Added Benefits for Medicaid

We provide our members with access to extra benefits and services not generally covered through Medicaid. These are known as “added benefits.” We provide the following added benefits:

2020 Added Benefits

Expand All

  • Adult Dental

    One oral dental exam, one cleaning, and one set of X-rays each year. The benefit is limited to in-network providers only.

    Qualifying Members: All eligible members age 21 and older. Excludes FAMIS.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: No

    Approval: No Care Coordinator involvement required. Member directed.

    Contact: DentaQuest at 844-824-2016 or https://www.dentaquest.com

  • Smiles for Children (standard dental benefit)

    Optima Health Community Care members 20 years old and younger, and Optima Family Care members 21 years old and younger receive comprehensive dental service.

    Pregnant women age 21 and older enrolled in Medicaid or FAMIS MOMs receive comprehensive dental services. Excludes orthodontics.

    Adults 21 years and older are limited to extractions and the exam.

    Please make sure your dentist participates in the Smiles for Children program.

    Qualifying Members:

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: Yes

    Approval: No Care Coordinator involvement required. Member directed.

    Contact: Call 888-912-3456 for more information.

  • Adult Literacy Program: The HEAL Program® sponsored by Optima Health Read. Learn. Grow.℠

    This adult health literacy program teaching members how to take control of their health through seven 90-minute classes about topics such as healthy eating, talking to the doctor, prescriptions, emergencies, and more.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: Yes

    Approval: Coordinated through Outreach.

  • Adult Vision

    Discounts on frames, lenses, and contacts. The benefit is limited to in-network providers only.

    Qualifying Members: All eligible members age 21 and older. Excludes FAMIS.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: No

    Approval: No Care Coordinator involvement required. Member directed.

    Contact: EyeMed at 888-610-2268 or https://eyemed.com/en-us

  • Assistive Devices

    Assistive devices help you with certain tasks like putting on socks and shoes, or reaching items safely. Members receive up to $200 lifetime benefit for non-medical devices. Common devices include mechanical extended grabbers, extended shoehorns, and flexible sock aids. Members must use an approved network.

    Qualifying Members: All eligible members with a demonstrated need who are unable to do certain tasks.

    • Optima Family Care: No
    • Optima Family Care – Medicaid XP: No
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: No

    Approval: Authorization required. Care Coordinator will manage.

  • Cell Phones

    Receive a free smartphone through the federal Lifeline program. It includes 350 minutes per month, 1 GB of data, free unlimited texting, and free calls to member services and the Care Coordination line. Eligibility must be approved.

    Qualifying Members: All eligible member households.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: Yes

    Approval: Members can check eligibility on the Lifeline website. Members have to be with the plan for 60 days before switching plans.

    Contact: https://www.lifelinesupport.org/Is/default.aspx

  • Diabetic Foot Care

    This benefit includes routine foot care visits, and one pair of therapeutic shoes or two shoe inserts per year up to $150 annually. Members must use an approved network.

    Qualifying Members: All eligible members.

    • Optima Family Care: No
    • Optima Family Care – Medicaid XP: No
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: No

    Approval: Authorization required. Care Coordinator will manage.

  • Diabetes Prevention

    Members most at risk for developing diabetes are invited into a special program. It features health coaching and a weight loss program.

    Qualifying Members: Eligible pre-diabetic members. The invitation is based on claims history.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: No
    • Optima Health Community Care – Medicaid XP: No
    • FAMIS: No

    Approval: No Care Coordinator.

  • GED Voucher Program sponsored by Optima Health Read. Learn. Grow.℠

    Members may receive up to $275 for the GED testing voucher and online prep program.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: Yes

    Approval: Coordinated through Outreach.

  • Healthy Member Incentives

    Certain members may earn up to $50 in gift cards for going to the doctor and getting their vaccines. Pregnant women earn them for their prenatal visit and postpartum follow-up. Children and pre-teens earn them for certain vaccines and their well-child or well-adolescent checkup. Foster care children who have a dental visit and see their doctor may earn a gift card. A gift card is also the reward for a diabetic eye exam.

    Qualifying Members: Eligible members.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes, except prenatal and postpartum follow-up.
    • Optima Health Community Care – Medicaid XP: Yes, except prenatal and postpartum follow-up.
    • FAMIS: Yes

    Approval: Outreach and Quality Improvement will manage. View program details.

  • Healthy Moms: Partners in Pregnancy

    The Partners in Pregnancy program expanded to include a Parenting Magazine voucher, baby showers, free breastfeeding classes, and a breast pump.

    Qualifying Members: Pregnant women.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: Yes

    Approval: Outreach and Partners in Pregnancy will manage.

  • Healthy Savings Program

    This benefit helps make it easy to save on healthy food and making healthy food choices when shopping groceries at participating stores. Learn about Healthy Savings.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: No
    • Optima Health Community Care – Medicaid XP: No
    • FAMIS: Yes

    Approval: Coordinated through Outreach.

  • Home Delivered Meals

    Members may receive up to two meals a day for up to seven days. Must use approved network.

