The Health Plan
The Health Plan is a West Virginia-based HMO and managed care organization offering Medicaid, Medicare Advantage, Medicare Supplement, and commercial health insurance to members across West Virginia and Ohio, with self-funded plans available in all 50 states. Founded in 1979, it operates as one of three state-approved Medicaid MCOs.
- Company typePrivate
- Founded1979
- HeadquartersWheeling, United States
- Headcount101–250
- GTM typeB2B
- OfferingServices
What The Health Plan does
The Health Plan of West Virginia Inc. is a privately held, non-profit health maintenance organization (HMO) and licensed health-insuring corporation headquartered in Wheeling, West Virginia, founded in 1979. The company operates as a managed care organization offering a full portfolio of government-sponsored and commercial health insurance products, including Medicaid managed care (under the West Virginia Mountain Health Trust program), WVCHIP for children and pregnant women, Medicare Advantage plans (HMO, PPO, and D-SNP variants) for Ohio and West Virginia residents, Medicare Supplement plans through its wholly-owned subsidiary THP Insurance Co., Inc., and commercial HMO/PPO/POS plans for small and medium businesses, plus self-funded ASO plans with stop-loss coverage available in all 50 states.
The technology platform combines a member-facing MyPlan portal and mobile application (iOS and Android) with multi-factor authentication, a Find-a-Provider directory, a CMS-mandated Patient Access API for third-party interoperability, and integrated member tools including Healthcare Bluebook price comparison. Core operations rely on a network of third-party service partners rather than internally built technology: Express Scripts for pharmacy benefit management, Teladoc for telehealth, eviCore for prior authorization and utilization management, SkyGen for dental administration, Superior Vision for vision benefits, Gainwell for pharmacy help desk, and Change Healthcare as the exclusive EDI gateway for electronic claims. Clinical decision support is delivered through InterQual, and the company maintains NCQA Health Plan Accreditation for HMO, Medicare, and Medicaid product lines.
Revenue is generated primarily through premium payments from employer groups, individuals (Medicare Advantage, Medicare Supplement, Medicaid), and Administrative Services Only (ASO) fees from self-funded employer plans including stop-loss coverage. The go-to-market model combines a local broker relations team with a broker portal for employer and Medicare sales, direct enrollment through the company website for individual Medicare products, and state-level Medicaid enrollment through the West Virginia Department of Human Services with The Health Plan as an MCO choice. Customer segments are diversified across Medicaid members, Medicare beneficiaries, small and medium employer groups, and self-funded employers, with a sole disclosed named enterprise customer being the State of West Virginia Public Employees Insurance Agency (PEIA).
The Health Plan firmographics
Firmographics- Name
- The Health Plan
- Legal name
- The Health Plan of West Virginia Inc.
- Website
- https://healthplan.org
- Company type
- Private
- Founded year
- 1979
- Operating status
- Operating
- Headcount range
- 101–250 employees
- Short description
- The Health Plan is a West Virginia-based HMO and managed care organization offering Medicaid, Medicare Advantage, Medicare Supplement, and commercial health insurance to members across West Virginia and Ohio, with self-funded plans available in all 50 states. Founded in 1979, it operates as one of three state-approved Medicaid MCOs.
- Ownership category
- akta.pro rank
The Health Plan industry classification
Industry- Product category
- Managed Care Health Insurance
- NAICS
- Direct Health and Medical Insurance Carriers (524114)
- SIC
- Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)
- akta.pro primary industry
- Group HMO Plans (FSAIAFAK)
- akta.pro secondary industries
- Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH), Small Group POS Plans (HLAEAOAI), Small Group Health Insurance (2–50/100) (FSAIAFAD), Self-Funded Employer POS (ASO/TPA-Administered) (HLAEAOAH)
Keywords
Where The Health Plan is headquartered
LocationHeadquarters
- HQ city
- Wheeling
- HQ country
- United States
- HQ region
- North America
Offices4 records
Markets served
The Health Plan business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure, Supply Chain
Revenue model
- Premium Revenue: The Health Plan generates primary revenue through premium payments from employer groups, individuals (Medicare Advantage, Medicare Supplement, Medicaid), and self-funded plan administration fees.
