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The Health Plan SecureChoice Reliance (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for The Health Plan SecureChoice Reliance (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on The Health Plan SecureChoice Reliance (PPO) in 2026, please refer to our full plan details page.
The Health Plan SecureChoice Reliance (PPO) is a PPO plan offered by The Health Plan of West Virginia, Inc. available for enrollment in 2026 to people living in West Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that The Health Plan SecureChoice Reliance (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about The Health Plan SecureChoice Reliance (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For The Health Plan SecureChoice Reliance (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $43.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $150.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Health Plan SecureChoice Reliance (PPO) features a $150 annual drug deductible. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay when using preferred pharmacies or preferred mail order services. If standard pharmacies or standard mail services are used, Tier 1 copays start at $13 and Tier 2 copays start at $20 for a one-month supply. For higher-tier prescriptions, costs transition to coinsurance across all pharmacy and mail order channels. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance. Specialty Tier 5 medications require a 31% coinsurance for a one-month supply.
Additional Benefits
The Health Plan SecureChoice Reliance (PPO) offers comprehensive medical coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. Specialist visits and outpatient therapies require a $40 copay, while inpatient hospital stays carry a $475 copay per admission with no coinsurance. Emergency care is available with a $130 copay, which is waived if you are admitted to the hospital within 24 hours. Members also benefit from dental and vision coverage with no copay for routine exams, plus a $1,500 annual dental limit and a $200 eyewear allowance. Routine hearing exams are available for a $20 copay, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Additionally, the plan provides a $75 over-the-counter allowance every three months with no copay.
Inpatient Hospital See details
The Health Plan SecureChoice Reliance (PPO) covers inpatient acute and psychiatric hospital stays with a $475 copay per admission and no coinsurance, subject to prior authorization. This benefit is partially covered, offering unlimited additional days for acute stays at no copay, while additional psychiatric days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by The Health Plan SecureChoice Reliance (PPO) with no coinsurance for all services, though prior authorization is required for many. Copayments range from no copay for blood services, $40 for outpatient substance abuse sessions, and up to $325 for ambulatory surgical center, observation, and outpatient hospital services.
Partial Hospitalization See details
The Health Plan SecureChoice Reliance (PPO) covers partial hospitalization services with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
The Health Plan SecureChoice Reliance (PPO) covers ambulance services with no coinsurance, requiring a $200 copay for ground ambulance and a $500 copay for air ambulance, both of which require prior authorization. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by The Health Plan SecureChoice Reliance (PPO) with a $130 copay and no coinsurance, while urgently needed services require a $45 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $25,000 maximum limit with no coinsurance, which includes emergency care for a $130 copay and emergency transportation for a $200 to $500 copay, though worldwide urgent coverage is not covered.
Primary Care See details
The Health Plan SecureChoice Reliance (PPO) provides primary care physician services and telehealth benefits with no copay and no coinsurance. Most other covered services, including specialist visits, physical and occupational therapy, and mental health sessions, require a $40 copay and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by The Health Plan SecureChoice Reliance (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management. This benefit is partially covered as it excludes in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
The Health Plan SecureChoice Reliance (PPO) partially covers hearing services, offering routine hearing exams for a $20 copay and no coinsurance, and prescription hearing aids for a $399 to $899 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by The Health Plan SecureChoice Reliance (PPO) with no copay and no coinsurance. The plan covers one routine eye exam per year and provides a $200 annual maximum for eyewear (including contact lenses, eyeglass lenses, and frames), but other eye exam services, eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Dental services are partially covered by The Health Plan SecureChoice Reliance (PPO), with most preventive and comprehensive options like cleanings, exams, and fillings requiring no copay and no coinsurance up to a $1,500 annual maximum. Medicare-covered dental services have a $40 copay and no coinsurance, while fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and adjunctive general services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by The Health Plan SecureChoice Reliance (PPO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs carry no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
The Health Plan SecureChoice Reliance (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
The Health Plan SecureChoice Reliance (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic equipment, with no copay and a 20% coinsurance, though diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by The Health Plan SecureChoice Reliance (PPO), as lab services are not covered. Diagnostic procedures require a $50 copay with no coinsurance, diagnostic radiological services have no copay, outpatient X-rays require a $50 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered by The Health Plan SecureChoice Reliance (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
The Health Plan SecureChoice Reliance (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
The Health Plan SecureChoice Reliance (PPO) covers skilled nursing facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not needed, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
The Health Plan SecureChoice Reliance (PPO) partially covers other services, offering an over-the-counter (OTC) benefit of $75 every three months with no copay and no coinsurance. Acupuncture, meal benefits, and nicotine replacement therapy are not covered.
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