Benefits & Services

Your West Virginia Family Health (WVFH) Member Handbook can help you understand the way your plan works.  It tells you what you need to know about your Medicaid benefits in more detail.  If you have a question and you cannot locate the answer in your handbook, you can also contact WVFH Member Services at 855-412-8001; the TTY number is 711 or 1-800-982-8771.

Learn more about:

Benefits Table:

Review the complete WVFH Benefits Matrix (PDF)

Copayments

You may have to pay for some of the care you receive.  Members will be responsible for paying for care based on the household income.  The chart below gives more information Members will pay this amount for care received from in-network and out-of-network providers.


Service

Up to 50.0% FPL(1)

50.01 – 100.00% FPL(1)

100.01% FPL(1) and above

Inpatient Hospital

$0

$35

$75

Office Visit (Physicians & Nurse Practitioners

$0

$2

$4

Non-Preferred Drugs (See Note 2 below)

$2

$4

$8

Non-Emergency use of Emergency Department – Hospital only

$8

$8

$8

Any services received during a visit coded as non-emergent surgical procedures provided in a physician’s office, ambulatory surgical center, or any other outpatient setting excluding emergency rooms.

$0

$2

$4

(1) Federal Poverty Level

(2) WVFH will charge the same copay amount for a non-preferred drug as for a preferred drug in the same therapeutic category when your doctor determines that the preferred drug would not be as effective as the non-preferred drug. WVFH will also charge the same copay if the doctor determines that the preferred drug would have adverse effects for the member.

Beginning July 1, 2014, copays on all Medicaid PDL prescription drugs. 

Total Allowed Charge

Co-Payment

$0.00-$5.00

$0.00

$5.01-$10.00

$0.50

$10.01-$25.00

$1.00

$25.01-$50.00

$2.00

$50.01 and above

$3.00

WVFH will not charge copays for:

  • Children under age 21
  • Pregnant women, including the 60 day period after the pregnancy ends
  • American Indians and Alaska Natives
  • Members receiving hospice care in a nursing home
  • Dental services
  • Emergency room services (for emergent use of hospital ER only)
  • Members who meet annual maximum limit for cost sharing obligations

Other limits may apply as provided by the state plan amendment.

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