PEIA Updates and Clarifications: Important Changes for Plan Year 2024
PEIA Updates
and
Clarifications
Jan Powell
PEIA Communication Director
Introduction
PEIA Updates and Clarifications
Agenda:
•
Senate Bill 268 changes
•
Plan Year 2024 Financial Plan Changes
•
Leaves of Absence
•
Divorce reporting
•
Faxing documents
•
Questions and Answers
2023
2
Senate 268
•
Makes three substantial changes to PEIA effective July 1, 2023:
•
Imposes the monthly spouse surcharge for active employee policyholders from state agencies,
colleges, universities, and county boards of education whose spouses are offered employer-
sponsored insurance coverage but who choose to get coverage through a plan offered by
PEIA.
•
This change does not affect
•
non-state agencies,
•
retirees,
•
spouses who are employed by PEIA-participating agencies or are retired, or
•
spouses whose coverage is through Medicare, Medicaid, or TRICARE.
•
Increases health premiums to get the plan back to an 80/20 employer/employee premium split
for state agencies, colleges, universities, and county boards of education by July 1, 2023.
•
Increases reimbursement to providers to a minimum of 110% of Medicare’s reimbursement.
•
This increases out-of-pocket costs for all PEIA PPB Plan members
PEIA Updates and Clarifications
2023
3
Plan Year 2024 Financial Plan Changes
•
State Fund - Plan B deductibles and out of pockets adjusted to
have amounts at each salary index vs. the current two levels
•
Plan B medical coinsurance, copays and prescription benefits did not
change
•
Plan C deductibles increased to $1,500 for employee only and
$3,000 for employee with children and family policy tiers per IRS
guidelines
•
Addition of residential services benefit
•
Mandatory participation in the SaveOnSP manufacturer assistance
program for specialty prescriptions
PEIA Updates and Clarifications
2023
4
Plan Year 2024 Premiums
•
Employer premiums are increasing for PY 2024
•
actual per-tier increases for employer premiums are higher than the
estimated 22.4%
•
we are assuming migration from Family tiers to Employee only/Employee with
children due to spousal surcharge
•
This migration lowers the Er portion in the 80/20 calculation
•
R
equires higher premium increases on the current employer premiums to
maintain plan funding
PEIA Updates and Clarifications
2023
5
Leaves of Absence
•
The number of reported leaves of absence has fallen off dramatically
•
Fewer leaves or just less reporting?
•
New reporting form for employers to use starting July 1
•
Report any leaves that have not yet been reported to us
•
Form can be faxed to PEIA at 1-877-233-4295 or emailed to
PEIA.eligibility@wv.gov
•
Must hold an open position and expect the employee to return to
work at the end of the LOA.
PEIA Updates and Clarifications
2023
6
Leaves of Absence
•
Must report to PEIA when an employee goes on an approved
Leave of Absence.
•
Need to know
•
the start date of the LOA and
•
the expected end date of the LOA – cannot be TBD or more than 12
months from signature date on the form
•
If employee doesn’t return to work by expected end date,
submit another copy of the form with new anticipated end date.
PEIA Updates and Clarifications
2023
7
Leaves of Absence
•
Medical leave (non-worker’s comp)
•
employer must pay employer share of premium for up to 12 months
•
Employee must submit physician’s statement monthly
•
Employer must keep statements and produce if audited by PEIA
•
Personal leave
•
Employer must approve and report to PEIA
•
Employer makes agreement with employee about duration
•
No obligation to pay employer portion of premium – can make
employee pay full cost of coverage
PEIA Updates and Clarifications
2023
8
Leaves of Absence
•
Workers Comp Medical leave
•
No time limit
•
Employer and employee must pay their respective shares of the
premium cost if the employee receives temporary total disability
benefits.
•
If the employee fails to pay premium, the employer may terminate
coverage
•
Details for other leaves can be found in the BC Reference
Manual on the PEIA website or in the SPD
PEIA Updates and Clarifications
2023
9
Divorce Reporting -- Policyholders
•
Policyholders have to report divorces immediately
•
“Immediately” means
•
As soon as practically possible
AND
•
No more than thirty (30) days from the date of the divorce decree
•
Reporting means submitting either
•
A completed “Change in Status” form to the member’s Benefit
Coordinator or
•
An electronic transaction on the PEIA Manage My Benefits Portal
•
The form or transaction must include a copy of the divorce decree –
“waiting on my attorney” is not a legitimate reason to delay reporting
•
Cannot report a divorce with a phone call
PEIA Updates and Clarifications
2023
10
Divorce Reporting - Agencies
•
Agencies have to report divorces within 5 business days of receipt from
the policyholder
•
If employee reports to the employer, but employer fails to report to PEIA,
the employer is responsible for claims paid in error
•
Reporting means submitting
•
the completed paper Change in Status form (our least preferred
option) or
•
Entering the information from the Change in Status form in Benefit
Coordinator Data Entry on Manage My Benefits
•
Approving the electronic transaction on the PEIA Manage My Benefits
Portal
•
The form or transaction must include a copy of the divorce decree
PEIA Updates and Clarifications
2023
11
Thank you
Jan Powell
Janice.L.Powell@wv.gov
Peia.wv.gov
PEIA Updates and Clarifications
2023
12
Senate Bill 268 brings significant changes to the PEIA effective July 1, 2023, impacting spouse surcharges, premium splits, and provider reimbursements. Plan Year 2024 introduces financial plan adjustments, premium increases, and benefits modifications, emphasizing employer premium hikes and mandatory programs. The communication from Jan Powell, PEIA Communication Director, provides insights into these crucial updates affecting state agencies, colleges, universities, and education boards. Stay informed to navigate the evolving landscape of PEIA offerings.
