Qualifying Life Events
Under the IRS Code, Section 125, the employee must pay the same amount of premium each month during the year, unless the employee has a qualifying change in family status.
Qualifying Life Event Checklist and Instructions
Online Enrollment
Changes to your PEIA Health Insurance, Optional and Dependent Life Insurance can be made online. Follow these instructions to properly make your changes during a qualifying event. *Please note, this method will only allow changes to your health and life benefits.
Paper Change-In-Status Form
FBMC Change-In-Status Form
*FBMC requires a paper Change-In-Status form for changes in flexible benefits.
All required forms and *supporting documentation must be submitted electronically, printed, mailed or faxed
NO PHOTOS will be accepted.
Mailing address:
Benefits Administration
One Waterfront Place, Floor Two
PO B
ox 6640
Fax: (304) 293-7532