- Self-Funded Plan Administration: Administrative Services Only (ASO) fees from self-funded employer groups, including stop-loss coverage services.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Medicaid and WVCHIP plans offer low or no-cost coverage for eligible West Virginia residents |
| Subscription | Monthly | Medicare Advantage and Supplement plans for Ohio and West Virginia residents |
| Subscription | Monthly | Employer plans for small and medium businesses |
Go-to-market motion2 records
Distribution channels4 records
Marketing channels5 records
The Health Plan product offering
Product offeringCore offering
The Health Plan is a non-profit HMO and licensed health-insuring corporation that sells managed care health insurance and administers self-funded employer health plans in West Virginia and Ohio. Its core offerings span Medicaid managed care, Medicare Advantage (HMO/PPO/D-SNP), Medicare Supplement (Medigap) plans, WVCHIP, commercial HMO/PPO/POS plans, and self-funded plans with stop-loss and COBRA administration, supported by member digital tools (MyPlan portal and mobile app), pharmacy benefit management, clinical care management, and wellness programs.
Product overview
The Health Plan is a clinically-driven, technology-enhanced, and customer-focused health maintenance organization (HMO) established in 1979, offering a comprehensive portfolio of managed care products and services. The company's product portfolio centers on government-sponsored and commercial health insurance plans including Medicaid, Medicare Advantage (with HMO/PPO/D-SNP variants), Medicare Supplement plans, WVCHIP, and employer-sponsored Commercial and Self-Funded plans. These core insurance products are supported by an integrated ecosystem of digital services (MyPlan Mobile App and Member Portal), pharmacy benefit management through THP Rx/Express Scripts, clinical programs (CoreWellness, Chronic Disease Management, Behavioral Health, Case Management), quality improvement initiatives, and administrative services (COBRA Administration, Stop-Loss Coverage). The company operates primarily in West Virginia and Ohio with offices in Wheeling, Morgantown, and Charleston, WV and Massillon, OH.
Differentiator
Problem solved
Functional benefit
Brands
- MyPlan: Mobile application for members to access ID cards, find doctors, track copays and deductibles, view claims, and manage their health insurance.
- CoreWellness
- THP Rx
- THP Insurance Co., Inc.
Products and services
- Medicaid Managed Care Plans Managed care health insurance for West Virginia residents meeting income or other Medicaid eligibility requirements, covering doctors, specialists, dental, vision, mental health, and prescription drugs.
- Medicare Advantage Plans (SecureCare HMO, SecureChoice PPO, D-SNP) Medicare Advantage plans including HMO, PPO, and Dual-Eligible Special Needs Plan variants for Ohio and West Virginia residents ages 65 or older and those meeting other Medicare requirements.
- Medicare Supplement Plans (THP Insurance Co., Inc.) Medigap Plans A, C, D, F, High-Deductible F, G, High-Deductible G, and N that supplement Original Medicare by covering deductibles, copayments, and coinsurance for Ohio and West Virginia residents.
- WVCHIP (West Virginia Children's Health Insurance Program) Low- or no-cost health insurance for children up to age 19 and pregnant women living in West Virginia who meet eligibility requirements, covering doctor visits, specialists, dental, vision, mental health, and prescription drugs.
- Commercial Plans (HMO, PPO, POS) Traditional commercial health insurance plans with HMO, PPO, and POS options for organizations in Ohio and West Virginia.
- Self-Funded Plans (ASO Administration with Stop-Loss) Administrative Services Only (ASO) self-funded health plans for businesses to directly cover employee medical costs, with customizable benefit options and stop-loss coverage; available nationwide.
