West Virginia Code of State Rules Agency 151 - Public Employees Insurance Agency
1. Overview: Agency 151 — Public Employees Insurance Agency (PEIA)
The Public Employees Insurance Agency (PEIA) is a state agency established to provide and manage health insurance and related benefits for public employees in West Virginia.
The Agency’s mission includes:
Administering health insurance programs for state employees, teachers, public school service personnel, and other public workers.
Managing benefit plans, including medical, prescription drug, dental, vision, and life insurance.
Ensuring cost-effective delivery of insurance services.
Providing timely and accurate communication to insured members.
Maintaining financial stability of the insurance fund.
2. Organization and Governance
PEIA is governed by a Board of Directors, whose members include representatives from employee groups, retirees, state officials, and others as specified by statute.
The Board sets policy, approves budgets, and oversees the Agency’s operations.
PEIA employs an executive director and staff responsible for daily management.
The Board holds regular meetings in compliance with state open meetings laws.
3. Powers and Responsibilities (West Virginia Code and Rules)
Under West Virginia law and Code of State Rules, PEIA has the power to:
Develop, administer, and manage health and related insurance benefit plans for eligible public employees and retirees.
Set eligibility criteria for participation in the insurance programs.
Negotiate and enter into contracts with providers, insurance companies, and third-party administrators.
Establish premiums, co-payments, deductibles, and other plan features.
Review and approve claims and benefits payments.
Monitor the financial condition of the insurance funds.
Provide member services including enrollment, communication, and appeals.
Establish rules and procedures governing the operation of insurance plans.
4. Procedural Rules (Agency 151 of West Virginia Code of State Rules)
The Code of State Rules under Agency 151 includes detailed provisions on:
Eligibility requirements for participants.
Enrollment procedures and deadlines.
Benefit plan design, including covered services and limitations.
Premium rates and contributions from employers and employees.
Claims processing and appeals.
Privacy and confidentiality of member information.
Complaint and grievance procedures.
Vendor and contractor procurement.
Board meeting procedures including public access and transparency.
5. Legal Status and Case Law (West Virginia Only)
PEIA is a state agency created by statute with authority to administer public employee insurance.
West Virginia courts recognize the Board’s broad discretion in managing insurance programs within statutory limits.
Case law involving PEIA often addresses:
Challenges to eligibility or benefit determinations.
Disputes over interpretation of insurance plan provisions.
Procedural fairness in claims and appeals processes.
Courts generally uphold PEIA decisions when consistent with applicable rules and policies.
6. Summary Table
Aspect | Description |
---|---|
Agency Name | Public Employees Insurance Agency (Agency 151) |
Purpose | Administer health and related insurance for public employees |
Governance | Board of Directors with employee and official representatives |
Powers | Manage insurance plans, set premiums, contracts, benefits |
Procedures | Enrollment, eligibility, claims, appeals, meetings |
Legal Status | State agency with statutory authority |
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