Health Plan Information

FAMIS offers health benefits through two delivery systems, managed care organizations (MCO) and fee-for-service (FFS).

MCO

Most FAMIS children get their care through an MCO. An MCO is an organization with a network of primary care providers (PCPs), specialists, and hospitals. A PCP is the doctor you choose to provide and coordinate your child's health care. Different MCOs are available in different areas. Your choices are based on where you live. MCOs that provide health care to FAMIS children include Amerigroup, Anthem HealthKeepers Plus, CareNet, MajestaCare, Optima Family Care, and Virginia Premier. Look at the Health Plan Listing by Locality to determine which program is available in your area.

Fee-for-Service

For the first month or two after initial enrollment, children across the state will receive their health care through our fee-for-service system prior to choosing an MCO. While in FFS, children can go to any doctor who takes FAMIS. The only exception to MCO enrollment are resident’s of Tangier Island and members with third party liability (TPL).

Your Health Plan Cards

Once your child is enrolled in FAMIS, you will get a permanent Commonwealth of Virginia health insurance card from DMAS. Each enrolled child in your household will get a card. If your child is also enrolled in a managed care organization (MCO), he or she will also get a separate identification card from the MCO. You are responsible for:

• Making sure the provider takes FAMIS insurance or your child’s MCO;
• Showing your child's cards to the provider each time your child gets medical or dental services; and
• Paying any required co-pays.