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The Health Plan Insurance Coverage For Drug And Alcohol Rehab

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The Health Plan was established in 1979 to serve clients in West Virginia and Ohio. Today the insurance company has grown to serve more than 200,000 individuals. The Health Plan is one of the largest completely self-funded firms in the nation. As a self-funded insurance company, The Health Plan is considered a more conservative option for patients seeking affordable health insurance coverage.

This is a community-based health maintenance organization, or HMO. Thanks to being community based, The Health Plan is also seen as a more patient-centric insurance provider.

The Health Plan provides more than just health insurance coverage to the general public. Over the last four decades, The Health Plan has started or acquired the following insurance products:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Point-of-Service (POS)
  • THP Insurance Co.
  • HomeTown Health
  • Vested Health
  • D-SNP Product
  • MEWA product

The Health Plan also offers the following health insurance plans for the federal government, including:

  • Medicare Advantage Plans SecureCare (HMO)
  • Medicare Advantage Plans SecureChoice (PPO)
  • Medicare Supplement Coverage
  • W.V. Medicaid

The Health Plan offers a few health insurance plans that provide coverage for patients struggling with addiction. The plans that are available to individuals and families who are interested in health insurance include:

  • HMO Bronze Plan for Ohio residents
  • HMO Bronze Plan for West Virginia residents

The Health Plan also offers insurance products for employers and large groups. The rates for those plans will vary based on the individuals within the group and their chosen coverage.

The levels of care that are available for patients with insurance through The Health Plan is extensive. Services include observation, as well as intensive outpatient care for chemical dependency. Patients can request detox, inpatient crisis stabilization and partial hospitalization under this health insurance provider.

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Does The Health Plan Cover Drug And Alcohol Detox?

One of the first steps of many successful treatment programs for drug and alcohol addiction is detox. Medical detox may be necessary for addiction to certain substances such as barbiturates, alcohol and heroin. These drugs can lead to chemical dependency and attempts to quit these substances leads to painful and sometimes dangerous withdrawal symptoms.

For patients who need drug and alcohol detox, The Health Plan does provide coverage. Detox coverage is available for HMO plans in West Virginia and Ohio. Patients can also request inpatient crisis stabilization or partial hospitalization. These offer alternatives for detoxification from drugs and alcohol.

Does The Health Plan Cover Inpatient Rehab?

For individuals who have coverage under the Bronze HMO plans in West Virginia and Ohio, The Health Plan covers inpatient rehab. This falls under inpatient services for those who are suffering from substance use. Both plans offer the same coverage.

The coverage for inpatient drug rehab is 40 percent coinsurance for in-network healthcare providers. For out-of-network providers there is no coverage. Patients must get preauthorization for care, unless it is an emergency.

Does The Health Plan Cover Outpatient Rehab?

The Health Plan provides coverage for several types of outpatient services. Patients who are struggling with drug addiction but who also have a job or family obligations may benefit from outpatient care.

Depending on how severe the addiction is, a patient may also require more extensive outpatient rehab. The Health Plan also covers chemical dependency intensive outpatient care. This level of care offers more intensive therapy and support compared to typical outpatient rehab.

Both of the Bronze HMO plans for West Virginia and Ohio cover outpatient services for substance use disorder treatment. The plans feature 40 percent coinsurance per visit. In addition, if the patient is only visiting the doctor’s office for care, the deductible is waived.

Does The Health Plan Cover Medication-Assisted Treatment?

The Health Plan’s policy documents do not specifically state that medication-assisted treatment is covered. However, the insurance plans do cover prescription drugs, some of which may be used as part of a MAT program.

The Health Plan offers medication coverage for drugs categorized as:

  • Generic prescription drugs
  • Preferred brand prescription drugs
  • Non-preferred brand drugs
  • Specialty drugs

Each of these categories of prescription drugs are covered by The Health Plan. All drugs except specialty drugs on both HMO plans come with a 40 percent coinsurance cost. For specialty drugs, the patient is responsible for 50 percent coinsurance. This fee is for each retail purchase or home delivery of the prescription. If the patient chooses the brand name over the generic brand, they are responsible for the difference in pricing.

Does The Health Plan Cover Sober Living Houses?

After completing a drug rehab program, patients may transition into sober living houses. The Health Plan does provide coverage for rehabilitation services, which may include sober living homes. These services come with a price tag of 40 percent coinsurance for both HMO plans.

Coverage is only offered for in-network rehab providers; out-of-network rehab is not covered with this insurance. In addition, preauthorization is required before the patient can receive coverage for sober living.

What’s The Difference Between In-Network And Out-of-Network Benefits?

The Health Plan individual health insurance plans provide coverage for in-network providers and facilities. As a result, patients must choose a provider for substance use treatment or drug rehab from within The Health Plan’s provider network. If the patient chooses to go outside of the network, then The Health Plan does not provide coverage for either the West Virginia or Ohio HMO plans.

The Ohio in-network counties for The Health Plan HMO plan at include:

  • Lorain
  • Geauga
  • Cuyahoga
  • Richland
  • Galia
  • Jackson
  • Lawrence
  • Vinton
  • Licking
  • Knox
  • Washington
  • Meigs
  • Hocking
  • Athens
  • Belmont-Perry
  • Chocton-Noble
  • Guernsey-Monroe
  • Harrison-Morgan
  • Jefferson
  • Muskingum
  • Tuscarawas
  • Stark
  • Carroll
  • Holmes
  • Wayne
  • Columbiana
  • Mahoning
  • Trumbull
  • Summit
  • Portage
  • Medina
  • Ashland

For the West Virginia HMO individual plans, the in-network counties include:

  • Braxton
  • Calhoun
  • Clay
  • Fayette
  • Greenbrier
  • Nicholas
  • Roane
  • Kanawha
  • Boone
  • Lincoln
  • Logan
  • McDowell
  • Mingo
  • Wyoming
  • Mercer
  • Monroe
  • Raleigh
  • Summers
  • Cabell
  • Mason
  • Putnam
  • Wayne

Residents living in these counties should be eligible to sign up for The Health Plan policies to receive coverage for addiction treatment. However, it is still important to make sure that the medical provider is within the in-network coverage area. Patients will need to check their specific directory of doctors in their network. This information is generally updated annually.

The Health Plan provides insurance products that include coverage for substance use disorder treatment, which is beneficial for patients who are seeking a way to pay for drug and alcohol detox, inpatient drug rehab or outpatient services. In addition, The Health Plan covers both West Virginia and Ohio. This greatly expands the service area for in-network providers. As a result, patients can expect to receive quality addiction treatment coverage when choosing The Health Plan.