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Qualifying Life Events (Change in Status)

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 events which end dependent eligibility (such as divorce) must be reported immediately. If an event that ends dependent eligibility is not reported immediately the policyholder may face certain repercussions, such as reimbursement of claims paid by PEIA on the in-eligible dependent or premium cost reimbursement to WVU.

Qualifying changes in family status are:

  • marriage or divorce of the employee.
  • death of the employee’s spouse or dependent.
  • birth or adoption of the employee’s child.
  • commencement or termination of employment of the employee’s spouse or dependent.
  • a change from full-time to part-time employment status, or vice versa, by the employee or his or her spouse.
  • an unpaid leave of absence taken by the employee or spouse.
  • a significant change in the health coverage of the employee or spouse attributable to the spouse’s employment.
  • annulment.
  • change in the residence or work site of the employer, spouse, or dependent.
  • a dependent loses eligibility due to age.
  • employment change due to strike or lock-out.

WVU employees may make plan changes when a spouse or dependent changes coverage during Open Enrollment under his/her plan if:

  • the other employer’s plan permits mid-year changes under this event, and
  • the other employer’s plan year is different from PEIA. The employee may make a change in coverage (add a dependent, for example) that increases the insurance premium, or that has no effect on the premium, without having one of these events, but the employee will pay any resulting increased premium on an after-tax basis until the next open enrollment period.

How to Enroll

Option 1: Online Enrollment

  • Go to:
  • Click the Manage My Benefits button at the top of the page
  • Log in or Register a new account
  • To add new dependents to coverage, click “Add a New Dependent” and follow the instructions
  • Be sure to Finalize your changes!
  • If adding dependents, please upload copies of required dependent eligibility documentation or submit to the WVU Benefits Office with the policyholder’s name and last 4 digits of SSN written in top right hand corner.

Option 2: Paper Form

  • PEIA Change In Status Form
  • Complete and submit the PEIA Change In Status Form to the WVU Benefits Office:
    One Waterfront Place – 2nd Floor,
    Campus Mail: PO Box 6640

Required Documentation

    To add dependents, PEIA requires “Dependent Eligibility Documentation:”
  • Spouse: Copy of Marriage Certificate
  • Children: Copy of Birth Certificate
  • Adopted Children: Copy of Adoption papers or Court Documents
  • Foreign Nationals: Include copies of VISAs in addition to marriage and birth certificates for any dependents who are citizens of a foreign country
  • Please include the policyholder’s name and last 4 digits of SSN on ALL paper documents submitted to the WVU Benefits Office.

Please use the PEIA Required Documentation Guide as a reference when making changes to your coverage as a result of a life/qualifying event.

Questions? Contact: WV PEIA

WVU Benefits Administration