shopper’s guide - peia · the coming plan year. read more about these programs on pages 10 and...
TRANSCRIPT
Shopper’s Guide
Plan Year 2011 Benef its
JulY 1 , 2010 - June 30 , 2011
the fine Print
This Shopper’s Guide is not intended to be a formal statement of benefits. It is designed to provide general information about the available plans. It is intended to be a first step in helping you choose the most appropriate health benefit plan for you and your family.
Questions about particular benefits, limitations, costs, providers, or restrictions, should be directed to the individual plans for answers. If you enroll in a managed care plan, the plan you select will send you an “evidence of coverage” booklet with more complete details of your benefits.
PEIA cannot guarantee the quality of services offered by the various plans, so please gather information and make your decision carefully. Before enrolling, assure yourself that the plan you choose offers a level of care and convenience with which you and your family will feel comfortable.
Also be aware that the continuing participation of managed care network providers is not guaranteed throughout the Plan Year. If a provider chooses to withdraw from a managed care network, the member may be required to receive services from another participating provider.
We have tried to ensure that the information in this booklet is accurate. If, however, a conflict arises between this Guide and any formal plan documents, laws or rules governing the plans, the latter will necessarily control.
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table of Contents
What’s Important For 2011? ..................................................................................................................................................3How To Have a Successful Open Enrollment ...........................................................................................................................4Terms You Need To Know ......................................................................................................................................................4Eligibility Rules ...................................................................................................................................................................6-7PEIA PPB Plan C ..................................................................................................................................................................8-9
Benefits at-a-GlanCeBenefits At-A-Glance ......................................................................................................................................................11-21
Benefit Fairs Sites & Dates ....................................................................................................................................................22Managed Care Plans’ Enrollment Areas ................................................................................................................................22
Premiums and rates: emPloYees and retireesMonthly Premiums: Employee or Employee/Child .................................................................................................................24Monthly Premiums: Family or Family/Employee Spouse .........................................................................................................25Non-State Agency: Premiums ...............................................................................................................................................26Non-Medicare Retiree Premiums .....................................................................................................................................27-28Medicare Retiree Premiums ..................................................................................................................................................29COBRA Rates For State Agencies, Colleges, Etc. ..................................................................................................................31COBRA Rates For Non-State Agencies ..................................................................................................................................31
oPtional life insuranCeActive Employee’s Optional Life Insurance: TOBACCO FREE ..................................................................................................33Active Employee’s Optional Life Insurance: TOBACCO USER .................................................................................................34Retired Employee’s Optional Life Insurance: TOBACCO FREE ................................................................................................35Retired Employee’s Optional Life Insurance: TOBACCO USER ................................................................................................36Other Insurance Rates ..........................................................................................................................................................37
Premium ConVersion PlanPEIA’s Premium Conversion Plan: Make Your Choices ...........................................................................................................39Commonly Asked Questions ...........................................................................................................................................39-42Premium Conversion Plan Form (detachable form) ...............................................................................................................42
West VirGinia Center for end of life CareAdvance Directives for Health Care Decision-making ............................................................................................................44Combined Medical Power of Attorney and Living Will (detachable form) ..............................................................................45
What’s important for 2011?Carelink
• Despitelengthynegotiations,PEIAandCarelinkwereunabletocometotermsforPlanYear2011.
• CarelinkwillnotbeavailableasamanagedcareoptioneffectiveJuly1,2010.
• CurrentCarelinkmemberswillhavetomakeachoiceduringthisopenenrollment.Youwillreceivealetterfrom Carelinknotifyingyouoftheirwithdrawal.YouwillalsoreceivealetterandaTransferFormfromPEIAsoyoucan indicateyourplanchoiceforPlanYear2011.Ifyoudonotchooseaplanduringopenenrollment,PEIAwillmoveyou toPEIAPPBPlanAeffectiveJuly1,2010.
