Optima

The Premier Health Optima plan option is perfect for families looking for the most comprehensive health insurance package. Optima includes all the benefits offered under our Secure plan option, plus some additional benefits including outpatient psychiatric services, AIDS/HIV/ARC treatment, and unlimited diagnostic testing. Additionally, the plan provides a higher lifetime maximum and increased benefit limits.

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Explore the benefits of this plan

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Plan Highlights

  • Worldwide coverage including inside the United States
  • Guaranteed renewability
  • Maternity benefits and complication of pregnancy included
  • Remote Second Medical Opinion and patient concierge services
  • Travel Assistance Program included
  • Deductible forgiveness for good claims history
  • 2 Years of premium waived upon death of primary insured
  • Unlimited Diagnostic Testing
  • AIDS / HIV / ARC Treatment
  • Outpatient Psychiatric Services

Lifetime Maximum Benefits

$4,000,000 annual maximum coverage per insured

$750,000 lifetime maximum per human organ transplant

All benefits are subject to Usual, Customary and Reasonable (UCR) fees. The benefits, coverage and exclusions listed herein are only a summary, and are subject to the specific terms and conditions of the plan concerning eligible benefit, limitations, eligibility and exclusions. Please refer to the Conditions of Coverage for details.

Penalties to the benefits payable under this plan may apply if the requirements are not met. Please refer to the section labeled Pre-Certification Requirements and Procedures in the plan’s Conditions of Coverage. You must contact the pre-certification provider number listed on your identification card.

The following services require pre-certification:

  • Hospitalization
  • Surgeries
  • Diagnostic Testing
  • Oncology Treatment
  • Repatriation of Mortal Remains
  • Therapy
  • Organ Transplant
  • Medical Air Evacuation / Air Ambulance
  • Rehabilitation
  • Home Health Care
  • Extended Care Facility

Failure to perform the pre-certification requirements within a minimum of 5 business days prior to the planned treatment of a non-emergency service or within 72 hours of an emergency service, will result in a penalty of 30% of the allowable charge for the entire episode of care. The penalty will not count toward the deductible or co-insurance maximum as defined on the Certificate of Coverage.

For Travel Assistance all notifications must be done within 24 hours of occurrence.