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.

PEIA Legislative Update-Dependents May Continue Coverage to Age 25

During the 2007 Legislative session, a bill passed allowing parents to keep unmarried, dependent children on their insurance coverage to age 25. The bill is effective July 1, 2007.

Your unmarried child or stepchild age 19 - 25 will qualify for benefits if he or she meets the definition of a "qualifying child" OR a "qualifying relative." For details of these definitions, go to www.wvpeia.com.

If you have qualifying unmarried children between ages 19 - 25 that you want to enroll for coverage, see your benefit coordinator, Vicki Hammer, for a Change-In-Status form. Complete the form and return it to Vicki. If you get this form to your benefit coordinator before June 30, 2007, coverage will not be effective July 1.

PEIA will not require documentation to add these dependents but will be conducting individual eligibility audits after July 1. If you are audited, you will have to produce either a student verification form for the dependent in question or your most recent Federal tax return showing that you've claimed the dependent on your taxes. If you cannot prove that the dependent qualifies for coverage, coverage will be terminated retroactively to the date the child would otherwise have been terminated, and PEIA will pursue reimbursement of any medical or prescription drug claims paid on the dependent.

Available Plans - Three plans are available to school employees in Pendleton County:

• PEIA PPB Plan A, which is the plan most all of the employees are currently in; or
• PEIA PPB Plan B, which has lower premiums but significantly higher deductibles and out-of-pocket expenses.