Our tradition of exceptional health benefits and broker support
Sentara Health Plans has been providing Virginia-based employers with high-quality health benefits since 1984.1
With more than four decades of experience, we understand the needs of mid- to large-size businesses. We are meeting those needs with offerings that include:
- A robust portfolio of plan choices and cost-sharing options
- A comprehensive provider network including specialists, primary care physicians, and hospitals2
- Impactful health improvement programs that help members maximize their health
- Local service representatives who help members get the most out of their health benefits
Working with Sentara Health Plans is easier than ever with online tools and our exemplary broker support services. The 2027 Mid-Market and Large Group online guide is an additional resource that puts information about plans and services right at your fingertips. If you have questions, our sales and service teams are ready to help.
Improving health every day
When your clients choose Sentara Health Plans, they are selecting a health plan headquartered in the Commonwealth of Virginia. We’re proud of the reputation we’ve built in our community. Employers and brokers consider us a trusted partner because they can rely on us for excellent benefits and service.3
We have sales and service representatives, network managers, case managers, and staff located in offices throughout the Commonwealth. Working and living in the communities we serve means we have first-hand experience with the doctors, facilities, and services within our robust provider network.
We help members get the most out of their health coverage by providing:
Group sizes
Serving the needs of individuals and employer groups of all sizes.
Sentara Health Plans makes it easier for people and businesses to get the health coverage they need with the quality they deserve. Our group health plans include a robust portfolio of benefit plans, exceptional service, and budget-friendly options for access to care. We offer consumer driven health plans that empower employees to make cost conscious care decisions.
Groups that are eligible for our Small Group plans include:
Mid-Market Group
More than 50 total employees with 150 or fewer eligible
We help employers and their employees get more value for their healthcare dollars.
Large Group
151+ eligible employees
Sentara Health Plans helps employers manage large groups with integrated services. Brokers have access to utilization data and other reports that make it easier to help clients manage their resources.
If you are looking for information about our level-funded product, BusinessEDGE®, please visit the BusinessEDGE® Plan Guide landing page.
If you are looking for information about our Small Group plans, please visit the Small Group Plan Guide landing page.
Provider Access
Making quality care easier to access
As part of a not-for-profit, integrated delivery system, Sentara Health Plans has a unique approach to provider contracting.
Key clinically integrated networks within the Sentara Health Plans provider network offer members the benefit of new models of care from a custom care team, to deliver the right care, in the right place, at the right time. 100% of acute care hospitals in Virginia are in-network.5
We offer our members a variety of ways to access providers:
POS and PPO plan members and dependent children on group HMO plans also have access to a national network through PHCS/MultiPlan. This network has providers in all 50 states, and6:
- 900,000+ healthcare professionals
- 4,500+ hospitals
- 90,000+ ancillary care facilities
Dependent children living outside of the service area have access to in-network benefits on a Vantage HMO plan—even when they’re away at college. They can receive covered services from PHCS providers at the in-network benefit level.
Sentara Health Plans offers our clients the opportunity to engage with our Value-Based Care Program. We provide a successful model that involves the health plan and provider networks working in concert to offer value-added medical services, reduce clinical care gaps, and improve access. This program enhances the overall member experience and empowers providers to make positive changes to their approach to care.
Annual examinations are a covered benefit and value-added discounts for corrective lenses and materials are available from VSP's expansive provider network. Members may access these services through independent optometrists as well as national, regional, and online retail providers.
Members have access to Emergency Travel Assistance for medical and travel emergencies at no additional cost.8 The service covers members whenever they travel 100 miles or more away from their permanent residence, or are in another country.