- PEIA (Public Employees Insurance Agency) Plans Additional benefits and lower copays for active State of West Virginia employees enrolled through the Public Employees Insurance Agency via The Health Plan.
- MyPlan Mobile App Mobile application enabling members to access ID cards, find doctors, track copays and deductibles, view claims, view coverage, and find plan documents across iOS and Android.
- MyPlan Member Portal Secure online portal for members to track copays and deductibles, find doctors, print Member ID cards, view claims, and access plan documents with multi-factor authentication.
- CoreWellness Health Coaching Program Health coaching and education program for nutrition, healthy weight, physical activity, stress management, depression screening, and tobacco cessation with 1-month and 3-month post-program follow-up calls.
- COBRA Administration Services Outsourced COBRA administration services for employers to reduce non-compliance risk and administrative burden on employers offering group health plans.
- Stop-Loss Coverage Stop-loss insurance coverage for self-funded employer health plans, protecting businesses from catastrophic medical claims.
- THP Rx Pharmacy Services Pharmacy benefit management including formulary coverage for generic, brand-name, and non-formulary options, home delivery through Express Scripts, specialty pharmacy network, medication review services, and specialty drugs for complex chronic conditions.
- Quality Improvement Program Annual quality improvement program monitoring HEDIS performance, CMS Star Ratings, CAHPS surveys, HOS outcomes, NCQA accreditation, and member complaints to continuously improve care and services.
Quantifiable outcome
- Member ID cards mailed within 5 days of enrollment
- +2 more outcomes
Companies that use The Health Plan
Customer profileNamed customers1 record
Segments6 records
Ideal customer profiles5 records
The Health Plan technology and API
TechnologyTechnology focussed No
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration11 records
Feature3 records
The Health Plan partnerships and signals
Strategic signalPartnerships
Eight partnerships are on record, tiered minor and core.
- NAMI West VirginiaminorCo-hosted the 4th Annual Wheeling Food Truck Festival at Heritage Port to combat mental health stigma by providing community access to mental health resources.
- TeladoccoreTeladoc provides online telehealth appointments allowing members to see a doctor by phone or video. Available as an extra benefit for Medicaid and other plan members.
- Express ScriptscoreExpress Scripts Pharmacy serves as the pharmacy benefit manager (PBM) providing home delivery services, claims processing, and pharmacy network management.
- Superior VisioncoreSuperior Vision administers routine vision benefits for Medicare Advantage members. Providers must be contracted with Superior Vision to treat THP Medicare Advantage members.
- SkyGen DentalcoreSkyGen Dental provides dental benefits administration for Medicaid members. Contact at 1.888.983.4690 for contracting, billing, and benefits information.
- eviCore healthcarecoreeviCore healthcare provides prior authorization and utilization management services. Contact at 1.877.791.4104.
- Gainwell TechnologiescoreGainwell provides pharmacy help desk services for prescription drug questions at 1.888.483.0797.
- Healthcare BluebookcoreHealthcare Bluebook provides price comparison tool integrated into THP MyPlan portal for self-service cost estimates and fair price information.
Scale indicators4 records
Recent moves6 records
Expansion highlights6 records
The Health Plan competitors and assessment
Company assessmentDirect peers
- Highmark Blue Cross Blue Shield West Virginia: Highmark BCBS WV is the dominant commercial and government health plan in West Virginia, directly competing with The Health Plan across Medicare Advantage, commercial, and self-funded employer products in the same state.
- UniCare (Elevance Health): UniCare is one of the other WV Medicaid managed care organizations under Mountain Health Trust and a direct competitor in commercial and Medicare products across West Virginia.
- Aetna Better Health of West Virginia: Aetna Better Health is the third approved MCO in the WV Mountain Health Trust Medicaid program, making it a direct peer on the most strategically important product line for The Health Plan.
