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Click ‘Get Form’ to open the wv peia benefits form in the editor.
Begin by entering the Policyholder Name and ID Number in the designated fields. Ensure accuracy as this information is crucial for processing your benefits.
Fill in your Address and list any Dependents Covered, including their names and dates of birth where applicable.
Indicate whether you or any dependents have other insurance by selecting 'Yes' or 'No'. If 'Yes', specify the Type of Coverage (e.g., Medical, Dental) and provide details about the other insurance plan.
Complete the Employee’s Name field and provide the name, address, and effective date of the other insurance. If Medicare is involved, include that information as well.
Select whether the other insurance uses the gender rule or birthday rule for coordination of benefits.
If applicable, enter the termination date of any previous insurance plans.
Sign and date at the bottom of the form. Make sure to include a contact phone number for any follow-up questions.
Once completed, save your document and return it within 30 days to avoid delays in claims processing.
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PEIA PPB Plans The medical coverage is identical in PPB Plans A and B. The differences are in the annual deductible, out-of-pocket maximums and drug co-payments. PEIA PPB Plan C is an IRS-qualified High Deductible Health Plan which can be paired with a Health Savings Account (HSA).
How much is the PEIA spousal surcharge?
Starting July 1, 2025, the Spousal Surcharge will be increasing to $350* per month.
What does PEIA stand for?
Public Employees Insurance Agency 601 57th St., SE, Suite 2. Charleston, WV 25304-2345.
What is WV Treasury peia?
PEIA was established under the Public Employees Insurance Act of 1971, to provide hospital, surgical, group major medical, prescription drug, group life, and accidental death and dismemberment insurance coverage to eligible employees; and to establish and promulgate rules for the administration of these plans.
What is the highest income to qualify for Medicaid in WV?
Under the expanded eligibility guidelines, adults aged 19-64 are eligible for Medicaid with a household income up to 138% of the poverty level. For a single adult in 2025, that amounts to $21,597 in total annual income2 (Medicaid eligibility can also be determined based on current monthly income).
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