FAQ
When an adopted child is placed in the home of a member, the member has the month the child was born and/ or placed in the home and the two following calendar months to add coverage for the child.
Coverage will be retroactive to the date of birth or placement if enrolled during the initial qualifying event period. If the child is not added to the insurance during the initial enrollment period, the child cannot be added until open enrollment or until another qualifying event occurs (insurance will not be retroactive).
To add an adopted child to your health insurance, you can:
- Visit your Benefits Coordinator and fill out a Change in Status Form. You will need a copy of the certificate of placement or legal adoption papers as documentation.
Log into your Manage My Benefits account.
- From your Menu screen, choose Add a Dependent.
- Enter the child's demographic information into the system.
- Answer if the child has insurance other than PEIA. If you want to chose a Primary Care Physician, you can do it here. Choose finalize.
- The next screen will have your child's name, click Next.
- From this screen you will choose if you want to manage Health Insurance for the dependent or Life Insurance.
- Choose adoption and enter the child's date of birth of date, date of placement or date of legal adoption in the MM/DD/YYYY format and continue.
- You will see and/or choose your plan on the next screen, click continue.
- Mark a yes by the dependent's name. On the next screen select finalize.
- On the main menu, click the gray box that says Upload Required Documentation.
- The type of file is Adoption Papers. Choose the child's name.
- Browse to the file with the placement certificate, birth certificate and/or the adoption decree and then click upload at the bottom of the page.
You can find details about making changes like this in the Summary Plan Description under Qualifying Events.
PLEASE NOTE: Any change that is made with PEIA does not change with your Mountaineer Flexible Benefits. To change demographic information for FBMC, please contact FBMC directly.
The birth of a child to a policyholder creates an eligibility event that allows the policyholder to enroll their new dependent. Policyholders have the month the child was born and the two following calendar months to add coverage for the child. If the child is not added to the insurance during the initial enrollment period, the child cannot be added until open enrollment or until another qualifying event occurs.
To add a child to your health insurance, you can:
- Visit your Benefits Coordinator and fill out a Change in Status Form. You will need a copy of the birth certificate as documentation.
- Log into your Manage My Benefits account.
- From the Menu screen choose Add a Dependent.
- Enter the child's demographic information into the system.
- Answer if they have insurance other than PEIA. If you want to chose a Primary Care Physician for the dependent, it can be done here.
- Choose finalize.
- The next screen will have the child's name; click next.
- From this screen choose Health Insurance for the dependent or Life Insurance.
- Choose birth of a child as the qualifying event and enter the child's date of birth in the MM/DD/YYYY format and click Continue.
- The next screen shows the current plan, click continue and mark a yes by the dependents name.
- On the next screen select finalize.
- From the main menu, click the gray box that says Upload Required Documentation.
- The type of file is Birth Certificate. Choose the child's name and browse to the file with the Birth Certificate and then click upload at the bottom of the page.
For information on Breastfeeding supplies or Lactation Services PEIA policies, click here.
Divorce is a qualifying event to make changes to your insurance. Qualifying events which end eligibility (such as divorce) must be reported immediately. For purposes of eligibility, the term “immediately” shall mean as soon as practically possible and, in no case, greater than thirty (30) days from the date of the final divorce decree. You must remove your ex-spouse and stepchildren from all of the policies that they were covered by i.e. Health and Dependent Life, Dental, Vision etc..
To make the change, you can fill out a Change in Status form, check the box divorce and turn it in to your Human Resources Department. Coverage would be effective the first day of the month following PEIA receiving the Change in Status form and the divorce decree.
To make the change, you can also log into your Manage My Benefits account by clicking on the green Manage My Benefits button and make your changes to your insurance plan online.
From your Menu screen you will choose your stepchild's and/or spouse's name and you click next.
From this screen you will choose if you want to manage Health Insurance for the dependent or Life Insurance.
You will choose divorce and enter the date the divorce is final with backslashes and continue.
Uncheck the box beside the dependent's name and then on the next screen finalize.
When you go back to the main menu, you will see a grey box that says Upload Required Documentation. Click it.
The type of file is Divorce Decree. Choose the spouse's name.
Browse to the file with the Divorce Decree and then click upload at the bottom of the page.
