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PEIA Finance Board approves burdensome FY 2018 proposal

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PEIA Finance Board approves burdensome FY 2018 proposal
By WVEA Communications Staff

The PEIA Finance Board approved a Fiscal Year 2018 plan Thursday, Dec. 1, that tweaked the proposal sent out to public hearings in November, but still puts far too much burden for rising health-care costs on active employees, retirees and their families. 

The total plan savings – by way of benefit cuts – will be about $55 million.

Active employees with PEIA Plans A, B, and D would see their deductibles increase by $200 for a single employee plan and $400 for a family plan. Out-of-pocket maximums would increase by $1,000 for a single plan and $2,000 for a family plan.

A 90-day prescription fill for all maintenance medications would become MANDATORY. For instance, a blood pressure or diabetes maintenance medication would need to be filled for a full 90 days, which would cause a plan member to pay two copayments up front for generic or preferred brand drugs.

PEIA Director Ted Cheatham acknowledged that many pharmacies in the state will not allow a 90-day fill for all drugs, so patients would have to find another pharmacy that works for them or order maintenance medications through the mail.

This is just one of the hardships plan participants would face if the FY 2018 plan takes effect. 

By voicing our opposition and putting pressure on the new Legislature and Governor – as we had to do last year – we can make a difference and improve this bad proposal.

Last year’s outcry ultimately made a difference in how Gov. Tomblin and the Legislature reacted to the PEIA shortfall. We will need a similar effort in the coming weeks and months, and we will keep you updated on needed actions.   

On Thursday, accepting the 90-day prescription fill apparently allowed the Finance Board to avoid another option that would have required plan members to pay up to $100 per prescription and a minimum of $25 if it was a preferred brand prescription drug.

The failed option also would have increased prescription out-of-pocket maximums to $2,500 for a single plan or $5,000 for a family plan.      

Under the FY 2018 proposal, costs also would rise for many active employees when they receive services that require co-insurance, particularly when medical services are received out of state. For example, the co-insurance responsibility would be 20 percent for services received in West Virginia in Plans A and D but 30 percent for members in Plan B.

That would increase to 30 percent responsibility (in Plans A and D) and 35 percent (Plan B) for services requiring co-insurance outside of West Virginia with approval from HealthSmart. Plan members in A and B would have to pay 40 percent and 50 percent, respectively, for services requiring co-insurance outside the state that are NOT approved by HealthSmart.

Non-Medicare retirees in Plans A and B face the same co-insurance changes.  

The Finance Board also decided Thursday to NOT collapse the 10-tier employee salary structure to a much broader 4-tier structure.

The new tier structure would have somewhat affected an employee’s premium, deductible and out-of-pocket maximum costs.  

The Finance Board also opted to NOT base an employee’s premium for a family plan on total family income, which would have taken the salary of an employee’s spouse into account.          

Non-Medicare retirees would see many of the same plan changes as active employees, including the mandatory 90-day prescription fill for maintenance drugs. There are some big differences, however. For instance, non-Medicare retirees also are facing a 4 percent premium increase.

Their deductibles would increase by $100 for a single plan and $200 for a family plan. Family out-of-pocket maximums would increase to $3,000 total for Plan A participants and $6,000 total for Plan B participants.

Also, a non-Medicare retiree with Medicare dependents on their plan would see their out-of-pocket maximum increase to $2,700.     

Active employees and non-Medicare retirees also can expect:

| A modest premium increase/adjustment of 0.5 percent for members with Plan A (and Plan D for actives).

| Specialty drug copayments to increase to $100/$150 total.

| More than 130 outpatient procedures – ranging from X-rays to MRIs, ultrasounds and cancer screenings -- would be subject to maximum facility fees.

| $20 copayments for all primary care physician (PCP) or medical home program (MHP) visits.  

Medicare retirees also will experience cost increases. Participants in the Humana/PEIA Plans 1 and 2 and the Special Medicare Plan would see a 4 percent premium rate increase, a deductible increase of $50 and an out-of-pocket increase of $450, as well as prescription drug changes.

Here are the prescription changes for members in Humana/PEIA Plans 1 and 2: Tier 1 generic drugs would cost $5; Tier 2 preferred brand drugs would cost $15; Tier 3 non-preferred brand drugs would cost 50 percent co-insurance and Tier 4 specialty drugs would cost $100.

Pharmacy benefits for retirees in the Special Medicare Plan will follow PEIA’s Plan A prescription benefits plan.

Participants in the Retiree Benefit Assistance program will see an increased medical deductible of $25, a $300 medical out-of-pocket increase and the same “Tier 1 through Tier 4” pharmacy changes as members in Humana/PEIA Plans 1 and 2.

Participation in the Retiree Benefit Assistance program is based on income and is available to Medicare participants.

WVEA Communications and Government Relations Specialist Davin White spoke before the Finance Board on Thursday, and told board members that many teachers and public employees are either leaving the profession or not entering it to begin with because the increase in their health-care costs are eroding their already low salaries.

“It’s really becoming difficult for employees to take on much more, and PEIA has unfortunately become a plan that punishes those who need medical care the most,” he said.

We also urged the Finance Board to join us in calling on the new Legislature and Governor to finally reach a long-term solution to fully funding PEIA and building back its reserves.

It’s time to stop “kicking the can down the road.”