• CarelinkwillcontinuetoserveitsexistingmembersthroughtheendofthisPlanYear.Ifyouhavebenefitquestionsor concerns,contactCarelinkat1-800-348-2922
the Health Plan
• MariettaMemorialHospitalisnowacontractedproviderandinTheHealthPlan’snetwork!
• TherewillbeaplandesignchangeeffectiveJuly1,2010forbothPlanAandPlanB:SpecialtyDrugswillbecovered undertheprescriptiondrugrider.Theywillbecoveredwitha30%copayor$300copay,whicheverisless,per30day supplyforbothretailandmailorder.SpecialtyDrugsarethosehighcostmedications,includingbiotechnologydrugs thatmaybeadministeredbyinjection,oral,transdermalorinhaled.SpecialtyDrugsareusedtotreatveryspecific diseasesandrequireextensivemanagementforsafetyandeffectiveness.Dosagesneedtobemonitoredfor effectiveness and adjustments may be needed for adequate response to effectively treat the disease. Specialty drugs requirecomplexdispensingtechniquesanddispensingmaybelimitedtopharmacieswithspecificskillsanddistribution programs to assure proper delivery of these medications.
• TheHealthPlanmaintainsitsExcellentAccreditationwiththeNationalCommitteeforQualityAssurance(NCQA).
• VisittheHealthPlanatwww.healthplan.org.YouwillfindinformationabouttheservicesofferedbyTheHealthPlan andhelpfullinksforbetterhealth.YoucanalsocontactTheHealthPlantollfreeat1-888-847-7902or1-800-624-6961.
Peia PPB Plans
Peia PPB Plan C. BeginningJuly1,2010.PEIAwillofferanIRS-qualifiedHighDeductibleHealthPlan(HDHP)thatwe’recallingPEIAPPBPlanC.Theplanofferslowerpremiums,butahighdeductiblethatmustbemetbeforetheplanbeginstopay.TheplanisdesignedtoworkwitheitheraHealthSavingsAccount(HSA)oraHealthReimbursementArrangement(HRA).Foradetailedlookatthenewplan,seepages8-9.AnydiscussionregardingtheHSAorHRAisprovidedforinformationalpurposesonly.PEIAcannotgivetaxadvice.YoushouldconsultyourtaxadvisorforinformationonHSAsorHRAsandtheirtaxconsequences.
family out-of-Pocket maximum (ooPm) increase. BeginningJuly1,2010,inPEIAPPBPlanA,theOOPMforemployeeandchild(ren),familyandfamilywithemployeespousecoverageswillincreasetooneandonehalftimestheindividualOOPM.Thenewamountsareprintedinthepremiumtablesatthebackofthisguide.Besuretotakenoteofthechange.
Premium discounts.Duringthiscomingplanyear(afterJuly1,2010),PEIAwillrollouttwonewwaystoreceiveapremiumdiscounteffectiveJuly1,2011.Onediscountwillbeavailabletomemberswhocertifythattheyhaveexecuteda Living Will, and the other will be available to members who have certain modifiable health risk factors screened during thecomingplanyear.Readmoreabouttheseprogramsonpages10and44,andlookforfulldetailscomingthissummer!
face 2 face diabetes management change.EffectiveJuly1,2010,tobeeligibletoenrollandparticipateintheFace2Faceprogram,theparticipantmustbetobacco-freeandbereceivingthetobacco-freepremiumdiscount.Thatmeansthemembermusthavebeentobacco-freeforatleastsixmonths.
lifetime maximum.ForallPEIAPPBPlans,thelifetimemaximumhasincreasedfrom$1millionto$1.5millioneffectiveJuly1,2010.
life insurance.Besuretocheckoutthelifeinsuranceinformationonpages33-37.Ratesarechangingthisyear.
