Health Plans

WVSOM employees receive health insurance through the West Virginia Public Employees Insurance Agency (PEIA).

Employees currently have a choice between two primary health plans available:

  • PEIA Preferred Provider Benefit (PBB) Plans
  • The Health Plan

PEIA PBB Plans

PEIA offers the PEIA PPB Plans A, B and C to all activeWVSOM employees.

Plan A is the standard plan. Plan B is similar to Plan A, but offers lower premiums with higher deductible, higher out-of- pocket maximums, and higher copayments for prescription drugs. The medical coverage is identical in PPB Plans A and B. The differences in deductible, out-of-pocket maximums and drug copayments.

PEIA PPB Plan C is an IRS-qualified High Deductible Health Plan which can be paired with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA).

When considering a PBB Plan remember:

  • Employees pay annual deductible and co-insurance amounts up to an annual out-of-pocket maximum. Both amounts are determined by annual salary.
  • There are restrictions on traveling outside of West Virginia to get medical care.
  • Prescription drugs have a separate annual deductible and out-of-pocket maximum.
  • A discount is avaiable for employees who are tobacco free.

Questions about a PBB Plan?

Questions about medical claims should be addressed to Wells Fargo:

(888) 440-7342
http://www. wellsfargo.com/tpa

Questions about prescription drugs should be addressed to Express Scripts:

(877) 256-4680
http://www.express-scripts.com

Questions for PEIA should be addressed to the West Virginia Public Employees Insurance Agency:

(888) 680-7342
http://www.peia.wv.gov

PBB Plan Pre-certification & Out of State Referrals

Requests for pre-certification or out-of-state referrals for medical care should be addressed to ActiveHealth:

(888) 440-7342

The Health Plan

The Health Plan is a Health Maintenance Organisation (HMO).

HMO's manage health care for their members by coordinating the use of health care services through their Primary Care Physicians. When considering the Health Plan remember:

  • Members must be referred for specialty care.
  • PPO (Preferred Provider Organization) offers both "in and out-of-network" services.
  • Premium contributions are set by the managed care plans and are based on salary.
  • Plans have deductible and co-pays and annual out-of-pocket maximums.
  • Members must choose a Primary Care Physician.

Questions about the Health Plan

Questions about the Health Plan should be directed to the Health Plan:

(800) 624-6961
http://www.healthplan.org

Continuing Health Insurance with COBRA

Employees and their enrolled dependents may be eligible to continue current health coverage for a limited time under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA).

COBRA is available for all PEIA's insured, including those under managed care, and is administered by Wells Fargo TPA.

  • An election to continue coverage under COBRA must be made within 60 days of the end of coverage.
  • To enroll for COBRA benefits, contact Wells Fargo TPA.
  • When an employee terminates or resigns, they complete a form for PEIA that will automatically initiate the COBRA process.

Questions about COBRA?

Questions about medical claims should be addressed to Wells Fargo:

(888) 440-7342
http://www. wellsfargo.com