Request Printed Plan Documents
Plan Year
2020
2021
Plan Name
Optima Medicare Advantage Plans
OptimaFit Individual and Family Plans
Medicare Advantage Plans*
-- Select Plan --
Optima Community Complete (HMO SNP)
Optima Medicare Classic
Optima Medicare RX (PDP)
Optima Prime Central/Halifax
Optima Prime Northern VA
Optima Prime Peninsula
Optima Prime Southside
Optima Value Central/Halifax
Optima Value Northern VA
Optima Value Peninsula
Optima Value Roanoke/Alleghany
Optima Value Southside
Optima Value Southwest
Material Option
Evidence of Coverage (EOC)
Annual Notice of Changes
Pharmacy Formulary
Please contact member services at 1-800-927-6048 (TTY:711) to request a printed provider directory.
Member Services hours vary by time of year:
October 1–March 31 | 7 days a week | 8 AM–8 PM
April 1–September 30 | Monday–Friday | 8 AM–8 PM
Individual and Family Plans
-- Select Plan --
Catastrophic
Direct
Select
HIOS Code/OptimaFIT Plan Name
Material Option
Evidence of Coverage or Certificate of Insurance - Legal Benefit Documents
Summary of Benefits and Coverage (SBC)
To request printed OptimaFit benefit information for plans prior to 2021 please call the number on the back of your member ID card. Electronic copies are available when you sign in to optimahealth.com or the Optima Health mobile app.
Effective Date
Effective Date
Member ID
Member ID#*
Barcode
Barcode
Barcode
EOC Barcode
SBC Barcode
Full Name
First Name*
Last Name*
Email Address
Email Address*
We will send you an email confirmation of your request that you have submitted today. Once your documents are dropped in the mail, you will receive another email notification to let you know they have been mailed.
Address
Street Address*
Street Address Line 2
City*
State / Province*
Zip / Postal Code*
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