PEIA Finance Board unveils FY 2011 plan

WVEA opposed to a number of proposals

 

Thursday, October 22, WVEA President Dale Lee attended the PEIA Finance Board meeting. During the public comment segment of the meeting, President Lee stated that WVEA is very disappointed and concerned about stripping retirement subsidy benefits of new employees while the board continues to increase premiums and deductibles.

 

WVEA opposes increasing employee’s premiums without increasing employee’s salaries.  WVEA understands the rising cost of health care, however, school employees have not received a pay increase in more than two years and had a $500 bonus snatched from them in September.

 

WVEA is committed to ensure that PEIA provides an adequate benefit to employees and those benefits be provided at the lowest possible cost to members. It is unheard of today that the State of WV expects to get by with only a 4% increase in health insurance costs and dump the balance on the backs of hard-working school employees and state employees.  Furthermore, WVEA has real problems with proposed concepts that single-out classes of employees (i.e. obese) and charging those individuals higher premiums.

 

In addition, WVEA is further concerned that the proposed plan includes at least an 11% employee premium increase in the 2012 plan; 12% in 2013; and 11% in 2014. The increasing cost of health care is a problem that must be addressed; the answer must not be simply to place the burden on the backs of employees. 

 

Finally, the Finance Board is considering, at the Governor’s request, imposing a a possible premium reduction for those who live healthy lifestyles.  WVEA has real problems with the proposal:

1  What is the definition of a healthy lifestyle?  What is the procedure for gathering that information on any insured? 
2  PEIA should be promoting good health practices if they truly encourage healthy lifestyles.  They should expand their assistance efforts

3  In may parts of our state employees do not have available to them the kinds of programs that assist employees with weight management or lifestyle programs. In fact, many counties in WV do not even have a YMCA. How will PEIA ensure equitable opportunities for healthy lifestyles in those areas

During the meeting, the board voted on a proposed plan that will be taken to public hearings in November.  The plan proposes premium and benefit plan changes for next fiscal year, which begins in July 2010. 

 

 

 The proposed changes include:

 

* A 4% increase in Governor Manchin’s funding of PEIA

 

* A 4% average increase in premiums for active employees and retirees -

          (However, certain income tier increases will be higher and others lower).

 

Example of premium increases for employees earning between $36,001 and $42,000

 

Employee only

Employee & child

Family

Employee spouse

Plan A

From $50 to $54

From $94 to $102

From $187 to $202

From $130 to $140

Plan B

From $26 to $27

From $42 to $44

From $130 to $135

From $82 to $85

Plan C (new)

$52

$98

$194

$135

 

* A 5% benefit reduction in the form of increased deductibles and out of pocket maximums.

 

* Creation of a new in-state only plan, titled Plan C, requires the use of West Virginia health care providers for all health services. In addition, agreements would exist with Duke University Hospital and the Cleveland Clinic to provide some specialty care services.  Details of this new plan are not yet complete.

 

 
Proposed changes to PEIA PPB Plan A -

 

Increase annual deductible by either $25 or $50.

 

Example of a $25 annual deductable increase for employees earning $36,001 and $42,000.

 

Employee only

Employee & child

Family

Employee spouse

Plan A

From $225 to $250

From $450 to $500

From $450 to $500

From $450 to $500

Plan C

$250

$500

$500

$500

 

Example of a $50 annual deductable increase for employees earning $36,001 and $42,000.

 

Employee only

Employee & child

Family

Employee spouse

Plan A

From $225 to $275

From $450 to $525

From $450 to $525

From $450 to $525

Plan C

$275

$525

$525

$525

 

                            

Increase the family Maximum Out Of Pocket (MOOP) to double that of the individual maximum. 

 

For members earning between $36,001 and $42,000.

         

Employee only

Employee & child(ren)

Family

Employee spouse

Plan A

Remains $1500

From $1,500 to $3,000

From $1,500 to $3,000

From $1,500 to $3,000

Plan C

$1500

$3000

$3000

$3000

 

         

Increase lifetime maximum from $1 million to $1.5 million. 

 

 

 Proposed changes to PEIA PPB Plan B

 

Dramatic Increases in Deductibles

 

Increase in Deductable for employees earning between $36,001 to $42,000

         

Employee only

Employee & child

Family

Employee spouse

Plan B

From $500 to $1100

From $1100 to $2200

From $1100 to 2200

From $1100 to $2200

 

Increase the family Maximum Out Of Pocket (MOOP) for the Employee Only plan and double that of the individual maximum for Employee with Child (ren), Family and Family with Employee Spouse plans.

 

MOOP for Plan B members earning between $36,001 and $42,000 increases

         

Employee only

Employee & child

Family

Employee spouse

Plan B

From $2000 to $4500

From $4000 to $9000

From $4000 to $9000

From $4000 to $9000

 

Plan B participants would also be offered a Health Savings Account (HSA) under the proposed plan.  Health Savings accounts involve pre-tax contributions placed into specified accounts to pay for qualifying medical distributions. Earnings from HSAs are tax-free.  The participant owns and controls the account.  Contributions made in one year can be used in subsequent years to pay eligible medical expenses

 

 Proposed Changes for all PEIA participants

PharmacyPEIA plans to adopt a High Performance Formulary.  This maximizes some brand rebates and moves some drugs to higher copay tiers – which will result in 9.4% of participants seeing a tier increase, therefore resulting in higher costs while 1.5% of participants will see a tier decrease, resulting in savings.  PEIA believes that increased utilization of generic drugs would lower costs.


Non-employee spouses covered by PEIA
- If a PEIA member’s spouse has the option of enrolling in health insurance coverage with his or her employer, and the spouse elects or elected to forgo that coverage for enrollment in PEIA, there would be a $50 per month premium increase.

 

Living Will – Under this proposed plan change, any PEIA member providing an affidavit to PEIA verifying he or she executed a living will receives a premium reduction similar to the tobacco-free premium reduction.  There is some confusion surrounding the logistics of the reduction.  Originally, the proposed concept allows an employee to receive either a tobacco free reduction or a living will reduction, but not both.  Dale Lee, President of WVEA, suggested in if this option is selected, PEIA should provide three tiers- one for tobacco free, one for living will and a third for both.

 

Proposed Changes for Retirees

 

Retirees would see an average of 4% increases in premiums

 

Retiree Assistance Program- which provides premium reductions to certain retirees meeting income guidelines is increased at all levels and the Maximum Out Of Pocket (MOOP) is $300 opposed to $750 for qualifying retirees.

Click here for the dates and locations of the public hearings.