Optima Health: List Of Insurance Services And Healthcare Plans

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For many, the healthcare insurance industry is a confusing and often unnavigable system. With a complex range of competing plans, differing levels of coverage, and complicated, uneven balances between premiums and out-of-pocket costs, consumers aren’t sure what to buy. But what if there was a health insurance services company that offered robust flexibility, added benefits, and a variety of plans to suit your every need? 

What Is Optima Health?

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Optima Health is an insurance provider that currently serves approximately 450,000 members. Based out of Virginia Beach, VA, Optima Health is a service of Sentara, an integrated healthcare system providing healthcare services throughout the country. The company, which seeks to improve health every day by being the health plan of choice in the communities they serve, offers a multitude of health plan coverage products. The services they offer include Individual and family health plans, employee assistance plans, as well as plans that accommodate Medicare and Medicaid.

Why Use Optima Health?

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With over 40 plans for a variety of enrollees including individuals, families, employers, employees, small businesses, Medicare and Medicaid recipients and families, Optima Health has a variety of plans for every type of health care plan beneficiary. By offering an array of health plans, Optima Health provides flexibility in health care coverage with the ability to meet a multitude of different health care needs, all while offering added benefits. Through cost-effective, comprehensive insurance, Optima Health Insurance Services works to meet the needs of every member and to help them pursue their best and healthiest living.

Optima Health Insurance Services

Optima Health Insurance Services offers a variety of healthcare plans for consumers. Plans offered by Optima Health include:

  • Individual & Family Plans
  • Employer Plans
  • Medicare Plans
  • Medicaid Plans
  • Employee Assistance Program

Individual & Family Plans

Optima Health offers three different plans within their Individual & Family Plans product line, also known as OptimaFit. The health plans come in bronze, silver, and gold. They cover a range between lower premiums and higher out-of-pocket costs to higher premiums and lower out-of-pocket costs. Features of these plans are outlined below:

  • BRONZE
  • SILVER
  • GOLD

This health plan offers the lowest premiums of the Individual & Family plans, but requires the highest out-of-pocket costs. Bronze is the most affordable plan of the OptimaFit group and is best for those who don’t expect to use health care services as often

Employer Plans

Optima Health offers three basic categories of plans for employers and businesses seeking to provide health care plan coverage to their employees. The following commercial plans are available to companies with 51 employees or more:

  • The HMO: Vantage plan offers employers flexibility with no referral required, the ability to select a primary care provider, and open access
  • The PPO: Plus plan grants employers access to a national provider network while offering in-network rates and In and Out-of-network benefits
  • The POS: A combination of the best of the benefits that HMO: Vantage and PPO: Plus have to offer with no specialty referrals and out-of-network options

Each plan is offered as part of two product lines offered by Optima Health. These two product lines are called HSA: Equity and HRA: Design.

 

  • HSA: Equity
  • HRA: Design

In HRA: Design, employers fund a health benefit plan which reimburses employees for qualified out-of-pocket expenses, with all unused funds remaining with the employer

For businesses employing fewer than 51 people, Optima Health offers flexible versions of their commercial plans including 15 Optima Plus plans, 16 Optima POS plans, and 23 Optima Vantage Plans.

Medicare

Optima Medicare HMO is a health coverage plan available to Medicare beneficiaries. While exact benefits vary based on location, all Optima Medicare HMO plans include Medicare Advantage plans (Part C) and Prescription Drug Coverage (Part D). Extra benefits available with Optima Medicare HMO include:

  • Additional coverage of dental, vision, hearing, and transportation to medical appointments
  • Low premiums and limits on out-of-pocket expenses
  • Wellness & Fitness plans; up to $200 reimbursement for gym memberships
  • Access to a large network of providers
  • Access to MDLive, a virtual health-care professional appointment service providing an alternative approach to everyday care

Medicaid

Through Optima Family Care, Medicaid recipients can have access to a diverse number of benefits that contribute to family care. Benefits included are:

  • Doctor of choice
  • Access to specialists
  • Services covered by Medicaid including:
  • Check-ups, including infant check-ups
  • Physicals, including sports physicals
  • Vision and hearing exams
  • Immunizations
  • Free prescriptions
  • Discounts on glasses and contacts
  • Home health care and rehabilitation therapy
  • Addiction Recovery and Treatment services
  • Maternity care
  • Behavioral health services
  • Free smart-phone with unlimited monthly minutes and data provided through Lifeline

An additional benefit offered to Medicaid recipients through Optima Family Care is the 24/7-365 availability of a nurse advice line.


