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  • Change In Status Peia 2009

Get Change In Status Peia 2009-2025

Change in Status Form Page 2 Policyholder s Last Name Last four digits of SSN COBRA Under Federal COBRA law PEIA must offer continued coverage to qualified policyholders or dependents under certain circumstances. State of West Virginia Public Employees Insurance Agency Change-In-Status Form Change in Status Complete this form to change the status of your coverage. Complete all sections as appropriate except the Employer Information on page 2 and.

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Retirees with Medicare receive health insurance through one of two plans: Medicare Advantage Plan (Humana) Special Medicare Plan (PEIA)

To change an address only, fill out a Change of Address and mail the form to PEIA. PEIA cannot accept address changes via telephone. 2. To make the change a policyholder can go into Manage My Benefits and on the account information screen, the name, address, telephone number or dependent information can be updated.

Mountaineer Flexible Benefits provides optional insurance coverage, including dental benefits, optical benefits, flexible spending accounts, disability insurance and more. Not all PEIA members are covered under the plan. Members who are covered bear the cost of optional insurance with pre-tax earnings.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232