Optima Health

What Optima Health does

Optima Health is a US-based health insurance company headquartered in Virginia Beach, Virginia, operating as a non-profit subsidiary of Sentara Health (founded 1984; 501-1000 employees). The company provides comprehensive health insurance coverage across four core product lines: Individual & Family Plans, Employer Plans, Medicare Plans, and Medicaid Plans, plus an Employee Assistance Program. These are distributed regionally (primarily Virginia) through a multi-channel model combining a self-serve digital platform (sentarahealthplans.com), direct enterprise sales, a broker network for Medicare and Medicaid, and a branded mobile application.

Optima Health's product surface extends beyond traditional insurance into member engagement features: a 24/7 virtual care partnership with MDLIVE providing board-certified doctor access via video or phone, the MyLife MyPlan wellness program, a Treatment Cost Calculator for out-of-pocket expense comparison, member discount programs (massage, eyewear, hearing aids), and digital claims/ID-card access through the mobile app. Marketing is conducted via Facebook, YouTube, Instagram, and LinkedIn, with content marketing anchored on the company's website.

Note on data integrity: the input contains material conflict between the US firmographic profile (Virginia Beach, non-profit, insurance, parent Sentara Health) and a parallel UK-based narrative referencing £123M revenue, a £100M PAM Healthcare acquisition, and £1.6B UK occupational health market positioning. The two appear to refer to distinct legal entities sharing the "Optima Health" name. This analysis is grounded primarily in the US firmographic data; UK-specific strategic moves (PAM Healthcare acquisition, Cognate Health acquisition, HSBC/Barclays financing, ACA whistleblower investigation referencing former Sentara subsidiary) are flagged where relevant but should be validated against primary sources before investment action.

Name

Optima Health

Legal name

Optima Health

Website

https://optimahealth.com

Company type

Private

Founded year

1998

Operating status

Operating

Headcount range

501–1,000 employees

Short description

Optima Health is a Virginia Beach-based non-profit health insurer and subsidiary of Sentara Health, offering Individual & Family, Employer, Medicare, and Medicaid plans to Virginia residents through digital, broker, and direct sales channels.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411), Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324)

akta.pro primary industry

Integrated Virtual-First Health Plans / ICHRA-Enabled Virtual Primary Care (HLALADAL)

akta.pro secondary industries

Commercial Vision Insurance Plans (Employer-Sponsored) (HLAEAJAA), MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG)

Keywords

• Health insurance plans
• Medicare insurance plans
• Medicaid managed care
• Employer health benefits
• Virtual care access

Headquarters

HQ city

Virginia Beach

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Others

Revenue model

1. Healthcare Services Revenue: Revenue from occupational health services to employers, expected to grow from approximately £123 million to £204 million by 2027 following PAM Healthcare acquisition
2. Health Insurance Premiums: Revenue from health insurance plans including Individual & Family Plans, Employer Plans, Medicare Plans, and Medicaid Plans

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels6 records

Core offering

Optima Health is the health insurance arm of Sentara Health Plans, offering Individual & Family, Employer-sponsored, Medicare, and Medicaid health insurance plans to U.S. consumers and businesses. The plans are delivered alongside 24/7 virtual care through an MDLIVE partnership, the MyLife MyPlan wellness programs, member discounts, and a mobile application for claims, scheduling, and ID card access.

Product overview

Optima Health is a UK-based occupational health services provider operating as a single unified product offering. The company offers occupational health services to employers, with recent expansion through the acquisition of PAM Healthcare for £100 million. The acquisition positions Optima Health as the clear leader in the UK's £1.6 billion occupational health market, with projected revenues growing from approximately £123 million to £204 million by 2027 and market share increasing from 10% to 15%. Note: A former Sentara subsidiary named Optima Health operated in Virginia's ACA insurance market, but the primary data refers to the UK-based occupational health company.

Differentiator

Problem solved

Functional benefit

Products and services

• Individual & Family Plans Health insurance plans designed for individuals and families seeking personal medical coverage.
• Employer Plans Group health insurance plans for businesses to offer employees as part of their benefits package.
• Medicare Plans Medicare health insurance plans targeted at individuals aged 65 and older.
• Medicaid Plans Medicaid coverage plans for people with low incomes and disabilities.
• Employee Assistance Program (Sentara EAP) Workforce support program designed to strengthen organizations by supporting their employees.

Quantifiable outcome

• Revenue growth from £123 million to £204 million by 2027
• +3 more outcomes

Named customers1 record

Segments5 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

One partnership is on record.

• MDLIVEcoreTechnology or IntegrationMDLIVE partnership provides 24/7 virtual care access through board-certified doctors via video conference or phone, integrated into Sentara Health Plans (parent company of Optima Health) offerings.

Scale indicators6 records

Recent moves5 records

Expansion highlights6 records

Direct peers

• Kaiser Permanente Mid-Atlantic: Integrated payer-provider serving Virginia, Maryland, and DC with commercial and Medicare plans. Direct competitor for Virginia employer groups and individual buyers, with a distinct integrated-care delivery model.
• Molina Healthcare: Government-program-focused health plan with Medicaid managed care contracts in Virginia and multiple states. Directly competes with Optima on the Medicaid segment and pursues similar state contract growth strategies.
• Sentara Health Plans: Optima Health's parent organization and brand shell, offering identical Individual, Employer, Medicare, and Medicaid plans across Virginia. Directly comparable product portfolio, geography, and distribution model.
• Anthem Blue Cross Blue Shield of Virginia: Dominant commercial and Medicaid health plan in Virginia with overlapping employer-group and government program offerings. Directly competes for the same Virginia employer and individual buyer base as Optima.

Broad incumbents

• Humana: Medicare Advantage leader with growing commercial and Medicaid presence. Closely comparable on the Medicare segment that Optima serves, and increasingly competing on senior-focused employer retiree plans.
• UnitedHealthcare: Largest US health insurer offering commercial, Medicare Advantage, and Medicaid plans with national employer relationships. Direct overlap on all four of Optima's plan categories, particularly in self-funded employer contracts.
• Centene Corporation: Largest US Medicaid managed care company with marketplace and Medicare Advantage exposure. Overlaps with Optima on Medicaid and individual ACA marketplace segments in Virginia and adjacent states.
• Aetna (CVS Health): National carrier with strong employer-sponsored and Medicare Advantage presence, including Virginia. Competes with Optima in employer benefit decisions and Medicare shopping; broader portfolio but overlapping target customers.
• Cigna Group: Major national carrier with strong employer-sponsored and Medicare focus. Competes with Optima for mid-market and large employer group business across Virginia.

Regional players

• CareFirst BlueCross BlueShield: Mid-Atlantic regional carrier serving Virginia, Maryland, and DC with commercial and Medicare plans. Comparable regional carrier footprint and employer-group go-to-market motion to Optima.

Market position

Strengths4 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

• Facebookfacebook.com/optimahealth
• LinkedInlinkedin.com/company/optima-health

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A1 record

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Optima Health