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How to Have a Successful Open Enrollment1. Read through “What’s Important for 2011” to get a quick overview of the changes for the coming Plan Year. 2. Review the side-by-side comparison of the plans in the “Benefits At-A-Glance” charts. 3. Check page 22 to be sure you’re eligible to enroll in the plan you want. The PEIA PPB Plan is available in all areas. Remember, you must live in one of the counties listed on page 22 to enroll in The Health Plan. 4. Check the premium table for your employer type (State agency, county board of education, non-State agency, retiree, etc.) and for the type of coverage you have (employee only, family, etc.) to find the premium for the plan you want. 5. Remember that PEIA health and optional life insurance premiums are based on your tobacco-use status. For family coverage, all enrolled family members must have been tobacco-free by January 1, 2010, to qualify for the premium discount, and this year, we’ve printed only the standard premium. If you are tobacco-free, you must subtract $25 for a single plan or $50 for a family plan to get your correct premium. The Health Plan does not offer a tobacco-free premium discount. PEIA may check tobacco use. 6. If you want to change plans or change your tobacco status, go to www.wvpeia.com and click on the Online Open Enrollment button and follow the instructions. Make any changes or plan selections you wish. Remember, your deadline is midnight on April 30, 2010. 7. If you need to make a change and don’t have internet access, call PEIA for a Transfer Form.
Terms You Need To KnowAnnual Out-Of-Pocket Maximums: Each plan has limits on what you are required to pay in out-of-pocket expenses for medical services and prescription drugs each year. You’ll find details in the “Benefits-At-A-Glance” charts.
Coinsurance: The percentage of the allowed amount that you pay when you use certain benefits.
COBRA: Gives employees rights to continue health insurance coverage after employment terminates. See your Summary Plan Description for full details.
Coordination of Benefits (COB): Health plans use COB to determine which plan will pay benefits first, and to make sure that together they do not pay more than 100% of your bill. Be sure to ask the managed care plans about COB before you make your choice.
Copayment: A set dollar amount that you pay when you use certain services.
Deductible: The dollar amount you pay before a plan begins paying benefits. Not all services are subject to the deductible, so check the “Benefits-At-A-Glance” charts.
Explanation of Benefits (EOB): Forms issued by health plans when medical claims are paid. Most HMOs do not issue EOBs for in-network care. If you need an EOB, talk to the HMO to see how you can get the paperwork you need.
Health Maintenance Organization (HMO): HMOs manage health care by coordinating the use of health care services through PCPs. If you join an HMO, you’ll pick your PCP from their list, and then you’ll receive all of your non-emergency care from network providers. Ask the HMOs about their rules.
Health Savings Account (HSA): A health savings account (HSA) is a tax-exempt trust or custodial account that you set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur. No permission or authorization from the IRS is necessary to establish an HSA. When you set up an HSA, you will need to work with a trustee. A qualified HSA trustee can be a bank, an insurance company, or anyone already approved by the IRS to be a trustee of individual retirement arrangements (IRAs) or Archer MSAs. The HSA works in conjunction with a High Deductible Health Plan. For more information, and a full description of PEIA’s HDHP (PEIA PPB Plan C), see pages 8-9.
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High Deductible Health Plan (HDHP): A High Deductible Health Plan (HDHP) is a plan that includes a higher annual deductible than typical health plans, and an out-of-pocket maximum that includes amounts paid toward the annual deductible and any coinsurance that you must pay for covered expenses. The HDHP deductible includes both medical services and prescription drugs under a single deductible. Out-of-pocket expenses include copayments and other amounts, but do not include premiums. For a full description of PEIA’s HDHP, PEIA PPB Plan C, see pages 8-9.
Lifetime Maximum Benefit: Each plan has a maximum it will pay for a member in a lifetime. You’ll find details in the Benefits-At-A-Glance charts.
Medicare Advantage Plan: Medicare retirees’ medical benefits are administered through Humana, Inc. and their prescriptions are administered by Express Scripts, Inc. Please read more about these programs on page 29 of this booklet.
