Top Rating in Virginia Achieved by Optima Health

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OptimaFit® Individual and Family health plans awarded highest CMS Star Rating in Virginia, a 4.0. Optima Health 4-Star score for Member Experience the highest in Virginia.

We improve health every day.

We improve health every day.

As we strive to improve the health of our members, it is especially pleasing to know our members appreciate our exemplary service.

Optima Health achieved Virginia’s highest score, a Global 4-Star quality rating, for its OptimaFit® Individual and Family health plans, by the Centers for Medicare & Medicaid Services (CMS) 5-Star Quality Rating System.[1] This top Virginia rating was accomplished in the first year of a pilot program initiated by the CMS to present health insurance quality ratings for Individual and Family health plans, also known as Marketplace plans.

CMS quality ratings provide information that can be helpful for anyone who is shopping for health insurance coverage during Open Enrollment.

In all three of the areas making up the overall 4-Star Rating, Member Experience, Medical Care and Health Plan Administration, Optima Health consistently achieved 4 Stars. Additionally, Optima Health achieved the highest rating in the state of Virginia - 4 Stars - for Member Experience.

“As we strive to improve the health of our members, it is especially pleasing to know our members appreciate our exemplary service,” said Optima Health Senior Vice President of Sales and Marketing, John DeGruttola. “Providing an excellent member experience is at the heart of what we do at Optima Health, and being number one in this area really fuels our efforts to continually exceed our members’ expectations.”

Optima Health also achieved the highest possible score - 5 Stars - in the areas of Doctors and Care, Enrollee Experience and Patient Safety. Covered in these respective areas are members’ experience with: medical services, including those provided by personal doctors and specialists; the service provided, including answering questions and providing necessary information, and; the care received and access to medications needed to manage conditions.

With Open Enrollment for Marketplace plans currently underway, CMS health plan quality ratings provide new information about the service and care obtainable from a health plan. Virginia Marketplace shoppers can utilize this resource by visiting a health plan’s website to view the summarized CMS quality results before buying.

About Optima Health

Optima Health, based in Virginia, provides health insurance coverage to approximately 450,000 members. With 30 years of experience in the health insurance arena, Optima Health offers a suite of commercial products including consumer-directed, employee-owned and employer-sponsored plans, individual health plans, employee assistance programs and plans serving Medicare and Medicaid enrollees. Its provider network features 26,000 providers including specialists, primary care physicians and hospitals across Virginia. Optima Health also offers programs to support members with chronic illnesses, customized wellness programs and integrated clinical and behavioral health services, as well as pharmacy management – all to help members improve their health. The company’s goals are to provide better health, be easy to use and offer services that are a great value. To learn more about Optima Health, visit[2]

[1] CMS rates qualified health plans (QHPs) offered through the Marketplaces using the Quality Rating System (QRS), which is based on third-party validated clinical measure data and QHP Enrollee Survey response data. CMS calculates QRS ratings annually using a 5-star scale. QHP issuers contract with HHS-approved survey vendors that independently conduct the QHP Enrollee Survey each year. QRS ratings and QHP Enrollee Survey results may change from one year to the next. For more information, please see CMS’ Health Insurance MarketplaceSM Quality Initiatives website at:

[2] The membership figure includes total membership in all group and individual insured products, Medicare Managed Care Plans, Medicaid and Famis Plans, and self-funded health plans issued or administered by Optima Health. Total Medical Membership based on Membership History Report, June 2016. Includes members from all Optima Health Licenses, products, Medicare and Medicaid products. Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, and Sentara Health Plans, Inc. Optima PPO plans, and Medicare Managed Care Plans are underwritten or administered by Optima Health Insurance Company. Optima Vantage HMO plans, Medicaid, and Famis products are underwritten or administered by Optima Health Plan. Sentara Health Plans provides administrative services to self-funded plans but does not underwrite benefits. Employee Assistance Programs (EAP) are administered by Optima Behavioral Health Services, Inc. Wellness programs are administered by Sentara Health Plans. Source for provider network is Optima Health, Provider Status Report, February 2016.

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Pamela Walters
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