Emergency Travel Assistance services include:
- Medical consultation, evaluation, and referral
- Hospital admission assistance
- Emergency medical evacuation
- Medical monitoring
- Medical repatriation
- Prescription assistance
- Compassionate visit
- Care of minor children
- Return of mortal remains
- Emergency trauma counseling
- Lost luggage or document assistance
- Interpreter and legal referrals
- Return of vehicle
Value for employers and members: consumer-driven health plans
Helping employers and members get more value
Sentara Health Plans offers a suite of tools and services to empower members to be better health consumers and enable employers to recognize cost savings.Cost-efficient benefits for employers and their employees
Sentara Health Plans employers and members can get more for their healthcare dollars with consumer-driven health plans (CDHP). Our CDHPs ease the cost burden for employers while providing competitive benefit plans to members. For example, some preventive drugs are available before the deductible for CDHPs that include a Health Savings Account (HSA). Partnering with HealthEquity® account services enables us to offer an integrated solution that simplifies administration for both employers and members. Eligibility and claims data flow directly from Sentara Health Plans to HealthEquity. Members have easy access to claims information through the HealthEquity portal, eliminating paperwork requirements and facilitating the payment process.CDHP implementation process
As part of the implementation process coordinated by your representative, employers interested in participating in Health Reimbursement Arrangements or Health Savings Accounts should submit the New Business Information Form: sales.healthequity.com/onboarding.Afterward, the following will take place:
- A HealthEquity representative will contact the employer within five-seven business days to walk through the plan setup and application.
- Employers will complete group enrollment with Sentara Health Plans, who will send the following group information to HealthEquity:
- Group setup files
- Daily eligibility files
- Weekly claims files
- HealthEquity will create the employer portal.
- HealthEquity will open employee accounts and send welcome materials to members.
Health and wellness services: MyLife MyPlan
Services that empower members to live healthier lives
Small changes can make a big difference. That’s why Sentara Health Plans offers MyLife MyPlan.9 This personalized health and wellness program encourages members to build healthier habits into their daily lives. It’s part of our mission to improve health every day.
MyLife MyPlan wellness programs and services are:
Personalized
Our well-being platform, offered through WebMD® Health Services, is tailored to each member’s age, biometrics, lifestyle, and overall health objectives.Flexible
Members can engage on their own time, and at their own pace, so they’re more likely to adopt healthy habits for life.Accessible
MyLife MyPlan programs are offered in multiple formats to enable members to reach their goals in ways that work for them.
Health and wellness services: MyLife MyPlan
This group of programs offers a wealth of resources that address the needs of members of all ages.11 Our self-paced 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.
The Sentara Well-being Rewards program offers a flexible solution designed to empower employees as they engage in healthy actions. From preventive care to condition management, members can choose which activities are most meaningful to them and earn up to $250 each plan year. This offering is for fully insured groups only.
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.12 Our services meet members where they are and empower them to take the next step to improve their health.
- Worksite wellness programs: Our team of nurses and health educators comes to the workplace to provide health screenings, flu shots, and health improvement presentations. We can provide screening services to help identify potential risks for high blood pressure or diabetes, and connect members with next-level care. Presentations include health improvement topics like healthy eating, moving more, and tobacco cessation. Based on health screening findings, members receive group, individual, and self-paced programs to reduce cardiovascular health risks and promote health.
- 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.
- Customized health incentive programs: We can help employers design a tailored employer funded wellness incentive program using WebMD ONE, where members access a rewards lobby to complete activities and track progress. Members earn points for actions like health assessments, content engagement, disease management, and step tracking, with options for both portal-based and claims-verified self-reported activities.
To level up well-being programming with exclusive opportunities, we offer:
- Enhanced Well-being Services that provides on demand streaming and individualized support in all areas of wellness through key partners (self-funded Large group only).
- Comprehensive Well-being Services that extends wellness programming to all employees including those without Sentara Health Plans medical coverage (self-funded Large group only).
- An Annual Roadmap to Well-being toolkit and a short guided tour of the WebMD ONE portal.
Eligible members can participate in structured diabetes and heart disease prevention programs. The programs include a cellular connected scale, weekly online learning sessions, a personal health coach, and peer support to facilitate weight loss for those who are at risk for developing diabetes.
