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Important note: Answers to common questions are general guidelines for health plans offered by Sentara Health Plans. While most answers apply to all plans offered by Sentara Health Plans, there may be some slight differences. Please refer to member materials or contact us for information on your specific health plan.

Enrollment

For groups enrolling 25 or more subscribers the following is needed:

  • Employer Group Health Questionnaire (EGHP)
  • current plans / benefits
  • census split if they have more than one plan
  • current and renewing rates

For groups enrolling 2-24 subscribers the following is needed:

  • all four pages of Sentara Health Plan's application and health questionnaire (or Universal app) for each enrolling subscriber

Yes. Enrollment documents can be sent directly to Sentara Health Plans by US mail, fax, or secure email.

Please allow five business days for small group underwriting.

Products and Coverage

Sentara Health Plans provides a full range of healthcare coverage products for large and small groups.

  • Plans for Large Groups: We define large groups as employer groups with 151 or more eligible employees. Our standard plan designs and funding arrangements may be offered, or they may be customized depending on the size, needs and resources of the group.
  • Plans for Mid-Market Groups: We define mid-market groups as employer groups with 51 to 150 eligible employees. Our standard plans are available with a range of coverage levels, deductibles and copayments.
  • Plans for Small Businesses: Small businesses are defined as companies with two to 50 eligible employees. Our standard plans are available with a range of coverage levels, deductibles and copayments.

*Sentara Health is the trade name of Sentara Health Plans, Sentara Health Insurance Company, and Sentara Health Group, Inc. Sentara HMO products, related Patient Optional Point-of-Service products, Point-of-Service products, and Open Access products are underwritten by Sentara Health Plan. Sentara Health Plans Preferred Provider Organization products are underwritten by Sentara Health Insurance Company. Self-funded plans are administered by Sentara Health Plans, Inc.

All plan members receive:

  • member ID cards mailed to the home address on record
  • benefit information guides, usually distributed by the employer prior to enrollment
  • coverage documents that are available online and may be mailed to the member’s home at the member’s request

In addition, members may receive:

  • member newsletter
  • other direct mail
  • Explanation of Benefits (EOB) when care is received

A pre-existing condition is any medical condition, other than pregnancy, for which medical advice, diagnosis, care, or treatment was recommended or received within a six-month period ending on the enrollment date.

If your plan has a pre-existing condition exclusion or waiting period, you will not be covered for those specific pre-existing conditions for a period of 12 months. You may receive credit to reduce or eliminate the pre-existing condition waiting period for any creditable coverage if you were continuously covered under another health plan with no more than a 63-day break in coverage. Please refer to the Notice of Pre-Existing Condition Exclusion included with your plan documents, if applicable.

A certificate of creditable coverage is intended to help you and your dependents in case you lose or change health plan coverage.

Under a federal law known as the Health Insurance Portability and Accountability Act (HIPAA), you or your dependents may need evidence of coverage to reduce a pre-existing condition exclusion period under another plan, to help get special enrollment in another plan, or to get certain types of individual health coverage.

When you change healthcare coverage, or if you or your dependents lose coverage under a health plan, the plan sponsor is usually required to provide written certification of how long you and your dependents were covered under that plan. You or your dependents can also request a certificate of creditable coverage if one is not automatically provided to you. When you enroll in Sentara Health Plans we ask that you include a copy of certificates of creditable coverage for you and your dependents so that we may ensure you receive credit for your prior coverage against any pre-existing condition exclusion periods under your Sentara Health Plans.

Please call member services if you have any questions about obtaining a certificate of creditable coverage. Most group health insurance (including government or church plan), individual health insurance, Medicare, Medicaid, military-sponsored healthcare (TRICARE), a program of Indian Health Service, a state health benefits risk pool, the Federal Employee Health Benefits Program (FEHBP), a public health plan as defined in the federal HIPAA regulations, and any health benefits plan under section 5(e) of the Peace Corps Act.

These health improvement programs provide information and lifestyle tips to reduce cardiovascular health risks and promote health.

To take your Personal Health Assessment and for more information about all of our health and wellness programs, visit Health and Wellness.

Certain Sentara Health Plans products give members the option of receiving covered services out of the area through a national carrier. Also, Sentara Health Plans provides coverage for emergency care out of the area. Contact your insurance broker or Sentara Health Plans account representative for more information.
In most cases these employees or dependents can be covered through Sentara Health Plans’ out-of-area PPO. Contact your insurance broker or Sentara Health Plans account representative for more information.
A full-time, active employee who has not worked for a time period due to illness or injury (disability) may continue to be covered under the group’s health plan for up to six months.

Contact Information

Release of Information

Information/Authorization of Designated Agent form whenever anyone other than the member needs to obtain and/or change the member’s health information. This form must be signed, witnessed and returned in order for it to be in effect.