PEIA Finance Board approves benefit changes

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By Shauna Johnson, WV Metronews

CHARLESTON, W.Va. – Roughly $40 million in benefit cuts have been made to the health insurance plan that covers West Virginia’s state workers.

During a Thursday meeting, members of the Public Employees Insurance Agency’s Finance Board approved the changes that will take effect on July 1, 2015.

“Nobody wants any cuts. Nobody wants any changes, but we do have a fiscal responsibility to the taxpayers and to the government of West Virginia to balance this budget and keep it balanced and that’s what we’re doing,” said Ted Cheatham, PEIA director.

“As difficult as those decisions are, I think we’ve done a reasonable job of structuring a plan to do that.”

According to Cheatham, the following changes were made in coverage for active workers:

-The generic drug and preferred drug co-pays have been increased.
 -The co-pays for primary care visits and specialist visits have been raised.
 -Deductibles will be $25 more for singles and $50 more for families.
 -Outpatient surgery co-pays are going from $50 to $100 while emergency room co-pays are a flat $100.
 -Out-of-pocket maximums for families have been raised to equal twice the single out-of-pocket maximums.
 -A $100 co-pay has been added to inpatient admissions.

Altogether, Cheatham said the changes for active workers would save approximately $36 million in the coverage year that begins on July 1.

For retirees, the following changes were made in coverage:
 -The co-pays for primary care visits and specialist visits have been raised.
 -Outpatient surgery co-pays are going from $50 to $100.
 -Deductibles have been raised by $75 per person.

The changes for retirees, Cheatham said, should save PEIA approximately $4 million.

Additionally on Thursday, PEIA’s Finance Board approved the three-year “Healthy Tomorrows” wellness program.

“First year, name a physician. Second year is go to your physician and know your numbers and that’s cholesterol, glucose and blood pressure and waist circumference,” Cheatham explained. “The third year is go to your physician, know your numbers and get those numbers within reasonable standards.”

Those who do not meet the yearly benchmarks will see a $500 additional deductible added to their healthcare plans.

Six public hearings on the proposed PEIA cuts were held throughout West Virginia prior to Thursday’s meeting. Cheatham said more than 4,200 people responded to an online survey as well.

For the past three years, the finance board has used the agency’s reserve fund, about $32 million a year, to pay for higher healthcare costs.

State law prohibits the reserve fund from going below the 15 percent mark or $105 million.  Without the approved benefit cuts, projections showed that level would be exceeded.