Get high-quality and cost-effective health care for your employees in Ohio and West Virginia.
About Commercial Health Care Plans for Business
If you are looking to provide health insurance benefits for your employees, a fully insured health plan (also called a “Commercial Plan”) is a great choice. Your business will get predictable payments based on the number of employees you have, and your employees will have access to the coverage they need.
Choose the Commercial Plan that's Right for You
The Health Plan offers several types of fully insured plans for businesses in Ohio and West Virginia. Within each type, a variety of plans are available so you can find one that best fits your budget while ensuring your employees receive the coverage they need. All plans are accredited by the National Committee for Quality Assurance (NCQA).
Health Maintenance Organization (HMO)
How it Works
The Health Plan’s HMO options are generally the most cost-effective options for businesses. HMOs save costs by creating a smaller network of providers. They also require employees to choose a primary care physician, who they will see for most of their health care needs.
In addition to a strong doctor-patient relationship, employees will enjoy no-cost preventive care, lower deductibles, affordable copays, and fewer claim forms. And because all HMO options from The Health Plan have an unlimited lifetime maximum, employees can also be confident that they’ll be covered should they experience a major medical event or diagnosis.
West Virginia and Ohio Non-Group Individual
If you are enrolled in one of our HMO plans as a Non-Group Individual, your premium amount is now determined only by your age and the county you live in.
Summary of Benefits and Coverage for Ohio Non-Group Bronze Plan
West Virginia Residents
Summary of Benefits and Coverage for West Virginia Non-Group Bronze Plan
West Virginia Health Insurance Rates (areas 1-5)
West Virginia Health Insurance Rates (areas 6-11)
For an effective date of January 1, 2023, open enrollment for the Non-Group plan is from November 1, 2022, through December 15, 2022. After December 15, 2022, you must have a qualifying event to be eligible for individual health insurance. For more information, please call 740-695-7608.
Preferred Provider Organization (PPO)
How it Works
The Health Plan’s PPO options are usually the right choice for businesses that want to give employees access to more providers. They also do not require employees to select a single primary care physician that they would need to see for most appointments. Due to these options, PPOs tend to have higher premiums, copays, and deductibles than HMOs.
Employees will enjoy more freedom in their health care because the PPO network is larger than the HMO network. Employees can also elect to receive care outside The Health Plan network at specific benefit levels.
Point-of-Service Plan (POS)
How it Works
The Health Plan’s POS options provide the cost-savings of an HMO with additional out-of-network coverage. As with an HMO, POS plans have a smaller network of providers and require employees to choose a primary care physician, who they will see for most of their health care needs.
Employees will enjoy no-cost preventive care, lower deductibles, affordable copays, and fewer claim forms. In addition, they can receive care outside of The Health Plan network at specific benefit levels.
Your Rights & Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing
What is Balance Billing?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are Protected from Balance Billing
You are protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
This notice was written by federal agencies. It is intended to provide you with a brief summary of some of the protections provided by the federal No Surprises Act. The laws in certain states may also provide protection from surprise billing.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
You Have These Protections
When balance billing isn’t allowed, you also have the following protections:
- You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
Our team at The Health Plan wants to make sure you can access the health care you need, when you need it. To support this effort, we have created Access Plans. These documents provide detailed information about our health insurance network, including the factors we use to select providers and the number of providers in each county.
Read and download our Access Plan documents below, or contact us at 1-800-624-6961 to request a copy.
The Health Plan HMO Access Plan
The Health Plan PPO Access Plan