- CareSource: CareSource is a non-profit managed care organization with a heavy Medicaid focus across multiple states, making it a structurally and operationally comparable peer to The Health Plan's non-profit HMO model.
- Molina Healthcare: Molina is a publicly traded MCO concentrated in Medicaid and dual-eligible markets, with overlapping government-program focus and similar reliance on state procurement contracts as The Health Plan.
- Priority Health: Priority Health is a regional, non-profit-affiliated health plan offering HMO, PPO, Medicare Advantage, and Medicaid products in a single-state market, structurally comparable to The Health Plan's regional HMO/MCO positioning.
- Health Plan of San Mateo: HPSM is a non-profit, locally managed health plan serving Medi-Cal, Medicare Advantage, and commercial members in a single California county, providing a close analogue to The Health Plan's non-profit, locally anchored HMO business model.
Broad incumbents
- UnitedHealthcare: UnitedHealthcare is the largest U.S. health insurer with national Medicare Advantage, Medicaid, and commercial footprints and competes broadly with The Health Plan in Ohio and West Virginia across all product lines.
- Humana: Humana is a national incumbent with the second-largest Medicare Advantage franchise, competing directly with The Health Plan's MA HMO, PPO, and D-SNP products in the overlapping OH/WV service area.
- Elevance Health (Anthem): Elevance Health operates Anthem Blue Cross Blue Shield plans and UniCare across multiple states, including West Virginia and Ohio, competing with The Health Plan across Medicaid, Medicare, and commercial employer segments.
Market position
Strengths4 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights6 records
Customer concentration
The Health Plan social profiles
Digital presenceThe Health Plan compliance and trust
Trust signalCompliance8 records
The Health Plan financial estimates
Financial estimateRevenue estimate
Valuation estimate
The Health Plan leadership team
Management profileNumber of profiles
The Health Plan subsidiaries and ownership
Company hierarchySubsidiaries1 record
The Health Plan funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
The Health Plan M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about The Health Plan
What does The Health Plan do?
The Health Plan is a non-profit HMO and licensed health-insuring corporation that sells managed care health insurance and administers self-funded employer health plans in West Virginia and Ohio. Its core offerings span Medicaid managed care, Medicare Advantage (HMO/PPO/D-SNP), Medicare Supplement (Medigap) plans, WVCHIP, commercial HMO/PPO/POS plans, and self-funded plans with stop-loss and COBRA administration, supported by member digital tools (MyPlan portal and mobile app), pharmacy benefit management, clinical care management, and wellness programs.
Is The Health Plan a public or private company?
The Health Plan is a private company. It is classified as nonprofit foundation owned and is currently operating.
When was The Health Plan founded?
The Health Plan was founded in 1979. It employs 101 to 250 people.
Where is The Health Plan based?
The Health Plan is headquartered in Wheeling, United States, in the North America region.
How does The Health Plan make money?
Two revenue lines are on record. Premium Revenue is the primary driver. The others are self-Funded Plan Administration.
Who are The Health Plan's main competitors?
Direct peers on record are Highmark Blue Cross Blue Shield West Virginia, UniCare (Elevance Health), Aetna Better Health of West Virginia, CareSource, Molina Healthcare, Priority Health and Health Plan of San Mateo. Broad incumbents are UnitedHealthcare, Humana and Elevance Health (Anthem).
Does The Health Plan have an API?
Yes. The Health Plan offers Patient Access APIs to allow members to access their health data through third-party applications. These APIs are provided in accordance with CMS interoperability rules, enabling members to retrieve their claims, benefits, and other health information programmatically. Developer documentation is at www.healthplan.org/patient-access-api.
What industry is The Health Plan in?
The Health Plan's product category is Managed Care Health Insurance. Its primary akta.pro industry code is FSAIAFAK, Group HMO Plans, with a secondary code of HLAEAMAH, Medicare Advantage HMOs (HMO/HMO-POS). Its NAICS code is 524114 and its SIC code is 6324.