Staff Resources > Insurance Information

PEIA Shopper's Guide
Plan Year 2018 Benefits
July 1, 2017 - June 30, 2018

2015-16 PEIA Premiums

Retired Non-Medicare
Retired Medicare


The PEIA Finance Board approved the following changes to PEIA's health plans (effective July 1, 2017)Please click on the links below:


2017-2018 Shopper's Guide - PLEASE READ

Healthy Tomorrows Update for 2018 - Important - PLEASE READ!

NEW PEIA INFORMATION 2016-2017! - 8 August 2016

The PEIA Finance Board approved the following changes to PEIA's health plans (effective July 1, 2016)Please click on the links below:


2016-2017 Shopper's Guide - PLEASE READ

Healthy Tomorrows in a Nutshell - Important - PLEASE READ!


The PEIA Finance Board approved the following changes to PEIA's health plans (effective July 1, 2015):

Copay and out-of-pocket max increases Healthy tomorrows State Agencies, Colleges, Universities and County Boards of Education -- no premium change
Generic Drug Copays: 30-day supply will increase $5 90-day supply will increase $10 Preferred Brand Drug Copays: 30-day supply will increase $10 90-day supply will increase $20 Plan C only after Deductible is met and for medications on the Preventive Drug List.

Out-of-pocket maximum : Plans PPB A and D Family Out-of-pocket maximum increases from 1.5x the employee only amount to 2x the employee only amount Deductible All PPB Plans Deductible increase by $25 for employee only and $50 for family-type plans

PCP visit copay increases from $15 to $20 Specialist visit copay increases from $25 to $40 Outpatient surgery copay increases by $50 ER copay increases to $100, with no discount Waived if admitted Inpatient Hospital copay of $100 per admission In addition to existing deductible & 20% coinsurance

Healthy Tomorrows Open Enrollment 2016 --PEIA PPB Plan policyholders

Plan Year 2016:

Before May 15, 2015, all PEIA PPB Plan policyholders must name a PCP

Plan Year 2017:

Between April 2015 and the end of open enrollment in 2016, policyholder must: Continue to have a PCP named Have bloodwork done Report values to PEIA on form in this year's Shopper's Guide

Plan Year 2018:

Between April 2017 and the end of open enrollment in 2018, policyholder must: Continue to have a PCP named Have new bloodwork done Report values to PEIA on form in Shopper's Guide Have values in acceptable range Each year thereafter, will repeat requirement for 2018 Any year the policyholder does not meet the goal, policyholder pays an additional $500 deductible Only the policyholder needs to comply with Healthy Tomorrows requirements

Use Manage My Benefits to name a PCP When asked, be sure to choose Open Enrollment and the script will walk you through the process If no internet access, call PEIA at 877-676-5573 to request a Pick-a-PCP form On menu, choose to order a Pick a PCP form Enter SSN from telephone keypad Form will be mailed on the next business day PEIA will not take PCP designations for Plan Year 2016 after May 15, 2015 -- no exceptions

New hires during the plan year will not have to meet the Healthy Tomorrows goals until the following open enrollment Will not be charged the $500 deductible in the plan year in which they are hired The next open enrollment, the new hire will have to meet all requirements for the Plan Year.



The PEIA Finance Board approved the following changes to PEIA's health plans (effective July 1, 2014):

1. Discontinuation of the Improve Your Score dicount program. As you may recall, when the program was implemented, all premiums were increased by $10 per month, and then those who participated in the program got a $10 per month discount. Standard premiums for active employees will be reduced by $10 on July 1, 2014.

2. A second attempt at the Face-2-Face Diabetes Management Program. Members who either failed to comply or dropped out of the program will be give a second chance to participate. There is a 12-month waiting period after the first attempt. The Face-2-Face Program is available to active employees and non-Medicare employees only.

3. Two-tier specialty drug benefit ($50 co-pay for preferred specialty drugs and $100 co-pay for non-preferred specialty drugs). Specialty drugs are the fastest growing portion of the plan. The average cost is $3,200 a month. The change applies to active employees and non-Medicare retirees only.

4. $25 co-pay for the services below when received out-of-state. These services are widely available in all areas of the state. The copay applies only to PEIA-insured members living in West Virginia and the continguous counties of surrounding states when care is recieved in a bordering county. The changes applies to active employees and non-Medicare employees only. * Computerized tomography (CT) scans * Dialysis (Per treatment) * Durable medical equipment purchases that exceed $100 * Magnetic resonance imaging (MRI) * Magnetic resonance angiogram (MRA) * All outpatient surgery

5. No premium increases. The finance board held premiums steady for all employers, active employees and retirees (except for the premium decrease discussed above). Customer Service 1-304-558-7850, 1-888-680-7342


Click Here for Detailed Instructions for the PEIA Online System CLICK HERE

It's time to Complete Your Living Will/Advance Directive Affidavit! - 21 October 2010

Once you've completed your advance directive, the easiest way to get your discount is to complete the Living Will Affidavit on PEIA's "Manage My Benefits" site. Go to and click on the green "Manage My Benefits" button in the upper right corner. If you've used the site before, just log in. If you haven't used the site before, you'll use the "Need to Register" function before you complete your affidavit. When you get to your menu, choose the Living Will button and follow the instructions.

Please remember, PEIA does not want a copy of your advance directive or living will. Please DO NOT mail or fax a copy of your actual advance directive document to us. All you must do to receive the discount is complete the affidavit - either online or on paper.

Memo from PEIA Administration - 16 September 2009

In an effort to make our operations at PEIA more efficient, we'd like to ask your cooperation with the following:

1. Please refer all member eligibility calls to Customer Service. All members should be referred to Customer Service (1-888-680-7342, option 0) even if they have questions about eligibility. The Customer Service staff has the training in eligibility issues to be able to answer member calls. Please do not give the names and extension numbers of the eligibility staff to your PEIA members.

2. For claim or customer service issues, please refer your PEIA members to PEIA's contractors first. As you know, we have a VERY SMALL customer service staff here, and their job is to handle the more complex issues that the contractors can't handle. Questions should be referred to:

a. PPB benefits, claims, and ID cards: Wells Fargo TPA • 1-888-440-7342
b. PPB precertification and out-of-state referrals: ActiveHealth • 1-888-440-7342
c. PPB prescription issues: Express Scripts Inc. • 1-877-256-4680
d. Health Plan HMO questions: The Health Plan • 1-888-847-7902
e. Carelink HMO questions: Carelink • 1-800-348-2922
f. Medicare retiree benefit questions (thru 12/30/09): Advantra Freedom • 1-877-337-4178
g. Future (1/1/10) Medicare retiree questions: Humana • 1-800-783-4599

3. As a general rule, temporary ID cards will no longer be generated. Enrollment forms must be submitted to PEIA by the 15th of the month in order for eligibility to complete the data entry and for the member to receive an ID card by the first of the following month. Online transactions must be completed and approved by the 20th of the month for the member to receive an ID card by the first of the following month. If PEIA does not complete the data entry within a time frame to allow for the member to receive the ID card by the 1st of the month, then the member may request a temporary ID card. Otherwise, you may advise them to present a copy of their enrollment form, or they may use the policyholder's SSN as their ID number to receive services.

We appreciate your help as we try to change processes here to make the plan work more efficiently for everyone!

PEIA Update

Beginning with Plan Year 2009 on July 1, 2008, participants will no longer be required to complete a tobacco affidavit each year — unless there is a change in participant or dependent tobacco use. Changes (tobacco status, adding or deleting dependents, etc.) may be made through the Board office or online once you have gone through the initial registration process.


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Franklin WV 26807
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