Fees may apply for some services for self-funded groups.
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.Flexible Formulary
Sentara Health Plans is pleased to offer employers a choice of either an open or standard/closed formulary:
- Open formulary: more freedom to receive name-brand prescription drugs
- Standard/closed formulary: a narrower drug list that promotes cost-effective options
Mail-order drugs
Members may receive up to a 90-day supply of maintenance drugs13 through our mail-order pharmacy.14This 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.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.
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:
Holistic health management
Sentara Health Plans’ approach is member-centric rather than disease-centric to fit each member’s specific needs. For this reason, all clinical interventions incorporate depression assessment, stress management, tobacco cessation, and weight management when appropriate to better manage the population from a holistic health perspective. Our specialized services support members according to their preferences and their goals with guidance from clinical experts who are there with them throughout their health journey.
Sentara EAP
The Sentara Employee Assistance Program (Sentara EAP)15 serves as a strategic partner for employers to help improve employee performance, absenteeism, and presenteeism. We are a resource to help employees and their household members overcome life’s challenges, solve personal challenges, and address work-related concerns. This program is available to all employer groups.
Employees and their household members are eligible for up to five counseling sessions per presenting concern. The Work Life benefits are also available.
- Short-term solution-focused counseling
- Our clinicians are professional, caring, and licensed behavioral health providers
EAP Work Life benefits include the following:
- Telephonic Work Life consultations to find resources for daily life (childcare, eldercare, pet care, and education to solve other everyday living needs)
- Legal/financial assistance (identity theft)
- Access to 24/7 online resources
Management consultation
At no additional cost, we offer unlimited supervisory consultation services, including discussing employee performance concerns and receiving assistance in making a supervisory referral.
Critical incident response program
Sentara EAP offers structured group counseling services to respond to events that can cause disruption in the workplace. The Sentara EAP clinical team includes individuals trained in Critical Incident Stress Management. One (1) session per contract year is included. Additional Critical Incident Response Services can be purchased on a fee-for-service basis.
To access Sentara EAP services, employees or their household members can call 1-800-899-8174 or visit our website at sentaraeap.com for online resources.
We offer the option and convenience of face-to-face, telephonic, or virtual counseling sessions.
Member resources
We offer services that make it easier to access care when and where our members need it.
The Sentara Health Plans Mobile App helps members get the most value from their health benefits. Our app provides secure access to many services:
- Member ID card
- Virtual consults through MD Live
- Contact information
- Communication preferences
- Doctors and facilities search tool
- Claims and authorizations
- Wellness tools
- Cost estimates for treatments and services
- Important preventive care reminders
- Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA)18
- Common forms and documents
- Frequently asked questions and answers
For more information, visit sentarahealthplans.com/app.
Employer resources
Digital solutions for employers to support our customers
Sentara Health Plans provides access to many online resources to make it easy for employers to manage their plans. Our online portal allows employers to get the information they need when they need it. Employers can:
- View group information and plan documents
- Request member ID cards
- Pay monthly invoices
- Search provider directories
- Identify preventive services covered under the Affordable Care Act
Visibility through enhanced reporting capabilities with DataPoint
The Sentara Health Plans DataPoint reporting solution helps brokers and employers with 100+ enrolled employees make informed health benefit decisions. This tool provides:
- Secure, 24/7 access to detailed group utilization data
- Periodic monitoring to identify trends in healthcare expenditures
- Notifications of unexpected spikes in utilization, such as emergency room claims
- Early planning for renewals and budgeting purposes
Online enrollment tool
Sentara Health Plans offers an online enrollment tool for our employers and their employees. Employers can:
- Apply their organization’s eligibility rules
- Change employee and dependent demographic information
- Cancel employees’ benefit elections
- Approve benefit elections or changes made by employees
- Add, terminate, and rehire employees
- Run reports on census, benefits, and history of change
Employers also have the option to offer the employee self-service feature within the platform. Employees can compare and select their own benefits through our simple online tool as well as access the Plan Shopping Tool to estimate their out-of-pocket expenses. The Plan Shopping Tool gives employees support and guidance as they make enrollment choices. Depending on the plan, employers may have access to additional secure tools once signed in. Sentara Health Plans partners with the online enrollment platform Employee Navigator to accept electronic enrollment.19
For more information, visit sentarahealthplans.com/employers/manage-plans.