You can find details about making changes like this in the Summary Plan Description under Qualifying Events.
PLEASE NOTE: Any change that is made with PEIA does not change with your Mountaineer Flexible Benefits. To Change demographic information for FBMC, please contact FBMC.
Marriage is a qualifying event that allows a member to add or drop coverage.
A member may add coverage for a spouse during the month they are married and the 2 calendar months following. To do so, fill out a Change in Status form, check the box for marriage and turn it in to your Human Resources Department. Coverage would be effective the first day of the month following PEIA receiving the Change in Status form and the marriage certificate.
It is also a qualifying event to drop health coverage if a member is going to pick up coverage through their new spouse. To do so, fill out a Change in status form, check the box for marriage and turn the form along with documentation verifying other insurance coverage to your Human Resources Department. Coverage will end of the last day of the month in which you turn in your paperwork.
Stepchildren may also be added due to the qualifying event of marriage. To do so, add the step-children's names under dependents covered section of the Change in Status form. PEIA requires birth certificates for each child that needs to be added to the policy.
To make the change, you can also log into your Manage My Benefits account by clicking on the green Manage My Benefits button and make your changes to your insurance plan online. When adding coverage for dependents online remember it is a two step process. First the demographic information needs to be entered and then what type of coverage the dependents need ;must be chosen.
From your Menu screen you will choose Add a Dependent.
You will enter the child's and/or spouse's demographic information into the system.
You will answer if they have insurance other than PEIA and if you want to chose a Primary Care Physician, you can do it here.
Then choose finalize.
The next screen will have your child's and/or spouse's name and you click next.
From this screen you will choose if you want to manage Health Insurance for the dependent or Life Insurance.
You will choose marriage and enter the date of marriage with backslashes and continue.
Choose your plan on the next screen. Then click continue.
Mark a yes by the dependent's name and then on the next screen finalize.
When you go back to the main menu, you will see a grey box that says Upload Required Documentation. Click it.
The type of file is Marriage Certificate. Choose the spouse's name.
To add the stepchildren, the type of file is Birth Certificate. Choose the child's name
Browse to the file with the Marriage Certificate or Birth Certificate and then click upload at the bottom of the page.
You can find details about making changes like this in the Summary Plan Description under Qualifying Events.
PLEASE NOTE: Any change that is made with PEIA does not change with your Mountaineer Flexible Benefits. To Change demographic information for FBMC, please contact FBMC directly.
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).
PEIA understands that legal decisions must be made about medical and financial matters for our policyholders Here you will find some information, forms and references that PEIA hopes will be helpful in getting these set up and allowing our policyholders and their loved ones to have a piece of mind.
PEIA has put together an informational PowerPoint to help decipher the terms and usages of Power of Attorney forms: Powers of Attorney
Additional Forms
West Virginia Combined Living Will and Medical Power of Attorney Form
West Virginia Statutory Power of Attorney Form
Retirement - What do I do now ? Congratulations from PEIA on your retirement! Insurance is complicated enough, therefore, this website is here to help you navigate the transition from active employee to retiree with or without PEIA coverage.
See our Retirement Guide for more information.
If You Do Not Want to Continue ANY PEIA Coverage After You Retire
If you do not want to continue any PEIA coverage after you retire, please fill out a Termination Form and return it to your Benefit Coordinator to be signed and sent into PEIA. You will also need to fill out and return to your Benefit Coordinator a Retiree Basic Life and Health Form indicating that you are declining coverage.
Non-Medicare Retirees
If you are a Non-Medicare Retiree, your agency participates in PEIA retirement insurance and you want to continue PEIA Health Insurance, you will need visit your Retirement Board and your HR Department. You will need to fill out a Retiree Basic Life and Health Enrollment Form, a Retiree Optional and/or Dependent Life Enrollment Form and a Termination Form or you can contact PEIA customer service at PEIA to pick up a retirement packet or you can contact PEIA customer service at 1-888-680-7342 to request that a retirement packet be mailed to you.
If you are not Medicare Eligible, you will continue with the health plan you have when you retire. You will keep the same Medical ID card and use it as you did when you were an active employee for facilities, doctors and prescriptions.
