WV Public Employees Insurance Agency

What WV Public Employees Insurance Agency does

PEIA is a West Virginia state government agency established under W. Va. Code §5-16-1 et seq. and operating within the Department of Administration to administer health, life, and supplemental benefit programs for West Virginia public employees, retirees, and their dependents across state agencies, county boards of education, higher-education institutions, and political subdivisions. Its core product is a multi-tiered health plan portfolio — Preferred Provider Benefit plans (Gold, Silver, Gold HDHP, WV Bronze HDHP), HMO/POS through The Health Plan of West Virginia, Medicare Advantage through Humana — supplemented by Mountaineer Flexible Benefits and MetLife life insurance.

The technology stack centers on the member-facing Manage My Benefits portal, with the PEIA ACCESS enrollment platform scheduled to replace it in Summer 2026. Operational delivery is orchestrated through multi-vendor integrations: UMR for claims administration, Express Scripts for pharmacy benefit management, Humana for Medicare Advantage, and The Health Plan of West Virginia for HMO/POS networks. A network of Benefit Coordinators stationed at participating public employers provides in-person distribution layered onto the digital channel.

PEIA is funded through employer and employee premium contributions alongside state appropriations; the Finance Board, appointed by the Governor, exercises fiduciary oversight. The agency does not compete on a commercial basis — its addressable market is defined by statute and its scale is bounded by West Virginia's public-sector workforce and retiree population.

Name

WV Public Employees Insurance Agency

Legal name

West Virginia Public Employees Insurance Agency

Website

https://peia.wv.gov

Company type

Private

Operating status

Operating

Headcount range

1–10 employees

Short description

PEIA is the West Virginia state agency that administers statutory health, life, and supplemental benefits for public employees, retirees, and dependents across state agencies, county boards of education, higher-education institutions, and political subdivisions.

Ownership category

akta.pro rank

Product category

Government Health Insurance

NAICS

Insurance and Employee Benefit Funds (5251), Health and Welfare Funds (525120), Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

Fully Insured Group Health Plans (Employer-Sponsored) (FSAIAFAA)

akta.pro secondary industries

High-Deductible Health Plans (HDHP) with HSA-Eligible Coverage (FSAIAFAM), Group/Employer-Sponsored Critical Illness & Hospital Indemnity (FSAIAKAD)

Keywords

• Public employee health insurance
• Government health benefits
• Medicare advantage plans
• Retiree health coverage
• State employee benefits

Headquarters

HQ city

Charleston

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Others

Revenue model

1. Employer Health Insurance Premiums: Monthly premium contributions from participating employers (state agencies, county boards of education, colleges/universities, political subdivisions) and employees. Premium rates based on salary tiers, tobacco status, and spousal surcharge rules.
2. Retiree Premium Payments: Self-pay premium collection from retirees, including Non-Medicare and Medicare retirees, processed through State Treasurer's payment portal or direct draft.
3. Mountaineer Flexible Benefits Administration: Pre-tax benefit elections for dental, vision, hearing, FSA, HSA, disability, accident, and legal insurance administered through FBMC.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels6 records

Core offering

PEIA administers comprehensive health insurance plans for West Virginia public employees, retirees, and dependents, including Preferred Provider Benefit (PPB) Plans, HMO and POS plans, Medicare Advantage plans, supplemental benefits through Mountaineer Flexible Benefits, basic life insurance through MetLife, and wellness programs. Premiums are collected via employer payroll deduction for active employees and direct self-pay for retirees, with services delivered through third-party administrators (UMR for medical claims, Express Scripts for pharmacy, Humana for Medicare Advantage).

