Following weeks of public hearings, the PEIA Finance Board met and adopted the PEIA financial plan for Plan Year 2013, which begins July 1, 2012.
The 2013 plan for active employees and non-Medicare retirees:
1. Eliminates coverage for acupuncture
2. Adds a $10 per visit copay to outpatient physical, occupational, speech and massage therapy service and chiropractic for the first 20 visits in a plan year. This copay is in addition to deductible and 20% coinsurance. If further therapy is medically necessary and approved by ActiveHealth, visits beyond the first 20 require a $25 copay, plus deductible and coinsurance.
3. Keeps coverage for massage therapy, but requires massage therapists to have national certification and carry $2 million malpractice insurance; follow treatment guidelines of the American Massage Therapy Association.
4. Increases the Urgent Care copayment from $15/$20 to $25.
5. Increases the Specialist Office Visit copayment from $20 to $25.
6. Increases the emergency room copay from $50 to $100. The copay will be waived if the patient is admitted to the hospital. If the visit is determined to be a medical emergency not requiring admission, the copayment will be reduced to $50.
7. Adds a $500 copayment for medically necessary dental services and for bariatric surgery. These copayments are in addition to the deductible and 20% coinsurance; and
8. Provides the following pharmacy benefit:
- Generic copay: $5 (no change)
- Preferred drug copay $15/Plan A; $20/Plan B and C (no change)
- Non-preferred drugs 75% coinsurance. Plan pays 25%/member pays 75%
The 2013 plan for active employees also includes a new PEIA PPB Plan D – the West Virginia ONLY plan that will be available to all active employees who are West Virginia residents. Details of the plan will be published in the Shopper’s Guide which is distributed in late March.
The 2013 plan for Medicare retirees in the Special Medicare plan or the Humana Medicare Advantage plan includes none of the benefit changes listed above, but does include a premium increase of 9%.
Finally, the 2013 plan caps the amount that active employers and employees pay toward retiree benefits at $343 per retiree per month, with an annual escalator not to exceed 3% built in. This move will slow the growth of active employee premiums, but will increase the amount retirees will pay for their coverage.