Proposed PEIA Changes for Fiscal Year 2016
The Public Employee Insurance Agency is asking covered members to comment on proposed cuts that
could change deductibles, copays and some coverage options next year. Several public hearings will be
held around the state in November, and the PEIA Finance Board is expected to vote on the 2015-2016
benefits package in December.
Six public hearings are scheduled beginning Nov. 10, 2014, and running through Nov. 20 in Beckley,
Huntington, Martinsburg, Morgantown, Wheeling and Charleston. See below for a detailed list of the
public hearings.
The Finance Board must come up with $30 million in cuts for active employees, $4.5 million for pre-65
retirees and $4 million for Medicare retirees during the next plan year. For the first time, the board is
asking for members’ input. If you attend a public hearing you may vote on the specific benefit reductions
you’d prefer. There will also be online voting options (via Survey Monkey) for those unable to attend in
person. The Finance Board is not bound to select the most popular choices. However it was made clear
that the board would certainly consider the most popular choices in making its determinations.
Some of the suggestions include:
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Increase the A and D plans’ family out-of-pocket maximum from 1½ times the
employee-only amount to 2 times the employee-only amount. This is projected to save
$6.75 million.
Increase deductibles by $25 and $50 or $50 and $100 (employee only/family)
Increase copays – primary care from $15 to $20 and specialist from $25 to $40
Add a $100 copay to inpatient hospital care and genetic testing (in addition to
deductible and 20 percent coinsurance)
Increase surgery copay from $50 to $100
Increase ER copay from $50 to $100 (currently $50 if emergency, $100 if not)
Increase urgent care copay from $25 to $50
End coverage of massage therapy
End coverage of impacted wisdom teeth
Add Reference Based Pricing for 34 targeted procedures: Healthcare Bluebook provides
cost comparison, pricing and quality data for health-care procedures and providers.
Allows members to choose wisely and become aware of in-network providers within
their region. Member exceptions will apply for urgent and emergency care, treatment
related to oncology, and members living more than 50 miles from providers at or below
the Reference Price.
Change copays on generic prescriptions (currently $5 for 30-day supply/ $10 for 90-day)
o Increase to $10 and $20, or
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Charge 20 percent coinsurance for generic drugs with a $5 minimum and $25
maximum – 30-day supply and $10 minimum/$50 maximum on a 90-day supply
Change brand drug copays (currently $15 for 30-day supply/$30 for 90-day)
o Increase cost to $25 and $50, or
o Charge 20 percent or 30 percent coinsurance, both with a $15 minimum and
$50 maximum – 30-day supply and $30 minimum/ $100 maximum on a 90-day
supply
Discontinue a discount for 90-day supplies of both generic and preferred brand
maintenance drugs.
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The current discount of $5 for a 90-day supply of generic maintenance drugs (as
opposed to a 30-day supply) and $15 for a 90-day supply of a preferred brand
maintenance drug will be eliminated.
Medicare Proposed Options
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Increase deductible from $25 to $100 or $125
Increase out-of-pocket maximum from $750 to $1,000 or $1,200
Increase copayment for office visits from $10/20 to $20/$40
Increase inpatient hospital copay from $100 to $150 or $200
Increase outpatient surgery from $50 to $100
Add premium increase
After July 1, 2015, new surviving dependents can continue coverage at current years of service based on
policyholders’ status at time of death. Surviving spouse coverage terminates at (re)marriage and for
children at age 26.
Healthy Tomorrows Program
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Three year span
Status reported at Open Enrollment for active employees
Applies to policyholder ONLY
Penalty for failure to meet requirements results in an additional $500 annual deductible
New employees will have existing deductible structure but must comply during next open
enrollment
Year One (Plan Year 2016)
o Find a primary care physician
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Year Two (Plan Year 2017)
o Name primary care physician
o Report:
 Blood Pressure
 Glucose
 Cholesterol
 Waist circumference
Year Three (Plan Year 2018)
o Name primary care physician
o Reported values meet following:
 Blood pressure ≤ 140/90
 Glucose ≤ 125
 Cholesterol ≤ 245
 Waist circumference – no value required
o A physician’s statement that one or more of these values cannot be met will waive the
requirement for that specific measure.
Under the Affordable Care Act, members are entitled to one primary care visit covered at 100 percent
with no copays or deductibles. It is recommended that your medical home physician provide the exam.
The visit includes a physical and history consisting of screening and counseling for alcohol and substance
abuse, blood pressure, depression, diabetes, domestic violence, nutrition, obesity, physical activity, STD
prevention, review of medication and blood work that includes a lipid panel and general health panel.
Public hearings scheduled:
The proposed changes will be available at www.wvpeia.com by the end of October and at the public
hearings below. Registration for the 6 p.m. hearings will begin at 5 p.m. You must register to speak. If
you can’t attend a hearing, you may provide input by completing an online survey, which will be
available at www.wvpeia.com by the end of October.
Monday, Nov. 10, 2014 - Beckley
Tamarack - Ballroom A
One Tamarack Park, Beckley, WV
Thursday, Nov. 13, 2014 - Huntington
Marshall Medical School - Harless Auditorium
1600 Medical Center Drive, Huntington, WV
Monday, Nov. 17, 2014 - Martinsburg
Holiday Inn - Foxcroft Ballroom
301 Foxcroft Avenue, Martinsburg, WV
Tuesday, Nov. 18, 2014 - Morgantown
Ramada Inn - Grand Ballroom
20 Scott Avenue, Morgantown, WV
Wednesday, Nov. 19, 2014 - Wheeling
WV Northern Community College - Auditorium
1704 Market Street, Wheeling, WV
Thursday, Nov. 20, 2014 - Charleston
Charleston Civic Center - Little Theater
200 Civic Center Drive, Charleston, WV
Customer Service -- PEIA will provide customer service in each location from 5-6 p.m. If you have
questions about medical, prescription or life insurance benefits, come early and get answers. If you can’t
attend a hearing in person, please submit comments in writing by e-mail to: [email protected].