Board Votes on Premiums – AFT Responds

The Board has voted on increases in premiums for all but Medicare retirees, but the Medicare retirees get a higher out of pocket, a 50 % increase, again hurting the poorest when they are the sickest.

PEIA is also planning to request bids for Medicare Advantage as a PPO, which probably and most assuredly will be a more restrictive network. Not on Medicare yet? What PEIA is doing with the Medicare will affect you when you get to Medicare age and for your whole life.

Due to the thousands of calls, letters, petitions, faxes, and emails, the additional copays are off the table at present !!! All the contacts with the legislature didn’t hurt either!! It was always going to be the decrease in benefits, increase in premiums, or a combination this year. Since the copays still don’t apply to deductible or out of pocket or our 20/80 match on premiums, they tend to over look this cost shifting.

The groups affected the most are those already with high premiums, families, employees with children, retired non Medicare.

The PEIA’s projected increase in premiums over the next 4 years totals 57% for active employees & 64% for retirees (a little less for Medicare retirees as they have the increased Out of Pocket Maximum this year instead).

The unions, retiree groups, and thousands of individuals working on their own and with their groups, did wonders, especially as they had little notice and such a short time frame. Now is the time to continue your efforts. Express your concerns. The interim committees in legislature meet Sunday, Dec. 7, 1 pm to 7 pm, Monday, Dec. 8, 9am to 7pm, and Tuesday, Dec. 9, 9am- 4 pm. Remember every voice helps.

See summary of changes below next paragraph

If you are concerned about the constant erosion of benefits and ever increasing premiums, support your retirees group or union. PERSA would be a good place for retirees to start. PERSA is $1 a month. It’s open to actives too. Go to www.peiawatch.wordpress.com to find various groups. Go the rallies in Feb. Call & write all the delegates, not just your own, as many are on a number of committees that can help. Legislative interim meeting dates December 7 – 9. Benefits are being shredded away bit by bit, year by year & the plan bears little resemblance to the under which most were hired. With ever increasing copays, increasing drug copays ($50 on some), escalating premiums, loss of traditional coordination of benefits, & forcing Medicare retirees of Original Medicare, while the private Medicare companies reap the profits, has eroded benefits beyond recognition. Many can not afford to even use the insurance due to copays with no cap, that do not apply to deductible or Out of Pocket Maximum.

Below is quote from AFT site

http://www.wvft.org/legislationpoliticalaction/default.as

“ PEIA Plan as Passed by the Finance Board

December 4, 2008

Your efforts paid off! The PEIA Finance Board adopted a plan today that addresses many of the concerns raised by WVSSPA and AFT-WV. For example, the new plan which will take effect July 1, 2009 will not include any:

• Benefit reductions;
• Prescription co-payment increases;
• Out-of-pocket maximum increases (for active employees);
• Change in out-of-state coverage (you will not be penalized for going out-of-state).

However, the Board adopted the following premium increases:

I. Active employee premiums will increase, on average, 6% for non-tobacco users.

Examples for Single Coverage/Family Coverage for non-tobacco users (PPB Plan A)

Salary Range Current monthly Rate New monthly Rate

20,001 – 30,000 $37 single, $136 family $39, $144

30,001 – 36,000 $44 single, $160 family $47, $170

36,001 – 42,000 $50 single, $187 family $53, $198

42,001 – 50,000 $64 single, $233 family $68, $247

50,001 – 62,500 $86 single, $294 family $91, $312

62,501 – 75,000 $99 single, $324 family $105, $343

Actives and retirees who use tobacco products will see an additional monthly increase of $10.00 for those who have a single plan and an additional monthly increase of $25.00 for those who have a family plan.

II. Retiree premiums will increase, on average, 11% for those under 65. Retirees who do not use tobacco products will see a premium increase of less than 11%. Those over 65 will not have an increase but their out-of-pocket maximum will increase from $500.00 to $750.00.

So what is our next step?

• We will aggressively lobby the legislature during the 2009 session and ask that they provide additional funds to PEIA in order to offset the increases. WV Code 5-16-5 specifically states that the
  • “Aggregate premium cost-sharing percentages between employers and employees, including the amounts of any subsidization of retired employee benefits, may be offset, in part, by a legislative appropriation for that purpose.”

WVSSPA and AFT-WV believe that during these difficult economic times, the legislature should use this provision of the code to stop the premium increases.

• We will be meeting with the Governor to respectfully request that he include funds in his budget to offset the proposed increases.

Finally, we will work with our members to contact their legislators and ask that they support the AFT-WV and WVSSPA position – No Premium Increases!

Again, your efforts paid off. Thank you for your involvement as the Board heard your concerns. As a result, the plan is much better than originally proposed. We will keep you informed as we continue to lobby for health care dollars. ”

Old 2007-Angry Retirees Question PEIA Changes

http://www.statejournal.com/story.cfm?func=viewstory&storyid=30917

“The State Journal
Angry Retirees Question PEIA Changes
Posted Thursday, November 1, 2007 ; 06:00 AM
Updated Thursday, November 1, 2007 ; 12:12 AM

Some PEIA subscribers are unhappy with changes in the state-run health insurance program.

Story by Beth Gorczyca Ryan
Email | Bio | Other Stories by Beth Gorczyca Ryan

HUNTINGTON — Hundreds of retired state workers are lashing out at the Public Employees Insurance Agency after the insurance provider changed carriers.

Between 175 and 200 retired and soon-to-be retired state workers and teachers gathered Oct. 29 at Huntington High School to learn why PEIA decided earlier this year to allow Kentucky-based Advantra to provide health care coverage for retirees who are eligible for Medicare.

One of the biggest complaints the retirees had is that the new card and provider are not accepted in some other states, including parts of Florida, North Carolina, South Carolina and Georgia. They also complained the new system was costing them a whole lot more and providing worse coverage than what they had before.

“I feel like PEIA sold us out,” said Imogene Parrish, a retired Cabell County Schools worker.

The group was so bothered by the changes that attendees began bombarding the PEIA representative with questions as soon as the meeting started. And the questions continued, one after another, sometimes being asked directly over another, for two hours. PEIA’s representative, Gloria Long, deputy director for insurance programs and services, tried to answer questions and calm people. But by the end of the meeting, people were just getting madder and blaming everyone from Gov. Joe Manchin to President Bush for the health insurance changes.

“The intention was never to stick you out there without insurance or to make you feel uneasy about your insurance,” Long said.

She told the group the PEIA board decided a while ago to allow Advantra to handle insurance for all PEIA members who were eligible for Medicare. Advantra then set up a plan based on PEIA’s requirements, as well as specifications Medicare demands. PEIA’s board accepted the proposal, and the new benefits went into effect July 1.

She said PEIA has heard about problems, particularly with finding providers in other states.

“There are some pockets of the U.S. that don’t accept Advantra,” she said. “We are calling providers to ask them to start accepting (it). We are trying to help out.”

She said every doctor or health care provider that accepts Medicare payments should be accepting Advantra as well. But some areas just aren’t willing to accept the new carrier. She said that has caused lots of problems for retirees who travel a lot or spend several months in warmer climates. As a remedy, she said PEIA has agreed to let some retirees who do spend a lot of time out of state rejoin the old plan for the time being.

Another common complaint was that some retirees under the new carrier were losing the supplemental insurance they had purchased for themselves and their spouses over the years.

“I’m just wondering if you are aware how this is impacting other plans,” one man called out from the audience.

“Painfully aware,” Long said. “The issue there is Medicare considers any plan with a Plan D (or prescription drug coverage) as double dipping, and they kick you out.”

That was not the answer the man wanted to hear.

“I paid for this insurance while I was working, and now I have less than before,” he said.

Long told him one solution would be for him to maintain his PEIA life insurance but drop his PEIA health insurance and sign up under his wife’s plan. She said if he did that, he could rejoin PEIA at any time.

The new coverage also is limiting where some people can go to the hospital. Long said she’s heard of cases where hospitals have turned away patients with Advantra. Her recommendation to those in the group was to call the hospital before any planned procedures to make sure they accept that carrier.

