Gov. Jim Justice on Tuesday sent his recommendations to the group that is exploring a long-term fix for the state’s public employee health insurance program.
People who are insured by PEIA and living in border counties would pay less out of pocket for health care they seek in a neighboring county out of state, if the governor’s recommendations are adopted.
"Today, we're able to maybe take off the barriers to be able to go right across the river, to be able to go to your doctor across the river, and eliminate the co-pays and these penatlities," he said at a press conference Tuesday on other topics.
In this situation, PEIA currently covers 70 percent of coverage for those with Plan A benefits, with customers picking up the rest. If the task force takes up the recommendations, it would move the plan back to an 80/20 model. Those with Plan B benefits on a 60/40 model would go back to 70/30.
PEIA members have told the task force soliciting feedback about the system that improving border coinsurance was a priority, according to American Federation of Teachers-West Virginia President Fred Albert, who called those recommendations "encouraging."
"That means less money out of the customer’s pocket and less money out of their paycheck," said Albert, a Dupont Middle School teacher, who was elected to head the teacher union last month.
Overall, the proposed changes are a step in the right direction, he said.
"These recommendations are not a long-term fix, but they’re very helpful, and it’s very promising," Albert said.
Other recommendations include removing fee limits from out-of-state facilities, removing the $25 copay for out-of-state services and adding an appeal process for people requiring a third-tier non-preferred drug to allow for reduced copays. Justice also said he's asked for a wellness plan review "to further incentivize our members to seek better health outcomes."
"I believe these recommendations address the issues that will benefit PEIA recipients the most," he said in a press release. "These changes along with my proposal for $100 million to the PEIA stabilization fund over the next two years will go a long way to fixing PEIA."
Justice established the task force amid a nine-day statewide strike by teachers, who were calling for an increase in pay and a long-term solution to their health insurance program. The task force was split into three subcommittees: Public Outreach, Cost and Revenue and Coverage and Plan. Justice submitted the recommendations Tuesday to the latter group.
The full task force is set to meet Monday, Dec. 10, to adopt a final report.