Medicare Retirees
If you are a Medicare Retiree, your agency participates in PEIA retirement insurance and you want to continue PEIA Health Insurance, you will need visit your Retirement Board and your HR Department. You will need to fill out a Retiree Basic Life and Health Enrollment Form, a Retiree Optional and/or Dependent Life Enrollment Form and a Termination Form. You can visit customer service at PEIA to pick up a retirement packet or you can contact PEIA customer service at 1-888-680-7342 to request that a retirement packet be mailed to you.
You will need to visit the Social Security Office and sign up for Medicare parts A and B. PEIA will need a copy of your Medicare card when you receive it. If any dependent is Medicare eligible, PEIA will need a copy of their Medicare Card also. When your dependents become Medicare Eligible, please send a copy of their Medicare card into PEIA.
If you are Medicare Eligible, you may transfer directly to Humana. You must have Medicare parts A and B. If you choose to move directly to Humana, you will need to call PEIA at 1-888-680-7342 and request a transfer form. Once PEIA receives, reviews and processes the form, you will be moved into the Humana Plan and receive a welcome package.
Another alternative is to continue in the PPB plan you have when you retire through PEIA's Special Medicare Plan (see section below). Medicare-eligible employees who retire after the beginning of a plan year, and retired employees who become eligible for Medicare during the Plan year will be moved to the Special Medicare Plan. These members in the Special Medicare Plan will be moved to PEIA’s Medicare Advantage Plan at the beginning of the next plan year (the following January).
Special Medicare Plan
PEIA offers the Special Medicare Plan to two groups of Medicare-eligible retirees:
- Members who are unable to access medical care through the PEIA Medicare Advantage (Humana) Plan due to provider network limitations are permitted, on a case-by-case basis, to move into PEIA’s Special Medicare Plan. These members may remain in the Special Medicare Plan until adequate provider access becomes available.
- Medicare-eligible employees who retire after the beginning of a plan year, and retired employees who become eligible for Medicare during the Plan year will be moved to the Special Medicare Plan. Retired members who are enrolled in an HMO when they become Medicare-eligible will be transferred to PEIA’s Special Medicare Plan. These members in the Special Medicare Plan will be moved to PEIA’s Medicare Advantage Plan at the beginning of the next plan year (the following January).
Under the Special Medicare plan, the member purchases traditional Medicare Parts A and B, and their secondary medical and prescription claims are paid by UMR and Express Scripts, respectively. Medical benefits under the Special Medicare Plan are generally the same as those provided under PEIA’s Medicare Advantage plan. For Medicare Retirees, Medicare will be primary and PEIA will be secondary. You will need to update your coordination of benefits with UMR.
Premiums
Once all of your paperwork is turned in, it will be 2-3 months before your retirement check will arrive. The full premium for the months from the date of retirement to the date of the first retirement check will be withdrawn.
If you do not have your payment taken out of your retirement check payments can be made here after you receive your first bill. You can also sign up for Direct Draft to automatically pay your bill each month.
Life Insurance
You may continue your basic, optional and dependent life insurance at the time of retirement. If you wish to elect new or increased life insurance as a retired employee, you must enroll and submit medical information during the calendar month of retirement or the two following calendar months. Coverage will be effective upon approval of PEIA’s life insurance carrier. You may not elect or increase life insurance after this period. If your life insurance lapses after retirement for any reason, for example, for non-payment of premiums, you will not be permitted to reinstate that coverage; you will need to seek life insurance from another source.
Mountaineer Flexible Benefits
You can elect optical and dental care through Mountaineer Flexible Benefits with after-tax earnings.
PEIA is required by law to apply a monthly spousal surcharge to active employees of State agencies, colleges, universities, and county boards of education if your spouse is eligible for employer-sponsored coverage through his/her employer, and has PEIA coverage. The spousal surcharge will be added to health insurance premiums each month. If your spouse is eligible for coverage as an employee of a PEIA-participating agency, has Medicare, Medicaid, TRICARE or is retired, the spousal coverage surcharge does not apply.
If both spouses are public employees, the surcharge does not apply, but you may need to act to avoid the surcharge. If the spouse who is not the health policyholder has Basic Life insurance, you do not need to complete a Spousal Surcharge Affidavit. If the spouse who is not the health policyholder DOES NOT have Basic Life insurance, you must complete a Spousal Surcharge Affidavit to avoid paying the surcharge. If you previously submitted a Spousal Surcharge Affidavit, and your status has not changed, you do not need to submit a new affidavit during open enrollment. Your previous affidavit remains in effect.
