Sentara Health Plans

What Sentara Health Plans does

Sentara Health Plans is a Virginia-based health insurance organization founded in 1984 that underwrites and administers medical, Medicare Advantage, Medicaid, and employer group health coverage for approximately one million members across Virginia with expansion into Florida effective January 2025. The company operates multiple legal entities including Sentara Health Plans (HMO/POS issuer), Sentara Health Insurance Company (PPO issuer), Sentara Health Administration, Inc. (self-funded plan administration), and Sentara Behavioral Health Services, Inc. (EAP), and is affiliated with the broader Sentara Health integrated delivery network. Its product portfolio spans Individual & Family Plans (HMO, PPO, POS, HSA, HRA), Employer Group Plans, Sentara Medicare Advantage (including Dual Eligible Special Needs Plans), and Sentara Community Plan Medicaid, distributed through field sales, inside sales, direct-to-consumer, and an extensive broker/agent network.

The company's technology stack centers on a health insurance administration platform with member-facing digital tools including the Sentara Health Plans mobile app, Treatment Cost Calculator for real-time cost transparency, MDLIVE-powered 24/7 telehealth, and the MyLife MyPlan wellness program powered by WebMD Health Services. Provider-facing infrastructure includes FHIR-based APIs for interoperability, a HealthSparq-powered provider directory, Express Scripts pharmacy benefit management, and most recently Veradigm Payer Insights for EHR-integrated care gap alerts. The revenue model is dominated by premium revenue from individual, employer, Medicare, and Medicaid capitation streams, supplemented by self-funded plan administration fees from large employer groups through BusinessEDGE plans.

Sentara Health Plans is a private company with 1,001-5,000 employees, four regional offices across Virginia (Virginia Beach headquarters, Richmond/Glen Allen, Roanoke, and Northern Virginia/Reston), and is regulated under NCQA accreditations held continuously since 1997. Recent strategic activity centers on cost-containment partnerships (Quest Diagnostics exclusive lab, Avalon genetic testing management) and clinical quality technology (Veradigm Payer Insights), alongside the Florida geographic expansion.

Name

Sentara Health Plans

Legal name

Sentara Health Plans

Website

https://sentarahealthplans.com

Company type

Private

Founded year

1984

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

Sentara Health Plans is a Virginia-based health insurer founded in 1984 that underwrites and administers medical, Medicare Advantage, Medicaid, and employer group health coverage for approximately one million members in Virginia and Florida.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

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

SIC

Hospital & Medical Service Plans (6324), Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH)

akta.pro secondary industries

Medicaid Expansion (ACA Adult) Managed Care Plans (HLAEAEAB), MA PPO Plans (Local/Regional PPO) (HLAEACAB), ACA Marketplace (On-Exchange) Individual Plans (FSAIAEAA), Self-Funded Employer POS (ASO/TPA-Administered) (HLAEAOAH), POS with Health Reimbursement Arrangement (HRA-Integrated) (HLAEAOAG)

Keywords

• Health insurance plans
• Medicare Advantage coverage
• Medicaid managed care
• Employer group benefits
• Individual family coverage

Headquarters

HQ city

Virginia Beach

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Revenue model

1. Premium Revenue: Insurance premiums collected from members and employers. Includes Individual & Family plans, employer-sponsored group plans, Medicare Advantage premiums, and Medicaid capitation payments
2. Self-Funded Plan Administration: Administration fees from large group self-funded health plans and BusinessEDGE plans managed but not underwritten by Sentara Health Administration, Inc

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels6 records

Core offering

Sentara Health Plans sells health insurance products to individuals, families, employers, Medicare beneficiaries, and Medicaid recipients across Virginia and Florida. The company offers HMO, PPO, POS, HSA, and HRA plan designs under brands including Vantage HMO and Plus PPO, alongside Medicare Advantage plans, the Sentara Community Plan (Medicaid), and the BusinessEDGE self-funded product for employers. The portfolio is supported by digital tools such as a mobile app, Treatment Cost Calculator, MyLife MyPlan wellness platform, and MDLIVE virtual care.

Product overview

Sentara Health Plans is a health insurance company serving close to one million members in Virginia with a full suite of commercial products. The product portfolio includes Individual & Family Plans, Employer Plans (group health insurance), Medicare Advantage Plans (Sentara Medicare), and Medicaid Plans (Sentara Community Plan). Plan types include Vantage HMO, Plus PPO, Point of Service (POS), and integrated account-based products (HSA and HRA). The company also offers an Employee Assistance Program (EAP) administered by Sentara Behavioral Health Services. Member-facing digital tools include the Sentara Health Plans Mobile App, Treatment Cost Calculator, MDLIVE virtual care partnership, and MyLife MyPlan wellness program. The portfolio operates through a network of quality providers and hospitals across Virginia.

