Welcome!

Be sure to see petition above to print, alter (if wish) and send or FAX to 304-558-2516 (and then mail to be sure). No FAX, then email to peia.help@wv.gov and then mail the signed original. FAX or email before board meeting at 1:00 today. See 8 key points for important issues to address, will post results of board meeting today. Also see 6 Ways to Help , and there is a petition you can sign and FAX. If you do nothing else, please ***write a letter to the PEIA Finance Board by Dec. 4 *** for the most immediate effect. It can be faxed too, but I’d still mail the hard copy to be sure. Below are announcements of Save PEIA Benefits Meetings in Huntington, followed information about PEIA Finance Board Meeting you can attend Dec. 4, then an article about the Premium Increases up to 64%, Benefits Decreases, and some Anticipated Negative Changes to PEIA Medicare. Please check back frequently, we are adding links etc. daily. Also though it’s best to write your own letters to the Finance Board, sample letters will be posted Sun. or Mon. We will have samples at the meetings. Be sure to check above at 8 key points and 6 Ways to Help/ Fight Back – it has links to find legislators, support groups, all newspapers in the state and the media, and also ways you can help anonymously. Lastly, please email you sample letters (you sent to the PEIA Finance Board and delegates) to savepeia@live.com. Also, email savepeia@live.com to be added to an email list. We’ll post a few (minus all identifying info) to lend inspiration to some, and help others with writer’s block. This is your site too, and you have much to contribute. Thanks for all the emails.

Circulate the Petition to Reform PEIA

petition-2008-for-peia-reform-and-against-disastrous-proposed-changes

Next PEIA Finance Board Meeting, 12/04/08

PEIA Finance Board/Retiree Trust Fund Meeting

The next PEIA Finance Board and Retiree Trust Fund meeting is set for Dec. 4, 2008, 1 – 3 p.m. in the Canaan Valley Hearing Room, Division of Environmental Protection Building, 601 57th St., SE, Charleston, WV. It is open to the public and you can comment. DIRECTIONS – FROM I64 EAST OR WEST – Take exit 95 and go approximately one mile west on MacCorkle Ave. Turn left on 57th St. SE and go approximately a tenth of a mile. 601 57th St. SE is on the right. 

 

 

 

 

Premium increases up to 64% in 4 years and/or benefit decreases

The PEIA Public Hearing Presentation shows proposed premium increases, benefit cuts, or a combination, with increases for retirees of 11, 17, 13, and 12 percent over 4 years. These increases compound from year to year, and therefore would add up to a 64 percent increase in premiums ! With little computation one finds for a non-Medicare retiree currently paying $208 monthly, premiums would increase to about $341 per month ( $1692 more yearly by the beginning of the fourth year), for yearly premiums of about $4093 (higher for fewer years of service). Premiums for Medicare retirees increase by the same percentages.

For active employees the increases are 9, 14, 13, and 12 percent, a total premium increase of 57 percent by the start of 4^th year. Active employees with incomes at just over 20, 30, 36 and 42 thousand in PEIA PPB Plan A Family Preferred Plan see increases over the 4 years of up to $930, $1094, $1279, $1593 more per year respectively, for compounded yearly total premiums of about $2362, $3012, $3516, and $4389. The monthly premiums would have gone up in each income bracket as follows: from $136 to $213, $160 to $251, $187 to $293, and from $233 to $365 per month. Those in the lowest part of each bracket will be paying over 10 percent of their income just for the premiums!

There are about 17 proposed benefit decreases. Proposals include increasing specialist visit copays to $25, Tier Two ((Preferred Brand Name) medication copays to $25, possibly moving some drugs to categories requiring higher copays, and increasing OPP (Out of Pocket) family cap by 50 percent. Non-Formlarly (Nonpreferred Brand-name)medications would no longer be covered. Also Nexium, Prevacid, Aciphex, Clarinex, and Xyzal will no longer be covered. (Though these can now be purchased over the counter, they sometimes cost a lot, and PEIA has not made any provision to reimburse, or supply the over the counter version, even when the medication is prescribed by the physican. Coinsurance for Network Providers Outside of WV increases to 30 percent. Note copays, do not apply to the Out of Pocket maximum for either retirees or employees. They are regressive putting the heaviest burden on the sickest, poorest, and oldest.

In addition, for Medicare/PEIA retirees copays will be added for urgent care, out patient mental health care, durable medical equipment and prosthetics, hearing exams, and outpatient rehab (physical therapy, etc.), again putting the burden on the oldest.

The Presentation also proposes increases in copays for Non-Medical Home physician visits. However, all primary care physicians and internists in the PEIA network, are not considered medical home physicians. So if you see an internist or family practice physician in the WVPEIA network, but who is not a “Medical Home Physician,” you will have to change to and Medical Home physician or pay the increased copays.

