The PEIA Finance Board approved the following changes to PEIA's health plans (effective July 1, 2015):
Copay and out-of-pocket max increases
State Agencies, Colleges, Universities and County Boards of Education -- no premium change
Generic Drug Copays:
30-day supply will increase $5
90-day supply will increase $10
Preferred Brand Drug Copays:
30-day supply will increase $10
90-day supply will increase $20
Plan C only after Deductible is met and for
medications on the Preventive Drug List.
Out-of-pocket maximum :
Plans PPB A and D
Family Out-of-pocket maximum increases from 1.5x the employee only amount to 2x the employee only amount
All PPB Plans
Deductible increase by $25 for employee only and $50 for family-type plans
PCP visit copay increases from $15 to $20
Specialist visit copay increases from $25 to $40
Outpatient surgery copay increases by $50
ER copay increases to $100, with no discount
Waived if admitted
Inpatient Hospital copay of $100 per admission
In addition to existing deductible & 20% coinsurance
Open Enrollment 2016 --PEIA PPB Plan policyholders
Plan Year 2016:
Before May 15, 2015, all PEIA PPB Plan policyholders must name a PCP
Plan Year 2017:
Between April 2015 and the end of open enrollment in 2016, policyholder must:
Continue to have a PCP named Have bloodwork done
Report values to PEIA on form in this year's Shopper's Guide
Plan Year 2018:
Between April 2017 and the end of open enrollment in 2018, policyholder must:
Continue to have a PCP named Have new bloodwork done
Report values to PEIA on form in Shopper's Guide
Have values in acceptable range
Each year thereafter, will repeat requirement for 2018
Any year the policyholder does not meet the goal, policyholder pays an additional $500 deductible
Only the policyholder needs to comply with Healthy Tomorrows requirements
Use Manage My Benefits to name a PCP
When asked, be sure to choose Open Enrollment and the script will walk you through the process
If no internet access, call PEIA at 877-676-5573 to request a Pick-a-PCP form
On menu, choose to order a Pick a PCP form Enter SSN from telephone keypad
Form will be mailed on the next business day
PEIA will not take PCP designations for Plan Year 2016 after May 15, 2015 -- no exceptions
New hires during the plan year will not have to meet the Healthy Tomorrows goals until the following open enrollment
Will not be charged the $500 deductible in the plan year in which they are hired
The next open enrollment, the new hire will have to meet all requirements for the Plan Year.
NEW PEIA INFORMATION FROM THE ONE AND ONLY VICKI HAMMER! - 19 March 2014
The PEIA Finance Board approved the following changes to PEIA's health plans (effective July 1, 2014):
1. Discontinuation of the Improve Your Score dicount program. As you may recall, when the program was implemented,
all premiums were increased by $10 per month, and then those who participated in the program got a $10 per month discount.
Standard premiums for active employees will be reduced by $10 on July 1, 2014.
2. A second attempt at the Face-2-Face Diabetes Management Program. Members who either failed to comply or dropped out
of the program will be give a second chance to participate. There is a 12-month waiting period after the first
attempt. The Face-2-Face Program is available to active employees and non-Medicare employees only.
3. Two-tier specialty drug benefit ($50 co-pay for preferred specialty drugs and $100 co-pay for non-preferred
specialty drugs). Specialty drugs are the fastest growing portion of the plan. The average cost is $3,200
a month. The change applies to active employees and non-Medicare retirees only.
4. $25 co-pay for the services below when received out-of-state. These services are widely available in all areas
of the state. The copay applies only to PEIA-insured members living in West Virginia and the continguous counties of
surrounding states when care is recieved in a bordering county. The changes applies to active employees and
non-Medicare employees only.
* Computerized tomography (CT) scans
* Dialysis (Per treatment)
* Durable medical equipment purchases that exceed $100
* Magnetic resonance imaging (MRI)
* Magnetic resonance angiogram (MRA)
* All outpatient surgery
5. No premium increases. The finance board held premiums steady for all employers, active employees and retirees
(except for the premium decrease discussed above).
PEIA ONLINE ENROLLMENT INSTRUCTIONS!
- 18 March 2014
Click Here for Detailed Instructions for the PEIA Online System CLICK HERE
It's time to Complete Your Living Will/Advance Directive
Affidavit! - 21 October 2010
Once you've completed your advance directive,
the easiest way to get your discount is to complete the Living
Will Affidavit on PEIA's "Manage My Benefits" site.
Go to www.wvpeia.com
and click on the green "Manage My Benefits" button in
the upper right corner. If you've used the site before, just log
in. If you haven't used the site before, you'll use the "Need
to Register" function before you complete your affidavit.
When you get to your menu, choose the Living Will button and follow
Please remember, PEIA does not want a copy of your advance directive
or living will. Please DO NOT mail or fax a copy of your actual
advance directive document to us. All you must do to receive the
discount is complete the affidavit - either online or on paper.
Memo from PEIA Administration -
16 September 2009
In an effort to make our operations at PEIA more
efficient, we'd like to ask your cooperation with the following:
1. Please refer all member eligibility calls to
Customer Service. All members should be referred to Customer Service
(1-888-680-7342, option 0) even if they have questions about eligibility.
The Customer Service staff has the training in eligibility issues
to be able to answer member calls. Please do not give the names
and extension numbers of the eligibility staff to your PEIA members.
2. For claim or customer service issues, please
refer your PEIA members to PEIA's contractors first. As you know,
we have a VERY SMALL customer service staff here, and their job
is to handle the more complex issues that the contractors can't
handle. Questions should be referred to:
a. PPB benefits, claims, and ID cards: Wells Fargo
b. PPB precertification and out-of-state referrals: ActiveHealth
c. PPB prescription issues: Express Scripts Inc. 1-877-256-4680
d. Health Plan HMO questions: The Health Plan 1-888-847-7902
e. Carelink HMO questions: Carelink 1-800-348-2922
f. Medicare retiree benefit questions (thru 12/30/09): Advantra
g. Future (1/1/10) Medicare retiree questions: Humana
3. As a general rule, temporary ID cards will no
longer be generated. Enrollment forms must be submitted to PEIA
by the 15th of the month in order for eligibility to complete
the data entry and for the member to receive an ID card by the
first of the following month. Online transactions must be completed
and approved by the 20th of the month for the member to receive
an ID card by the first of the following month. If PEIA does not
complete the data entry within a time frame to allow for the member
to receive the ID card by the 1st of the month, then the member
may request a temporary ID card. Otherwise, you may advise them
to present a copy of their enrollment form, or they may use the
policyholder's SSN as their ID number to receive services.
We appreciate your help as we try to change processes
here to make the plan work more efficiently for everyone!
Beginning with Plan Year 2009 on July 1, 2008,
participants will no longer be required to complete a tobacco
affidavit each year unless there is a change in participant
or dependent tobacco use. Changes (tobacco status, adding or deleting
dependents, etc.) may be made through the Board office or online
once you have gone through the initial registration process.