Frequently Asked Questions
If you need answers to other questions or need to ask about a specific plan and benefits please call member services from 8 a.m. to 6 p.m. Monday through Friday at the phone number listed on the back of your member ID card. If you are not a member and need information about enrolling, call 757-552-7401. TTY lines for the hearing impaired are 711.
Sentara Individual & Family Health Plans are offered for people who do not have coverage through their employer.
Sentara Health Plans also offers a health plan for Virginia Medicaid and FAMIS beneficiaries, as well as, a managed long-term services support plan. Our Medicare Advantage and Medicare Advantage Special Needs plans include everything offered by original Medicare, plus more.
Visit our Treatment Cost Calculator page to learn how estimates are produced, what costs are included in each estimate, and some helpful hints to help users take full advantage of the various resources available in the tool. These FAQs will evolve based on the user experience, so check back for updates.
Remember, in an emergency always call 911 or go to the nearest emergency department.
A registered nurse will ask you to describe your medical situation in as much detail as possible. Be sure to mention any other medical conditions that you have, such as diabetes or hypertension.
Depending on the situation, you may be advised about appropriate home treatments or to visit your doctor to seek care. If necessary, the nurse may direct you to a Plan urgent care center or Emergency Department.
The 24/7 Nurse Advice Line nurses have training in emergency medicine, acute care, OB/GYN, and pediatric care. The staff are well-prepared to answer medical questions for members and their dependents. However, since they are unable to access medical records, they cannot diagnose or medically treat conditions, order labs, write prescriptions, order home health services, or initiate hospital admissions or discharges.
If you have a behavioral health question or situation, please call our Behavioral Health Crisis Line at the number on the back of your member ID card.
If you received emergency care and are admitted, you or a family member should contact Sentara Health Plans within 48 hours (two business days) or as soon as medically possible. This enables us to arrange for appropriate follow-up care, if necessary. Please note that in each of these situations, care may be reviewed retrospectively to make sure it met the criteria for coverage of emergency care treatment.
An emergency is the sudden onset of a medical condition with such severe symptoms or pain that a person with an average knowledge of health and medicine (prudent layperson) would seek medical care immediately because there may be serious risk to your physical health, your mental health, or that of your unborn child.
Some examples of situations that would require the use of an Emergency Department include but are not limited to:
- heart attack/severe chest pain
- trouble breathing
- loss of consciousness
- head trauma
- broken bones
- severe bleeding
- loss of vision
- fever over 104°F
- vaginal bleeding when pregnant
- plans to harm yourself or others
The following conditions do not ordinarily require Emergency Department treatment, and may be more appropriately treated in your doctor’s office, or at a Plan urgent care center:
- sprains or strains
- chronic conditions such as arthritis, bursitis, or backaches
- minor injuries and puncture wounds of skin
- refill and renew medications
- chronic illness
- long-term urine/bowel issues
- most behavioral health needs
- flu, sore throat, fever
- cough/cold/runny nose
- throat pain or sore throat
- ear pain
- pain/burning in urine
- loose stools/diarrhea
- fever less than 104°F
- back pain
- penile/vaginal discharge
- minor injuries, cuts, burns
Remember, we may review all Emergency Department care retrospectively—after the fact—to determine if a medical emergency did exist. If an emergency did not exist, you may be responsible for payment for all services.
If you received emergency care and are admitted, you or a family member should contact Sentara Health Plans within 48 hours (two business days) or as soon as medically possible. This enables us to immediately begin reviewing your situation and arrange for appropriate follow-up care. Remember all emergency care may be reviewed retrospectively to make sure it met the criteria for coverage of emergency/urgent care treatment.
If you are admitted to a hospital outside of Sentara Health Plans service area, call member services or the 24/7 Nurse Advice Line at the number on the back of your member ID card. Be prepared to give the following information:
- member name
- reason for treatment
- hospital name
- city and state where treatment is occurring
- name of treating doctor
The doctor or hospital may also call clinical care services.
A complete description of your rights under HIPAA can be found in the Sentara Health Integrated Notice of Privacy Practices. A copy of the notice will be included in your Plan documents when you enroll. You can view a copy of our privacy notice online.
The Commonwealth of Virginia also has laws in place to protect the privacy of our members’ insurance information. We will not release data about you unless you have authorized it, or as permitted or required by law. Sentara Health Plans requires an Authorization for Use or Disclosure of Medical Information (Designated Agent) form whenever anyone other than the member needs to obtain and/or change health information. To download a copy of the form, sign in and visit Forms and Documents, or call member services at the number on the back of your member ID card.
Under HIPAA and Virginia law you have certain rights to see and copy health information about you. Through HIPAA, you have the right to request an accounting of certain disclosures of the information and under certain circumstances, amend the information. You have the right to file a complaint with Sentara Health Plans or with the Secretary of the U.S. Department of Health and Human Services if you believe your rights under HIPAA have been violated.
You can review a list of participating providers for your plan online. You can choose or change your PCP online when you sign in either online or the mobile app, select Change Primary Care Physician from the menu, and follow the onscreen instructions. In most cases, your PCP selection will be effective the next business day.
Please note, you do not need prior authorization from Sentara Health Plans or from any other person, including your PCP, to access obstetrical or gynecological or other specialty care from a healthcare professional in our network. The healthcare professional may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or other Plan requirements.
If you have not seen your designated PCP within the last 24 months, please contact your PCP’s office or member services to ensure that the office still lists you as a patient. Having your correct PCP on file ensures that any correspondence or other outreach to your PCP is accurate.
Generally, adults choose a family practice or internal medicine doctor for their PCP. For children, you may choose a participating pediatrician as their PCP.
If you have a Sentara Vantage or HMO plan and your Plan doctor directs you to a non-Plan provider, you will be responsible for payment of these services.
If you have a POS or Plus PPO plan, you have the option of using Plan providers or non-Plan providers. Claims from non-Plan providers will be paid at a reduced benefit level and you will usually pay higher deductible, copayment, and coinsurance amounts. You may also be balance billed for any charges in excess of the Plan’s allowable charges. To find an in-network doctor, use the Find a Doctor, or Find a Facility search feature, either online or via the mobile app, download a Provider Directory, or call member services at the number on the back of your member ID card.
Yes. Sentara Health Plans offers individual plans for individuals who do not have coverage through their employer or have retired but are not Medicare-eligible. Discover your Individual Plan options.
If you are self-employed or a sole proprietor, you may be able to purchase a Small Group Plan.
Discover your Individual Plan options.
Ensure you are following our username and password requirements:
- Usernames must begin with a letter, and can include only letters (a-z or A-Z), numbers (0-9), and underscores (_).
- Usernames cannot include spaces or special characters and are not case sensitive.
- Usernames can be a maximum of 20 characters long.
- Passwords must be 8 - 64 characters long.
- Passwords cannot contain your username, first name or last name.
- Passwords cannot contain the words "Sentara", "MyChart", or "MyHealth" using any case.
- Passwords cannot contain three or more repetitive or sequential characters (i.e. "aaa" or "123").
- Passwords cannot be a dictionary word by itself.
Please note that if you choose a password that we identify as having previous security concerns, we will ask you to choose a different one.
If you have forgotten your username you can complete the first step of the registration process again to recover your username. If you have previously set up a username, your username will appear at the top of the registration page after you have submitted the registration form. You may also contact member services at the number on the back of your member ID card to find out your username.