Any proposed changes that are approved will take effect July 1, 2009. They have proposed so many decreases in benefits and increases in premiums, that it is almost impossible to determine how much it will cost the participants.

Not mentioned in the Public Hearing Presentation was that PEIA as early and Jan. or spring could be issuing a Request for Proposals for bids for the Medicare Advantage, and probably will be switching from the Private Fee for Service (PFFS) to a Preferred Provider Organization (PPO) which would probably and most assuredly be a smaller, more restrictive provider network both within WV and when going out of state, when compared with Traditional Medicare. This more restricted network, if viewed with regards to West Virginia’s Omnibus Health Care Act (which was referenced in a previous bid proposal), might mean that any WV physicians/providers outside the network but within WV must accept the in-network rate, and can not balance bill the patient. Apparently you might be unable to see Medicare physicians in WV who don’t take the Advantage rate, even if you’re willing to pay the difference. These are physicians that seniors could still have seen, had PEIA not forced them off Traditional Medicare onto Medicare Advantage (if it becomes a PPO plan). Medicare Advantage is really a Dis-Advantage when compared to Traditional Original Medicare with PEIA as a supplement.

Why were participants not told of the probable plan to switch to a PPO, before and during the last Public Hearings, so they could discuss it before the new request for bids is posted? This wasn’t even in the PEIA Public Hearing Presentation; even through they plan to rebid it soon. I suppose their logic is that it won’t go into effect until July 2010, and there will be public hearing in Nov. 2009. However, by then it will be almost a done deal. Shouldn’t it have been discussed before it’s let out for bid? Something as important to the Medicare retirees as the possibility of changing from a PFFS plan to a PPO plan should be discussed ahead of the bid request not at the last minute!

Consider the legal concept of detrimental reliance. Most state employees were extremely low paid. They were told that we had the insurance instead. Retirees worked for 30 to 40 plus years, and now that they live on small pensions, the insurance bears no resemblance to the original plan. It’s like buying a house (our labor for decades), making some of the payments (the low wages they gave us), and then deciding to keep the house but only paying a part of what is owed. We couldn’t do that, so why can the state. The health insurance is deferred compensation for labor provided for decades. These negative changes and all the negative changes over the years, amount to a decrease in pensions and salaries.

This is to be voted upon by the Board Dec. 4. If you are concerned about the erosion and loss of benefits write PEIA Finance Board and all state delegates and senators. Failure to relate your concerns and objections could be interpreted as tacit support for all these negative changes.

Marilyn Howells, retiree

Note 1: With regard to the comments above about Medicare Advantage. The phrase that I quoted was in the first request for bids 2 years ago. Since they finally contracted it as a PFFS there wasn’t a network, but if they make it a PPO network, just how will this apply. It was on page p. 18 of the request for bids that year in Section 2.15.4 Prohibition of Balance Billing and reads “ The Omnibus Health of Care Act enacted by the West Virginia Legislature in April 1989 applies to the PEIA and its primary members. The law requires that any West Virginia health care provider who treats a PEIA insured must accept assignment of benefits and cannot balance bill the insured for any portion of charges over an above the PEIA fee allowance or for any discount amount applied to a provider’s charge or payment, this is know as prohibition of balance billing. Any provisions regarding balance billing and assignment acceptance from CMS shall also be enforced by the MAPD Plan.” This probably doesn’t bode well – for any provider out of state who is not in the Advantage plan, being willing to see to see you. Is that what the phrase about CMS provisions means??? Probably doesn’t bode well – for any provider out of state who is not in the Advantage plan, being willing to see to see you. Is that what the phrase about CMS provisions means???

Note 2: This last note only applies to a few people, but constituted another take away of benefits that applies only to couples, where the spouses both worked and carried insurance on themselves and each other, one through PEIA and the other through another employer related plan that was not PEIA. With Traditional Original Medicare when they retired Medicare of course is the primary payer and pays first, and then through a Traditional Coordination of benefits, the private plans through the employer pays second, and the spouse’s plan pays 2^nd’’ if there is anything left to pay. (This reverses for your spouse). This situation continues even after both are on Medicare. In other words, Traditional Original Medicare allows 2 supplements. However, Medicare Advantage does not allow 2 supplements so you are forced to drop either your spouses insurance or the PEIA. So after both have worked a lifetime for their employers, and earned both supplements, Medicare Advantage won’t let you have the 2^nd supplement.

So just by forcing retirees on to Medicare Advantage, PEIA (a supplement) has not only changed its benefits, but denied participants the right to participant in Traditional Original Medicare, and for those who had a 2^nd supplement (for which their spouse worked) forced them to lose it. They messed up 2 to 3 insurances for each participant, with the stroke of a pen.

Your Voice Matters

(Results are not automatically forwarded to PEIA.  Write them a letter!)