Get Pick A Pcp Form - Peia Wv

Filling out the Pick A PCP Form for PEIA can seem daunting, but by following a clear step-by-step process, you can complete the form with ease. This guide will assist you in accurately filling out the necessary information required for your primary care provider selection.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your PEIA ID number from your medical ID card. If you do not have the ID number, you may also enter the last four digits of your Social Security Number.
3. Fill in the policyholder's name in the designated field.
4. Provide the address, including city, state, and zip code, for the policyholder.
5. You are required to name a primary care provider (PCP). If you have the PCP's number from the online directory, write it neatly in the space provided.
6. If your chosen physician is not listed in the online directory, write the physician's name and address in the provided fields, ensuring to include city, state, and zip.
7. Certify the accuracy of the information by signing in the designated area and dating the form.
8. Once you have filled out all sections of the form, save your changes, download a copy, and print the form if needed.
9. Finally, you can share the form by sending it to PEIA at the designated address: PEIA, Pick a PCP Unit, 601 57th St., SE, Suite 2, Charleston, WV 25304-2345.

Complete the Pick A PCP Form online today to ensure your primary care provider is designated correctly and avoid any potential deductible increase.