Some of the biggest complaints, however, were about retirees having to pay co-pays, co-insurance and deductibles, something they didn’t have to pay under the old system. That’s a big change for some former state workers. And it’s a bitter pill for them to swallow.

Long said while many people are blaming Advantra for the problems, she said Advantra designed a program to meet PEIA’s requirements and specifications.

“The plan design we have to take credit for at PEIA,” she said.

The plus side of the changes, Long said, is that it won’t raise premiums. In addition, retirees will have a maximum out-of-pocket expense for health care per fiscal year of $500. However, she said retirees who make less than 250 percent of the federal poverty rate are eligible to have that maximum out-of-pocket amount reduced.

Money spent on prescriptions is not included in that maximum out-of-pocket amount.

She said despite the retirees’ complaints, she believes the program is good and provides retirements with the same excellent level of health care. But she admitted that it’s different, a bit confusing and that adjusting to the new system could take some time.

“I believe you have a good health plan; if I didn’t, I wouldn’t be here,” she said.

Cabell County Delegates Kelli Sobonya and Carol Miller, both of whom are Republicans, called the meeting, which was attended by the county’s two senators, Robert Plymale and Evan Jenkins, both of whom are Democrats. All four not only listened to complaints but also tried to answer questions, or at least help them find someone who could answer their questions.

“There were so many questions we couldn’t answer, so we figured we’d bring PEIA here to answer them for you,” Sobonya told the audience. “

WVEA Angered by Finance Board Actions FY 2010 adopted plan

From wvea.org

“ PEIA Finance Board Adopts PEIA 2010 plan The PEIA Finance Board adopted the FY 2010 plan. It includes premium increases for plan participants under age 65. For more information …click.

Public hearing photos and WVEA testimony are online.”

(Note this leads to President Dale Lee’s inspiring “I Am Appalled” WVEA testimony

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Item below is also from WVEA site. Also be sure to go to this great site and read President Dale Lee’s inspiring “I Am Appalled” WVEA testimony at Public Hearing.

WVEA angered by Finance Board actions

http://www.wvea.org/leg_action_ctr/peiaadopted.aspPremium Increases

“Active Increases

Single – $2 to $19*

Family – $9 to $57*

(*per month depending on participant’s salary)

WVEA angered by Finance Board actions WVEA is angered by the actions of the PEIA Finance Board. They have once again chosen to balance PEIA’s budget by shifting costs to employees and retirees. Hundreds of employees and retirees attended the public hearings and their concerns seem to have fallen on deaf ears. “I believe the Finance Board had a plan in mind all along and the public hearings were just an exercise they were required to go through,” stated WVEA President Dale Lee. “It appears they had a direction they intended to go and they held firm.” For active employees and retirees under the age of 65 premiums will increase – an average of 9% for active employees and 11% for retirees under age 65. The tobacco differential for smokers was increased $10 for a single plan ($15 to $25) and $20 for a family plan ($30 to $50). Medicare eligible retirees saw no premium increase; however, their out-of-pocket maximum was increased from $500 to $750 in a plan year. These increases come at a time when many participants have seen a reduction in their income and have dipped into their savings as the national economy continues in a decline. Meanwhile, PEIA has a revenue surplus of over $20 million. This is more than enough to offset benefits or premium changes; yet it is not being used to assist employees or retirees. Because our members voiced their opposition to the proposed plan, we were successful in eliminating the new drug formulary, eliminating the proposed 70/30 split for out-of-state network providers, stopping increases in co-pays and Tier II drugs and stopping the increases in the out-of-pocket maximums. By holding back those changes, employees and retirees were able to mitigate a portion of the cost shifting. In addition, premium increases were eliminated for retirees over 65 years of age. “The continued chipping away of benefits and increasing premiums is not acceptable. Retirees and employees should not have the PEIA budget balanced on their backs,” states WVEA President Dale Lee. “We understand that health care costs are a source of concern for all employees, employers and retirees in our state and nation. Shifting costs to employees and retirees while PEIA is experiencing a surplus is the reserve account is unacceptable.” “When you look at the plan in total (premiums, co-pays and deductibles) employees and retirees contribute nearly 40% of the overall cost of the plan. WVEA will continue our efforts to amend the current 80/20 legislation regarding PEIA,” concluded Lee.”

