Friday November 13, 2009
Couples may see increase for PEIA
Board considering charges for spouses that can obtain insurance under own employer
by Sara Gavin
CHARLESTON, W.Va.--One proposed change in coverage provided by the Public Employees Insurance Agency could cost some West Virginia families an additional $600 a year, but officials can't say for sure how many people would be affected or how much money the measure might yield.
Among a number of other proposed changes, the PEIA Finance Board is considering charging members whose spouses are covered under the same policy an additional $50 a month if those spouses could obtain medical coverage through their own employers.
"PEIA is covering spouses of policyholders who could attain health care insurance through their own employer; however, due to the plan offered by PEIA, they elect to participate in our plan," said Diane Holley-Brown, spokesperson for the state Department of Administration.
"If the proposal were to be approved, there would be additional revenue for PEIA to use in providing health care coverage for all of its members."
PEIA does not gather data on spouses who could obtain medical insurance through their own employers. As a result, the agency doesn't have a clear idea what percentage of its 215,000 members could potentially be hit with the higher fee.
"You're making a proposal without having the basic facts of what this is going to save the plan, and we're just nickel-and-diming employees to death," said Dale Lee, president of the West Virginia Education Association, one of the two largest teachers' unions in the state.
PEIA has about 90,000 policyholders with an additional 125,000 dependents, including spouses and children. At its last finance board meeting, PEIA's actuary noted that if 15 percent of estimated eligible spouses participated in this proposal, the state could generate more than $5 million.
The proposal would affect those policyholders with "family" coverage and "employee and spouse" coverage. It does not apply to members who qualify for "family with employee spouse" coverage, a situation where a policyholder is married to someone also covered by PEIA. Currently, policyholders married to other PEIA members are eligible to receive a discount. That benefit would remain under the current proposal.
Perry Bryant, executive director of West Virginians for Affordable Health Care and a former member of the PEIA finance board, thinks the spousal coverage fee proposal has merit but needs more research.
"I think it's worth exploring. I don't think we know enough about how it's going to be administered or what kind of cost-savings or impacts it could have," said Bryant.
Currently, PEIA does not ask members' spouses to report whether their employers offer medical insurance. The proposal would require them to do so. Holley-Brown said spouses would not be forced to sign up for the other insurance plan but would be charged the $50 monthly fee on top of their regular premiums.
Both Bryant and Lee are wary that the plan may be too broad and wouldn't factor in the quality of health care insurance offered by other employers.
"Just to say you have insurance doesn't mean it's adequate," said Bryant.
Lee worries that families on the lower end of the income scale would be hurt the most.
"People are just going to be hit extremely hard at a time when economically they're struggling to survive as it is," he said.
Bryant doubts the move would encourage spouses to join other health care plans. He points out that higher fees for tobacco users have done little to curb the behavior of PEIA members.
"If I were still on the finance board, I would be reluctant to vote for this without good data about potential cost-savings and impact," said Bryant.
Holley-Brown says PEIA's actuary is currently looking into national statistics about the number of spouses who are eligible for their own coverage to share with the finance board at its Dec. 3 meeting.
Other changes the board will consider include raising premiums by an average of 4 percent, as well as increasing deductibles by $50 and out-of-pocket maximums for family coverage an average of $1,500 a year.