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Changes for Plan Year 2019 Adopted

12/8/2017

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Changes for Plan Year 2019 Adopted
The PEIA Finance Board met on December 7, 2017, and adopted the financial plan for Plan Year 2019, which begins on July 1, 2018.  The final plan adopted by the board differed significantly from the proposed plan discussed during the public hearings in November.  Based on feedback from those hearings, these are the only changes that were adopted:

1. For all active employees, non-Medicare retirees, and Special Medicare Plan members in the PEIA PPB Plans, change the cost-sharing for Preferred Brand Drugs from $25 or $30 copayment (depending on your plan) to 20% coinsurance with a $25 minimum and a $50 maximum per 30-day supply or $50 minimum and $100 maximum for a 90-day supply. 
 
2. For active employees of state agencies, colleges, universities and county boards of education, there are changes that affect premium:

 There will be a required premium increase of 0.5%, which is necessary due to the 80/20 law.  The state contributed additional funding, which then requires employee premiums to be increased. 

 The plan will move from having 10 separate salary index codes for premium determination, to just 5 salary index codes in $30,000 increments from $0 to $120,000 and above.

 There will be four coverage tiers:
      employee only,
      employee and child(ren),
      employee and spouse (two spouses – no children), and
      family (employee, spouse and child(ren). 

 The family with employee spouse tier (two public employees married to each other) will no longer be offered.  

 Total family income will be used as the basis for calculating premiums in the ‘employee and spouse’ and ‘family’ coverage tiers.  

 Total family income is only applied when the spouse is covered.

3. For Medicare Retirees in the Humana Plan beginning January 1, 2019,
     The Generic Drug copayment will increase from $5 to $10 for a 30-day supply.
    The Preferred Brand Drug copayment will increase from $15 to $25 for a 30-day supply.  This also applies to Humana members with Benefit Assistance. 

Contact Information

Call: 1-888-680-7342 Email: peia.help@wv.gov