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Optima Health Insurance Company

The Optima Health Insurance Company provides coverage for more than 415,000 people in Virginia. This insurance company offers individual, family and group health plans. Optima also has plans for people who are eligible for Medicare and Medicaid.

Optima Health has been providing health insurance services across the state of Virginia for more than 20 years. The Optima Health network of providers consists of over 15,000 Doctors, hospitals, clinics, and health care facilities.

Read through this Optima Health review, read the reviews of Optima Health Insurance left by customers of Optima at the bottom of this page, and then enter your zip code into the box on the side of this page to compare quotes from top health insurance providers across the US.

Optima Health Insurance Plans

There are a number of different Optima health insurance plans for VA residents to choose from. Here is a synopsis of each of them:

Optima Vantage HMO

The Optima Vantage plan is a Health Maintenance Organization (HMO) model for insurance coverage. This option allows subscribers to choose a doctor to act as their primary care physician and see a specialist when they need to without having to get a referral first. The plan has a large network of health care providers to choose from. To receive benefits under the plan, members must seek treatment from a doctor or a hospital that is part of the plan’s member network. In return for this commitment to a specific provider network, the subscriber pays lower premium rates than with other types of plans.

Optima Plus PPO

For people who would like to have more flexibility in their health care options, the company offers Optima Plus. This is a Preferred Provider Organization (PPO), and subscribers have the option of seeing doctors or getting treatment from hospitals that are outside of the network if they wish. They still have coverage if they decide to exercise this option, but at a lower level of benefits than if they had stayed with a network provider.

The Optima Plus plan offers a range of deductibles starting at $500 per year for individuals and $1,000 per year for family coverage. Plan members get an unlimited number of doctor visits per year with a low co-pay. This coverage option includes prescription drugs.

A PPO is a good choice for people who are planning to travel often and who don’t want to be confined to getting care from within a specific network of providers. Low deductibles are available with this coverage option, and when a subscriber gets in-network care, they don’t need to fill out any paperwork. Subscribers have the option of seeing a specialist for their health care needs without waiting to see a primary care physician for a referral.

Optima POS

The Optima Point of Service plan allows members to access care from in-network providers, as well as from healthcare professionals who are not participants. This plan has a large number of providers to choose from. If a subscriber needs to see a specialist, they do need to get a referral first.

Optima Medicare

Optima Medicare offer members a superior level of coverage with low out-of-pocket expenses. Plan members can access a network of doctors and hospitals for their medical care. This coverage option provides a higher level of benefits than Medicare alone provides.

Optima Foursight

The Optima Foursight Plan offers comprehensive medical insurance coverage with moderate premium levels. Plan members can visit the doctor of their choice without having to get a referral. This plan would be a good choice for people who don’t have to go to see a doctor often. Deductible levels for individuals start at $500 per year and go up to $5,000. Family coverage with an annual deductible ranging from $1,000 to $10,000 per year is available with this plan.

Optima Equity 100

People who are interested in having coverage for major medical expenses can consider the Optima Equity 100 plan. This option combines a high-deductible health insurance plan with a Health Savings Account (HSA). The plan member deposits funds into the HSA each year. This money qualifies as a tax deduction. As long as the funds are withdrawn to pay for eligible medical expenses, they can be withdrawn on a tax-free basis.

This option isn’t right for everyone, but may be a good choice for people who want to have coverage in place for major medical expenses and have the means to pay for their regular medical care. Deductibles for an individual start at $2,500 per year. For a family, the annual deductible with this plan is $5,000.

Optima Equity 80

The Optima Equity 80 is another HSA-eligible plan. It is designed for people who are looking for a plan that provides basic coverage. Premiums are kept affordable and this is the right choice for people who are looking for health insurance on a “just in case” basis.

Compare Optima Health Insurance Quotes

The Optima Health Insurance Company has a range of plans designed to suit any budget. Being without health insurance isn’t a good idea, especially since medical expenses can add up very quickly. You can find out how affordable this company’s offerings are, and compare them with those from other providers, by clicking on the free insurance quote tool on this page now. Get started comparing health insurance providers today!

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9 reviews

  • Angry Customer /
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    What dreadful customer service and plans! How I wish my company had chosen a better provider. This company is absolutely horrendous. They do not answer questions, pay at ridiculously low rates and overprice their premiums.

    This company exemplifies all that is wrong with the insurance industry.

  • Upset costumer /
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    Optima is horrible , we had blue cross before but our. Company switched us and it’s bad really bad

  • Reginald Wills /
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    Can a private non-profit Health Care Insurance Company bill me for 6 weeks that I had no coverage?

