The WV Public Employees Insurance Agency (PEIA) proposed 2019-20 benefit plan allows an appeals process for insureds who require medications that are on the Tier 3 nonpreferred brands which carries a 75 percent copayment up to the $1,750 annual out-of-pocket maximum for prescription drugs.
These changes will cost PEIA nearly $15 million in the coming plan year, but, as Task Force members noted, will go a long way toward building goodwill among participants.
The Agency is conducting hearings around the State to receive comments from active state employees and retirees. Any changes in the insurance program covering about 250,000 teachers, school service personnel, other state and public employees, retirees and their families are to occur in the 2019-20 plan year.
The plan proposes eliminating the current financial penalties for going out-of-state for health care, including a 10 percent higher coinsurance payment, a $25 per visit copay and a facilities fee that saddled insureds with paying the difference between discounted instate rates and the higher out-of-state and out-of-network rates for routine procedures, such as lab tests, MRIs and colonoscopies.
The 2019-20 plan promises another year without premium increases.