Medical Home: PEIA offers a Medical Home program that focuses on patients as active participants in their own health and well-being. Patients are cared for by a physician who leads the medical team that coordinates all aspects of preventive, acute and chronic needs of patients using the best available evidence and appropriate technology. These relationships offer patients comfort, convenience, and optimal health throughout their lifetimes. Medical home office visits in PEIA PPB Plans A and B have a discounted copayment of $10 per visit.
PEIA Preferred Provider Benefit Plans (PPB): The self-insured PPO plans offered by PEIA that cover care based on where you live, and where you receive your care. To determine which out-of-state providers are PPO providers, call Wells Fargo TPA at 1-888-440-7342. For full details of the benefits, see your Summary Plan Description.
Pre-Existing Condition Limitations: A pre-existing medical condition is one that has been diagnosed or treated, or for which you or your dependents have incurred expenses within the three months immediately before the effective date of coverage. If you move from one plan to another during open enrollment, you and your covered dependents will face no limitations on preexisting medical conditions, regardless of what plan you join.
Primary Care Physician (PCP): A provider in a network who coordinates members’ health care. PCPs are usually family doctors, general practice physicians, internists, or pediatricians. Some plans allow OB/GYNs to be PCPs for women in the plan. PCPs must provide coverage for their practices 24 hours-a-day, 7 days-a-week so you can reach them if you need care.
Public Employees Insurance Agency (PEIA): The State agency that arranges for health and life insurance benefits for West Virginia’s public employees. PEIA administers the PEIA PPB Plans, and contracts with all of the managed care plans that are offered to public employees.
Breaking News!
As we go to press, there is pending legislation that will remove the pre-existing condition limitation from the PEIA PPB Plans. The bill also tightens PEIA’s eligibility rules to:
1. Allow existing plan members to add dependents to their coverage only during the open enrollment period each spring or when they have a qualifying event (see chart on page 41); and
2. Allow employees who declined health coverage to enroll in the plan only during open enrollment or at the time of a qualifying event.
We believe these changes will take effect on July 1, 2010, so existing plan members and new hires need to be aware that the rules may be changing. Currently, PEIA PPB plan members can add dependents at any time by completing a change in status form, but those dependents are subject to pre-existing condition limitations.
Watch PEIA’s website for more information at www.wvpeia.com.
eligibility rulesThissectionoffersgeneralinformationabouteligibilitythatyoumayneedduringOpenEnrollment.Forcompletedetails,please refer to your PEIA Summary Plan Description. It’s on the web at www.wvpeia.com.
Who is eligible to transfer or enroll? Current members.CurrentenrolleesinanyPEIA-sponsoredmanagedcareplanorthePEIAPPBPlanorPEIA-sponsoredlifeinsuranceonly(nohealthinsurance),mayjoinanyplan.
eligible non-members. An employee or retiree who is eligible for benefits may enroll in any plan for which they qualify duringOpenEnrollmentPeriod.
medicare. IfyouoranyenrolleddependentshaveMedicareasyourprimaryhealthcoverage(orwillatanytimeduringtheplanyear)youmaynotjoinamanagedcareplan.YouronlyoptionforPEIA-sponsoredMedicarecoverageistheHumanaPlan.IfeitheryouoryourenrolleddependentsbecomeMedicare-primarywhileenrolledinamanagedcareplan,youmustnotifyPEIA.Generally,Medicareisprimarywhenthepolicyholderisretired.IfyouhavemorequestionsaboutwhenMedicareisprimary,calltheOpenEnrollmentHelpline.FormoreinformationontheHumanaPlan,seepage29.CurrentHealthPlanmembersmayhavetheopportunitytoremainintheHealthPlanatthetimeofMedicareeligibility.ContacttheHealthPlanformoredetails.