Product overview

WV Public Employees Insurance Agency (PEIA) offers a comprehensive health insurance portfolio for West Virginia public employees and retirees through multiple plan types. The core offerings include four Preferred Provider Benefit (PPB) Plans (Gold, Silver, Gold High Deductible, and WV Bronze High Deductible) administered by UMR and Express Scripts. Additionally, PEIA provides HMO and POS plans through The Health Plan of WV, Medicare Advantage and Prescription Drug Plans through Humana, and a Special Medicare Plan for those not enrolled in MAPD. The Mountaineer Flexible Benefits program (administered by FBMC) offers supplemental benefits including dental (Sun Life), vision (Humana/EyeMed), hearing (EPIC), legal (ARAG), FSAs, HSAs (Inspira Financial), disability, accident, critical injury, and hospital indemnity insurance. Life insurance is provided through MetLife with $10,000 basic coverage at no cost for active members. PEIA also offers wellness programs including Face-to-Face Diabetes and Weight Management Programs, telehealth through ReviveHealth, wellness platforms (Personify Health, Wondr Health), tobacco cessation, and hemophilia care. The agency is transitioning to a new enrollment system called PEIA ACCESS in Summer 2026.

Differentiator

Problem solved

Functional benefit

Products and services

• PEIA PPB Gold Plan Preferred Provider Benefit plan with higher premiums but lower deductibles, administered by UMR and Express Scripts. Available for Active Employees and Non-Medicare Retirees of West Virginia public agencies.
• PEIA PPB Silver Plan
• PEIA PPB Gold High Deductible Plan
• PEIA PPB WV Bronze High Deductible Plan
• The Health Plan HMO Plan A
• The Health Plan HMO Plan B
• The Health Plan POS Plan
• Medicare Advantage and Prescription Drug Plan (MAPD)
• Special Medicare Plan
• Mountaineer Flexible Benefits
• MetLife Life Insurance
• Face-to-Face Diabetes Management Program
• Face-to-Face Weight Management Program
• ReviveHealth Telehealth
• Personify Health Wellness Platform
• Wondr Health Program
• Comprehensive Care Partnership (CCP)
• PEIA ACCESS Enrollment System New self-service enrollment and account management platform for PEIA members, replacing the Manage My Benefits portal. Designed to be more user-friendly, intuitive, and efficient for benefit enrollment, plan changes, and HRIS functions.

Quantifiable outcome

• Telehealth $10 copay for non-emergent conditions
• +2 more outcomes

Named customers4 records

Segments3 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration16 records

Feature3 records

Partnerships

Twelve partnerships are on record, tiered minor, core and major.

• Myers and Stauffer LCminorImplementation/ SI/ Consulting Partner · 18 June 2026Myers and Stauffer LC conducts the PEIA Spousal Surcharge Audit to verify compliance with spousal coverage rules.
• UMRcoreTechnology or IntegrationUMR serves as the third-party administrator for PEIA's Preferred Provider Benefit (PPB) Plans, handling medical claim processing, case management, utilization management, precertification, prior approval, and customer service. UMR provides the provider network for in-state WV providers and the UnitedHealthcare Choice Plus network for out-of-state coverage.
• Express ScriptscoreTechnology or IntegrationExpress Scripts (ESI) is the Prescription Drug Manager for PEIA, handling prescription claims processing, drug list management, mail-order pharmacy services, and specialty medication management for PPB Plan members and Special Medicare Plan members.
• HumanacoreTechnology or IntegrationHumana provides medical and prescription drug benefits for Medicare-primary PEIA members through the Medicare Advantage and Prescription Drug (MAPD) Plan. Humana also provides vision benefits through EyeMed under the Mountaineer Flexible Benefits program.
• The Health Plan of WVcoreTechnology or IntegrationThe Health Plan of WV offers HMO Plans and one Point of Service (POS) Plan for PEIA members. The Health Plan provides in-network providers throughout West Virginia for members who choose these plan options.
• MetLifecoreTechnology or IntegrationMetLife provides life insurance coverage for PEIA members. Active members receive $10,000 basic term life insurance at no cost. Optional life insurance and dependent life insurance available for purchase. MetLife also provides disability insurance under Mountaineer Flexible Benefits.
• Mountaineer Flexible Benefits / FBMCcoreImplementation/ SI/ Consulting PartnerFlexible Benefits Management Company (FBMC) administers the Mountaineer Flexible Benefits program, providing optional supplemental benefits including dental (Sun Life), vision (Humana/EyeMed), hearing (EPIC), legal (ARAG), FSA, HSA, disability, accident, and critical injury insurance through pre-tax salary reduction.
• ReviveHealthmajorTechnology or IntegrationReviveHealth (formerly iSelectMD) is PEIA's preferred telehealth provider for PPB Plan members, offering 24/7 access to board-certified physicians via phone or video for non-emergent conditions at a $10 copay.
• Personify HealthmajorTechnology or IntegrationPersonify Health is a wellness platform offering healthy habit tracking, step challenges, video library, and health assessments for PEIA PPB Plan policyholders. Members can earn $300 in rewards annually for participating in wellness activities.
• Wondr HealthmajorTechnology or IntegrationWondr Health provides an online weight management program for PEIA PPB Plan policyholders and adult dependents. The program teaches mindful eating principles through ten weekly lessons with no calorie counting or food prepping required, at no cost to eligible members.
• Sun LifemajorTechnology or IntegrationSun Life provides dental benefits and accident/critical injury/hospital indemnity insurance under the Mountaineer Flexible Benefits program.
• Inspira FinancialmajorTechnology or IntegrationInspira Financial provides Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) for PEIA members under the Mountaineer Flexible Benefits program.

