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 and mailed or returned prior to Benefits Administration.

Mailing address:
One Waterfront Place, Floor Two
PO Box 6640
Morgantown, WV 26506-6640

*Supporting documentation MUST be a scanned/printed paper copy, benefit vendors will not accept photos.