    Qualifying Members: All eligible members older than 21 years of age, post-discharge from inpatient stay or transitioning from a nursing home to the community.

    • Optima Family Care: No
    • Optima Family Care – Medicaid XP: No
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: No

    Approval: Authorization required. Care Coordinator will manage. Service limits.

  • Memory Alarms and Devices

    This benefit provides additional home security devices such as door or window alarms, memory devices, bed alarms, chimes, and devices similar to baby monitors. Members must use approved network.

    Qualifying Members: All eligible members diagnosed with dementia or Alzheimer's disease.

    • Optima Family Care: No
    • Optima Family Care – Medicaid XP: No
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: No

    Approval: Authorization required. Care Coordinator will manage.

  • Reading Program for Children through Optima Health Read. Learn. Grow.℠

    Child reading and language program through Puppet Shows.

    Qualifying Members: 0 to 13 years old.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: Yes

    Approval: Coordinated through Outreach.

  • Telehealth Services through MDLIVE®

    Members have access to virtual visits through MDLIVE. It offers 24-hour doctor access from a computer, mobile device, or landline, including weekends and holidays. Members may use a virtual visit for medical and mental health needs. The board certified doctors and licensed therapists can help with non-life threatening health questions and other medical needs including prescriptions. Learn more about MDLIVE.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: Yes

    Approval: No Care Coordinator involvement required.

    Contact: Members can download the Optima Health mobile app, call 888-469-9198 or sign in to optimahealth.com to get started.

  • Transportation Services: Non-Medical

    Members may have up to three round trip rides every three months to places like community events, grocery stores, and more.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: Yes

    Approval: No Care Coordinator involvement required.

    Contact: Southeastrans, Inc. 

    • Optima Family Care: 877-892-3986
    • Optima Health Community Care: 855-325-7558
  • Wellness Programs: Smoking Cessation

    The free program helps members quit smoking or using tobacco. It includes tips, guides, audio programs, and resources. Smoking Cessation is also covered as a medical benefit. Online only.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: Yes

    Approval: No Care Coordinator involvement required.

    Contact: View program details

  • Wellness Programs: Weight Management

    The Eating for Life program materials can assist members with improving their current eating and exercise habits. Online only.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Family Care – Medicaid XP: Yes
    • Optima Health Community Care: Yes
    • Optima Health Community Care – Medicaid XP: Yes
    • FAMIS: Yes

    Approval: No Care Coordinator involvement required.

    Contact: View program details


2021 Added Benefits

Expand All

  • Adult Dental

    Two oral dental exams, cleaning, and one set of X-rays each year. The benefit is limited to in-network providers only.

    Qualifying Members: All eligible members age 21 and older.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: Yes

    Approval: No Care Coordinator involvement required. Member directed.

    Contact: DentaQuest at 844-824-2016 or https://www.dentaquest.com

  • Smiles for Children (standard dental benefit)

    Optima Health Community Care members 20 years old and younger, and Optima Family Care members 21 years old and younger receive comprehensive dental service.

    Pregnant women age 21 and older enrolled in Medicaid or FAMIS MOMs receive comprehensive dental services. Excludes orthodontics.

    Adults 21 years and older are limited to extractions and the exam.

    Please make sure your dentist participates in the Smiles for Children program.

    Qualifying Members:

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: No

    Approval: No Care Coordinator involvement required. Member directed.

    Contact: Call 888-912-3456 for more information.

  • Adult Literacy Program: The HEAL Program® sponsored by Optima Health Read. Learn. Grow.℠

    This adult health literacy program teaching members how to take control of their health through seven 90-minute classes about topics such as healthy eating, talking to the doctor, prescriptions, emergencies, and more.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: Yes

    Approval: Coordinated through Outreach.

  • Adult Vision

    One eye exam and $100 frames each year. The benefit is limited to in-network providers only.

    Qualifying Members: All eligible members age 21 and older.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: Yes

    Approval: No Care Coordinator involvement required. Member directed.

    Contact: EyeMed at 888-610-2268 or https://eyemed.com/en-us

  • Cell Phones

    Receive a free smartphone with 350 minutes per month, 1 GB of data, and free unlimited texting. Eligibility must be approved.

    Qualifying Members: All eligible member households.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: Yes

    Approval: Members can check for eligibility on the Lifeline website. Members have to be with the plan for 60 days before switching plans.

    Contact: https://www.lifelinesupport.org/Is/default.aspx

  • College Application Assistance sponsored by Optima Health Read. Learn. Grow.℠

    Members may receive up to $75 for college application assistance. Restrictions apply.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: Yes

    Approval: Coordinated through Outreach.

  • Diabetic Foot Care

    This benefit includes routine foot care visits, and one pair of therapeutic shoes or two shoe inserts per year up to $150 annually. Members must use an approved network.

    Qualifying Members: All eligible members.

    • Optima Family Care: No
    • Optima Health Community Care: Yes
    • FAMIS: No

    Approval: Authorization required. Care Coordinator will manage.

