May 6, 2010
The agency has been conducting the audit for the last several months to determine how many people actually ineligible for coverage are getting it.
A recent audit of employees in higher education and state agencies turned up nearly 34,000 workers and dependents eligible, but nearly 3,000 were not.
PEIA Chief Financial Officer Jason Haught says in some cases workers who have left the state failed to cancel their coverage, but in other cases dependents no longer eligible were still on the list.
Haught believes PEIA could save millions a year by keeping its rolls up to date. "We could be looking at 10 million dollars in savings on an annual basis," he said.
Haught says just more than 3,900 workers in the latest round failed to respond. He says PEIA will cut their health insurance coverage. He says when that happens they usually quickly turn in the paperwork.
"We're not trying to get rid of people. We just want to make sure that everybody that is on the insurance coverage is eligible," he said.
Eligibility letters go out beginning next week to teachers, school service personnel and other public education employees. Haught says once the letter is received the workers have a month to turn in the necessary paperwork, which includes birth certificates.
Eligibility letters will be sent out to retired state workers beginning in June.
PEIA Dependent Eligibility Verification
PEIA has contracted with Healthcare Data Management Inc. (HDM) to identify and remove ineligible dependents from PEIA coverage (health and dependent life insurance coverage). All PEIA policyholders with dependents are being asked to provide dependent eligibility documentation. The documentation required may include: page 1 of your 2008 federal income tax return, marriage certificate or birth certificate
Policyholders must submit both the grace-period affidavit and the proof-of-eligibility documents by the date in the letter received. For additional information regarding the verification of PEIA member’s dependents as well as links to the materials mailed from HDM follow the link below.
https://web.nea.org/exchweb/bin/redir.asp?URL=http://www.peia.wv.gov/customers/members/Pages/dependent_eligibility_verification.aspx
February 19, 2010
PEIA Finance Board meets and adopts a new Plan C option
When you receive your PEIA Shoppers Guide in a few weeks you many notice a new option for PEIA participants. The PEIA Finance Board met on Thursday, February 18th and voted to offer PEIA Plan C.
Plan C is a high deductible plan with a flat premium rate. It will be available to all PEIA participants. Specifics of the plan include premiums of $51/mo single; $123/mo employee and child; and $245/mo for a family plan regardless of income levels.
The plan also has a $1,200 single / $2,400 family deductible. The deductible includes both medical and drug expenses. The out-of-pocket maximum (MOOP) for the plan is $2,400 for a single and $4,800 for a family plan. The MOOP includes all covered expenses, prescription drugs and deductibles paid.
All services would be subject to the high deductible except: preventative services that are currently paid at 100% (mammogram, pap smear, colonoscopy, etc.) and drugs on the new Preventative Drug list which will have a $5/$20/$50 co-pay. After the $1,200 or $2,400 deductible is met the payment is on the 80/20 schedule. Once the MOOP is met, the plan pays $100% for all covered medical and prescription drug costs. PEIA’s networks still apply to Plan C.
“Obviously, a high deductible plan is not for everyone,” states WVEA President Dale Lee. Lee was in attendance at the Finance Board meeting. “Quite honestly new Plan C is best suited for healthy individuals or those with higher incomes. While premiums may be lower the costs are made up by requiring participants to pay for their services through the increased deductibles and out of pocket expenses. Be cautious and give it great consideration before selecting any high deductible plan.”