Get the free peia medical home change form - peia wv

Coverage in the Medical Home Program will be effective on the rst day of the month following the month we receive your medical home physician selection form.. PEIA MEDICAL HOME PROGRAM Medical Home Physician Selection Form Policyholder Name Address ID Number Insured Effective Date Daytime Phone Covered Individual Date of Birth Relationship Code from enclosed Provider Directory Please Note This is not an open enrollment.

How to fill out peia medical home change

How to fill out peia medical home change:

1. Obtain the peia medical home change form from your employer or the peia website.
2. Complete your personal information section of the form, including your name, address, and contact information.
3. Provide your current peia medical home information, including the name of your current medical home and any other relevant details.
4. Indicate the reason for the change in the designated section of the form.
5. Research and select a new medical home that meets your healthcare needs.
6. Fill out the section of the form with the details of your new medical home, including the name, address, and contact information.
7. If necessary, include any additional documentation or supporting paperwork with your form.
8. Review the completed form for accuracy and make any necessary corrections.
9. Sign and date the form.
10. Submit the peia medical home change form as instructed, either by mailing or delivering it to the appropriate peia department.

Who needs peia medical home change:

1. Employees or beneficiaries who are currently enrolled in the peia medical home program and wish to change their designated medical home.
2. Individuals who have chosen a medical home that no longer meets their healthcare needs and want to switch to a different one.
3. Anyone who has relocated and needs to select a new medical home within their new area of residence.
4. Individuals who have experienced a change in their healthcare needs and require a different medical home that specializes in their condition or situation.

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What is peia medical home change?

PEIA medical home change refers to making a change in the primary care physician or healthcare provider selected under the Public Employees Insurance Agency (PEIA) medical insurance plan.

Who is required to file peia medical home change?

Any individual covered under the PEIA medical insurance plan who wishes to change their primary care physician or healthcare provider must file a PEIA medical home change.

How to fill out peia medical home change?

To fill out a PEIA medical home change, you need to obtain a PEIA medical home change form from the PEIA website or their office, provide the required information such as your personal details, current primary care physician, and the new primary care physician or healthcare provider you wish to select, and submit the completed form to the designated PEIA office.

What is the purpose of peia medical home change?

The purpose of PEIA medical home change is to allow individuals covered under the PEIA medical insurance plan to select a primary care physician or healthcare provider who meets their specific healthcare needs and preferences.

What information must be reported on peia medical home change?

On a PEIA medical home change form, you must report your personal details such as name, employee identification number, current primary care physician or healthcare provider, and the new primary care physician or healthcare provider you want to select.