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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 
PEIA 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:

Shared Services
One Waterfront Place, Floor 3
PO Box 6700
Morgantown, WV 26506-6640