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W.Va. PEIA director presents 2019 plan year changes


The Register-Herald

CHARLESTON, W.Va. — The Public Employees Insurance Agency director said the agency plans to propose changing the 80-20 match for PEIA in the upcoming legislative session.

PEIA Director Ted Cheatham presented proposed changes for the 2019 plan year during Sunday’s select committee on PEIA, Seniors and Longterm Care meeting. He told legislators he anticipates asking the Legislature to change the 80-20 rule, where the state puts in 80 percent and the member comes up with 20 percent.

He said he will recommend changing the statute to say the state would not pay more than 80 percent or possibly less.

He said this would give the board flexibility in terms of cuts in a situation where there is a shortfall between what the Legislature allocates and the funding PEIA needs. He said under the current 80-20 rule, all goes to benefit reductions.

Cheatham also discussed proposed plan changes for 2019. Currently, there are about 230,000 to 240,000 enrolled in PEIA, Cheatham said. About 10,000 are nonstate.

He said PEIA needed an additional $20 million. The governor’s office notified that it would provide an additional $10 million of that $20 million.

Cheatham said he is working to remodel the proposal to give different options to the board, which will meet Thursday to make a final decision on the proposal.

One of the proposed changes includes eliminating the proposed Healthy Food Program. Under this plan, a person could earn discounts on healthy foods at Walmart by playing games on an app.

“This was universally panned at public hearings and I will recommend to the board we not do this,” Cheatham said.

The PEIA board held public hearings throughout the state in the last few months. At a public hearing at the University of Charleston last month, state employees and retirees were critical of the proposed changes, saying the plan created winners and losers within their ranks.

Some of the more controversial proposed changes included changing flat rates for family plans to pay-by-person, collapsing 10 salary tiers to three, and increasing premiums.

For active state employees, the proposal includes a half of a percent rate increase. For nonstate employees — which includes about 600 entities encompassing cities and municipalities among others — and non-Medicare and Medicare retirees, the proposal calls for a 2 percent rate increase.

The proposal also calls to change the preferred brand prescriptions from a flat fee of $25-$30 to 30 percent coinsurance. For a 90-day supply, the minimum is $50 and the maximum is $200. For Medicare retirees, the proposal called to increase the generic tier from $5 to $10.

For active state employees, the plan proposes total family income to apply but only if a spouse is covered by PEIA. This is defined as the sum of both married spouses’ adjusted gross income.

Cheatham said total family income has been on the table for years and is something House and Senate leadership along with the governor’s office has indicated they wanted the agency to pursue. He said total family income is a philosophical change and is revenue neutral.

When the board approves a plan, financials are submitted to the governor’s office and then it goes through the budget process. He said there will be an additional $10 million line item for PEIA in the budget with about $6 million additional out of general revenue.

Changes will go into effect next July for active state employees and January 2019 for Medicare retirees.

Email Andrea Lannom at [email protected] or follow her on Twitter @AndreaLannom.

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