Listed below are links to help you file an appeal or grievance, request a new ID card or change an address.
Make a Request
Members may use this form to request a new ID card, make a change in your
address, add or change a physician or send us a comment.
We encourage you to let us know right away if you have questions, concerns, or problems related to your covered services or the care you receive. If you have a grievance, call Member Services at 1.877.847.7907/TTY: 1.800.622.3925 (Ohio Valley & Mountaineer Region) or 1.800.426.9013/ TTY: 1.877.236.2291 (HomeTown Region).
Member Prenatal Risk Screen
Members may use this form to fill out a prenatal risk screening.
Accident Report (254k)
Form to be filled out if Health Contract contains a subrogation clause. The
Health Plan is obligated to recover any claim payments made on your behalf
from the third party's insurance carrier or from you if you received that
claim payment. Contact our Funds Recovery Department at 1.800.624.6961, ext.
7903 if you have any questions, or to give the information by phone.
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