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PEIA cuts set unless altered by new officeholders

BECKLEY, W.Va. — The Public Employees Insurance Agency Finance Board is considering cutting $54 million from the program to make it solvent in 2018, but PEIA State Director Ted Cheatham said his “new boss,” Governor-elect Jim Justice, could step in with funding suggestions to prevent further cuts.

For now, the agency must propose cuts based on Gov. Earl Ray Tomblin’s directive that there is “no new money for PEIA,” he explained.

Changes are slated to go into effect July 2017, except for changes to Medicare retirees, which will start January 2018.

He doesn’t know how newly elected legislators or Governor-elect Justice could affect the proposal, he said.

Under the proposed changes, nonstate employees will see a 6 percent premium increase and active employees will see a 0.5 percent increase on Plan A and D and a 5 percent degrees on Plan B.

Both nonstate and active state employees will see a $200 increase in deductibles for singles and $400 for family plans, and specialty drug copays will increase to $100 and $150.

Moreover, outpatient procedures will have fixed fees. For those procedures done out of state, PEIA will only pay the fixed fee and individuals will be responsible for the difference.

Nonstate and active employees are being asked to provide input on two proposed prescription changes.

Proposal one increases preferred brand drug cost-sharing to 30 percent with a minimum of $25 and maximum of $100 for 30-day prescriptions.

The second proposal would leave the current cost-share but implement a mandatory 90-day prescription fill for all maintenance medications.

Cheatham noted that under this option, individuals would pay two copays for 90-day fills, but because some pharmacies do not offer 90-day maintenance fills, there are individuals who might have to switch to mail-order prescriptions.

Non-Medicare and Medicare retirees will see a 4 percent premium increase. Non-Medicare insured will see an increase in out-of-pocket maximums by $1,000 for singles and $2,000 for families. Medicare patients will have out-of-pocket deductibles increase by $50 and out-of-pocket maximums increase by $450.

PEIA is undergoing an audit of its divorce and survivor numbers. Cheatham asks all insured to keep their information up-to-date. Ex-spouses are not eligible for coverage, and divorces must be reported immediately. Surviving spouses may continue coverage if they remain unmarried.

PEIA will hold public hearings across the state over the next week. The last meeting will be 6 p.m. Nov. 17 at the University of Charleston’s Ballroom. Previously, on Nov. 10, a hearing was held in Beckley. Many in attendance put the blame for PEIA’s continuing financial issues on the legislature.

Public comments on the proposed changes can be submitted in writing to Public Comment, West Virginia Public Employees Insurance Agency, 601 57th St. SE, Suite 2, Charleston, WV 25304, or by email at [email protected].

— Email: [email protected]; follow on Twitter @Sarah_E_Plummer

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