If your spouse’s coverage status changes, spouse loses coverage, is currently eligible or becomes eligible for, health coverage through their employer, you must report the change in writing to PEIA during the month the change occurs or within the two following months. You are required to report the spouse's eligibility for employer sponsored health insurance even if the cost(s) of that employer sponsored health insurance is viewed as, 'too expensive' or 'not practical'. Failure to notify PEIA in a timely manner will result in your being billed for any additional spouse surcharge due, and no refunds will be granted. If you remove your spouse from your PEIA coverage, that loss of coverage is a qualifying event for your spouse to add coverage under his/her employer’s coverage. PEIA can provide you documentation of the termination of coverage, just call us at 1-888-680-7342. If your spouse drops coverage from their employer, that is a qualifying event to add them to your coverage, but the spousal surcharge will apply.
Click here for additional information on PEIA's Spousal Surcharge: PEIA SPSU_FAQ
Here’s what you need to know about the health care forms, IRS 1095-B and 1095-C.
PEIA mails these forms in late February, as required by law. PEIA members will receive either a 1095-B or 1095-C, depending on their employer and employment status.
According to the IRS website, you do not need these forms to file your taxes. If you want more information, check out these handy FAQs on the IRS website: https://www.irs.gov/affordable-care-act/questions-and-answers-about-health-care-information-forms-for-individuals
Welcome to the Public Employee's Insurance Agency! We understand that it can be overwhelming trying to pick the best insurance coverage for you and your dependents. At PEIA, we have compiled various resources for our members to help them make their insurance decisions.
Benefits Guide
The Shopper’s Guide is an invaluable tool for all employees and provides information about the plans offered as well as rate tables for premiums for the current plan year.
Summary Plan Description
The Summary Plan Description (SPD) provides PEIA PPB Plan participants with an easy-to-read description of benefits available through the Plans and instructions on how to use these benefits. The SPD is a summarized version of a portion of PEIA’s Plan Document.
Mountaineer Flexible Benefits Booklet
Fringe Benefits In-Depth Description and Information
The Mountaineer Flexible Benefits Booklet provides eligible participants with an easy-to-read description of flexible benefits (dental, vision, hearing, long and short-term disability, group legal insurance, flexible spending accounts, health savings accounts and limited healthcare FSA) that may be available to them.
Note: To enroll in fringe benefits as a new employee, you must complete the paper enrollment form and submit to your Benefit Coordinator.
Life Insurance Certificate of Coverage
Basic, Optional, and Dependent Life Insurance Coverage Information
View the MetLife Life Insurance Certificate of Coverage as well as other important information (including rates and coverage tiers) on our website. Life insurance plan rates are published annually in the Benefit's Guide.
Additional Links and Plan Information:
Instructions to Enroll on Manage My Benefits
PEIA Health Plan Comparison Calculator
PEIA Summary of Benefits and Coverage Tool
PEIA offers a premium discount on all health and optional life insurance to active and retired policyholders who verify through a tobacco affidavit that all enrolled family members are tobacco-free.
Tobacco-free plan members subtract $25 from the premium for employee-only coverage or $50 from the employee/child, family or family with employee spouse premium.
What constitutes tobacco use? If the product is regulated by the FDA under the 2009 Family Smoking Prevention and Tobacco Control Act, Public Law 111–31, then it is considered a tobacco product and its use is "tobacco use" under PEIA Rule(s). To qualify for the Tobacco-free Preferred Premium for all of the plan year, you and all enrolled family members must have been tobacco-free by January 1 of the previous plan year.
If your doctor certifies on a form provided by PEIA, that it is unreasonably difficult due to a medical condition for you to become tobacco-free or it is medically inadvisable for you to become tobacco free, PEIA will work with you for an alternative way to qualify for the tobacco-free discount. Send all such doctors’ certifications and requests for alternative ways to receive the discount to:
PEIA Discount Alternatives, 601 57th St., SE, Suite 2, Charleston, WV 25304-2345.