PEIA Insurance Can Help Guide You Through The Recovery Process

First and foremost, before delving into PEIA insurance rehab coverage, let’s begin with the fundamentals of PEIA insurance itself.

The acronym it is known by stands for WV Public Employees Insurance Agency. As the name implies, PEIA differs from major insurance providers which are entirely private or associated with the federal government. Instead, PEIA is funded by the state of West Virginia, relying “almost solely on the premiums paid directly by its participating employers and employees” for revenue.

As regards its history and goals, the Agency notes:

“PEIA was established under the Public Employees Insurance Act of 1971, to provide hospital, surgical, group major medical, prescription drug, group life, and accidental death and dismemberment insurance coverage to eligible employees; and to establish and promulgate rules for the administration of these plans.”

Thus, PEIA insurance has a distinctly local focus within the state of West Virginia. As the Agency notes, “benefits are made available to all active employees of the State of West Virginia and various related State agencies and local governments”. This is vital to ensuring eligibility, should you be considering PEIA insurance plans.

For a deeper overview of PEIA and more quick facts on it, you may also visit the official West Virginia Chamber’s website.

PEIA Insurance Plans

That said, PEIA insurance rehab coverage will largely depend on the plan in question. While PEIA does not offer as many plans as other providers, making your research easier, it does offer plenty. For your convenience, here we may briefly outline them so you may better understand your benefits.

#1 Preferred Provider Benefit (PPB) Plan A

PPB Plan A comes with the highest premiums. However, it also comes with lower deductibles, out-of-pocket maximums, and drug copays.

#2 Preferred Provider Benefit (PPB) Plan B

In contrast, PPB Plan B comes with lower premiums, but higher deductibles, out-of-pocket maximums, and drug copays. The stark difference between the two allows beneficiaries to best meet their needs.

#3 Preferred Provider Benefit (PPB) Plan C

Unlike both, PPB Plan C is a high-deductible plan. Instead of a more robust set of offerings, it comes with the option of setting up a Health Savings Account or a Health Reimbursement Arrangement to cover expenses.

Given these features, Plan C stands out among the 4 basic plans. For a summary of it, you may consult the Agency’s relevant page.

#4 Preferred Provider Benefit (PPB) Plan D

A more affordable option, PPB Plan D comes with lower premiums. Unlike Plan B, however, which is more flexible in this regard, most services are limited to West Virginia providers only.

Nonetheless, Plan D shares many common features with Plans A and B. For a summary of all 3, you may consult the Agency’s relevant page.

#5 The Health Plan

Finally, The Health Plan consists of two parts; Health Maintenance Organization Plans A and B, and Preferred Provider Organization.

For a deeper overview of each plan’s offerings and details on PEIA insurance rehab coverage, you may also consult the Agency’s plan descriptions page.

PEIA insurance rehab coverage depends more on addiction treatment programs than on addiction types. To explain this, here we may cover the most common programs alongside their coverage.

Inpatient Programs

Inpatient programs, also known as residential programs, take place in clinical settings. They follow a thorough diagnosis and establish clinical services a patient will require. A typical program for Inpatient drug rehab in WV will follow and include:

• Medical detoxification. Also known as medically-assisted treatment (MAT), detox with medical assistance and under clinical supervision is typically necessary for rehab programs.
• Co-occurring mental health disorder diagnosis. Better known as dual diagnosis, this type of diagnosis also occurs in clinical settings and informs the course of rehab.
• Personalized services. Better known as case management, specialized services such as pharmacotherapy may also occur at this stage and inform aftercare plans.

Naturally, the vast majority of insurance providers and plans cover such essential services. PEIA is no exception in this regard.

Intensive Outpatient Programs

Beyond clinical settings, Intensive Outpatient Programs (IOPs) and Outpatient Programs (OPs) are among the most common rehab programs for milder cases and progressing individuals. Any robust intensive outpatient program West Virginia has to offer will typically entail:

• Group counseling and therapy, including 12-step meetings
• Pharmacotherapy and medication management where necessary
• Continued case management

While such services are indeed removed from clinical settings, they remain essential and largely overlap with the above. However, prolonged IOPs and OPs may begin to not be covered as extensively, as health insurance plans do come with such limitations.

