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)
Network
• 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.