Got Questions?

Following are some questions and answers you may have before selecting your healthcare plan.

Warning: If you or your family members are covered by more than one Health Care Plan, you may not be able to collect benefits from both plans. Each Plan may require you to follow its rules or use specific doctors and hospitals. It may be impossible to comply with both Plans at the same time. Before you enroll read all of the rules very carefully, including the Coordination of Benefits Section, and compare them with the rules of any other Plan that covers you or your family.

What is a Health Maintenance Organization (HMO) or Health Insuring Corporation (HIC)?
A Health Maintenance Organization (HMO) in West Virginia, Health Insuring Corporation (HIC) in Ohio is an organized system of health care delivery. The Health Plan is a state and federally qualified Health Maintenance Organization (HIC in Ohio). HMO’s/HIC’s contract with various physicians and facilities to provide medical care to their members.

What does this mean? The Health Plan has an organized provider network to provide medical services to our members. In joining an HMO/HIC, a member agrees to utilize the HMO’s/HIC’s provider network for care and usually receives a higher level of benefits than under a standard insurance plan. The Health Plan is not considered to be an insurance company. Unlike traditional insurance, one’s medical care is coordinated by a Primary Care Physician (PCP).

Are all Health Maintenance Organizations, or Health Insuring Corporations, the same?
No. We offer traditional and preventive health care through over 1000 private physicians in this area. Some Health Maintenance Organizations/Health Insuring Corporations are committed to a group practice, or clinic concept, requiring the use of physicians in a particular location or facility. The Health Plan operates under a totally different concept. Therefore, when you join The Health Plan, you become a member of a prepaid health care program based on the concept of virtually free choice of one’s personal physician from our Provider List.

Who pays for all of the medical services I use?
The dollars we collect as premium payments from employers pay for the services our members use. By encouraging our members to take advantage of the preventive services available through our program, we believe that a substantial number of potentially expensive health problems are taken care of before they become more serious and more costly. This concept is the basis for the success of The Health Plan.

How do I choose my Primary Care Physician (PCP)?
The Health Plan wants you to have a Primary Care Physician or personal physician who knows you and your medical history. You will choose the physician to coordinate all of your health care needs. Such a choice is not final. A member may change physicians once per calendar month. You are entitled to services from many of the Plan’s physicians and hospitals.

What happens when I am out of the Service Area and need medical care?
If you are out of The Health Plan Service Area and receive medical services for a medical emergency, present your Health Plan I.D. card for payment. If you are admitted outside The Health Plan Service Area, The Health Plan should be notified within 48 hours or as soon as reasonably possible. On the back of the I.D. card, the persons rendering services will find payment and billing instructions. If you encounter problems with such payment or if the emergency room requires you to pay the bill, we ask that you pay for the services and send the bill to The Health Plan Member Relations Department. If a charge is made to a member for any services with respect to benefits under your Agreement, written proof of such charge must be furnished to The Health Plan within one year after the performance of the service.

Will you help me find a physician if I need one?
All of our members receive a listing of Plan physicians, hospitals and other health care providers. The Provider List provides you with each physician’s address, phone number and specialty. If you need assistance, call The Health Plan office at 740.695.3585, 1.800.624.6961, TDD 740.695.7919, 1.800.622.3925, email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Can I have a second medical opinion?
A second medical opinion can be obtained. We have many Plan physicians in all of the medical specialties. As a member, you are entitled to the services of many of these participants. While we endorse the idea of coordinated health care provided by a single physician, you can obtain a second opinion from another Plan physician. This can be arranged through your Primary Care Physician.

Who can I talk to if I have more questions?
Call The Health Plan at 740.695.3585, 1.866.218.2826, TDD 740.695.7919, 1.800.622.3925, email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .