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PEIA Hearings: Governor's Plan vs. PEIA Task Force Plan

As the PEIA Public Hearings continue, we wanted to clear up some confusion you may have about the plan presentation.

At these hearings the Finance Board will actually present two plans, with the difference being how out-of-state facilities will be treated. These plans will be referred to as the Governor’s Recommendations and the PEIA Task Force Recommendations.

The Governor’s plan will only extend the 80/20 coinsurance to counties that border West Virginia. The Task Force Plan will extend the 80/20 coinsurance to all out-of-state facilities.

It is important that we speak on behalf of and support the PEIA Task Force plan at the hearings that are left. This idea was proposed by WVEA President Dale Lee and will allow plan participants to receive the best care at the hospital closest to them.

You can find the difference between the two plans that will show up in the Public Hearing handouts below:

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PEIA Talking Points

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Full PEIA Task Force Meets to Approve Recommendations 

The full PEIA Task Force met on Monday, December 11 to consider recommendations from the Coverage & Plan Subcommittee and the Cost and Revenue Subcommittee. They approved the following:

  • Agreed to accept Governor Justice’s pledge of $100 million to stabilize PEIA
  • Broadened the out-of-state proposal to allow participants to go to any in-network out-of-state provider at the 80/20 rate
    • This is expected to cost around $6 million
  • Approved a recommendation to create an appeals process for prescriptions on PEIA’s Tier 3 nonpreferred brand-name drugs
  • Created a new subcommittee, chaired by WVEA President Dale Lee, to look at the 80/20 premium requirement and changing the plan from a fiscal year to a calendar year

The PEIA Finance Board will meet December 20. That will also be the first meeting of the new subcommittee. The Cost and Revenue Subcommittee of the PEIA Task Force has set a next meeting date of Jan. 8.

Don’t forget about the public hearings for the 2020 plan. The telephonic hearing will take place on December 12. All other meetings can be found below. All meetings begin at 6PM.

Dec. 13 – Beckley at the Raleigh County Convention Center, 200 Armory Dr.

Dec. 17 – Morgantown at the Erickson Alumni Center, One Alumni Drive

Dec. 18 – Charleston at the Coliseum/Convention Center, Little Theater, 200 Civic Center Dr.

Dec. 19 – Martinsburg at the Holiday Inn, 301 Foxcroft Avenue

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PEIA Public Hearing Plan Released

PEIA has released the proposed plan for FY20 (2019-2020). This is the plan that will be the focus for the public hearings scheduled in the upcoming week.

There have been some improvements to the plan. Those include:

  • UMR will be the new Third-Party Administrator for the plan. As part of that change participants will be issued new ID cards and create a new web portal with the ability to chat with Plan Advisors. They will also place 5 community care nurses around the state to focus on member education and engagement.
  • The requirement for the annual Healthy Tomorrows bloodwork is eliminated – nothing is required between now and May 15. PEIA will explore new wellness options for the future.
  • New programs are being explored – pilot project called Naturally Slim (weight loss and health); Diabetes Prevention Project and others.
  • For Medicare retirees there will be no benefit changes (including premium increases) for Plan Years 2019 or 2020. Formulary changes may occur during that time.
  • For active employees and non-Medicare retirees the plan will include the recommendations from the PEIA Task Force
    • Plan A – 80/20 coinsurance in WV external bordering counties only
    • Plan B – 70/30 coinsurance in WV external bordering counties only
    • Remove facility fee limits
    • Remove the $25 copay for out-of-state services
    • Restore an appeal process for those requiring a third-tier non-preferred drug to receive reduced copays
  • There are no premium increases for active and non-Medicare retirees for FY20.

WVEA President Dale Lee made the following comments on the proposed plan, “I am glad to see PEIA propose a plan that does not increase costs to plan participants. I am pleased there are no premium increases and that measures are being introduced to lower the cost incurred by plan participants, especially those in our border counties and those with Tier Three drugs.

I am disappointed, however, that our goal of finding a long-term solution to fix the problems of PEIA has not been addressed at this point. This proposed plan is a Band-Aid that will get us through another year without passing the plan’s cost to participants but ultimately, we are just delaying the inevitable and kicking the can down the road.

I encourage the work of the PEIA Task Force to continue and work to find a long-term sustainable funding source for the plan as they were charged to do. I urge the Legislature to pass legislation to address the funding issue and to look at legislation to help contain and curtail the rising costs of prescription drugs for plan participants."