Broker services
We’re here for you, so you can focus on your clients.
When you have questions, our sales and service teams are easy to reach. We resolve many inquiries without having to transfer your call. When employer groups and members have inquiries, they can count on us to respond promptly. Our high service standards are one of the many reasons brokers prefer Sentara Health Plans.20
There are many ways you can reach us for broker support:
Broker services line
Our concierge service helps resolve claims issues and eligibility inquiries for existing Sentara Health Plans customers.
- 1-866-927-4785, 8 a.m. to 5 p.m. EST, Monday through Friday
- sentarahealthplans.com/brokers
- brokerservices@sentara.com
Sales team
Sentara Health Plans proactively manages the sales process and offers prompt responses to inquiries about plan offerings for new business and plan renewals.
- 1-866-927-4785, 8 a.m. to 5 p.m. EST, Monday through Friday
- sales@sentara.com
eBroker
Our online portal gives brokers even more flexibility to work with us and serve clients. You can request quotes, manage your groups, and view report activity without having to call us. eBroker also offers access to sales materials and educational content so our brokers can stay informed about the latest updates impacting Sentara Health Plans and the health insurance industry. To register or get more information about eBroker, contact your Sentara Health Plans sales team.
Flexible plan design
We give employers more health plan choices
Sentara Health Plans offers a broad range of health plan choices. Whether employers are seeking comprehensive plans or empowering their employees through cost-sharing, our offerings are the perfect match.Sentara Health Plans core health plan options
All health benefits packages with Sentara Health Plans are based on one of our core plan options. Our offerings include21:
- Sentara Vantage (HMO): These plans cover services administered in-network, as well as in emergency situations. To achieve overall care management, we require that members select a primary care physician (PCP) from our robust proprietary network. As an open access HMO, members do not need referrals for specialty care.
- Sentara POS and Sentara Plus (PPO): In addition to the Sentara network, members have access to a national provider network with in-network benefits.
Our Score with Core Program for Large Groups
Large employer groups (151+ eligible employees) have plan options that include:
- Selecting a package of core plans as-is and recognizing a discount (Score with Core)
- Modifying our core plans by tailoring copayment and deductible levels or adding non-standard benefits
Special benefits available
Mid-Market groups (more than 50 total employees with 150 or fewer eligible) may include select benefits for additional cost. These benefits include:
- Morbid obesity surgery or other approved methods recognized by the National Institutes of Health
Large employer groups (151+ eligible employees) may include specialized benefits for an additional cost, such as:
- Enhanced vision services and materials
- Infertility Services Rider
- Latrogenic infertility
- Wisdom tooth extraction services
- OOA dependent rider coverage
- Morbid obesity surgery or other approved methods recognized by the National Institutes of Health
- Weight loss management drug rider
- Hearing Aid Rider
2027 plan design options
| Product types | Vantage HMO | POS | Plus PPO |
| Product typesNo referrals required | Vantage HMO | POS | Plus PPO |
| Product typesNational network for in-network coverage included | Vantage HMO | POS | Plus PPO |
| Product typesIn-network coverage only23 | Vantage HMO | POS | Plus PPO |
| Product typesIn-and-out of network coverage | Vantage HMO | POS | Plus PPO |
Plan Types
HSA
Employers and employees can contribute tax-free income for qualified medical expenses. These accounts are easy to manage, with integrated claims accessed through the Sentara Health Plans online portal.
HRA
Employer-funded health benefit plan that reimburses employees for some of their out-of-pocket medical expenses. All unused funds remain with the employer.