Payer Overview
HEALTH PLAN GRP Market Analysis: Market Share and Coverage by State
HEALTH PLAN GRP is a regional-focused health insurer with concentrated state footprints and a small national market position. Its presence is meaningful for local provider negotiations where it has scale.
Payer Overview
HEALTH PLAN GRP operates as a modest national health insurer positioned in the broader A&H market as the #97 ranked US payer by premium, writing $793M in the US market and holding a 0.06% US market share. The company reports a footprint spanning 2 states, and it serves an estimated 106.2K members while operating through 2 affiliated subsidiaries.
HEALTH PLAN GRP's business is concentrated regionally rather than evenly distributed across the country, with its leading state presences driving the bulk of its premium. The payer does not hold a #1 market position in any state.
2 rows
| Subsidiary | Domicile |
|---|---|
| The Health Plan of Wva Inc | WV |
| Thp Insurance Company | WV |
National Market Presence
National Market Footprint
| State | Market Share | Premium Written | Estimated Members |
|---|---|---|---|
| OH | 0.14% | $85.7M | 11.7K |
| WV | 8.18% | $707M | 94.6K |
| National Total | — | $793M | 106.2K |
HEALTH PLAN GRP's premium is heavily concentrated in West Virginia, where it writes $707M in premium and serves roughly 94.6K members. Ohio represents a much smaller foothold with $85.7M in premium and about 11.7K members. Nationally, the payer's footprint totals $793M in premium and 106.2K estimated members, indicating a regional strategy with deep penetration in a limited set of states.
For provider contracting, this concentration means negotiations will be most consequential in West Virginia, where the payer has local scale and can influence network participation and reimbursement terms. In states like Ohio, the payer's smaller membership base suggests less bargaining power and potentially different contract approaches such as targeted narrow networks or selective service-line agreements.
State-by-State Market Position
HEALTH PLAN GRP shows its strongest presence in the Appalachian region, specifically West Virginia, where its market share and premium are dominant relative to its overall footprint. With $707M of premium in WV versus $85.7M in OH, the payer's exposure is regionally concentrated rather than dispersed across multiple census regions.
This geographic distribution means multi-state provider groups operating across the Midwest and Northeast should prioritize discussions in West Virginia to address the payer's largest book of business, while treating Ohio as a supplementary market. For providers, the payer's concentrated footprint suggests opportunities for tailored contracts in WV that reflect local utilization patterns and a more standardized or limited approach in Ohio.
Estimated Member Demographics
| Age Band | West Virginia | Ohio | National Total |
|---|---|---|---|
| Under 6 | 4724 | 713 | 5437 |
| 6–18 | 13363 | 1857 | 15220 |
| 19–25 | 8815 | 1091 | 9906 |
| 26–34 | 9941 | 1403 | 11344 |
| 35–44 | 11718 | 1588 | 13306 |
| 45–54 | 13358 | 1598 | 14956 |
| 55–64 | 13851 | 1711 | 15562 |
| 65–74 | 11053 | 986 | 12039 |
| 75+ | 7768 | 711 | 8479 |
Nationally, the largest age bands are 55–64 (15,562 members), 45–54 (14,956), and 6–18 (15,220), indicating a strong presence in both working-age adults and pediatric populations. The senior segments (65–74 and 75+) together account for over 20,000 members, highlighting a meaningful presence in older age groups.
West Virginia skews slightly older, with higher counts in the 55–64 and 65–74 bands compared to Ohio. Ohio's member profile is more evenly distributed, but with a smaller overall population. Providers should note the significant pediatric and senior representation, which may influence care delivery patterns and resource allocation.
Estimated Members by State
HEALTH PLAN GRP's estimated member distribution is highly concentrated in West Virginia, with 94,591 members, compared to 11,657 in Ohio. This aligns with the payer's higher market share and premium volume in West Virginia, where it holds a rank of 4 and a market share of 8.18%. In Ohio, despite a much lower market share (0.14%) and rank (32), the member count is still notable due to the state's larger population base.
The geographic concentration in West Virginia means providers in this state are likely to encounter HEALTH PLAN GRP members frequently, making payer relations and contracting strategies particularly important. In Ohio, the payer's footprint is more limited, but providers should still be aware of their presence, especially in regions where the payer may have targeted employer groups or niche products. This distribution suggests that provider organizations in West Virginia should prioritize engagement with HEALTH PLAN GRP, while Ohio-based providers may treat the payer as a secondary or tertiary contracting partner.