Differentiator

Problem solved

Functional benefit

Brands

• Vantage Health Maintenance Organization (HMO): Health Maintenance Organization plan issued and underwritten by Sentara Health Plans.
• Plus Preferred Provider Organization (PPO)
• Sentara Community Plan
• Sentara Medicare
• Sentara Employee Assistance Program (EAP)
• MyLife MyPlan
• BusinessEDGE

Products and services

• Individual & Family Health Plans
• Employer Group Health Plans
• Medicare Advantage Plans
• Sentara Community Plan (Medicaid)
• BusinessEDGE Self-Funded Plans
• Employee Assistance Program (EAP)

Quantifiable outcome

• 4 out of 5 CMS Quality Stars Rating for Individual & Family Health Plans (2025)
• +2 more outcomes

Named customers3 records

Segments5 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration8 records

Feature4 records

Partnerships

Six partnerships are on record, tiered core.

• VeradigmcoreTechnology or Integration · 10 November 2025Implementation of Veradigm Payer Insights software solution to improve patient care and reduce costs through integrated care gap alerts. Deployment supports Sentara's provider network across Virginia and Northeastern North Carolina by delivering critical alerts within existing EHR systems.
• Avalon Healthcare SolutionscoreStrategic or Co-development Partner · 20 January 2025Expanded partnership to implement evidence-based genetic testing management services for Sentara Health Plans' nearly one million members in Virginia and Florida. Partnership began in 2021 and has delivered significant reductions in out-of-pocket lab spending costs while improving healthcare outcomes. Genetic testing management services rolling out to commercial plans with expansion to other offerings planned.
• Quest DiagnosticscoreStrategic or Co-development Partner · 18 September 2024Multi-year strategic collaboration making Quest Diagnostics the exclusive independent laboratory provider for all Sentara Health Plans members in Virginia and Florida, effective January 1, 2025. Covers clinical laboratory and anatomic pathology services for both commercial and government programs. Partnership includes expansion of Quest's patient service center network and redirection of members from higher-cost out-of-network providers to reduce healthcare costs.
• MDLIVEcoreTechnology or IntegrationNational telehealth partnership providing 24/7 access to board-certified doctors and licensed therapists via video conference or phone. MDLIVE is integrated into Sentara Health Plans member portal and mobile app for on-demand virtual care.
• Express ScriptscoreTechnology or IntegrationPharmacy benefit management services including prescription drug search, formulary access, and pharmacy network for all Sentara Health Plans members across employer, individual, Medicaid, and Medicare products.
• HealthSparqcoreTechnology or IntegrationProvider directory search tool integrated into Sentara Health Plans website allowing members to find doctors, facilities, and pharmacies within the plan network.

Scale indicators3 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• Humana: National health insurer with the largest Medicare Advantage-focused franchise plus group, specialty and Medicaid offerings. Comparable as a large MA-heavy carrier, but operates at much greater national scale and depth than Sentara.
• Centene Corporation: Largest US Medicaid managed care insurer with significant Marketplace and Medicare presence. Comparable government-program heavy mix, particularly relevant to Sentara's Sentara Community Plan Medicaid franchise.
• Molina Healthcare: Multi-state managed care company focused on Medicaid, Medicare and dual-eligible plans. Comparable to Sentara's Medicaid and D-SNP franchises, especially in government program administration.

Direct peers

• Geisinger Health Plan: Regional integrated payer-provider serving central and northeastern Pennsylvania with HMO, PPO, Medicare Advantage and Medicaid plans. Closely comparable in being a regional, system-affiliated multi-segment carrier with full commercial and government product offerings.
• Independence Blue Cross: Philadelphia-based Blue Cross Blue Shield licensee offering commercial, Medicare Advantage, ACA Marketplace and Medicaid plans. Comparable multi-segment regional plan with overlapping product structures (HMO, PPO, POS, EPO, HSA) to Sentara.
• Highmark: Integrated regional payer-provider serving Pennsylvania, West Virginia, Delaware and parts of New York with commercial, Medicare Advantage and ACA Marketplace plans. Comparable multi-segment, multi-state regional carrier with similar product breadth to Sentara.
• CDPHP: Capital District Physicians' Health Plan serving upstate New York with commercial, Medicare and Medicaid products. Comparable as a mid-sized regional, multi-segment health plan with similar HMO/POS/HRA product mix.
• Blue Cross and Blue Shield of North Carolina: Largest health insurer in North Carolina offering individual, employer, Medicare and ACA Marketplace plans. Highly comparable to Sentara as a single-state dominant regional carrier now beginning to serve Northeastern North Carolina overlap.
• Priority Health: Michigan-based non-profit health plan offering commercial, individual, Medicare Advantage and Medicaid plans. Comparable as a regional carrier with broad segment coverage and a focus on integrated provider partnerships, similar to Sentara's Sentara Health system affiliation.
• CareFirst BlueCross BlueShield: Mid-Atlantic non-profit licensee of the Blue Cross Blue Shield Association serving individuals, employers, Medicare and Medicaid members across Maryland, D.C. and Northern Virginia. Most directly comparable to Sentara in terms of regional, multi-line health plan footprint and product mix including MA, Medicaid and commercial HMO/POS.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• YouTubeyoutube.com/@sentarahealthplans
• Facebookfacebook.com/sentarahealthplans
• LinkedInlinkedin.com/company/sentara-health-plans
• Instagraminstagram.com/sentarahealthplans

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

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

M&A

Investments

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

Frequently asked questions about Sentara Health Plans