Additional Information/Forms


The Health Plan/THP Insurance Company's Affirmative Statement Regarding Incentives:

The Health Plan/THP Insurance Company bases its decision making for coverage of health care services on medical appropriateness utilizing recognized criteria. Incentives are not offered to providers or The Health Plan employees involved in the review process for issuing nonauthorization. Also, no incentives are given that foster inappropriate restrictions of health care services or underutilization by provider, nor does THP Insurance Company condone underutilization, nor inappropriate restrictions on health care services.


Direct Claim Form


ACH Letter & Contract
This contract will allow you to pay The Health Plan bill automatically each month with the Automated Payment Program. Deductions on your health care premium will be on the 4th or 5th of each month depending on what region you live in.


Medicare Secondary Payer Form
Required form by the Centers for Medicare and Medicaid Services.


Appointment of Representative Form
This form will allow you to authorize an individual to act as your representative for requesting a coverage determination or an appeal.

Authorization to Disclose Protected Health Information
This form will allow you to authorize an individual(s) to contact The Health Plan and receive information regarding your THP benefit information such as claims, payments, etc.


Individual Request for Access to Protected Health Information
This form will allow you access to inspect and obtain a copy of your health information.


Medical Pre-Authorization Form
This form allows you to request for Medical Pre-Authorization.

Need Help?


Contact Us

THP_WEB_Phone_Icon[1].png By Phone:

Current Members
Call us at 1.877.847.7907
 
Prospective Members
Call us at 1.877.847.7915
 
Hearing Impaired Services
Please call (TTY: 711)

THP_WEB_Mail_Icon[1].png By Mail:

The Health Plan
1110 Main Street
Wheeling, WV 26003-2704


THP_WEB_Hours_Icon[1].png Hours of Operation

October 1 through March 31:
8:00 a.m. to 8:00 p.m.,
7 days a week

April 1 through September 30:
8:00 a.m. to 8:00 p.m.,
Monday through Friday

Last Modified: September 11, 2020 at 11:47 AM