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PEIA Finance Board Plan Proposal

Summary of PEIA Plan Proposal for FY 2020

(July 2019 – June 2020)

The PEIA Finance Board has released its Proposed Plan for the next fiscal year. Below is a synopsis of the plan. While plan changes appear minimal, AFT-WV is analyzing these proposals and will address any concerns at the public hearings.

  • Third Party Administrator Change
  • UMR, a UnitedHealthcare company, is the new TPA
  • Effective 7/1/19 for all our active and pre-65 populations
  • UMR is the nation’s largest TPA with 2,800 customers and 4.5M members
  • Currently UMR serves 559 state and public sector customers
  • PEIA is UMR’s largest customer
  • $9.2M estimated first year savings

In addition to the current PEIA customer service staff, PEIA will be serviced from a UMR

Customer Service Center in Charleston, WV.

  • Member engagement and member health

UMR will provide Utilization Management & Care Management (including 5 community care nurses placed regionally around the state focusing on member education and engagement)


•            UMR will also manage out of state contracts with national UHC networks.

•            National Centers of Excellence for Transplants, including CAMC and WVU for certain transplants

•            Management and Clinical Reporting for the Comprehensive Care Program (CCP)

– improving member health is a key initiative

 What members can expect:

•            New ID cards and new web portal which will include the ability to chat with Plan Advisors

•            Plan Advisors to assist members in navigating health care services

 What providers can expect:

•            Ability to access pre-authorization or prior approvals online through a new provider portal as well as view status of claims and eligibility;

•            Benefits Fax Back as confirmation of benefits when a provider calls to confirm service or eligibility of a member

  • Healthy Tomorrows

•            There will no longer be an annual requirement for blood work in FY 2020.

•            PEIA is continuing to evaluate the program for future years and exploring new wellness options for the future

•            New programs

  • Pilot project – Naturally Slim (weight loss and health)
  • Diabetes Prevention Project – evaluating services
  • Other programs are being explored
  • Medicare Retirees

(Plan year January 2020 – December 2020)

•            Received 2-year rate guarantee from Humana

•            No benefit changes for Plan Years 2019 or 2020

•            Probably will see formulary changes for 2020, since those changes happen regularly

  • Active Employees, Non-Medicare Retirees, and Non-State Agencies

Recommendations from the PEIA Task Force

•            Plan A back to 80/20 coinsurance in WV external bordering counties only

•            Plan B back to 70/30 coinsurance in WV external bordering counties only

•            Remove facility fee limits

•            Remove $25 copay for out-of-state services

•            Add an appeal process for people requiring a third-tier non-preferred drug to allow for reduced copays


Click here to view PEIA's powerpoint presentation on these proposals. 

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