Having highlighted our programs and key offerings, you may now be considering us as your best companion through rehabilitation.  If you are, you’ll be pleased to know Harmony Ridge accepts all major insurance providers, including:

• PEIA Insurance
• Humana Insurance
• Blue Cross Blue Shield
• TRICARE Insurance

While this does offer flexibility as regards payment and extends your likely coverage options, a prior point bears repeating. Exact coverage can differ quite significantly across providers and plans, and depending on the exact programs you opt for and services you will require. To help you further in this regard, we welcome you to contact our teams at (855) 942-3797 for a full review of your plan, coverage, and available options. Our representatives are available 24/7, and will always offer assistance and clarifications as professionally and discreetly as possible.

If PEIA insurance rehab coverage sufficiently covers your rehab needs, getting started with Harmony Ridge is very easy. Once you contact our representatives, the process will only require 3 steps:

• Evaluation. First, our representatives will contact PEIA on your behalf and evaluate your plan’s benefits. This process is strictly confidential.
• Confirmation. After verifying your benefits and coverage, we will inform you of your options and expected costs. If you need any financing advice, we will provide it during this step.
• Admission. Finally, if everything is clear and you’re ready, we will proceed with the admission process.

Still, there might be cases where PEIA insurance rehab coverage doesn’t extend to the full cost of your rehab. Whether you choose us or one of our peers, this is always a possibility – especially for longer programs. In such cases, you and your provider will have to explore alternative financing options to cover the remaining expenses after coverage, such as:

• Co-insurance
• Self-pay
• Personal loans
• Medicaid

If you do choose Harmony Ridge, our representatives will thoroughly explore all such options with you in advance.  Our philosophy holds that costs should not prevent anyone in need from receiving life-changing treatment, and we always strive to uphold this principle.

In addition to the above, you can also arrange for a family member or loved one to pay for what insurance might not cover. Such payments are often an option across West Virginia rehab centers – but do tend to require arrangements.

Typically, individuals entering rehab will need to reassure paying family members that the funds are being used as intended. To do so, a common choice is to arrange for direct payments to treatment providers. If you choose us for your journey to recovery, our representatives will explain this option and help you make such arrangements as needed.

Is it possible to send a picture of my birth/marriage certificate for PEIA enrollment?

No. You must use photocopies of your original documents. PEIA will not accept pictures as a substitute for photocopied documents.

When does my PEIA insurance coverage start?

Your PEIA health insurance will become effective on the first day of the month that follows your date of enrollment. If you happen to enroll before you are actually employed (before the employment start date), the coverage will start on the first day of the month following your first day of active employment instead.

If you experience a qualifying life event, you may also file a change of status which will influence the starting date of your coverage. Unless the event is a Divorce, you have two months to make the change. If you are changing the status due to a Divorce, you need to make the change immediately. Any approved changes in status will become effective on the first day of the month following either the date of the qualifying life event or following the receipt of your change in status request, whichever is later.

What constitutes a qualifying life event?

Qualifying life events include the following:

• Divorce
• Marriage
• Childbirth
• Start of spouse’s/dependent’s employment
• Adoption
• Open enrollment under the spouse’s/dependent’s employer’s benefit plan
• End of spouse’s/dependent’s employment
• Adding coverage for other children that reside with you
• Death of a spouse/dependent

Each event will require you to submit documentation that corresponds to it. For example, you will need a copy of the adoption papers for the Adoption qualifying life event. Furthermore, these are not all qualifying life events that may allow you to make a change to your coverage. Refer to the PEIA shopper’s guides for the current year for more details.

What do I do if I do not receive my PEIA health insurance card?

Before you do anything else, you will want to wait at least 2-4 weeks after your effective date of coverage to get your PEIA health insurance card. You may still utilize your health insurance benefits by contacting your PEIA insurance provider and acquiring a temporary card. Alternatively, you can talk to PEIA directly by calling 1-888-680-7342, and they might issue you a temporary ID card as well.

What is PEIA’s annual deductible?

According to PEIA, the average resident of West Virginia that has a small group rate single coverage will need to pay an average annual deductible of $4,000. The small group rate for family coverage averages double that amount and is $8,000. If you are getting single coverage through the Affordable Care Act exchange, you will need to pay an average of $4,750 in deductibles or $7,350 for family coverage. However, if you are enrolled directly with PEIA, these deductibles are considerably lower.

What is the PEIA annual out-of-pocket maximum?

The average out-of-pocket maximum for West Virginia residents that opt for individual PEIA coverage plans is $7,150. Family coverage doubles this amount, making it $14,300. Out-of-pocket maximums for PEIA enrollees are set up the same as their deductibles and are significantly less than those commonly found in the private sector. This also means that no individual family member will need to pay more than the individual out-of-pocket maximum before you get full coverage.