Health Insurance

Marshall University offers health insurance for active employees and retirees through West Virginia Public Employees Insurance Agency (PEIA). Basic and major medical insurance benefits cover hospital and surgical services, physician expenses, laboratory fees, x-ray services, and prescription drugs. There are seven (7) health benefit plans.

Coverage for Insurance is Employee Only, Employee and Child(ren), Family, and Family with Employee Spouse.

  • Benefits-eligible employee.
  • Spouse of eligible employee.
  • Children ages birth to 26

Enrollment period is the month of hire and the following two calendar months. Coverage begins the first day of the month after enrollment and employment. EXAMPLE: An employee is hired January 17 but does not complete enrollment process until February 1, coverage would begin March 1. However, if employee completes enrollment prior to January 31, coverage would begin February 1. Premium is based upon salary and type of coverage, use of tobacco, etc. Changes in existing health care coverage can be made during “open enrollment” which occurs annually in the spring OR due to a qualifying event outside of open enrollment.

Please Note – You must have Basic Life Insurance to enroll for Health Insurance or Optional /Dependent Life Insurance Coverage.  You may choose to enroll in the Basic Life coverage without enrolling for Health Insurance.

This Terms to Know document will help you through the health insurance process.

Health benefit plans:

PEIA PPB Plans
 

PEIA offers four plans:

  1. PPB Plan A
  2. PPB Plan B
  3. PPB Plan C
  4. PPB Plan D – For WV Residents Only
  • The levels of coverage include Employee Only, Employee and Child(ren), Family, and Family with Employee Spouse.
  • Monthly premiums are based on the employee’s annual salary and type of coverage elected.
  • All plans are eligible to receive a $25 tobacco free discount for employee policies and a $50 discount for employee and child(ren) and family policies.

PPB Plan A
PPB Plan B
PPB Plan C
PPB Plan D (West Virginia ONLY

These are Preferred Provider Benefit (PPB) plans. PPB Plan A pays for a wide range of health care services for employees and their dependents. These plans are based on the yearly base salary of an employee.

The benefits are identical and include hospital services, medical services, surgery, durable medical equipment and supplies, and prescription drugs. The difference in these plans are the deductibles and out-of-pocket maximums.

You should review all online material in the PEIA Shopper’s Guide as this presentation cannot cover all information.

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These are Preferred Provider Benefit (PPB) plans. PPB Plan B pays for a wide range of health care services for employees and their dependents. These plans are based on the yearly base salary of an employee.

The benefits are identical and include hospital services, medical services, surgery, durable medical equipment and supplies, and prescription drugs. The difference in these plans are the deductibles and out-of-pocket maximums.

You should review all online material in the PEIA Shopper’s Guide as this presentation cannot cover all information.

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This is a High Deductible Health Plan (HDHP) and can be paired with the Health Savings Account (HCA). The HDHP premium is not salary based.

A HDHP is a plan that includes higher annual deductible than typical health plans. This plans also has higher out-of-pocket maximum that includes amounts paid toward the annual deductible and any coinsurance that you must pay for covered expenses.

The deductible in this plan is combined medical services and prescription drug costs, and must be met before the plan will pay for medical services or prescription drugs. The deductible does not include premiums.

You should review all online material in the PEIA Shopper’s Guide as this presentation cannot cover all information.

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This plan you must have all services and care in West Virginia. The only services/care allowed outside of West Virginia is emergency care to stabilize patients for transport back to a West Virginia facility.

This is a Preferred Provider Benefit (PPB) plan and is based on yearly base salary.

The benefits are identical to PPB Plans A & B and include hospital services, medical services, surgery, durable medical equipment and supplies, and prescription drugs. The difference in these plans are the WV only services/care, deductibles and out-of-pocket maximums.

You should review all online material in the PEIA Shopper’s Guide as this presentation cannot cover all information.

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Health Plans
The Health Plan offers three plans:

  1. Health Plan A (HMO) – Coverage Information
  2. Health Plan B (HMO) – Coverage Information
  3. Health Plan C (PPO) – Coverage Information

West Virginia’s Public Employee Insurance Agency (PEIA) is The Health Plan’s largest fully insured account, with over 14,000 members, since 1981. The Health Plan, a West Virginia company, is offered in all 55 counties in West Virginia.

