We want to make sure you know that we do all we can to make sure your health care and services are available to you. The Health Plan recommends contacting your doctor's office first if you suspect you might be sick. We also encourage our members to use the telephone to get the health care you need. The Health Plan is working with Medicaid and your doctors to make sure this is available to you.

Frequently Asked Questions Regarding COVID-19

How can I stop the spread?

  • Wash your hands often with soap and water for at least 20 seconds
  • Use hand sanitizers when you cannot wash your hands
  • Avoid touching your eyes, nose or mouth with your hands
  • Stay home when you’re sick
  • Cover your coughs and sneezes with a tissue and throw it away
  • Clean frequently touched surfaces

Where can I get more information about symptoms, what to do if I am sick and how to protect myself?
Visit our COVID-19 information page. If you develop trouble breathing, persistent pain or pressure in the chest, confusion or the inability to get up, or bluish lips or face, get medical attention immediately. Call 911 if you have a medical emergency.

Where can I get testing?
If you think you have been exposed to COVID-19 and get a fever, cough or have trouble breathing, call your doctor. Most testing sites require a doctor’s order before testing. Check out the latest test sites.

Do I have to get pre-approval (prior authorization) for a COVID-19 test?
No, prior authorization is not required for COVID-19 testing.

What happens if I run out of my medications?
Call The Health Plan Pharmacy Service number on your ID card. Don’t stop taking your medicines as prescribed and get your refills on time.

What do I do if I am waiting for test results?

If you are sick and waiting test results or tested positive for COVID-19, follow these steps to help prevent the disease from spreading.

Do I have to pay for COVID-19 testing?
No. The Health Plan will cover the cost of copays for COVID-19 testing when recommended by a doctor.

What is telemedicine?
Telemedicine is a safe and effective way for you to see a doctor to receive health guidance from your home via a smart phone, tablet or computer-enabled web cam.

Can I use telemedicine?
We encourage you to use telemedicine if it is available in your plan. West Virginia Medicaid members can also use Teladoc. Additional information on this benefit can be found here.

Other Helpful Links:

Member Overview

The Health Plan's practice guidelines and criteria for medical necessity are based on well-supported clinical evidence. These guidelines or criteria are reviewed and updated on a regular basis or when new scientific evidence is published. They are available to our members or potential members upon request. Based on these guidelines, The Health Plan makes decisions including: 

  • Utilization Management
  • Enrollee Education
  • Coverage Services
  • Other Areas

In addition to the links to this information on our website, you can call our Customer Service Department at 1.888.613.8385 (TTY: 711) to request a printed copy or ask any questions or concerns. Our customer service representatives can also assist you with any of the following topics related to your coverage:

  • Specialty care and other benefits, not provided by the PCP
  • Mental health and non-emergency transportation are covered benefits available through Medicaid
  • Benefits covered by The Health Plan
  • How and where to access emergency care and post-stabilization services
  • Providing benefit information in an alternative language or format due to special needs such as vision, read impairments, or language translation difficulties. Translation services are available at no cost for members.

Member Resources

Click on any of the links below to check out important information about your coverage through The Health Plan:

Call our Customer Service Department at 1.888.613.8385 (TTY: 711) if you need a printed copy for any of these materials or if you have any questions.

The WV DHHR Bureau for Behavioral Health (BBH) in partnership with the WVU Center of Excellence in Disabilities is asking you to take their online survey for feedback on support and resources available for families by April 20, 2020.

Participants of the survey will have the opportunity to be entered into a $30 Walmart gift card drawing!