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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...
- 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.
Manage My Benefits (select to complete PEIA forms online) After completing the PEIA benefits enrollment through the PEIA website, complete the basic life and optional life insurance beneficiary for m on the MetLife website by clicking here
Public Employees Insurance Agency. 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.
State of West Virginia Public Employee Insurance Agency. CIS. Change In Status Form. Complete this form to Change the status of your coverage. . Complete all sections of the form except “AGENCY” form. If none of the people enrolled on your PEIA coverage use tobacco, you will receive the discount on your health and Opt/Dep life insu.
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.
