PEIA 2013-14 Adopted Plan
On Thursday, December 6 Governor Tomblin committed an additional $4 million in funding to PEIA. The PEIA Finance board decided to use a portion of the new funds to reverse a change passed more than a year ago. This change, scheduled to begin in 2014, increased family maximum out of pocket expenses (MOOP) to two times the individual rate. After Thursday’s adoption of a plan, the family MOOP will remain at one and a half times the individual rate.
The Board also voted to use half a million dollars of the money to assist certain members utilizing high-priced specialty drugs by keeping those copays at $50 instead of increasing them to $85, as originally proposed in public hearings. However, copays for non-preferred brand name specialty medications will increase from $50 to $100.
Highlights of the newly adopted plan for ACTIVE employees include:
• Premiums will remain the same for Plan A.
• Premiums for plans B, C and D will decrease to encourage new enrollees.
• Benefits will not change significantly; although some out of network costs may increases.
• Expansion of Wellness Program options to add accessibility to assist employees in keeping their premium discounts
– Increased workplace lifestyle and fitness coaching
– Diabetes Prevention Program expands
– Participation in cardiac rehab program (subject to deductibles and copays)
– WVU Extension Service classes
– Million Hearts program collaboration
– Expansion of medical homes and comprehensive care programs
– Online nutrition and journaling options
– Weight Watchers participation (at members expense) is engagement for premium discount
– Weight Management Program will now allow second attempt if first attempt fails
– Tobacco Cessation Program. All policy holders will be required to resubmit a tobacco affidavit during open enrollment in April of 2013.
– Face to Face Diabetes Management Program
– Waiver of 3rd tier brand name diabetic medications will cease. Copayments will continue for generic and preferred medications.
Highlights of the newly adopted plan for RETIREES include:
Non Medicare Retirees
• No premium adjustments
• Plan B will be available to non-Medicare retirees and only available to members without Medicare dependents.
• A 6-month plan will be in effect from July 2013 through January 2014.
• The MOOP is reduced until during that time ($400 medical and $900 prescription).
• A 12-month plan begins January 1, 2014 with current benefits and rates to match the calendar year. PEIA is shifting the start of the plan year for retirees from July 1, where it will remain for active employees, to Jan. 1. That change will allow the agency’s prescription drug program for retirees to draw down an additional $10 million in federal funds.
• Members will be able to select between two plans beginning January 2014 (Silver and Gold plans).
Additional information on the plan changes can be found online from PEIA. Go to www.peia.wv.gov for details.
September 24, 2012
PEIA Finance Board Seeks Input for FY 2014 plan
No premium increases scheduled
The PEIA Finance Board met last week and adopted the plan for 2013-14. Public hearings are scheduled in November and the PEIA Finance Board will approve the plan in December.
The plan does not call for premium increases in 2013-14 but makes up a $20 million gap through plan changes for employees.
Below are the highlights of the proposed changes and a list of scheduled public hearing dates/locations.
No premium increases in FY 2014. Note-FY 2015 plan projections call for 14% premium increases.
Premium Adjustments for Active Employees. The plan proposes lower premiums for Plans B, C and D to encourage enrollment in the plans. Premium reductions for employees are as follows: Plan B reduces to 80 %, Plan C reduces to 95%, and Plan D reduces to 90%.
Deductibles and Maximum Out Of Pocket (MOOP) increases.
• Deductibles may increase between $25-$100 per single plan and $50-$200 per family
• MOOP may increase between $150-$600 per single plan and $300-$1,200 per family. Note- Family and Parent/Child MOOP are already set to increase next year to match that of 2x the single plan.
Proposed Benefit Changes
• Increase specialist co-pay from $25 to $40
•Increase non-medical home co-pay from $15 to $25
• Double co-pays for out-of-state preventative services
• Double co-insurance for out of state durable medical equipment utilization
• Plans A, B and D – Increase ER co-pays
Increase Improve Your Score (IYS) discount to $25/month. It is currently $10. If your IYS score is yellow or red, plan participants must participate in one of the “Engagement Options” to receive the added discount. Those with green scores automatically qualify for the increased discount. IYS is for active employees only.
Specialty Drug Co-pay Changes. Increase co-pays of preferred brand name and generics.
• Increase co-pay for specialty medications from $50 per 30 day supply to $85 in 2014 and to $100 in 2015
• $125 for non-preferred, brand specialty medication
Non-Medicare Retirees. Plan B will be made available to retirees for the first time in FY 2014.
Medicare Retiree Changes. The standard retiree plan sees no changes but 2 new plan options will be available.
• 15% Plan – slightly higher deductibles and co-pays at a 15% discounted premium
• 30% plan – provides highest cost deductibles and co-pays at a 30% discounted premium
Public Hearings Scheduled
The PEIA proposed plan will be discussed at Public Hearings throughout the state. Registration is from 5 - 6 p.m. with the public hearing scheduled for 6 - 8 p.m.
Monday, November 12
Martinsburg - Holiday Inn
Tuesday, November 13
Morgantown - Ramada Inn
Wednesday, November 14
Wheeling - WV Northern Community College
Thursday, November 15
Huntington - MU Medical School Harless Auditorium
Monday, November 19
Beckley - Tamarack Ballroom A
Tuesday, November 20
Charleston - Civic Center Little Theater
Comments may also be made via written comments. Send your comments to:
601 57th Street SE, Suite 2
Charleston, WV 25304