More rewarding healthcare

At Sentara Health Plans, we're passionate about helping our members live healthier and happier lives.

As part of our mission to improve health every day, we’re committed to going above and beyond for our members by building strong relationships and supporting them on their journey to better health. Backed by a dedicated member services team and an outstanding network of providers, our members know we’ve got them covered.

We are proud to offer:

  • Several plan options with a wide range of cost-share amounts and network choices
  • Health and wellness programs that focus on the mind as well as the body
  • Multiple ways to pay premiums, plan for healthcare costs, and connect with a Sentara Health Plans representative
  • Robust provider network including specialists, primary care physicians, and hospitals
  • Virtual consult are available 24/7 to diagnose and treat a variety of non-emergency medical conditions and behavioral health concerns
  • Additional help with Emergency Travel Assistance, 24/7 Nurse Advice, and 24/7 Behavioral Health Crisis Lines
  • Excellent customer service from Sentara Health Plans member services team

To learn more, contact us at individualsales@sentara.com.

Virginia headquarters

When your clients choose Sentara Health Plans, they are selecting a health plan headquartered in the Commonwealth of Virginia. We have sales and service representatives, nurse case managers, and staff located throughout the Commonwealth. Working and living in the communities we serve means we have first-hand experience with the many providers and facilities in our network. Since 1984, we’ve been helping Virginians get the most out of their health coverage by providing1:

Sentara Health Plans combines advanced technology and experienced staff to deliver exceptional service and resolve issues quickly. Our representatives’ local knowledge, holistic and empathic approach to care enables us to assist employers and members.
We regularly provide free health screenings to identify health risks and guide members and non-members to take steps to manage them. We also actively support a variety of local nonprofits that strengthen our community, such as food banks, youth centers, and scholarship programs.
We have a team of registered nurses, health coaches, and social workers available to help members improve their health. When members work with our case management team, they feel empowered to take an active, informed role in their health.
Our care managers bring together local providers and high-risk patients to address complex needs. They also provide education and coaching to support self-management of new and existing diseases.

2027 Sentara Individual & Family Health Plans

Our Sentara Individual & Family Health Plans offer more choices, innovative solutions, and enhanced access to high-quality care—whether your clients are purchasing our health plans On-Exchange through Virginia’s Insurance Marketplace or Off-Exchange directly through sentarahealthplans.com. All Sentara Individual & Family Health Plans include robust benefits, wellness programs, preventive services, and useful tools.

  • Sentara Plans are part of our open-access network with no need to get a referral to see a specialist within our broad network of quality providers and facilities.5
  • Sentara Unique Off-Exchange Plans are only offered outside of Virginia’s Insurance Marketplace. These plans are ideal for those without subsidies to help lower out-of-pocket costs.
  • Sentara Standard Plans6 offer the same out-of-pocket costs as Standard Plans from other carriers, but with Sentara’s broad network of quality providers and facilities.

Provider Network

Sentara Individual & Family Health Plans include access to our network of primary care providers, specialists, and hospitals across Virginia. Use the Find-a-Doc tool to quickly search for participating providers.

Plans are available throughout the Commonwealth of Virginia.

Pharmacy benefits

Easy-to-access, integrated prescription drug coverage

Sentara Health Plans provides more convenient access to prescription drugs through a large network of retail chains and local pharmacies. Benefit options include generic and brand name drugs with tiered cost share amounts to help both employers and members control costs. Plus, our pharmacy and medical benefits are fully integrated, allowing access for members to use services with one member ID card and for our case managers to get the required data to provide the best care. New members may be able to refill retail prescriptions up to a 90-day supply without pre-authorization when they enroll in Sentara Health Plans. Please refer to the Benefit Summaries for specific plan details.

  • Mail-order drugs

    Members may receive up to a 90-day supply of maintenance drugs through our mail-order pharmacy.10 This option helps members with conditions such as diabetes and heart disease save money and reduce trips to the pharmacy.

  • Online pharmacy benefit tools

    Our online tools, which include a medication search, help members identify and learn more about cost-effective drug alternatives. These tools help members maximize their pharmacy benefits.

    Find out more at sentarahealthplans.com/pharmacy.

  • Specialty pharmacy services

    Comprehensive medication therapy management programs are available to patients with acute and chronic conditions through our specialty pharmacy services.

    Specialty pharmacy services may include:

    • A plan of care between the patient, the pharmacy, and the prescriber
    • Medication shipment to the provider’s office, member’s home, or other appropriate site of care
    • Ongoing clinical and educational support
    • Monthly refill reminder calls or text messages
    • Insurance support and financial assistance programs
    • Language translation services for pharmacy interactions
    • 24-hour access to a pharmacist for emergency needs

    Find out more at sentarahealthplans.com/find-doctors-drugs-and-facilities.

