"In its mission to provide a comprehensive delivery of healthcare services, The Health Plan strives to protect the patient's right to obtain services in a cost efficient and quality system where patient dignity and satisfaction are enhanced by the services of The Health Plan and its provider network." - The Health Plan Mission Statement
The Health Plan of the Upper Ohio Valley, Inc. was established in 1979 through provisions under the Federal HMO Act. As a federally qualified and state-certified, 501(c)(4) not-for-profit HMO, our goal is to provide high quality, comprehensive and cost effective health care to residents of Ohio and West Virginia.
The Health Plan is West Virginia’s first and largest HMO, and is a licensed health-insuring corporation (HIC) in Ohio with a service area encompassing 76 counties. Cities served include Wheeling, Weirton, Morgantown, Clarksburg, Charleston, Huntington, Beckley, and Parkersburg in West Virginia; and Akron, Canton, Cambridge, Dover/New Philadelphia, Marietta, Steubenville, and Zanesville in Ohio. Our extensive provider network includes nearly 10,000 physicians, over 100 hospitals, and a national network of more than 52,000 pharmacies.
In July 2003, The Health Plan purchased HomeTown Health Network, a Massillon-based managed care organization, from Akron General Health System. On April 1, 2006, HomeTown’s membership and that of its divisions – which included HomeTown Health Plan, HomeTown Insurance Group, HomeTown Administrative Services – were transferred to The Health Plan, completing the merger of HomeTown into its parent company.
A strong, regional plan with a distinct, local market focus.
The Health Plan employs 400 people and maintains offices in three locations throughout its service area: St. Clairsville, OH ~ The Upper Ohio Valley Region; Massillon, OH ~ The HomeTown Region; and Morgantown, WV ~ The Mountaineer Region.
The Health Plan takes pride in maintaining its community, not-for-profit status. We’ve been able to develop new lines of business and expand our markets while remaining locally managed, which we believe benefits our members. These business lines include HMO, PPO, POS, Medicare Advantage, WV Medicaid (Mountain Health Trust/Mountain Health Choices), VEBA administration, workers’ compensation programs and a variety of TPA services.
Solid strategies have led to consistent, steady growth for The Health Plan. With over 370,000 members enrolled across our diverse product lines, The Health Plan’s size is also a strength. Over 50 percent of Health Plan members are enrolled through their employers, while over 15,000 members are enrolled in Medicare programs and more than 190,000 are covered under managed workers’ compensation programs.
Being one of the most financially stable managed care organizations in both West Virginia and Ohio has been a key to The Health Plan’s success. We spend 91 cents of every healthcare premium dollar to pay claims. The remainder is used to cover administrative overhead – a low eight percent administrative cost – and any surplus at the end of the year is invested as equity and reserved for the protection of our members. In 2012, total reserves exceeded $190 million.
Helping members stay healthier while helping employers provide high-quality health coverage for their employees.
The Health Plan offers a complete line of managed care products and services designed to provide clients with innovative healthcare benefits at a reasonable cost. These include:
- Fully Insured Health Maintenance Organization (HMO)
- Fully Insured Preferred Provider Organization (PPO)
- Fully Insured Point-of-Service (POS)
- SecureCare (HMO) & SecureChoice (PPO) Medicare Advantage Plans
- Self-Funded Health Plans (EPO, PPO, POS, HMO)
- Exclusive Stop Loss Coverage
- Medicare Supplement coverage (Plans A, C, F and N)
- Medicare Prescription Drug Plan (PDP)
- Mountain Health Trust/Mountain Health Choices – W.V. Medicaid
- Ohio Workers' Compensation Programs
- Self-Funded Workers' Compensation programs
- Complete VEBA Administration and TPA Services
- Access to many ancillary benefits such as group term life, AD & D, STD, LTD, Dental, Vision, Prescription Drugs and COBRA Administration