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Thank you for selecting Optima Family Care for your healthcare coverage and allowing us to serve your healthcare needs. Our goal is to provide you with quality healthcare and excellent customer service. We look forward to exceeding your expectations in any way we can.

Plan Information

  • Member Guides

  • Vision Services

    Vision Services are provided by EyeMed Vision Care.

    To find a participating provider, call EyeMed Vision Care at 1-888-610-2268 or visit EyeMed.com. EyeMed’s hours are 9 a.m. to 8:30 p.m. Monday through Friday, and Saturdays from 9 a.m. to 5 p.m.


    Routine eye examinations for all enrollees shall be allowed at least once every 2 years.

    Each Optima Family Care/FAMIS* member under age 21 is eligible to receive the following services:

    • Writing of lens formulas and prescriptions
    • Dispensing/fitting procedure
    • Subsequent glasses adjustments as necessary
    • If prescribed, each member is entitled to one of the following:*
      • One pair of glasses with clear plastic single vision lenses, or
      • One pair of glasses with multi-focal plastic lenses, or
      • One pair of glasses frames chosen from a selection on display in the provider’s office, or
      • One pair of contact lenses, only if medically necessary

    *Note: No more than one pair of glasses will be allowed within a 24 month period without a statement of medical need.

    You are fully covered for these services and materials, as long as they are provided by an EyeMed provider. If you select frames or lenses costing more than the amount covered by an Optima Health insurance plan, you are responsible for the additional charge.

    Prior authorization is needed for contact lenses and only as a result of any of the following conditions:

    • To correct extreme visual acuity problems that cannot be corrected with lenses,
    • Certain conditions of anisometropia, or
    • Keratoconus

    Members at or over the age of 21 will receive the following discounts:

    • Standard Plastic Lenses priced at:

      $50 for Single Vision
      $70 for Bifocal
      $105 for Trifocal
    • 40% off frames
    • Contact lenses, 15% off conventional, no discount for disposal contact lenses (discounts and fees apply only if a complete pair is purchased in same transaction.)
    • Laser vision correction surgery (e.g. LASIK) 15% off retail price or 5% off discount off promotional price discount.

    NOTE: FAMIS members please see Summary of Benefits in your member guide for Copayment information.

  • Dental Services

    Dental Services are covered for members under age 21 through Smiles for Children.

    Effective March 1, 2015, pregnant women enrolled in Medicaid and FAMIS MOMS who are 21 years of age and older are eligible to receive comprehensive benefits, excluding orthodontics, covered by the Smiles For children program. Dental benefits for pregnant women who are 21 years of age and older will be discontinued at the end of the month following their 60th day postpartum.

    All Optima Family Care/FAMIS members are covered for medically necessary services resulting from a dental accident or for medically necessary procedures to the mouth where the main purpose is not to treat the teeth.

    Medically necessary services include:

    • Dental services performed by a medical provider as the result of a dental accident
    • Hospitalization and Anesthesia Related Services for medically necessary dental services including extractions
    • Transportation and medical care related to dental services (Does not apply to FAMIS)
    • Medically necessary dental services performed during an emergency room visit immediately after the traumatic injury and in conjunction with the initial stabilization of the traumatic injury are covered subject to utilization review for medical necessity

    Contact Smiles for Children at 1-888-912-3456 or visit Smiles for Children.

  • Specialty Pharmacy

  • Partners in Pregnancy

    Optima Family Care recognizes that pregnancy in itself can be a life-altering journey and even the most experienced mom may feel in need of extra support. That’s why we developed Optima’s Partners in Pregnancy Program -- a program dedicated to providing guidance, support, and education to all expectant moms with Optima Health insurance.

    Learn more about Partners in Pregnancy

  • Member Appeals and Grievances

    Optima Family Care would like our members to be completely satisfied with the medical care and services they receive. Therefore, if you have a problem or complaint concerning the operation of the Plan, understanding of covered services, timeliness or quality of services provided, pre-authorization decisions or assignment of Primary Care Physicians (PCPs); a process has been developed for you to register your complaint so it can be resolved to your satisfaction. Should a problem or an incident cause you dissatisfaction, it is hoped that it can be resolved informally between you and the Plan staff or the provider involved. However, formal complaint procedures are available if your concerns cannot be resolved informally.

    Complaint Packet

    Appeal Information
    A member may file an appeal for reduced, terminated, or denied requests for service or denied claims (also called an adverse action). As an Optima Family Care member, you have the right to appeal directly to DMAS for a State Fair Hearing (SFH) before, during, after or instead of appealing to the Plan, despite the reason for reduced or denied medical services. Eligibility issues should be appealed directly to DMAS. To appeal to DMAS, the member should contact DMAS Appeals Department at 1-804-371-8488 or send a written request within 30 calendar days of receipt of a notice of adverse action/denial to:

    Department of Medical Assistance Services
    Appeals Division
    600 East Broad Street
    Richmond, VA 23219

    Additional information on the State Fair Hearing Appeal process, as well as SFH appeal request forms are available at: www.dmas.virginia.gov/Content_pgs/appeal-home.aspx.

    Appeal Packet

  • Member Newsletters

  • Free Cell Phones

    The benefits you receive are:

    • A free cell phone
    • 350 free minutes each month
    • Unlimited free text messages
    • 500 MB free data each month (high-speed 3G data)
    • Health plan access 24 hours a day that will not apply towards your 350 minutes
    • Free Texts with health tips and reminders
    • Free Mobile health coaching programs
    • Free Data for our health messaging app

    To apply: www.LifelineApply.com/OptimaHealth

Additional Resources

Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, and Optima Health Group, Inc. Optima HMO products, related Patient Optional Point-of-Service products, Point-of-Service products, and Open Access products are underwritten by Optima Health Plan. Optima Preferred Provider Organization products are underwritten by Optima Health Insurance Company. Self-funded plans are administered by Sentara Health Plans, Inc.