Division of Administrative Services

Division of Administrative Services

Home > Sections > Human Resources > Benefits

Benefits

Areas of Responsibility:

457 Plan
Change-in-status
Consolidated Public Retirement Board (PERS)
Medical Child Support Orders
Mt. Flex
Public Employees Insurance Agency (PEIA)
Self-Pay
Supplemental Insurance

forms:

DAS Benefits New Hire Checklist

457 Retirement Plus

Mountaineer Flex Benefits Guide

Mountaineer Flex Benefits Guide (Retiree)

Mountaineer Flex Enrollment Form

Mountaineer Flex Enrollment Form (Retiree)

PERS Enrollment Form

PERS Application For Refund

PERS Name Change

PERS Pre-Retirement Beneficiary Designation

PERS Authorization to Release Information

PERS Benefit Estimate Request

PERS Combined Living Power of Attorney

PERS Less Than Honorable Service Notification

PERS Living Will

PERS Medical Power of Attorney

PERS Qualified Domestic Relations Order

PERS Application to Purchase Out-of-State Service

PERS Retired Public Safety Officer Authorization For Insurance Premium Deduction

PERS Retired Public Safety Officer Insurance Carrier Agreement

PEIA Basic Life Enrollment Form

PEIA CCP Enrollment Form

PEIA Change-in-Status Form

PEIA Disabled Dependent Eligibility Application

PEIA Health Benefit Enrollment Form

PEIA Optional Life

PEIA Policyholder Termination of Coverage Form

PEIA Retired Employees Optional Life Enrollment Form

PEIA Retirement Health Benefits and Basic Life Instructions and Enrollment Form

PEIA Shoppers Guide

PEIA Surviving Dependents Health Benefits Form

PEIA Term Life Benefitciary Designation Form

Resources:

WV PEIA - https://PEIA.WV.gov

WV Consolidated Public Retirement Board - https://www.wvretirement.com

Contact Us | Site Map