The West Virginia Insurance Exchange (Marketplace) is the Federally-facilitated Marketplace.
The Health Insurance Exchange is a Partnership Marketplace jointly administered by the State and federal government, under the Department of Health and Human Services (HHS).
General information about the Health Insurance Exchange can be found at: https://www.healthcare.gov/marketplace/individual/#state=westvirginia.
PATIENTS
The Health Insurance Exchange is essentially a marketplace for individuals to shop for health insurance if they do not already have insurance coverage from another source. If individuals have insurance from another source such as employment, retirement benefits, or spousal benefits, they do not need to obtain it from the Marketplace.
HIV PROVIDERS
Providers must contract with each of the Qualified Health Plans offered in the marketplace individually to participate fully in the Federally-facilitated Marketplace.
This process is similar to enrolling in insurance or managed care organization provider networks. See below the list of insurers participating in the Federally-facilitated Marketplace, and information about contacting them.
As an HIV provider, you may qualify for designation as an “Essential Community Provider (ECP).” The Qualified Health Plans participating in the Insurance Exchange (Marketplace) are required to contract with a minimum number of ECPs and Specialists to ensure network adequacy.
Visit our Provider Resources Section for more specific instructions to assist you in contacting health plans.
REPORTING PROBLEMS
The state office of insurance is primarily responsible for examining and addressing issues with the plans offered within the state Exchange (Marketplace), and the companies that offer them. If you are experiencing problems as a medical provider with the plans or companies in the state exchange, or if your patients are experiencing problems with the plans or companies in the state exchange, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state office of insurance:
124 Smith St.
Charleston, WV 25301
888- 879-9842
http://www.wvinsurance.gov/
Complaints: http://www.wvinsurance.gov/ConsumerServices/ConsumerServices.aspx
Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.
QUALIFIED HEALH PLANS PARTICIPATING IN THE EXCHANGE
Below is a list of the Qualified Health Plans that have publically announced that they will offer plans in the Federally-facilitated Marketplace.
Wyoming has established Blue Cross Blue Shield of WY as the “benchmark” plan.
This list is being routinely updated, and may change as insurers join or drop out of the exchange. Please check back for updates.
Highmark Blue Cross Blue Shield
Plan Website: https://www.highmarkbcbswv.com/landing_members.html
Provider Enrollment: https://prc.highmark.com/rscprc/hwvbcbs/pub?document=https%3A//www.highmark.com/health/highmarkwestvirginia/documents/provider-apps.html&docId=172
Plan types offered: Individual, SHOP