The Health Plan of the Upper Ohio Valley > SecureCare, SecureChoice, SecureFreedom

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Listed below are links to help SecureCare, SecureChoice, or SecureFreedom members file an appeal or grievance, or request more information about The Health Plan Medicare Plans.

Request More Information
Members may use this form to request more information on The Health Plan SecureCare, SecureChoice, or SecureFreedom programs.

We encourage you to let us know right away if you have questions, concerns, or problems related to your covered services or the care you receive. If you have a grievance, call Member Services at 1.877.847.7907/TTY: 1.800.622.3925 (Ohio Valley & Mountaineer Region) or 1.800.426.9013/ TTY: 1.877.236.2291 (HomeTown Region).

You can mail or fax a written requests/forms to:

The Health Plan
Ohio Valley & Mountaineer Region
52160 National Road East
St. Clairsville, OH 43950
FAX: 740.699.6163

The Health Plan
HomeTown Region
100 Lillian Gish Blvd.
PO Box 4816
Massillon, OH 44648
FAX: 330.830.5634

Grievance Form - SecureCare, SecureChoice, or SecureFreedom (100k)

Direct Claim Form (42k)

You must contact us if you would like to request a coverage determination (including an exception). You cannot request an appeal if we have not issued a coverage determination. Please call The Health Plan Member Services at 1.877.847.7907/TTY: 1.800.622.3925 (Ohio Valley & Mountaineer Region) or 1.800.426.9013/TTY: 1.877.236.2291 (HomeTown Region).

Coverage Determination Request Form
When asking for a Part D prescription drug benefit, the first step is called requesting a coverage determination. When we make a coverage determination, we are making a decision whether or not to provide or pay for a Part D drug and what your share of the cost is for the drug. Coverage determinations include exceptions requests.

Appoint a Representative Form

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