Residents criticize PEIA proposed plan, saying it creates ‘winners and losers’

Nov. 16--CHARLESTON -- State employees and retirees at a public hearing at the University of Charleston Wednesday night were critical of proposed insurance coverage changes for the 2019 plan year, saying the plan created winners and losers within their ranks.

Ted Cheatham, Public Employees Insurance Agency director, explained the proposed health insurance benefit changes during the meeting.

The more controversial proposed changes were changing flat rates for family plans to pay-by-person, collapsing 10 salary tiers to three and premium increases.

PEIA needs to close a $50 million shortfall in benefits funding. The governor's office notified it would provide an additional $10 million in the budget for employer premiums. PEIA will use $11 million that otherwise would have been transferred to the retirees' trust fund.

Cheatham said the Finance Board will make a decision on Dec. 7.

Christine Campbell, president of American Federation of Teachers-West Virginia, criticized the plan, saying she felt benefits have been eroded while teachers and public employees have not had raises.

"There are winners and losers here," Campbell said. "It's clear to me the lowest and the middle third are paying for the top third. Increasing premiums of those earning the least while there is a decrease for the highest earners flies in the face of the board's fiduciary responsibilities."

For active state employees, the proposal includes a 0.5 percent rate increase. For non-state employees -- which includes cities and municipalities among others -- and non-Medicare and Medicare retirees, the proposal calls for a 2 percent rate increase.

The proposal also calls to change the preferred brand prescriptions from a flat fee of $25 to $30 to 30 percent coinsurance. There would be a $25 minimum and $100 maximum for a 30-day script.

Starting in July, PEIA imposed a mandatory 90-day maintenance fill. For a 90-day supply of a preferred brand, the minimum increases to $50 and the maximum increases to $200.

For Medicare retirees, the proposal would increase the generic tier from $5 to $10.

For active state employees, the plan proposes total family income to apply but only if a spouse is covered by PEIA. This is defined as the sum of both married spouses' adjusted gross income.

The new plan also proposes for active state employees to collapse 10 salary tiers to three for deductibles and out-of-pocket expenses.

Cheatham said collapsing the tiers simplifies the process.

"Actuaries picked these three salary tiers because it puts the population of PEIA into roughly thirds," Cheatham said. "About a third of the people are in the first tier, a third in the middle and a third are in the top tier after using the total family income."

Cheatham also outlined new programs including iSelectMD, a telemedicine vendor. Cheatham said doctors can prescribe over the phone and the copay of $40 is cheaper than the $50 copay for urgent care.

He also explained the Healthy Tomorrows Future. The new vendor is Humana Go365. Those who met the Healthy Tomorrows goals for this plan year don't have to submit bloodwork by May 15, 2018. Those who didn't meet the goals must submit bloodwork within a set time or have a doctor's excuse. This is for active employees.

There is also a Healthy Food program where a person can earn discounts on healthy foods by playing instructive internet games on the web or on an app.

Many in attendance said they feared they would not be able to afford prescriptions under the proposal. One correctional officer said his insulin would increase to $800 for three months -- 16 percent of his take-home pay.

Carrena Rouse, the local president of AFT-Boone County, also criticized the proposed new tier system.

"We are given the option for the Hunger Games for the higher tier or Walmart's Wheel of Fortune for the lower tier," she said.

Jay O'Neal, a teacher at Stonewall Jackson Middle School in Charleston, said this is his third year coming to hearings and expressed his frustration of coming yet again. O'Neal said he didn't feel collapsing the tiers was fair.

"The people who make the least will pay more and the wealthier people will pay less. Do we really want to see our teachers and public employees' income shrink while other highly paid employees increase?"

O'Neal said that while his health care costs have increased, his pay has not amounted to a significant increase over the last three years.

"Guess how much more I'm making now than at the same time three years ago? I'm making $1.06 more and with the proposed changes, I will be making less money next year," he said.

Wednesday's hearing was the last public hearing that PEIA conducted throughout the state.

-- Email: [email protected]; follow on Twitter @AndreaLannom

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