You have low $10 copay for primary care visits on all three of our options! If you are an active employee or non-Medicare retiree living or working in West Virginia, you are eligible for The Health Plan.Listed below are just some of the benefits PEIA members receive:

  • Ambulatory patient services
  • Rehabilitative and habilitative services and devices
  • Emergency services
  • Lab services
  • Hospitalization, maternity and newborn care
  • Preventive and wellness services
  • Mental health and substance use disorder
  • Chronic disease management
  • Pediatric services including oral and vision care
  • Prescription drugs

Members can log in to our secure member area and take advantage of CoreWellness, a program that allows you to adopt and sustain behaviors that reduce your health risks, improve your quality of life and enhance personal effectiveness. You can also complete a Compass health risk assessment and take a Journey towards bettering your health. For more information, you can call 1.888.847.7902 or email us at info@healthplan.org.

If you are already enrolled with The Health Plan and wish to continue your membership, no action is necessary. Your enrollment will continue automatically.


How to Enroll:

Online

Enrolling online is easier, faster and leads to fewer mistakes than printing a form and sending it to PEIA.  If you have previously had PEIA as your insurance carrier, you are unable to use Manage My Benefits to log in and enroll.   Please enroll with the paper enrollment form. Complete all sections of the form except “AGENCY”. You will return this form to your Benefits Coordinator.

  • Full instructions can be found here.

Reminder – You must have Basic Life Insurance to enroll for Health Insurance or Optional /Dependent Life Insurance Coverage.  You may choose to enroll in the Basic Life coverage without enrolling for Health Insurance.

By Paper

You will complete the paper form and return to your Benefits Coordinator. If you have previously had PEIA as your insurance carrier, you are unable to use Manage My Benefits to log in and enroll.   Please enroll with the paper enrollment form. Complete all sections of the form except “AGENCY”.

Reminder – You must have Basic Life Insurance to enroll for Health Insurance or Optional /Dependent Life Insurance Coverage.  You may choose to enroll in the Basic Life coverage without enrolling for Health Insurance.


Other Benefit Resources:

Benefits at a Glance

Review the side-by-side comparison of the plans in the “Benefits At-A-Glance” charts.

Eligibility Rules

This section offers general information about eligibility that you may need during Open Enrollment.

Healthy Tomorrows

Healthy Tomorrows is a three-year plan to get members to:

      • Develop a relationship with a primary care provider.
      • Know some basic, easily controlled numbers.
        • blood pressure
        • blood sugar
        • total cholesterol
        • waist circumference
      • Get those numbers into an acceptable range.
        • blood pressure ≤140/90
        • blood sugar ≤125
        • total cholesterol ≤245
        • or have a physician’s statement that the numbers can’t be met
      • If members do not meet these requirements by May 15 deadline each year, $500 added to medical deductible for the next plan year.

Healthy Tomorrow’s is covered in full by PEIA. You need to present the reporting form to the physician. This document will also tell the provider how to bill the insurance correctly. 

Tobacco-Free Discount

PEIA offers a premium discount on PEIA PPB Plan A, B, C and D, The Health Plan, the Special Medicare Plan, the Medicare Advantage and Prescription Drug (MAPD) plan, and optional life insurance to active and retired policyholders who verify through a tobacco affidavit that all enrolled family members are tobacco-free. Tobacco-free plan members subtract $25 from the premium for employee-only coverage or $50 from the employee/child, family or family with employee spouse premium. To qualify for the Tobacco-free Preferred Premium for all of Plan Year 2019, you and all enrolled family members must have been tobacco-free by January 1, 2018.

If your doctor certifies on a form provided by PEIA, that it is unreasonably difficult due to a medical condition for you to become tobacco-free or it is medically inadvisable for you to become tobacco free, PEIA will work with you for an alternative way to qualify for the tobacco-free discount. Send all such doctors’ certifications and requests for alternative ways to receive the discount to: PEIA Discount Alternatives, 601 57th St., SE, Suite 2, Charleston, WV 25304-2345.

Enroll in a Comprehensive Care Partnership (CCP) and Save

PEIA offers a healthcare program that allows members to receive specified primary care services while paying less. This program, called the Comprehensive Care Partnership (CCP) Program, is designed to promote quality of care, preventive services and appropriate use of health services to identify health problems early and maintain control of chronic conditions.

The CCP program is available to PEIA PPB Plan A, B and D insureds. Members who enroll in the CCP Program will have reduced or no copayments, deductible or coinsurance for specified covered services from their enrolled CCP provider. Office visits to a provider other than your CCP provider have a $40 copay, except for urgent care, which has a $50 copay. CCP providers are expected to provide primary care services, coordination of care, and some CCP locations also provide specialty care services and/or laboratory services. To find a physician in PEIA’s CCP program, go to www.wvpeia.com and click “Find a Form or Document” and Provider Directory under Documents. The Provider Directory is also at “Forms & Downloads” and “Enrollment Forms”.