Virtual care

We’ve added more ways for members to take control of their health and stay on top of their benefits. Our virtual care helps members make informed choices, manage their costs, and live healthier, even when life gets busy.

Members can securely connect with board-certified providers over the phone, online, or via video chat through:

 
Accessible 24/7 via our website or mobile app to diagnose and treat a variety of non-emergency medical conditions and behavioral health concerns. For most plans, virtual consults are available at no charge when accessed through the member portal or mobile app.7
In-network, provider-based virtual care offering video visits during office hours for care and relief of minor illnesses and injuries at the applicable PCP or specialist cost-share.

Consult with members and answer questions

Diagnose non-emergency conditions

Recommend treatment and discuss options

Prescribe medication and suggest a follow-up plan

Providers are able to treat a variety of non-emergency conditions and injuries, such as:

  • Allergies
  • Asthma
  • Behavioral health concerns7
  • Cold and flu
  • Earache
  • Joint aches and pain
  • Rash
  • Rehabilitative strength conditioning
  • Sinus problems
  • Sprains

Preventive Services

Patient Identification Manager Reminder System 

The Patient Identification Manager Reminder System informs members of recommended preventive healthcare screenings that help fight communicable diseases and diagnose cancer in the earliest, most treatable stages. Our health improvement programs give members valuable information and encouragement to reduce health risks. Employees who improve their health can reduce their healthcare needs, reduce absenteeism, and reduce healthcare costs. System initiatives include:

We send eligible members preventive care reminders. These include information on the importance of mammography screenings and how to prepare for appointments.
Members receive periodic communication during their pregnancy. They include pregnancy and parenting resources as well as helpful tips related to nutrition, stress management, pre-term labor, and postpartum visits. Members are connected with our Partners in Pregnancy team who are available throughout the gestational period for information and assistance.
Plan members whom we have an email on file for will receive a birthday email during their birthday month. This message includes key reminders for preventive health guidelines to achieve their personal best health.
Physicians receive monthly lists of their patients (our members) who were reminded through the Patient Identification Manager Reminder System and have still not completed their preventive screenings.

Value-added services paired with your coverage

We're always innovating and working to add value to the products we provide. All Sentara Individual & Family Health Plans include an array of additional benefits and services, such as:

With global emergency services, members can count on health coverage and access to on-call providers whenever they travel more than 100 miles away from home.
Members can receive discounts for services that include acupuncture, chiropractic, massage therapies, and more.
Eligible Sentara Health Plans members have dedicated care coaches who develop personalized care plans for each individual and facilitate prompt access to mental health providers.

Member resources

We offer services that make it easier to access care when and where our members need it.

Members can access a provider search tool by signing in to the member portal at sentarahealthplans.com/members, using the mobile app, or by visiting sentarahealthplans.com/ find-doctors-drugs-and-facilities. If the member is signed in, the provider search tool will automatically adjust to include the member’s plan information. If the member is not signed in, they will need to enter the plan name located on their member ID card. Members can search for a doctor or facility by name or specialty, or use the advanced search tools.

Members can calculate plan and provider-specific, out-of-pocket cost estimates for all covered services. These estimates help members make decisions that are the best for their health and budget.

For more information, visit sentarahealthplans.com/features/treatment-cost-calculator.

Members can securely connect with board-certified providers over the phone, online, or through video chat. Accessible by signing in to the member portal and mobile app, providers are available 24/7 to diagnose and treat a variety of non-emergency medical conditions and behavioral health concerns. For most plans, virtual consults are available at no charge when accessed through the member portal or mobile app.2 This is a separate benefit from telemedicine visits scheduled with a member’s provider.
 When Sentara Health Plans members have an illness or injury after their physician’s office has closed, Sentara Health Plans members can call the 24/7 Nurse Advice Line at 1-800-394-2237.
Sentara Health Plans offers a 24/7 Behavioral Health Crisis Line that is staffed by professionals who can triage and assist members going through a crisis. Members who need help should call 1-833-717-2310.3

Manage benefits on the go 

The Sentara Health Plans Mobile App helps members get the most value from their health benefits.

Our app provides secure access to many services such as:

  • Digital member ID cards
  • Virtual consults through MDLive
  • Doctors and facilities search tool
  • Cost estimates for treatments and services
  • Health Savings Account (HSA)4
  • Communication preferences
  • Common forms and documents
  • Contact information
  • Claims and authorizations
  • Wellness tools
  • Frequently asked questions and answers

Health and wellness services: MyLife MyPlan

Achieve your best health

We know that small changes can make a big impact. That’s why we offer MyLife MyPlan, a personalized health and wellness program that encourages members to incorporate daily healthier habits into their lives. It’s part of our mission to improve health every day.

