville and Rockingham areas of Virginia.

  • Do OptimaFit Select plans have different benefits from other Optima Health plans?

    No. All OptimaFit Select plans provide coverage for the same benefits as other Optima Health plans. OptimaFit Select plans are offered in a variety of plan designs to meet everyone’s needs and budget. You can view plan options in your area at healthcare.gov or optimahealth.com/individual.

  • How will doctors know that my plan uses the OptimaSelect network?

    The plan name and network will be clearly marked on the front of your member ID card. When you visit a doctor or hospital for services, you should always present your member ID card.

  • Can I still see my current primary care physician (PCP) if I get an OptimaFit Select plan?

    Members should use the Find a Doc tool on optimahealth.com or call Member Services at the number on the back of your member ID card to find out if your current—or preferred—PCP is in the OptimaFit Select network. If they are not part of the Select network, then services will not be covered if you choose to see an out-of-network physician.

  • Which doctors are in the OptimaFit Select network1?

    The OptimaFit Select network consists of doctors and facilities from:

    • Sentara Quality Care Network (SQCN) and Sentara Healthcare statewide
    • Virginia Commonwealth University
    • Riverside Health System
    • All participating oral surgeons
    • Children’s Hospital of the King’s Daughters
    • Tidewater Physicians Multispecialty Group
    • Eastern Virginia Medical School
    • Other physician groups in Virginia

    To find out if a specific doctor, specialist, or facility is in the OptimaFit Select network, you should always use the Find a Doc tool on optimahealth.com or call Member Services at the number on the back of your member ID card before using services.

    Members can also sign in to optimahealth.com/members and use the Treatment Cost Calculator to look up estimated costs for procedures, by doctor and facility.

  • What happens in an emergency situation?

    In an emergency situation, members will pay the in-network cost share as outlined in your plan Summary of Benefits, for ambulance services and emergency care from both participating and nonparticipating doctors and facilities.

  • Who can I contact if I have questions about my plan?

    Members may call Member Services at the number listed on the back of your member ID card for any questions about plan benefits or if you need additional information.


Find out your coverage

Plan Coverage Area For Select And Direct Plan

Optima Health is offering Select and Direct plans for more Virgnia Regions, however plan availability varies depending on your geographic location. Find out more about Direct and Select plan coverage areas. 

Learn About Plan Coverage Area
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Subsidy chart thumbnail displaying scale of subsidy discount

Subsidy Eligibility

Discover which subsidy you and your family are eligible for based on your income bracket. 

View Subsidy Chart
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Health and Wellness

OptimaFit plans include a wide array of wellness, programs, discounts and educational information.

Find Out More About Health And Wellness