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Presentation Transcript
PEIA Updates and Clarifications Jan Powell PEIA Communication Director
Introduction Agenda: Senate Bill 268 changes Plan Year 2024 Financial Plan Changes Leaves of Absence Divorce reporting Faxing documents Questions and Answers 2023 PEIA Updates and Clarifications 2
Senate 268 Makes three substantial changes to PEIA effective July 1, 2023: Imposes the monthly spouse surcharge for active employee policyholders from state agencies, colleges, universities, and county boards of education whose spouses are offered employer- sponsored insurance coverage but who choose to get coverage through a plan offered by PEIA. This change does not affect non-state agencies, retirees, spouses who are employed by PEIA-participating agencies or are retired, or spouses whose coverage is through Medicare, Medicaid, or TRICARE. Increases health premiums to get the plan back to an 80/20 employer/employee premium split for state agencies, colleges, universities, and county boards of education by July 1, 2023. Increases reimbursement to providers to a minimum of 110% of Medicare s reimbursement. This increases out-of-pocket costs for all PEIA PPB Plan members 2023 PEIA Updates and Clarifications 3
Plan Year 2024 Financial Plan Changes State Fund - Plan B deductibles and out of pockets adjusted to have amounts at each salary index vs. the current two levels Plan B medical coinsurance, copays and prescription benefits did not change Plan C deductibles increased to $1,500 for employee only and $3,000 for employee with children and family policy tiers per IRS guidelines Addition of residential services benefit Mandatory participation in the SaveOnSP manufacturer assistance program for specialty prescriptions 2023 PEIA Updates and Clarifications 4
Plan Year 2024 Premiums Employer premiums are increasing for PY 2024 actual per-tier increases for employer premiums are higher than the estimated 22.4% we are assuming migration from Family tiers to Employee only/Employee with children due to spousal surcharge This migration lowers the Er portion in the 80/20 calculation Requires higher premium increases on the current employer premiums to maintain plan funding 2023 PEIA Updates and Clarifications 5
Leaves of Absence The number of reported leaves of absence has fallen off dramatically Fewer leaves or just less reporting? New reporting form for employers to use starting July 1 Report any leaves that have not yet been reported to us Form can be faxed to PEIA at 1-877-233-4295 or emailed to PEIA.eligibility@wv.gov Must hold an open position and expect the employee to return to work at the end of the LOA. 2023 PEIA Updates and Clarifications 6
Leaves of Absence Must report to PEIA when an employee goes on an approved Leave of Absence. Need to know the start date of the LOA and the expected end date of the LOA cannot be TBD or more than 12 months from signature date on the form If employee doesn t return to work by expected end date, submit another copy of the form with new anticipated end date. 2023 PEIA Updates and Clarifications 7
Leaves of Absence Medical leave (non-worker s comp) employer must pay employer share of premium for up to 12 months Employee must submit physician s statement monthly Employer must keep statements and produce if audited by PEIA Personal leave Employer must approve and report to PEIA Employer makes agreement with employee about duration No obligation to pay employer portion of premium can make employee pay full cost of coverage 2023 PEIA Updates and Clarifications 8
Leaves of Absence Workers Comp Medical leave No time limit Employer and employee must pay their respective shares of the premium cost if the employee receives temporary total disability benefits. If the employee fails to pay premium, the employer may terminate coverage Details for other leaves can be found in the BC Reference Manual on the PEIA website or in the SPD 2023 PEIA Updates and Clarifications 9
Divorce Reporting -- Policyholders Policyholders have to report divorces immediately Immediately means As soon as practically possible AND No more than thirty (30) days from the date of the divorce decree Reporting means submitting either A completed Change in Status form to the member s Benefit Coordinator or An electronic transaction on the PEIA Manage My Benefits Portal The form or transaction must include a copy of the divorce decree waiting on my attorney is not a legitimate reason to delay reporting Cannot report a divorce with a phone call 2023 PEIA Updates and Clarifications 10
Divorce Reporting - Agencies Agencies have to report divorces within 5 business days of receipt from the policyholder If employee reports to the employer, but employer fails to report to PEIA, the employer is responsible for claims paid in error Reporting means submitting the completed paper Change in Status form (our least preferred option) or Entering the information from the Change in Status form in Benefit Coordinator Data Entry on Manage My Benefits Approving the electronic transaction on the PEIA Manage My Benefits Portal The form or transaction must include a copy of the divorce decree 2023 PEIA Updates and Clarifications 11
Jan Powell Janice.L.Powell@wv.gov Peia.wv.gov Thank you 2023 PEIA Updates and Clarifications 12
