Member Request Information

Members may use this form to request a new ID card, make a change in their address, add or change a physician or send us a comment.

Fields listed with an "*" are required.

Mandatory *

Choose Request

Change of Address
Request New ID Card
Change of Physician
Comment

First Name *

Please type your First Name

Last Name *

Please type your Last Name

Member ID *

Health Plan ID Number must be nine characters and begin with an H

New Address Please fill in, only if you are changing your current address.

City

State

ZIP Code

Current Phone Number

Name of New Physician Please fill in, only if you have a new physician

Location of New Provider Please fill in, only if you have a new physician

Please provide a valid email, if none exists, leave blank

Comments

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Ohio Valley/ Mountaineer Region Office
P: 740.695.7902
TF: 1.888.847.7902
F: 740.699.6163
Email: information@healthplan.org
Hours: Mon- Fri., 8:30 am to 5:00 pm

HomeTown Region Office
P: 330.837.6880
TF: 1.800.426.9013
F: 330.830.5634
Email: information@healthplan.org
Hours: Mon- Fri., 8:00 am to 5:00 pm

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Resources for Members

I want to . . .

Request a new ID card, change my information
Sign up for important screening test reminders (brought to you by the College of American Pathologists)
Get a FREE Online Personal Health Record
Improve your quality of care with your Personal Health Record. Please take a moment to visit this important site.
Find the Average Cost of Medical Procedures
This is information from a third party and may NOT reflect actual costs and/or charges at The Health Plan facilities but rather is averaged based on this companies analysis of the cost of medical procedures annually.
Find What Services Require PreAuthorization
Visit Vision Services Plan (VSP)
Questions concerning your Vision Services can be found here.

Quick Links

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