Optimate Health offers other added benefits, typically not included with or covered by Medicaid plans. These benefits include:

  • Partners in Pregnancy program
  • Assistance with weight management
  • Tobacco cessation program
  • Care Management Programs for children and adults
  • Community Mental Health Rehabilitation Services (CMHRS)
  • Mental health case management
  • Therapeutic Day Treatment (TDT) for children under age 21
  • Day treatment/Partial hospitalization for adults
  • Crisis intervention and stabilization
  • Intensive community treatment
  • Mental Health Skill-building Services (MHSS)
  • Intensive in-home
  • Psychosocial rehabilitation
  • Level A and B group home for children under age 21
  • Treatment foster care case management
  • Behavioral therapy
  • Mental health peer supports
  • Substance abuse residential treatment and/or day treatment for pregnant women
  • Substance abuse intensive outpatient

Optima also offers plans include dental care, provided by Smiles for Children. These plans are available to children under 21 and include all of the following benefits and services:

  • diagnostic
  • preventive
  • restorative/surgical dental treatment and procedures, and orthodontia

Dental services are also available to pregnant women and include:

  • x-rays
  • examinations
  • cleanings
  • root canals
  • fillings
  • gum treatment
  • crowns
  • bridges
  • partials
  • dentures
  • extractions
  • oral surgery and other dental care not including orthodontics, available up to and until 60 days after the child’s birth

​There is also dental care for adults over 21, which includes only coverage of limited medically necessary oral procedures

Medicare Managed Long-Term Services

The Optima Health Community Care provides Medicare recipients and their caregivers access to a plan that suits the needs of their long-term care. Plan enrollees will benefit from a customized care plan, coordination with family, caregivers, doctors, and other community resources. This is in addition to receiving all the benefits of Medicare Part C and Part D. Including its added benefits to medicaid recipients, the Optima Health Community Care plan offers the following benefits:

 

  • A dedicated Care Coordinator
  • Local Member Councils in each region to voice your concerns
  • Over 20 years’ experience providing care to Virginia’s Medicaid population
  • Wellness and support programs, including:
  • Cancer prevention programs
  • Diabetes education
  • Asthma education
  • Experienced support for caregivers
  • Weight management
  • Wellness rewards

Added benefits, including:

  • Assistive devices
  • Extended respite for caregivers
  • Diabetic foot care
  • Dental exam and cleaning
  • Memory alarms and devices
  • Pest control
  • Meals delivered to your home after discharge from inpatient hospital or nursing facility
  • Annual hearing aids

Employee Assistance Program

In addition to its insurance services offerings, Optima Health offers EAP (Employee Assistance Program), an employer-provided assistance plan offered to employees as a short-term counseling solution. The program, in conjunction with the HR departments of participating employers, provides counseling sessions to full or part-time employees, dependants and members of the household, or displaced employees, in order to increase employee effectiveness and minimize workplace issues. Coverage amount is determined by the employer but all details of this service remain confidential except to the client and care-provider.

CONCLUSION

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With a mission to improve health every day, Optima Health provides comprehensive health care plans to fit every person, budget, and unique care plan. Through flexible, build-your-own style coverage plans for individuals and families, plans for businesses small and large, and plans compliant with Medicare Part C and Part D, and Medicaid, Optima Health meets the needs of its more 450,000 members, giving them access to not only their best healthcare but also, their best living. Optima Health, by providing quality and cost-effective healthcare, marks itself as a choice healthcare insurance provider in the Virginia area.

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