Benefit Plan Changes to PEIA

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June 23, 2016 by WVU Benefits Administration

Special Open Enrollment
July 1 – July 15, 2016

For Plan Year 2017:
July 1, 2016 – June 30, 2017

Benefits Administration will continue to update the material on this page as new information becomes available from PEIA. The PEIA Finance Board meets on June 23, 2016 to clear up any issues related to the 2017 plan, and finalize the Shopper’s Guide. Please check back for updates.

Morgantown W.Va. — The Public Employees Insurance Agency (PEIA) will be holding a Special Enrollment period for all benefit-eligible state employees from July 1-15, 2016. All changes will be retroactive to July 1, 2016.

This Special Enrollment is in response to the adoption of the state budget with funding for PEIA. There are substantial changes in the benefits for State agencies, colleges, universities and county boards of education, as well as non Medicare retirees. Non-state agencies were not affected by the budget cuts.

The Special Enrollment period is NOT an extension of the 2017 Healthy Tomorrows deadline that ended in May. It is also not open enrollment for life insurance benefits.

Fringe Benefits Management Company (FBMC) will offer a concurrent Special Enrollment period for Mountaineer Flexible Benefits, so members may make changes to Health Savings Accounts, Medical Flexible Spending accounts, Limited Use Medical Flexible Spending accounts and other supplemental benefits.

What is Changing with PEIA?
Effective July 1, 2016:
All active employees of State agencies, colleges, universities and county boards of education will see a 12% premium increase.

Non-Medicare retirees will see a 6% premium increase.

The following benefit changes take effect July 1, 2016:

  1. Urgent Care copay increases to $50 for PEIA PPB Plans A, B and D.
  2. For Comprehensive Care Partnership (CCP) Program members, ANY non-CCP office visit now requires the $40 specialist office visit copay.
  3. The Face-2-Face Diabetes Program will be limited to two years. Current F2F members will be permitted two more years of services starting July 1, 2016, as long as they continue to meet the other requirements of the plan.
  4. Out-of-state, non-network services are no longer covered in any of the PEIA PPB Plans. Patients will be responsible for 100% of billed charges from non-network providers outside West Virginia, except in a medical emergency or when approved in advance by HealthSmart. PEIA PPB Plan members who reside more than one county outside of West Virginia may use in-network providers where they live without prior approval from HealthSmart, as long as PEIA has been notified of your residential address.
  5. Facility- fee limits for select facility-based services/procedures. If the member chooses an out-of-state facility that charges more than the PEIA facility fee limit, the member will be responsible for the difference between PEIA’s payment and the facility’s charge.
  6. Additional emergency room copay of $500 for high-risk behaviors, such as:
    • Accidents while driving motorcycle or UTV/ATV without a helmet
    • DUI/DWI or drug -related accidents
    • Failure to wear seatbelt(s)
  7. Opioid pain medications will have a quantity limit (QL) for all medications in the opioid class. Additional quantities require Prior Authorization.
  8. PEIA will no longer offer the Advance Directive/Living Will discount, although members are still encouraged to have an Advance Directive/Living Will and to discuss family and physician.

Benefits Employees Can Make Changes To:

  • PEIA and Health Plan (health insurance only)
  • FBMC Medical Flexible Spending Accounts, Limited Use Medical Flexible Spending Accounts and Health Savings Accounts

How Employees Can Make Changes:
PEIA – Members must complete the paper transfer form, located in the back of the Shopper’s Guide. Online changes will not be accepted.

Forms must be mailed directly back to:
WVU Benefits Administration
One Waterfront Place
PO Box 6640
Morgantown, WV 26506-6640

FBMC – changes can be made online at

Who to Contact with Questions:


WVU Benefits Administration

PEIA Special Enrollment Information
PEIA Shopper’s Guide PY 2017 (not yet available)
PEIA Transfer Form (not yet available)
PEIA Manage My Benefits Online Enrollment Access
How to use PEIA’s Manage My Benefits
PEIA Provider Directory
Prescription Drug Benefits
The Health Plan Schedule of Benefits – PY 2017

FBMC Online Enrollment Access
FBMC Resource Guide PY 2017