For more information, visit sentarahealthplans.com/app.

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    Personalized

    Our well-being platform, offered through WebMD® Health Services, is tailored to each member’s age, biometrics, lifestyle, and overall health objectives.
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    Accessible

    MyLife MyPlan programs are offered in multiple formats to enable members to reach their goals in ways that work for them.

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    Flexible

    Members can engage on their own time, and at their own pace, so they’re more likely to adopt healthy habits for life.

MyLife MyPlan includes:

Sentara Health Plans has partnered with WebMD to deliver health and wellness services such as: 

  • Personal Health Assessments: A 10-minute questionnaire resulting in a health profile, health risks identification, and recommendations on actions members can take to manage and improve health.
  • Daily Habits: A personalized and interactive experience to help members achieve their health goals and stay excited about healthier living – all from the convenience of a desktop or mobile device.
  • Health coaching: A one-on-one coaching opportunity that allows members to ask questions, discuss milestones, and set new goals that can be done online or over the phone.

This group of programs offers a wealth of resources that address the needs of members of all ages.8 Our programs are regularly updated and available for all plans.

  • Tobacco cessation services offer members tools and resources to enjoy a tobacco-free life.
  • Get advice on how to spot chronic disease risk factors to prevent diabetes and heart disease.
  • Enjoy movement and fitness programs such as MoveAbout, Qigong, and yoga.
  • Receive prompts to make healthy food choices at the grocery store and when meal planning. 
  • Get support for healthy sleep and stress management.

To make it easier for members to manage their health, MyLife MyPlan includes exclusive discounts on:

  • Gym memberships, fitness equipment and nutrition programs
  • Complementary alternative treatments such as acupuncture, massage therapy, and chiropractic care
  • Select vision and hearing services for adults

Sentara Health Plans offers special services that help members stay healthy, even when life gets busy. Our services meet members where they are and empower them to take the next step to improve their health.

  • Outreach events: Our member outreach includes presentations, screenings, and flu shots at various locations. These events reflect our genuine interest in helping our members stay healthy.
  • Well-being Education Series: As part of our ongoing effort to address relevant and timely risk reduction, our team of health educators host free learning opportunities on a range of wellness topics that include healthy eating, cultivating financial well-being, and supporting social wellness. This series is open to all and can be accessed at sentarahealthplans.com/mylifemyplan.
In keeping with our mission to improve health every day, Sentara Health Plans offers over 100 preventive services and medications that are covered at no cost to the member when administered by an in-network plan physician or pharmacy. An office visit copayment may be charged to health plan members for some services. To review a list of services that are covered, please visit sentarahealthplans.com/members/manage-plans/covered-preventive-services. Some preventive drugs are available before the deductible for HSA plans.

Holistic health management

Health management programs

Sentara Health Plans offers programs and trained healthcare professionals that are ready to help members make healthy lifestyle changes to manage cardiovascular disease, diabetes, and respiratory disease. The Partners in Pregnancy program also offers support to expectant mothers and provides members with information and guidance in making good choices throughout their pregnancy. 

Case management programs

Standard case management is an integrated part of our medical plan. Our approach is person-centered rather than disease-centered, so our programs flex to fit each member’s needs, goals, and preferences. We focus on improving health by engaging members on a personal level, addressing all their health needs, and collaborating with their providers.

1Sentara Health Plans is a trade name for Sentara Health Plans, Sentara Health Insurance Company, Sentara Health Administration, Inc., and Sentara Behavioral Health Services, Inc. Sentara Health Plans, previously Optima Health Plan, has been issuing HMO plans under that license since 1984. Sentara Health Insurance Company, previously Optima Health Insurance Company, has issued Preferred Provider Organization (PPO) Accident and Sickness plans since 1991. 2Mental health and substance use disorder virtual consults may carry an additional charge. HSA plans will carry an additional charge until the deductible is met. 3Members with thoughts of harming themselves or someone else should get help right away by calling 911 or go to the closest hospital for emergency care. 4Only applies to members with HSA plans. 5Sentara Health Administration, Inc., Provider Database, 2026, available at sentarahealthplans.com. 6Standard Plans offered on the Marketplace are the same for all health plans. 7Cost share may apply for HSA plans and other health situations such as mental health and substance use disorders. 8There may be an additional fee for these services. 9Not all drugs are available for mail order. 10Certain mail-order pharmacies have a day-supply minimum and require the member to fill at least a 35-day supply. Check with the network mail-order pharmacy of choice.