Health Insurance (Medical)

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Health Insurance Plans
Employees have the choice of two medical plans with Optima:

  • HMO (Health Maintenance Organization)
  • PPO (Preferred Provider Organization)
The HMO allows members to choose primary care physician (PCP) to guide and coordinate care without requiring a referral to visit a specialist. The PPO gives members more freedom and flexibility when selecting providers, offering in-network and out-of-network benefit options.

Qualifying Event / Status Change
You may be eligible to enroll, change or cancel health insurance outside the annual open enrollment period if you experience an event or status change such as:
  • Birth
  • Adoption
  • Marriage
  • Divorce
  • Loss of existing health coverage
  • Dependents turning age 26 and losing coverage through parent's plan 
You have 31 days from the date of the qualifying event to make the change.
Supporting documentation will be required such as birth certificate, copy of marriage license or a letter from previous employer.  The coverage will be effective the 1st day of the month following the qualifying event date, with the exception of birth.  

Click here to read the Notice of creditable coverage disclosure from the City of Portsmouth about creditable prescription drug coverage and Medicare.

For employee verification of eligibility for spouse medical coverage, click here to download the 2016 Spouse Health Insurance Eligibility-Employee Form.  

For retiree verification of eligibility for spouse medical coverage, click here to download the
 2016 Spouse Health Eligibility-Retirees Form.

For more information on Optima Health Benefit News, click here to read the
quarterly newsletter.  

If you would like to read more information on how to stay healthy, you can download the 
Staying Healthy, WebMD Health Assessment and Health Assistant.

Visit the Optima Website to learn more about the healthcare providers and services.

Click here for answers to frequently asked questions regarding health insurance.