eligible dependents. You and your enrolled dependents must all live in the enrollment area of a plan to be eligible to enrollforthatplan’sbenefits.Theonlyexceptiontothisruleismadeforfull-timestudentslivingoutofthearea.Youmayenrollthefollowingdependents:
• Yourlegalspouse(unlessyouareenrolledasaSurvivingDependent). • Yourunmarriedbiologicaloradoptedchildrenunderage25providedtheymeeteithertheIRSdefinitionofa “qualifyingchild”or“qualifyingrelative”below:
a qualifying child must meet these requirements: 1. relationship. Thetaxpayer’sunmarriedchildorstepchild(whetherbybloodoradoption). 2.residence.Hasthesameprincipalresidenceasthetaxpayerformorethanhalfthetaxyear.Exceptionsapply,in certain cases, for children of divorced or separated parents, and other special instances. 3.age. Mustbeundertheageof19attheendofthetaxyear,orundertheageof24ifafull-timestudentforat leastfivemonthsoftheyear,orbepermanentlyandtotallydisabledatanytimeduringthetaxyear. 4.support. Didnotprovidemorethanone-halfofhis/herownsupportforthetaxyear.
–or–
a qualifying relative must meet these requirements: 1.relationship. Thetaxpayer’sunmarriedchildorstepchild(whetherbybloodoradoption)whohasthesame principalabodeasthetaxpayerforthetaxableyearandisamemberofthetaxpayers’shousehold. 2. support.Forwhomthetaxpayerprovidesoverone-halfoftheindividual’ssupportforthatcalendaryear. 3.Qualifying Child.Isnotanotherwise“qualifyingchild”ofthetaxpayerorofanyothertaxpayerforanyportion ofthetaxyear.
Marriedchildrenarenoteligibleforcoverage.
two Public employees Who are married to each other, and who are both eligible for benefits under Peia may elect to enroll as follows:
1. as“FamilywithEmployeeSpouse”inanyplan. 2.as“EmployeeOnly”and“EmployeeandChild(ren)”inthesameordifferentplans(remember,you’llhavetwo out-of-pocketmaximumsandtwodeductiblesifyouenrollthisway). 3.as“EmployeeOnly”inthesameordifferentplansiftherearenochildrentocover(again,you’llhavetwo out-of-pocketmaximumsandtwodeductiblesifyouenrollthisway).
You may both be policyholders in the same plan, but only one may enroll the children. All children must be enrolled underthesamepolicyholder.ToqualifyfortheFamilywithEmployeeSpousepremium,bothemployeesMUSThavebasiclifeinsurance.TheFamilywithEmployeeSpousepremiumdiscountwillnotbegrantedunlessbothemployeesarebasiclife insurance policyholders in the plan.
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retired or retiring deputy sheriffs under age 55.
Premiumratesforallplansaresubstantiallyhigherthanthoselistedinthisguide.ContactPEIAoryourbenefitcoordinator for details of premium rates.
retiring employees: If you are considering retiring during the plan year, your choice this open enrollment will be an importantone.Atthetimeofretirementyoumaydropdependentsfromyourcoverage(ifyousochoose),oryoumay drop health coverage completely, but you may not change plans during the plan year unless you move outside a managedcareplan’senrollmentareaorunlessyou’llbeeligibleforMedicare—age65ordisabled—inwhichcaseyouwillbeprovidedPEIA’sMedicarebenefit.
transferring employees: If you transfer between State agencies during the plan year, remember that you can only change plans if you transfer out of the enrollment area of the plan you’re currently in. The PEIA PPB Plans don’t have a limited enrollment area, so if you’re in one of them, you’ll stay in it for the entire year, regardless of where you are transferred. TransferfromaStateagencytoanon-Stateagencymaypermitachangeincoverage.
mid-Year Plan Changes: The only time you can change plans during the plan year is if you move out of the enrollment area of your plan so that accessing care is unreasonable. Since the PEIA PPB Plans have an unlimited enrollment area, you will not be permitted to transfer out of them during the plan year, even if you move.
