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PEIA premiums won't go up but costs may

CHARLESTON, W.Va. -- State employees and others with health coverage through the Public Employees Insurance Agency won't see a premium increase next year.

But co-pays, deductibles and out-of-pocket expenses could go up for some state and public school workers under the proposed PEIA 2013-14 financial plan unveiled Thursday.

PEIA will hold public hearings about possible plan changes in six West Virginia counties in November. The agency's Finance Board will vote on next year's plan on Dec. 6, and the changes will take effect July 1.

"Actually, we're offering price reductions in three of our four [health insurance] plans," said Ted Cheatham, PEIA's executive director. "We are going to give people an incentive to switch to a lower benefit plan."

The overwhelming majority of state employees who receive health insurance coverage through PEIA take part in the agency's "Cadillac" plan that costs the most, but provides the best benefits.

The agency is considering a host of options to increase revenue or decrease expenses by $13 million to $15 million. PEIA received no increase in state funding for the upcoming fiscal year.

On Thursday, the PEIA Finance Board examined several proposed benefit changes to the agency's most popular plan, such as increasing co-pays for specialist physicians from $25 to $40 per visit. That would increase revenue by $3 million.

Another option would increase co-pays from $15 to $25 for PEIA recipients who visit a doctor that they haven't designated as their regular physician under the plan. That increase is expected to generate an additional $5.9 million for the program.

Other possible options include setting all emergency room co-pays at $100, and increasing premium discounts for insurees who complete a four-step health screening.

Last year, the Finance Board approved changes that would increase "out-of-pocket" expenses for families enrolled in PEIA plans. Those changes will take effect in July. 

Medical deductibles also could increase by $25 to $100, according to other options under review.

The agency is also considering a co-pay increase for specialty medications -- those used to treat chronic and complex health problems -- from $50 to $100 per 30-day supply. The change would save PEIA more than $500,000 a year.

For most retirees, PEIA's proposed 2013-14 plan features few changes. The plan will offer two new Medicare plans that are 15 percent to 30 percent less expensive.

PEIA plans to hold the following public hearings to take comments about proposed changes: Nov. 12 at the Holiday Inn in Martinsburg; Nov. 13 at the Ramada Inn in Morgantown; Nov. 14 at West Virginia Northern Community College in Wheeling; Nov. 14 at Marshall University Medical School in Huntington; Nov. 19 at Tamarack in Beckley; and Nov. 20 at the Charleston Civic Center.

Reach Eric Eyre at ericeyre@wvgazette.com or 304-348-4869.


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