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Wv peia prior authorization form 2025

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The document is a Prior Approval Request Form for Attention Deficit Disorder (ADD) medication under the West Virginia Public Employees Insurance Agency and Children's Health Insurance Program. It includes sections for patient and prescriber information, diagnosis details, treatment plan confirmation, and assessment dates. The form emphasizes confidentiality and provides contact information for assistance.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the difference between PEIA plan A and B?

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).

What are prior authorization forms?

A prior authorization form will include information about you, your medical conditions, and your health care needs. Its important to fill out the form completely and accurately. Incomplete or incorrect information could delay your request or result in a denial.

How much is the PEIA spousal surcharge?

Starting July 1, 2025, the Spousal Surcharge will be increasing to $350* per month.

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 does PEIA stand for?

Public Employees Insurance Agency 601 57th St., SE, Suite 2. Charleston, WV 25304-2345.

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).

Wv peia prior authorization form 2025

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