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Change of Demographic Information

​If a policyholder wants to update their demographic information, they can accomplish it in one of two ways.

1. Print a Change in Status Form, fill out the top portion of the form, and take it to the Benefit Coordinator to fill out the agency portion. The Benefit Coordinator can then enter the information through the Manage My Benefits portal and upload the form.

To change an address only,  fill out a Change of Address and mail the form to PEIA. PEIA cannot accept address changes via telephone.

2. To make the change a policyholder can go into Manage My Benefits and on the account information screen, the name, address, telephone number or dependent information can be updated.


PLEASE NOTE: Any change that is made with PEIA does not change with your Mountaineer Flexible Benefits. To Change demographic information for FBMC, please click here.