OptimaDirect is an exciting product that features a Tiered Network of doctors and providers. You select the level of care and cost that is right for you at the time of service.
How Does the OptimaDirect Tiered Network work?
OptimaDirect has grouped doctors into Tiers based on their location, specialty, and other factors.
Tier 1 - $
In-network options for care, at the lowest out of pocket costs.
Tier 2 - $$
Additional In-network options for care with higher out of pocket costs.
Tier 3 - $$$
Any other doctor or facility is considered Out-of-Network, and only available on a POS plan. (OptimaDirect POS plans may be available to members who have coverage through their employer.)
How Do I Know What Tier A Doctor Is In?
You will be able to search for OptimaDirect providers using the Find a Doctor feature on our website or our mobile app, MyOptima (download the flyer below for detailed information). Additionally, your Tiered cost share will display when using our Treatment Cost Calculator tool, ensuring you get accurate cost estimates for your services.
Do The Doctors Know What Tier They Are In?
Doctors within the Optima Health network have been educated about this product and should know what Tier they are in. Your member ID card will clearly identify your plan name as OptimaDirect.
It is important to note that your OptimaDirect member ID card will NOT have the cost share information for all Tiers. The Tier 1 Copayment and Coinsurance information will display on the card. Your plan documents, available online, will have more detailed information including your cost share for Tier 2 and any applicable out-of-network benefits.
Why Is OptimaDirect Only In The Richmond Area?
Optima Direct is available to Richmond Metropolitan Statistical Area (MSA) residents due to the large variety of medical providers in your area. This allows OptimaDirect members options for your best care, where you have a say in what you pay.
Coverage area includes the following cities and counties: Amelia, Caroline, Charles City, Chesterfield, Colonial Heights, Cumberland,
- Prospective members for an Individual & Family plan: please contact your broker or our sales team at 1-800-741-4825.
- Prospective members for an employer group plan: please contact your Benefits Administrator.
- Members: please contact Member Services at the phone number on the back of your member ID card.
- Providers: please contact your Network Educator or visit www.optimahealth.com/providers.