WV Small Business Plan Logo

Information for Physicians & Providers

Small Business Plan participating physicians and health providers are one of the three partner groups that makes the Small Business Plan work. The responsibility of each partner group is as follows.

The Public Employees Insurance Agency (PEIA) allows access to its reimbursement rates and multi-state drug purchasing plan.

Participating insurance carriers use PEIA rates plus lower administrative costs for Small Business Plan policies.

Physicians and providers agree to accept PEIA rates as payment in full. Through the Plan‘s sharing of responsibilities uninsured small businesses can obtain coverage at rates that are typically 17% - 22% lower.

Annual Opt Out Survey

The enabling legislation for the West Virginia Small Business Plan is Senate Bill 143. It mandates that an annual survey of all known in-state physicians and health care providers be conducted to notify them about the ability to opt out of the Small Business Plan service network.

The annual survey must be delivered by May 1. Providers choosing to not participate in the network must send a written statement to the Director of PEIA, postmarked by May 31. Refusal statements shall remain effective until rescinded by the provider and will not need to be renewed each year.

Providers who do not file a written notice of refusal will be considered as participants in the West Virginia Small Business Plan. Reimbursement will be the same as the rates for PEIA enrollees.

Duplicates of the 2006 survey materials are available here.

Letter from Governor Joe Manchin III

Legal memo from the Director of PEIA

Participation as a service provider under the WV Small Business Plan has no effect or implication on your status as a provider within the regular PEIA network. A provider can decline to be in the Small Business Plan network, but remain in the traditional PEIA service network.

Providers declining to be in the Small Business Plan network may still purchase coverage under the Plan for their office staff. The stronger the network, though, the more attractive the Small Business Plan will be to all uninsured small businesses.

No additional paperwork is required for providers. Claims will be processed according to the procedures established by the participating carriers. Enrollee ID mechanisms will be determined by each carrier.

Any carrier licensed by the State of West Virginia can offer policies under the provisions of the Small Business Plan. Presently, Mountain State Blue Cross Blue Shield is the sole carrier presenting coverage options