The Health Plan

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).

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

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

• Managed care plans
• Health insurance HMO
• Medicaid managed care
• Medicare Advantage plans
• Employer health benefits

Headquarters

HQ city

Wheeling

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure, Supply Chain

Revenue model

1. 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.
2. Self-Funded Plan Administration: Administrative Services Only (ASO) fees from self-funded employer groups, including stop-loss coverage services.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels5 records

Core 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

Named customers1 record

Segments6 records

Ideal customer profiles5 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration11 records

Feature3 records

Partnerships

Eight partnerships are on record, tiered minor and core.

• NAMI West VirginiaminorStrategic or Co-development PartnerCo-hosted the 4th Annual Wheeling Food Truck Festival at Heritage Port to combat mental health stigma by providing community access to mental health resources.
• TeladoccoreTechnology or IntegrationTeladoc 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 ScriptscoreTechnology or IntegrationExpress Scripts Pharmacy serves as the pharmacy benefit manager (PBM) providing home delivery services, claims processing, and pharmacy network management.
• Superior VisioncoreTechnology or IntegrationSuperior Vision administers routine vision benefits for Medicare Advantage members. Providers must be contracted with Superior Vision to treat THP Medicare Advantage members.
• SkyGen DentalcoreTechnology or IntegrationSkyGen Dental provides dental benefits administration for Medicaid members. Contact at 1.888.983.4690 for contracting, billing, and benefits information.
• eviCore healthcarecoreTechnology or IntegrationeviCore healthcare provides prior authorization and utilization management services. Contact at 1.877.791.4104.
• Gainwell TechnologiescoreTechnology or IntegrationGainwell provides pharmacy help desk services for prescription drug questions at 1.888.483.0797.
• Healthcare BluebookcoreTechnology or IntegrationHealthcare 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

Direct 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

• Xx.com/TheHealthPlanHQ
• Facebookfacebook.com/TheHealthPlan
• LinkedInlinkedin.com/company/the-health-plan-thp-

Compliance8 records

Revenue estimate

Valuation estimate

Number of profiles

Subsidiaries1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about The Health Plan