PEIA’s Medical Home program allows PEIA PPB Plan A & B members to choose a West Virginia physician from the Medical Home directory to serve as your medical home. Your medical home can be a general practice doctor, family practice doctor, internist, pediatrician, geriatrician, or, for women in the plan, an OB/GYN. When you choose and use your medical home, you will pay a $10 office visit copayment for each visit.
The intent of this program is to connect members with a physician who can oversee and coordinate all of their care. You ARE NOT required to have a referral to see a specialist, and this plan does not limit your ability to see any network doctor you choose. You may name a medical home each year during open enrollment, and you may make one change during the plan year, if you wish, unless there are extenuating circumstances, such as the death of your medical home physician or a move that makes it inconvenient for you to access care from your medical home.
If you are a Resident PPB Plan participant and you do not choose a medical home, you can still see any network physician you choose. Your copayments for preventive care will not change. Office visits to the providers eligible to be medical homes (general practice, family practice, internists, pediatricians, geriatricians and OB/GYNs) for illness or injury will continue to have a $15 copay. Specialist office visits will have a $20 copay per visit.
If you are a non-Resident PPB Plan participant (PEIA PPB Plan participant who resides outside West Virginia and beyond the bordering counties) and you do not choose a medical home (either because you don’t want to or because accessing care from a West Virginia provider is not possible), you can still see any network physician you choose. Your benefits and copayments will not be affected by this program.
Go to Medical Home Program documents