MU Faculty Senate Resolution Regarding PEIA

“LEGISLATIVE AFFAIRS COMMITTEE

RECOMMENDATION

SR-08-09-06 LAC

Recommends that the Faculty Senate, President Kopp, Marshall University Board of Governors, and the WV Advisory Council of Faculty, jointly endorse a resolution which urges the State and WV-PEIA to implement a 2-year moratorium on any increases in PEIA premiums, co-payment deductibles, and out-of-pocket maximum and/or decreases in medical/pharmacy benefits to all state employees both active and retired.

RATIONALE:

PEIA has recently proposed a plan to increase premiums, co-payments and out-of-pocket maximums that would take effect July 1, 2009. The 9% premium increase comes at a time when education employees are only receiving less than 3% in salary increases. The 11% premium increase will cripple those retirees who are on fixed incomes. Further, the increases of 150% on the amount of out-of-pocket maximum and the increases in co-payment deductibles while cutting drug benefits will create hardship on the lives of thousands of education and state employees, both active and retired. With the current economic crisis, and the cost of basic necessities dramatically increasing, employees simply can’t afford the increases in premiums and costs while medical benefits are cut as proposed.”

PEIA board should take hard look at premium hike (Kaiser study info)

PEIA board should take hard look at premium hike

Times West Virginian

November 30, 2008 01:03 am

— When the economy worsens, families often have to make tough decisions.
A recent study by the Kaiser Family Foundation found that a third of Americans had trouble paying medical bills, and at least half either did not pay a delinquent bill or did not seek medical care because of the cost. The American Hospital Association also reports that admissions and elective procedures are down nationwide and there has been an increase in the number of patients unable to make co-pays or the full cost of treatment for the uninsured.
It is a disturbing trend, and one that may worsen as wages stay constant, insurance premiums increase and costs escalate. All Americans should have access to adequate medical care at an affordable cost.
But the term “affordable cost” is a subjective one. Families with medical insurance often have to pay hundreds of dollars per month in premiums on top of co-pays for doctor appointments and payments toward a deductible for treatments and procedures. An increase in premiums, even a small one, could make things even more difficult for families who are already scrimping and pinching to make ends meet between paychecks.
More than 200,000 West Virginians insured by the Public Employees Insurance Agency may face up to a 9 percent increase in premiums an possible cuts to benefits next fiscal year. For retired public employees, the premium hike could be as high as 11 percent, which is unfortunate for those already on fixed incomes with limited options when it comes to health-care coverage.
The whole situation is unfortunate. In 2006 and 2007, PEIA actually turned over surpluses to the state. But this year, claims have jumped by $35 million to $454.4 million, not surprising considering the fact that baby boomers are advancing in age, and with age come chronic medical conditions that require regular care.
It’s also unfortunate that public employees have in the past negotiated for smaller or no wage increases to keep premiums flat. To increase those premiums now, especially for the retired public employees, is a little difficult to take.
PEIA officials have pointed to the fact that private insurance premiums are increasing at a similar rate, and certainly that has to be taken into consideration. Insurance administered by the state must be fiscally responsible and conservative. If a rate increase is necessary to make the agency sound, then it has to be done.
But we encourage the PEIA board when it meets on Dec. 4 to consider looking at its administrative budget and its projected costs again prior to settling on a percentage premium increase for those covered, especially the retired employees. A smaller increase, if it can be achieved, may be a bit more palatable. The agency should also consider investing even more in preventative care and health education programs, like weight management and smoking cessation, so that claims will be maintained in future years.
Those who have dedicated their lives to public service, whether it be law enforcement, teaching or municipal work, deserve the best we can offer them.

http://www.timeswv.com/editorials/local_story_335010335.html/resources_printstory