The Health Plan is a federally and State qualified Health Maintenance Organization based on the "personal physician" concept. It provides a wide variety of both traditional and preventative health care services.  The Health Plan makes these services available to you through any one of the 5974 private practice physicians who participate on the plan.

The Health Plan emphasizes early detection and treatment of medical problems.  We think you will be more likely to enjoy the benefits of such services when they are available to you through your own Primary Care Physician.

When selecting an HMO, take a look at The Health Plan. The Health Plan is West Virginia's first, and largest, HMO.   We've been keeping thousands of West Virginias well since 1979 through our large network of providers.

We believe the key to health is a strong bond between the patient and his or her doctor.  People and their doctors make decisions together about health care, and assure the best possible care for each Health Plan member.

The Health Plan's goal is to keep you healthy.  We'll help you get well and stay well.

• Check-ups, immunizations, mammography and other routine services are covered.
• Each family member can choose a different doctor, or you can choose a physician who will treat your entire family.   If you want to change doctors, you have hundreds to choose from.
• The Health Plan gives you access to outstanding doctors.
• If you are sick or injured away The Health Plan will cover all medically necessary care.   You don't have to pay doctor bills, just present your Health Plan I.D. card at each office visit to a participating doctor.
• The Health Plan is a not-for-profit corporation.  All revenues go to providing health care, administering claims and to a reserve to cover future health care costs.
• Health care shouldn't be a hassle.  We take the worry, and the wasted time, out of getting care.   There's virtually no paperwork.

Other benefit highlights:

With The Health Plan, you do not have to worry about any exclusion for pre-existing conditions.  In addition, The Health Plan covers many preventive care services such as routine physical exams, immunizations, well baby visits, prenatal care and mammograms.

Your prescription drug benefit will still be administered through WV Medicaid.  If you are out of The Health Plan Service Area, you still have coverage for emergencies.  Unless it is a life-endangering situation, you should still try to call your Primary Care Physician, or The Health Plan for direction on what to do.

How to use the Plan:

The Health Plan, as an HMO, provides an organized system of health care delivery that is coordinated by a Primary Care Physician.  Each member of the family can select a different Primary Care Physician from the list of participating physicians.  Members may change physicians at any time, but it is important to establish a relationship with your Primary Care Physician since they will coordinate all of your health care needs.   When medically appropriate, your Primary Care Physician may arrange for additional services such as referrals to other participating specialists or hospitals.  Visits to other providers or facilities on the provider list require a referral from the Primary Care Physician.  Female members may also select an Obstetrician/Gynecologist whom they can visit once per year (for routine care) without a referral.

If you need assistance selecting a Primary Care Physician, or OB/GYN Physician, call The Health Plan office at (740) 695-3585 or 1-800-624-6961, TDD (740) 695-7919 or 1-800-622-3925.  When a Health Plan member requires specialty care or services not available through the local in-plan net work of providers, then his/her physician will refer them to one of The Health Plan's participating tertiary providers.  The services at these providers must be pre-authorized by The Health Plan Medical Department prior to seeking treatment.

In an emergency situation, call your Primary Care Physician day or night.  He or she can direct you to the appropriate care and can assure the proper follow-up to that care.  If your Primary Care Physician cannot be reached, call The Health Plan's 24-hour emergency number.  You will be put in touch with your physician's back up or The Health Plan's nurse-on-call for direction on what to do.

The Member Handbook that comes with your I.D. card has more details on emergency care, selecting a physician, and benefits.

Type of plan and service area:

For Mountain Health Trust members, we serve the West Virginia counties of Brooke, Hancock, Marshall, Ohio, Harrison, Marion, Monongalia, Wood, Preston, Taylor, Tyler, Wetzel, Doddridge, Wirt, Gilmer, Lewis, Pleasants, Ritchie, Upshur, Barbour, Randolph, and Tucker. Expansion is planned into other counties.

Mountain Health Trust Physician Network and affiliated Hospitals:

Physicians
Primary Care Physicians

Obstetric/Gynecology
Specialists

Hospitals

The Health Plan is affiliated with 57 hospitals in the network.