Two members of the PEIA Task Force updated lawmakers on the task force’s work and proposed recommendations in Monday’s Select Committee on PEIA, Seniors, and Long Term Care.
Last week, Gov. Jim Justice sent a list of recommendations to the Coverage and Plan Subcommittee, which reviewed and approved them earlier this week. These recommendations are:
- Moving Plan A benefits back to 80/20 coinsurance in external bordering counties;
- Moving Plan B benefits back to 70/30 coinsurance in external bordering counties;
- Removing facility fee limits from out-of-state facilities;
- Removing $25 copays for out-of-state services;
- Adding an appeal process for people requiring non-preferred drugs allowing for reduced copays.
- Reviewing wellness plans
The governor also proposed dedicating $100 million to the PEIA Stabilization Fund over the next two years.
Joe Letnaunchyn, chairman of the Cost and Revenue Subcommittee, and Rob Alsop, chair of the Coverage and Plan Subcommittee, went over these recommendations Monday morning.
Alsop said the PEIA Finance Board froze premiums so there would be no increase as a result of the 5 percent pay increase for state employees—some of whom could have moved up an income tier as a result of the raise.
The task force also looked into its 10 income tiers. Alsop said PEIA is an outlier because it has so many tiers. He said if tiers are collapsed, there is a risk that people within the lower tiers would pay more. He said any change to the tiers should be accompanied by a compensatory adjustment so people in the lower tiers would not have their take-home pay negatively affected.
Alsop said the task force also has looked into wellness initiatives. People who reached out to the task force recommended wellness programs be incentives rather than penalties. He said the task force wants to look at PEIA’s programs and develop new wellness initiatives.
Alsop said people also have reached out, asking for an appeals process for prescription drugs.
He said there are drugs that are not on PEIA’s preferred list, which are more expensive. There have been instances where a generic drug is not the best treatment and a person has to take a prescription that is not on the preferred list. People have asked for relief from the 90-day refill provision. Alsop said the maximum out-of-pocket for a prescription is $1,750 and fewer than 400 people hit that amount.
The full PEIA Task Force met Monday afternoon to look at the Plan and Coverage Recommendations. In that meeting, the task force adopted an amendment to make the copay 80/20 for out of state in-network providers. This would be for a period of a year. Members of the task force said this would cost an additional $6.2 million. This is different than the original recommendation in that it is not limited to contiguous counties. The Cost and Revenue Subcommittee is also scheduled to meet, followed by the full task force to adopt the final report.