 

You can find the Public Hearing Presentation below:

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WVEA PEIA Update - December 4, 2018

This morning (12/4/18) Governor Justice sent a list of recommendations to the PEIA Task Force Coverage and Plan subcommittee. The items, listed below, are essentially the same as the recommendations made earlier by the Public Outreach subcommittee after they conducted the public hearings and issued their report.

A meeting of the full PEIA Task Force will be held on Monday, December 10 at 1:00 pm. At that time, the Task Force is expected to make their final recommendations. Shortly after that, the PEIA Finance Board should release the plan to be placed on comment during the public hearings.

WVEA President Dale Lee stated he is pleased to see many of the proposals made by his subcommittee reaffirmed by the governor. “I believe these recommendations will lessen the burden of PEIA participants and is a beginning to finding the long-term solution to make PEIA a more affordable and better plan for participants.”

The Governor’s list included the following recommendations:

  • Move Plan A benefits back to 80/20 coinsurance in WV external bordering counties only
  • Move Plan B benefits back to 70/30 coinsurance in WV external bordering counties only
  • Remove facility fee limits from out of state facilities 
  • Remove $25 copay for out-of-state services 
  • Add an appeal process for people requiring a third-tier non-preferred drug to allow for reduced copays
  • Asked the coverage committee to review the wellness plans to further incentivize our members to seek better health outcomes

In addition, the governor restated his proposal for $100 million to the stabilization fund over the next two years.

Stay tuned for additional details-

PEIA Finance Board Public Hearings Coming in December

 
The PEIA Finance Board wants your input! Proposals for Plan Year 2020 (Benefits from 7/1/19 – 6/30/20) are being finalized now.  You’ll find the
proposed changes at www.wvpeia.com as soon as they’re available – just click on the picture of the gavel or scroll to the News Center.  We have scheduled public hearings around the state as follows:
LOCATION
Wednesday, December 12, 2018 -- Telephonic
Dial in: 304-410-0513, Conference ID: 304-410-0513.  Conference will begin promptly at 6:00 p.m.
Thursday, December 13, 2018 -- Beckley
Beckley-Raleigh County Convention Center, 200 Armory Dr.*
Monday, December 17, 2018 -- Morgantown
WVU, The Erickson Alumni Center, One Alumni Drive
Tuesday, December 18, 2018 -- Charleston
Charleston Coliseum and Convention Center, Little Theater, 200 Civic Center Dr.*
Wednesday, December 19, 2018 -- Martinsburg
Holiday Inn, 301 Foxcroft Avenue
 
*Please note new locations 
 
Here’s the schedule in each location:
 
5-6 p.m.  Customer service and hearing registration.  If you have questions about claims, benefits or the proposals being discussed, we’ll have staff on hand to help you.  Everyone attending the hearing must register.  If you want to speak at the hearing, indicate that at registration.  Note: This will not take place for the telephonic meeting.
 
6-8 p.m. Public hearing.   The proposals for Plan Year 2020 will be presented, and members of the board will take input from the audience.
 
If you can’t attend a hearing in person, please submit comments to the Finance Board in writing to 601 57th St. SE, Suite 2, Charleston, WV  25304-2345, or via e-mail to: PEIAComments@wv.gov.  Comments are due by December 19. 
 

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WVEA President Dale Lee gives a recap of the General Election and talks PEIA

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WVEA President Dale Lee talks about the Upcoming election and PEIA

President Dale Lee Sends Letter to Governor Jim Justice About PEIA Task Force Meetings

 

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WVEA Statement on Governor's PEIA Announcement:

Governor Makes Announcement About PEIA 

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Wear Red for Ed Tuesday

 

PEIA Task Force Information

The PEIA Task Force has a website available to keep track of the latest happenings, see past meetings and view documents.

The findings of the PEIA Task Force on Public Outreach is available here. (8/16)

 

Latest from the Governor on PEIA-

To recap the Governor's PEIA comments from the press conference -

The governor is asking the PEIA Finance Board to amend the current salary tiers of PEIA so that the pay increase does not move anyone into another tier and cause them to have their premiums increased. This will take place in July and impact the upcoming school year.

It was a little confusing in live time but the intent is to keep premiums from increasing next month due to the 5% salary increase.

The PEIA Finance Board meets on Thursday and is expected to make the change at that time.

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WVEA President Dale Lee provides updates on Legislative actions -

 

You can also find the latest updates on our Dedicated Teachers Facebook page