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Comprehensive List of Forms and Documents. Health Care Providers. Medicare Retirees. Non-Medicare Retirees. Life Insurance Forms, Documents, and Information . Notice of Privacy Practices. Requests for Proposals / Quotations / Information.
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 online through the PEIA website, complete the basic life and optional life insurance beneficiary for m on the MetLife website by clicking here .
Downloads and Forms. The Unemployment Resources page is where you’ll find essential tools and information to help you navigate the unemployment benefits process with confidence and ease.
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.
” This form is available online at https://www.charlestonwv.gov/government/city-departments/human-resources/open-enrollment . Please note, if you elected PPB Plan C and would like to make an additional contribution to your HSA account, you may elect to do so using the “I Enrolled Online” form.