    I converted from a Cobra Group plan to an Individual policy and it took me 6 weeks to confirm payment and coverage. They continued to say I was not a member nor covered. Then the bill reflects 6 weeks in arrears to the tune of $618.91 ..I phoned Optima health on June 14th to find out why we had not received a bill for my individual health insurance for my second month of coverage.

    The representative on the phone said the cobra insurance had been cancelled 4/12 and I did not have any coverage with Optima Health. NONE. I explained that I enrolled before Cobra had expired. (as required by law.) I was then put on the phone with Lori Patterson.(enrollment and eligibility specialist) I explained the situation to her and emailed her proof that my check to Optima for May 2012 had cleared the bank. cashed.

    The following morning 6/15/2012 I received an email stating: The issue has been resolved. Coverage is now in place and a new ID card has been ordered. Thank you for your patience. clearly indicated coverage started 6/12 not 5/12. I have emails to prove this.

    Since coverage is now in place and a new Id card had been ordered, it meant he had not had coverage for MAY 2012, just like the representative said on the telephone. When I inquired about a bill, the reply was: The bill will be generated next month. Since coverage took place on June 15th, 2012. That’s when the payment should start. (The bill I received reverts back to May 1st when all records reflect I was not covered.)

    clearly, coverage started June, 15th 2012 according to Lorrie Patterson Optima Enrollment & Eligibility specialist. I would like a credit for May 2012 Payment. I had no claims during that time. (good thing) May can cover June, I will owe for July and August.

    This company will try to say if they admit fault then the Cobra laws will show a break in coverage. I am not asking them to admit guilt in the mistake, just pay for me the time I was not covered and I will proceed from there. Instead, they deny the mistake in the face of emails and phone records and “Hold Out” for another months premium. I phoned the billing dept, the members rep’s and Lorrie Patterson and Delvon Key (Super)and complained to no avail or remedy.

    Now the legal team is on me and they complain to my agent that I am complaining…

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    My family was covered for 4 years by Optima through my husband’s employer. When he got a new job and we were facing a 90-day lapse in insurance, we applied for Optima Cobra Coverage.

    The application required a THREE HOUR- YES, THREE HOUR phone interview and after MORE THAN 60 days we finally received letters that our family was denied coverage due to family history with ADD, an abnormal (yet benign) pap smear I had following childbirth, and an ER visit two years ago for a dislocated knee.

    They AUGHT TO WARN CONSUMERS: if you have seen any doctor for any reason in the last 4 years, DO NOT APPLY.

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    Since getting Optima Health Insurance, any doctor I saw was denied coverage and put under the pre-existing category. I got a routine eye exam/check up, only one I’ve ever had in my life, I had no conditions, I didn’t even need glasses, 20/20 vision…it was denied due to a pre-existing condition!

  • Ed Mahler /
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    Want to keep this brief, but if you are seeking insurance, pay a little extra and go some place else. Overall, one word describes this organization: Unbelievable!

  • C. Maurand /
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    Was on Anthem Health Keepers, company changed to Optima and everything has gone down hill big time. This is the worst coverage I’ve had in my life, premiums are expensive, coverage sucks, and out of pocket means I’d have to file for bankruptcy should I need any kind of procedure done.

    I’d be better off without any insurance, Optima offers nothing but crap…

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    My company switched to Optima and this has to be the worst insurance they could have picked.

    No one there can give you the correct number to call you just keep getting transferred from department to department. Their website is not user-friendly and doesn’t retain the information that’s entered. Just an overall horrible insurance.

  • Allison B. /
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    This health insurance company needs to be shut down! They discriminate against people who have mental disorders.

    They messed up my Dr’s tax ID number then constantly blamed the Dr’s office for the mistake, then the health insurance refused to correct the issue, then they refused to pay my Dr. I talked to the health insurance company several times and they told me that I do not owe a penny to anybody, now they are saying it is my responsibility to pay the entire bill to my Dr because it goes towards my deductible when my deductible was paid off months ago, and they are paying my other medical bills with no problem.

    The health insurance company refusing to pay my Dr. is keeping me from being able to see my Dr. so I can get my meds and he is the ONLY Dr. in my area that can get me my meds and accepts this s**** insurance.

    The lady on the phone from the insurance company even had the nerve to tell me that I have to move to an area where there is a provider that is in network. I told her I cannot do that as I am in college and she told me “too d*** bad.”

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