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Helpful Resources

 

Members may Request More Information on The Health Plan/THP SecureCareHMO or SecureChoicePPO programs.

• Direct Claim Form (46k)
• ACH Letter & Contract (Ohio Valley & Mountaineer Region) (32k)
  This contract will allow you to pay your Health Plan/THP bill automatically each month with the Automated Payment Program. Deductions on your health care premium will be on the 4th of each month.
• ACH Letter & Contract (HomeTown Region) (32k)
  This contract will allow you to pay your Health Plan/THP bill automatically each month with the Automated Payment Program. Deductions on your health care premium will be on the 5th of each month.
• Medicare Secondary Payer Form (34k)
  Required form by the Centers for Medicare and Medicaid Services.

Member Rights & Responsibilities

• SecureCareHMO (30k)
• SecureChoicePPO (30k)

Out-Of-Network Coverage

When can you use a pharmacy that is not in the plan's network?
We have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:

• Generally, we only cover drugs filled at an out-of-network pharmacy in limited, nonroutine circumstances when a network pharmacy is not available.

In these situations, please check first with Member Services to see if there is a network pharmacy nearby.

• EOC with RX coverage, Chapter 5, Section 3.5 for SecureCareHMO
• EOC with RX coverage, Chapter 5, Section 2.5 for SecureChoicePPO

Ending your membership in the plan

Information in this section refers to beneficiaries, plan rights and your responsibility upon disenrollment.

• see Chapter 10, Sections 1-5 of EOC with RX coverage for SecureCareHMO and SecureChoicePPO
• see Chapter 8, Sections 1-5 of EOC without RX coverage for SecureCareHMO and SecureChoicePPO

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SecureCareHMO Ohio Valley Region/Mountaineer Region Evidence of Coverage & Summary of Benefits

Offered to the residents of the following:

OHIO COUNTIES in the Ohio Valley Region: Belmont, Guernsey, Harrison, Jefferson, Noble, Monroe, Muskingum, and Washington counties.

WEST VIRGINIA COUNTIES in the Ohio Valley Region: Brooke, Hancock, Marshall, Ohio, Tyler, and Wetzel counties.

WEST VIRGINIA COUNTIES in the Mountaineer Region: Barbour, Calhoun, Doddridge, Gilmer, Harrison (WV), Lewis, Marion, Monongalia, Pleasants, Preston, Randolph, Ritchie, Taylor, Tucker, Upshur, Webster, Wirt and Wood counties.

2010 Annual Notice of Change/Evidence of Coverage (EOC)

• SecureCareHMO with RX (1.23MB)
• SecureCareHMO without RX (1.07MB)

Summary of Benefits

• SecureCareHMO (702k)

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SecureCareHMO HomeTown Region Evidence of Coverage & Summary of Benefits

Offered to the residents of the following:

OHIO COUNTIES in the HomeTown Region: Ashland, Carroll, Columbiana, Coshocton, Holmes, Mahoning, Medina, Portage, Stark, Summit, Trumbull, Tuscarawas, and Wayne counties.

2010 Annual Notice of Change/Evidence of Coverage (EOC)

• SecureCareHMO with RX (1.23MB)
• SecureCareHMO without RX (833k)

Summary of Benefits

• SecureCareHMO (696k)

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SecureChoicePPO Evidence of Coverage & Summary of Benefits

Offered to the residents of the following counties:

In OHIO: Ashland, Belmont, Carroll, Columbiana, Coshocton, Guernsey, Harrison, Holmes, Jefferson,
Mahoning, Medina, Monroe, Muskingum, Noble, Portage, Stark, Summit, Trumbull, Tuscarawas,
Washington and Wayne.

In WEST VIRGINIA: Barbour, Brooke, Calhoun, Doddridge, Gilmer, Hancock, Harrison, Lewis,
Marion, Marshall, Monongalia, Ohio, Pleasants, Preston, Randolph, Ritchie, Taylor, Tucker, Tyler,
Upshur, Webster, Wirt, Wetzel and Wood.

2010 Annual Notice of Change/Evidence of Coverage (EOC) - Ohio Valley/Mountaineer Region

• SecureChoicePPO with RX (1.22MB)
• SecureChoicePPO without RX (1.08MB)

2010 Annual Notice of Change/Evidence of Coverage (EOC) - HomeTown Region

• SecureChoicePPO with RX (1.22MB)
• SecureChoicePPO without RX (800k)

Summary of Benefits - All Regions

• SecureChoicePPO (948k)

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SecureCareHMO and SecureChoicePPO Directories

Listed are printed directories we currently have available online for you to download and print at your convenience. In addition to these directories, which are somewhat large, we have a provider look-up feature to facilitate searching for providers by specialty and location.

• Access the Provider Search

*Provider lists below are printed by Region. To determine which regional list is appropriate, review our reference map. *

If you reside or are looking for providers in any of the regions highlighted in grey -- please contact Customer Service Ohio Valley or Mountaineer Region at 740.695.7902/1.888.847.7902 and HomeTown Region at 330.837.6880/1.800.426.9013.

SecureCareHMO

(updated 06/10)

• Ohio Valley Region (422k)
• Mountaineer Region (430k)
• Hometown Region (897k)

SecureCareHMO Vision Service Provider (VSP) Directories

(updated 1/2010)

• Ohio Valley Region (76k)
• Mountaineer Region (60k)
• Hometown Region (100k)

SecureChoicePPO

(updated 06/10)

• Ohio Valley Region (455k)
• Mountaineer Region (433k)
• Hometown Region (935k)

SecureChoicePPO Vision Service Provider (VSP) Directories

(updated 1/2010)

• Ohio Valley Region (76k)
• Mountaineer Region (60k)
• Hometown Region (119k)

 

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