Scale indicators1 record

Recent moves5 records

Expansion highlights5 records

Direct peers

• South Carolina Public Employee Benefit Authority (PEBA): South Carolina's PEBA administers group health, dental, vision, life and disability benefits for state and public-sector employers. Same employer-sponsored, multi-employer public-sector mandate as PEIA with comparable plan menus (PPO, HMO, Medicare options).
• Georgia State Health Benefit Plan (SHBP): Georgia's SHBP administers health benefits for state employees, public-school teachers, and retirees. Comparable to PEIA in offering multiple plan tiers (HMO/HDHP), tobacco surcharges, wellness incentives, and wellness-program partnerships.
• CalPERS Health Benefits Program: California Public Employees' Retirement System administers health benefits for California public employees, retirees, and dependents. Directly comparable to PEIA in mission (state-mandated group health coverage for public employees), plan-design authority, and reliance on contracted TPAs and PBMs.
• State Health Plan of North Carolina: North Carolina's State Health Plan administers health coverage for teachers, state employees, retirees, and dependents. Closely analogous to PEIA in mandate structure, member mix (heavy on education employees), and TPA-supported administration.
• Ohio Public Employees Retirement System (OPERS): OPERS administers pension and group health benefits for Ohio public employees. Analogous to PEIA in statutory mandate for public-sector benefits, multi-employer coverage, and integration of health benefits with retirement programs.
• New York State Health Insurance Program (NYSHIP): NYSHIP provides health benefits for active and retired New York State and participating local-government employees. Directly comparable to PEIA in serving a defined public-employee population with a choice of HMO and PPO-style options.
• Tennessee State Group Insurance Program: Tennessee's Group Insurance Program (administered through Benefits Administration) provides health, dental, vision and other benefits for state employees, public-school employees, and local government participants. Closely aligned with PEIA in employer-sponsored mandate and member segments.
• Florida State Group Insurance Program (DSGI): Florida's Division of State Group Insurance administers health, life, dental and other benefits for state employees, retirees, and dependents. Similar to PEIA in mandated population, plan-options approach, and open-enrollment administration.
• Texas Employees Group Benefits Program (ERS): Texas Employees Retirement System's Group Benefits Program administers health and supplemental benefits for state employees and retirees. Comparable to PEIA in scope of services (medical, prescription, dental, vision, life, disability, wellness) and reliance on major TPAs.

Broad incumbents

• CVS Health (Aetna / Caremark): CVS Health operates a major national health insurer and PBM serving public and commercial employer plans, including integrations comparable to PEIA's UMR medical administration and Express Scripts pharmacy administration functions. Relevant as a broad incumbent alternative for the same plan-design space.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

• Facebookfacebook.com/profile.php
• LinkedInlinkedin.com/company/wv-peia

Revenue estimate

Valuation estimate

Number of profiles

Profiles11 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about WV Public Employees Insurance Agency