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PEIA
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Forms & Downloads
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Benefit Coordinators
Enrollment Reconcilliation Analysis / Dependent Eligibility Verificaton (ERA / DEV)
Enrollment Reconcilliation Analysis / Dependent Eligibility Verification Letter (8-5-09)
ERA and DEV Webinar Presentation for Benefit Coordinators (8-11-09, revised 8-20-09)
ERA and DEV PowerPoint for Benefit Coordinators (8-21-09)
ERA and DEV Authorization Letter (11-25-09)
Sample File Layout for Payroll Data with Description of Required Fields
Sample DEV Letter (Active Employees)
Sample DEV Letter (Retirees)
Sample DEV Grace Period Affidavit
Sample DEV Chart of Verification Documents
Sample DEV Frequently Asked Questions
HDM Services Agreement with PEIA
Dependent Qualification Form
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