  • Diabetes Prevention

    Members most at risk for developing diabetes are invited into a special program. It features health coaching and a weight loss program.

    Qualifying Members: Eligible pre-diabetic members. The invitation is based on claims history.

    • Optima Family Care: Yes
    • Optima Health Community Care: No
    • FAMIS: No

    Approval: No Care Coordinator involvement required.

  • GED Voucher Program sponsored by Optima Health Read. Learn. Grow.℠

    Members may receive up to $275 for the GED testing voucher and online prep program.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: Yes

    Approval: Coordinated through Outreach.

  • Healthy Member Incentives

    Prenatal & postpartum follow-up, well-child and adolescent well-child check-up, childhood and adolescent immunizations, diabetic eye exam, foster care children PCP and dental visits.

    Qualifying Members: Eligible members.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes, except prenatal and postpartum follow-up.
    • FAMIS: Yes

    Approval: Outreach and Quality Improvement will manage.

  • Healthy Moms: Partners in Pregnancy

    The Partners in Pregnancy program expanded to include a Parenting Magazine voucher, baby showers, free breastfeeding classes, and a breast pump.

    Qualifying Members: Pregnant women.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: Yes

    Approval: Outreach and Partners in Pregnancy will manage.

  • Healthy Savings Program

    This benefit helps make it easy to save on healthy food and making healthy food choices when shopping groceries at participating stores. Learn about Healthy Savings.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Health Community Care: No
    • FAMIS: Yes

    Approval: Coordinated through Outreach.

  • Home Delivered Meals

    Up to two meals a day for up to seven days. Must use approved network.

    Qualifying Members: All eligible members older than 21 years of age, post-discharge from a hospital or transitioning from a nursing home to the community.

    • Optima Family Care: No
    • Optima Health Community Care: Yes
    • FAMIS: No

    Approval: Authorization required. Care Coordinator will coordinate. Service limits.

  • Memory Alarms and Devices

    This benefit provides additional home security devices such as door or window alarms, memory devices, bed alarms, chimes, and devices similar to baby monitors. Members must use approved network.

    Qualifying Members: All eligible members diagnosed with dementia or Alzheimer's disease.

    • Optima Family Care: No
    • Optima Health Community Care: Yes
    • FAMIS: No

    Approval: Authorization required. Care Coordinator will manage.

  • Modifications

    Environment, home, and vehicle modifications. Restrictions apply.

    Qualifying Members: All eligible members.

    • Optima Family Care: No
    • Optima Health Community Care: Yes
    • FAMIS: No

    Approval: Authorization required. Care Coordinator will manage.

  • Reading Program for Children through Optima Health Read. Learn. Grow.℠

    Child reading and language program through Puppet Shows.

    Qualifying Members: 0 to 13 years old.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: Yes

    Approval: Coordinated through Outreach.

  • Sports Physicals

    Members receive free sports physicals. The exam helps determine if it is safe for you to participate in certain sports.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Health Community Care: No
    • FAMIS: Yes

    Approval: No Care Coordinator involvement required.

  • Telehealth Services through MDLIVE®

    Members have access to virtual visits through MDLIVE. It offers 24-hour doctor access from a computer, mobile device, or landline, including weekends and holidays. Members may use a virtual visit for medical and mental health needs. The board certified doctors and licensed therapists can help with non-life threatening health questions and other medical needs including prescriptions. Learn more about MDLIVE.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: Yes

    Approval: No Care Coordinator involvement required.

    Contact: Members can download the Optima Health mobile app, call 888-469-9198 or sign in to optimahealth.com to get started.

  • Transportation Services: Non-Medical

    Members may have up to three round trip rides every three months to places like community events, grocery stores, and more.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: Yes

    Approval: No Care Coordinator involvement required.

    Contact: Southeastrans, Inc.

    • Optima Family Care: 877-892-3986
    • Optima Health Community Care: 855-325-7558
  • Wellness Programs: Tobacco Cessation

    The free program helps members quit smoking or using tobacco. It includes tips, guides, audio programs, and resources. Smoking Cessation is also covered as a medical benefit. Online only.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: Yes

    Approval: No Care Coordinator involvement required.

    Contact: View program details

  • Wellness Programs: Weight Management

    The Eating for Life program materials can assist members with improving their current eating and exercise habits. Online only.

    Qualifying Members: All eligible members.

    • Optima Family Care: Yes
    • Optima Health Community Care: Yes
    • FAMIS: Yes

    Approval: No Care Coordinator involvement required.

    Contact: View program details


Open Enrollment


Open enrollment in Optima Family Care is available for Expansion members in all Virginia regions November 1 – December 31, 2020.

Open enrollment in Optima Family Care will be available for Medallion 4.0 Non-Expansion members in the following regions:

  • Roanoke/Alleghany: December 19, 2020 – February 28, 2021
  • Southwest: December 19, 2020 – February 28, 2021

This is your chance to switch to Optima Family Care.

Get Started   Check Eligibility

Optima Family Care