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Mountaineer Flexible Benefits

​​Forms (Plan Year 2022)
Mountaineer Flexible Benefits Enrollment Form (Active Employees)
Mountaineer Flexible Benefits Enrollment Form (Retirees)

Benefit Plans (Plan Year 2022)
Mountaineer Flexible Benefits Plan (Active Employees)
Mountaineer Flexible Benefits Plan (Retirees)​


Please note, to update your Mountaineer Flexible Benefits elections after a change-in-status event, you must complete an Enrollment Form with FBMC.                    ​Employees must submit the form, as well as supporting documentation, to their Agency Benefit Coordinator within the month of or two months following the status-changing event. Please select the appropriate Enrollment Form above (Active or Retiree) for the current plan year.​​

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Other Forms
Mountaineer Flexible Benefits Benefit Coordinator Reference Manual

Mountaineer Flexible Benefits Demographic Change Form (Active Employees)
Mountaineer Flexible Benefits Demographic Change Form (Retirees) 

Personal Pay Summary Form

Delta Dental Claim Form

MetLife Vision Claim Form

Contact Information

Call Customer Service at 1-844-559-8248
Email: mtflexbenefits@fbmc.com​