Optima Health Insurance Company Health Insurance

Optima Health

Better Health. Easy To Use. A Great Value.

Optima Health is proud to provide affordable, high quality health insurance featuring personalized service to more than 415,000 Virginians.¹ Our provider network features more than 15,000 providers including specialists, primary care physicians and hospitals across Virginia.²

We understand the health needs of our fellow Virginians and offer a wide range of health insurance products with that in mind including individual and family health plans; consumer-driven, employee-owned and employer-sponsored plans; employee assistance plans and plans serving Medicare and Medicaid enrollees.

Better Health: Helping you take care of yourself and your family is our guiding mission. You'll see our commitment to you in the variety of innovative heath coaching and wellness programs for members with chronic illnesses including customized wellness programs and integrated clinical and behavioral health services.

Easy To Use: Optima Health offers user-friendly customer service, claims processing and problem solving. You can expect personal service from enrollment to member services to renewal. We provide fast and accurate claim payments, so you spend less time following up on claim issues.

A Great Value: At Optima Health, we are committed to providing members with quality, cost-effective healthcare. Whether you're choosing a health plan for yourself, your employees or your family, we are confident you will find coverage that is right for you. We want to help you understand what coverage you need and find the plan that best meets those needs-no more, no less. Current plans offered include:

Optima Vantage - Health Maintenance Organization (HMO)

Optima Plus and Optima FourSight - Preferred Provider Organization (PPO)

Optima Equity - High Deductible Health Plans with an integrated Health Savings Account (HDHP / HSA)

Optima Medicare - Medicare product (PPO)

Family Care - Medicaid HMO product in Virginia

FAMIS - Virginia's program that helps working families provide health insurance for their children

At A Glance:

Founded In: 1984⁵

Plan options: HMO, PPO, HDHP with HSA and HRA options, Medicare, Medicaid, FAMIS

Coverage Area: Virginia (not all plans available in all areas)

Membership: 415,000 members

Network: More than 15,000 hospitals, doctors and specialists

Accreditations and Awards

With a national and regional track record for success, we take a great deal of pride in our ability to offer award-winning health plans, educational programs and community initiatives. Over the years Optima Health has garnered numerous accreditations, awards and commendations. A few include:

Highest Rating from NCQA

The National Committee for Quality Assurance (NCQA) has recognized our quest for excellence by awarding our commercial HMO and Medicaid HMO products with an "Excellent" accreditation status. This rating has been maintained since 1998, a claim no other regional health plan can make.¹ NCQA's "Excellent" accreditation status is reserved for the best health plans in the nation. It is only awarded to those plans that meet or exceed NCQA's rigorous requirements for consumer protection and quality improvement and deliver excellent clinical care.

A+ Rating from The Street (Weiss Ratings, Inc.)

Optima Health received an A+ rating from The Street (Weiss Ratings, Inc) for financial soundness,² recognizing its ability to withstand severe economic adversity and showing exceptional financial strength. The rating recognizes Optima Health as an outstanding insurer offering excellent financial stability for its customers, vendors, and employees. Fewer than five percent of the nation's HMOs and health insurers meet TheStreet.com ratings' criteria for exceptional financial strength. TheStreet.com is the nation's leading independent provider of ratings and analyses of financial services companies, mutual funds, and stocks.

Our Customers Rate Us the Best in the Area

Optima Health was named in 2006/2007 the top Virginia Health Plan for Customer Service by the National Research Corporation.³

U.S. News & World Report

Every year, U.S. News ranks health plans and recognizes the very best of the hundreds of commercial, Medicare, and Medicaid managed-care plans. Plans were scored from 0 to 100 based on data collected and analyzed by the National Committee for Quality Assurance (NCQA), managed care's major accrediting and standards-setting body. The rankings are the result of consumer surveys and success in preventing and treating illness compared with average health plans. Optima Health ranked 55th for its Commercial HMO/POS plans with a score of 84.9 out of 100 with four out of five stars in on our commitment to member satisfaction, making care accessible, and our prevention and treatment programs. We maintained our strong ranking for our Medicaid Plan with five out of five in consumer assessment and three out of five in prevention and treatment with an overall score of 83 out of 100.⁴

Centers for Medicare & Medicaid Services

Optima's Medicare Advantage plan scored above the national average in the areas of customer service, getting needed care, how well doctors communicate and getting information about prescription drugs as well as with the health plan overall areas in a survey conducted by the Centers for Medicare & Medicaid Services (CMS) to assess the experiences of beneficiaries in Medicare Advantage plans. Additionally, in the area of Medicare-specific, the plan scored above the national average in patients getting needed special therapy.

¹ Sentara Health Plans, Inc. Total Medical Membership Summary, July 2009

² Sentara Health Plans, Inc. Provider Database, December 2008

³ Letter from National Research Corporation dated February 15, 2007

⁴ U.S. News & World Report Rankings, November 14, 2008

⁵ Optima Health Plan HMO was founded in 1984. Over the next 20 years we expanded our licenses to include the following products: PPO, HDHP with HSA and HRA options, Medicare, Medicaid , and FAMIS

Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, and Sentara Health Plans, Inc. Optima Health Plan underwrites HMO and Point of Service products. Optima Health Insurance Company underwrites Preferred Provider Organization products. Self funded health benefit plans are administered by Sentara Health Plans, Inc.