PEIA Finance Board Approves Plan With No Premium Increase

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By Brad McElhinny

CHARLESTON, W.Va. — The PEIA Finance Board officially accepted several proposals from Gov. Jim Justice, including one meant to provide more flexibility for across-the-border medical care.

The board that oversees the Public Employees Insurance Agency voted Thursday afternoon to approve a financial plan for the coming fiscal year.

Discontent over proposed premium increases last year was a major factor that led to a nine-day walkout by teachers.

Justice made this year’s decision easier by agreeing to freeze plans, meaning premiums won’t increase.

The governor also has proposed pumping an additional $100 million into shoring up PEIA. The Legislature still would need to approve that $100 million dedication.

That took much of the potential controversy out of approval of this year’s plan.

But the Finance Board still had a decision to make about the cost of medical care across West Virginia’s border.

The governor had recommended evening out costs for those who seek care at in-network providers in counties contiguous to West Virginia.

However, the separate PEIA Task Force last week voted to go a step farther, recommending an expansion to any in-network provider in any other state.

West Virginia Education Association President Dale Lee today urged the Finance Board to accept that recommendation.

“Allowing plan participants to go to any in-network facility at the 80/20 rate would have leveled the playing field for all,” Lee said after the meeting.

“Instead, some participants will be required to continue traveling long hours and pay a higher price in order to receive the health care they need.”

Joe Letnaunchyn, president of the West Virginia Hospital Association, urged the Finance Board to stick with the governor’s recommendations.

Because in-state providers receive a lower reimbursement rate through PEIA, Letnaunchyn said, they would be at a disadvantage.

“While we are sensitive to issues related to PEIA members, we oppose the implementation of these program changes because, on a fundamental basis, they encourage PEIA members to seek medical care outside of West Virginia for services that are available within our state,” Letnaunchyn said.

The cost of broadening the proposal beyond the governor’s recommendation was estimated to be $6.2 million.

Members of the Finance Board agreed the governor’s proposal adds more flexibility without even more cost.

“This is a big step towards improving the plan,” said board member Geoff Christian. “Hopefully this helps with the recruitment and retention of new employees.”

As it does every year, the Finance Board’s approval of the coming year’s plan followed a series of public hearings around the state.

The plan adds an appeal process for people seeking non-preferred prescription drugs.

The West Virginia Education Association stated that it is pleased with several aspects of what was approved.

“This is the first time in several years that a plan by PEIA actually returns money to the plan participants instead of taking more money from their paychecks,” Lee stated.

But observers also have worried about the public employees insurance solvency over the long run.

Officials have warned that keeping up with the rising cost of health insurance could add up to an additional $50 million year over year over year.

The PEIA Task Force that has met over the past months has made no specific recommendations about dedicating more revenue or trimming expenses.

“This is why it is so important that we continue to lobby the legislature and ask for a long-term funding solution,” Lee stated.

“Without funding, all plan costs will eventually rise exponentially in the coming years.”

The PEIA Task Force has agreed to continue meeting.

After today’s PEIA Finance Board meeting, a subcommittee of the PEIA Task Force convened.

The subcommittee is meant to look at statutory aspects of PEIA.

One issue is whether switching from a fiscal year to a calendar year financial plan would allow greater foresight and flexibility.

Another is whether more flexibility could be provided for the rule requiring 80 percent funding from the state and 20 percent for public employees.

That subcommittee and the full PEIA Task Force are scheduled to get back together Jan. 8.