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

Sun Life Dental Claim Form​

Humana E​yeMed Claim Form​

Contact Information