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Comprehensive list of Forms and Documents. Alphabetical list of PEIA forms and documents . Documents for Benefit Coordinators
- Find a Form Or Document
The following is an alphabetical list of forms and documents...
- Enrollment Forms
Enrollment Forms. If a form has (Complete Online) next to...
- Shopper's Guides
Shopper's Guide (Plan Year 2013) PEIA is required by law to...
- Find a Form Or Document
The following is an alphabetical list of forms and documents on the Web site. If you see (Complete Online) next to a form, you can do this online by going to Manage My Benefits. It's easier, faster and leads to fewer mistakes than printing a form and sending it to PEIA.
Enrollment Forms. If a form has (Complete Online) next to it, you can do this online by going to Manage My Benefits. It's easier, faster and leads to fewer mistakes than printing a form and sending it to PEIA. Full instructions can be found here.
Employee Benefits. After completing the PEIA benefits enrollment online through the PEIA website, complete the basic life and optional life insurance beneficiary for m on the MetLife website by clicking here . Please provide the completed form to the HR coordinator for processing.
State of West Virginia Public Employee Insurance Agency Health Benefits Enrollment Form. Complete this form to enroll for health coverage. Complete all sections of the form except “AGENCY” HEALTH. September 2019.
If you are unable to complete the electronic enrollment via the PEIA website you may enroll in coverage using the paper enrollment form labeled “ Enroll For Me ”, located at https://www.charlestonwv.gov/government/city-departments/human-resources/open-enrollment .
Shopper's Guide (Plan Year 2013) PEIA is required by law to maintain the confidentiality, privacy, and security of our members’ protected health information (PHI).
