PEIA board approves burdensome FY18 proposal

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Information on PEIA's Go365  PDF of this page to share

We have had many questions regarding the GO365 program. We know there are concerns about the program and are working to address those issues. We are not endorsing the program but put this out to provide accurate information.

  • PEIA’s Healthy Tomorrow’s program has added a component known as Go365. Go365 adds a new vendor (Humana) and some new features. This was adopted at the December PEIA Finance Board meeting following the PEIA public hearings. Changes were made in the programs a result of comments made during the public hearings.
  • The basis of the program is still a participant’s healthy lifestyle and bloodwork goals:
  • For those who met the Healthy Tomorrows goals for the current plan year you do not have to submit bloodwork by 5/15/18.
  • For those who did not meet the Healthy Tomorrows goals for this year, you must submit bloodwork within range (or have a doctor’s statement stating why you cannot meet the goals) by 5/15/18 or pay a deductible penalty of $500 and an extra $25 per month on your premium for FY19. These penalties would start July 1, 2018. These penalties have always been part of PEIA’s Healthy Tomorrows plan if your goal was not met or there was not a reason supported by a doctor for not meeting the goals.
  • Healthy Tomorrows /Go365 applies to active employees and non-Medicare retirees. It is only for policyholders and not their spouses or dependents. It is not for retirees over age 65.
  • The Go365 program adds incentives and is designed to help guide you through healthy lifestyle choices. Beginning now, participants can log their activities and receive incentive rewards such as amazon gift cards and fitness devices. Participants continue to earn rewards and incentives for points earned throughout each year of the program.
  • The Go365 program is voluntary until July. Beginning in July 1, 2018 Go365 will be a requirement of the Healthy Tomorrows program.
  • PEIA’s Healthy Tomorrows/Go365 program is in its third year and has mapped out a four-year plan that begins in July 2018 and runs through June 2022. Go365 requires participants to earn a certain level of points in the program by May 15 of each year in order to avoid penalties for the following year of an additional $500 deductible and a $25/month premium increase: 2018-19 – earn 3,000 points; 2019-20 – earn 5,000 points; 2020-21 – earn 8,000 points; 2021-22 – earn 8,000 points and be negative for Metabolic Risk Syndrome by May 15, 2022. (To be negative a member must have at least 3 /5 risk factors in a healthy range -weight, cholesterol, triglycerides, blood pressure or blood glucose). Exemptions can be given if you have a doctor’s statement stating why you cannot meet the goals.
  • Go to the Go365 website or download the app to see ways to earn points. Some examples of ways points can be awarded are by doing a health risk assessment, getting a flu shot, donating blood, getting your teeth cleaned, having an eye exam, getting bloodwork, walking, eating healthy, etc.
  • The data collected does not go to PEIA but is being processed through Humana. Humana is currently a vendor for PEIA and is required to meet all HIPAA regulations while handling the data provided to them. HIPAA does not allow them to share your collected information with other vendors or companies.
  • Go365 is not unique to West Virginia and PEIA. Humana operates it as a nationwide program. It has operated in the state of Kentucky and Kentucky school systems for 6 years and also covers the state of Indiana



PEIA improves FY 2019 plan, but concerns remain

(Updated at 5 p.m. on Dec. 7, 2017)

The PEIA Finance Board on Dec. 7 made several changes to their initial proposal for the Fiscal Year 2019 plan, and approved those changes at the meeting. There are several positive changes, but some of what remains in the proposal is a real concern for many teachers, service personnel and retirees.

The latest changes include NOT paying for premiums by the person, keeping the existing pharmacy deductibles, requiring 20 percent coinsurance costs on “preferred brand” prescription drugs (down from a proposed 30 percent coinsurance cost) and moving from 10 to five salary tiers, which determine an employee’s premiums.

The Finance Board decided to keep their initial recommendation that total family income be considered when an active state employee covers his or her spouse.

Additionally, the Finance Board agreed to move to four “tiers of coverage,” which are different from salary tiers.

What this means is that instead of the three existing tiers of coverage for a 1) single employee, 2) employee and child, and 3) family, the Finance Board is setting different premiums, deductibles and out-of-pocket maximums for four tiers of coverage by splitting “family coverage” into a new 3) employee and spouse, and now, 4) family.  

(Click on this FY 2019 link to see what you or your family would pay next year in premiums, deductibles and out-of-pocket maximums.)

A 0.5 percent premium increase for active state employees will be reflected in the new salary tiers. The increase is required by the 80/20 rule because Gov. Jim Justice plans to increase PEIA’s budget appropriation by $10 million. The 2 percent premium increase initially proposed for both Medicare and non-Medicare retirees has been dropped.

Otherwise, non-Medicare retirees will see many of the same changes as active employees, including the 20 percent coinsurance costs on preferred brand drugs.
For Medicare retirees, generic prescriptions increase from $5 to $10 and preferred brand drugs will increase to $25 for a 30-day prescription or $50 for a 90-day prescription.

Unfortunately, both Medicare and non-Medicare retirees would still have to meet their existing pharmacy deductible. Under the initial proposal the pharmacy deductible had been removed across all plans.

Like active state employees, retirees will not need to pay premium costs for covered family members by the person. 

This PEIA proposal still creates winners and losers, particularly when you consider total family income and its impact on premiums and deductibles. Some will see even lower health-care costs, while others will see higher costs.

“While this is a better plan than what was presented at the public hearings, we still have concerns,” WVEA President Dale Lee said at the Dec. 7 Finance Board meeting. 

As Lee said during the finance board meeting, there needs to be a long-term dedicated stream of revenue to fund PEIA and keep teachers in the classroom. Vacancies continue to grow, our employees are among the lowest-paid in the country and they have gone years without a significant salary increase.

Lee also expressed concern that retirees with a spouse who works would get hit with total family income if the couple is on a family or employee/spouse plan. PEIA plans to factor that retiree’s income – including Social Security or disability benefits – when adding up total family income. 

If you haven’t already, WVEA urges you to sign the postcards circulating in your local association that are addressed to Gov. Justice, Senate President Mitch Carmichael and House Speaker Tim Armstead. The postcards encourage these leaders to stop the increases in medical and prescription drug costs and work toward a multiyear salary increase for school employees during the upcoming legislative session.

Among the other concerns in the PEIA proposal, preferred brand medications for asthma and diabetes are medically necessary and will still be a hardship for many people. People on these medications could pay up to $100 for a 90-day supply or $50 for a 30-day supply.

A teacher making $46,000 each year is paying $950 right now for their family deductible and $341 per month for their family premium in Plan A. Say the teacher’s spouse also earns a $46,000 annual salary. Their total family income would now bump their monthly premium up to $517 and their family deductible to $1,350.

On the other hand, if the same state employee earning $46,000 covers a child but not the spouse, their premiums would drop from $208 to $146 per month and their deductible from $950 to $750 in Plan A.                   

We will continue to post updates about the plan on this page as they become available.