Out-of-area benefits are available to dependents who reside outside West Virginia beyond the bordering (contiguous) counties of surrounding states.  If you have a dependent who lives more than one county outside West Virginia, you must complete this form annually to receive the highest level of out-of-state benefits for your chosen PPB plan, without having to seek prior approval for all services.  Services must be provided by UnitedHealthcare Choice Plus PPO network providers. 

Also, if you move, please complete a change of address form ​(or update your information on Manage My Benefits) at your earliest convenience to ensure you receive any important information such as ID cards or EOBs (explanation of benefits).