Physician Withdrawal from a Plan:IfyourPCPwithdrawsfromaplanyoumustchooseanotherPCP.Aphysician’sdeparture does not qualify you to change plans. Although most networks are stable, a physician can choose to withdraw fromanyplanatanytimewith60days’notice,soyouneedtobeawareofthatpossibilitywhenyoumakeyourselection.
death or divorce: A death or divorce occurs during a plan year, to continue coverage, you must remain in the plan you were in at the time of the death or divorce for the balance of the plan year. You can only change plans during the plan year if the affected dependents move out of the enrollment area of the plan so that accessing care is unreasonable.
terminated Coverage:Ifyourcoverageterminatesduetolossofemploymentorcancellationofcoverage,youMUSTceaseusingyourmedicalIDcard.Anyclaimsincurredaftertheterminationdatewillbetheresponsibilityofthepersonincurring the claims, and may be considered fraud.
special enrollment:Ifyouaredecliningenrollmentforyourselforyourdependents(includingyourspouse)becauseofother health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this planifyouoryourdependentsloseeligibilityforthatothercoverage(oriftheemployerstopscontributingtowardyouroryourdependents’othercoverage).However,youmustrequestenrollmentwithinthemonthoforthetwomonthsfollowingthedateyouroryourdependents’othercoverageends(oraftertheemployerstopscontributingtowardtheothercoverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may beabletoenrollyourselfandyourdependents.However,youmustrequestenrollmentwithinthemonthoforthetwomonths following the marriage, birth, adoption or placement for adoption. To request this special enrollment or obtain moreinformation,contactyourbenefitcoordinatororcall1-888-680-7342.
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Peia PPB Plan C
Peia’s High deductible Health PlanForPlanYear2011,PEIAisofferinganewkindofhealthplan.PlanCisaHighDeductibleHealthPlanwhichcanbepairedwithaHealthSavingsAccount(HSA)oraHealthReimbursementArrangement(HRA).
major Plan features:
deductible Theannualdeductibleis$1,200foremployeeonlycoverageand$2,400foremployeeandchild(ren),family,orfamilywith employee spouse coverage.
• Thisisacombinedmedicalandprescriptiondeductible. • Thisdeductiblemustbemetbeforetheplanbeginstopayformedicalservicesorprescriptiondrugbenefits. • UnlikePEIAPPBPlansAandB,inPlanCthefamilydeductiblecanbemetbyjustoneperson,andthefullamountof the family deductible must be met before the plan begins to pay. • Thefollowingservicesarenotsubjecttothedeductibleandarecoveredinfull: • Routineprenatalcare(physicianservices) • WellchildexamsandimmunizationsasrecommendedbytheAmericanAcademyofPediatrics • Highriskbirthscoreprogram • Annualscreeningmammogram • AnnualPapsmear • Colorectalcancerscreeningage50+above • Prostatecancerscreeningage50+above • AdultImmunizationsasrecommendedbytheAmericanAcademyofFamilyPhysicians • PrescriptionDrugsonthePreventiveDrugListarenotsubjecttothedeductible,butwillbecoveredwithnormal copaysof$5,$20and$50,dependingontheirgeneric,preferredornon-preferredstatus.Thesecopaymentsdonot counttowardtheannualdeductible,butDOcounttowardtheout-of-pocketmaximum.
CoinsuranceAllmedicalservicesinthisplanaresubjectto20%coinsuranceafterthedeductibleismet.Allcoinsurancecountstowardtheout-of-pocketmaximum.Theonlyservicesexcludedfromcoinsuranceare:
• Routineprenatalcare(physicianservices) • WellchildexamsandimmunizationsasrecommendedbytheAmericanAcademyofPediatrics • Highriskbirthscoreprogram • Annualscreeningmammogram • AnnualPapsmear • Colorectalcancerscreeningage50+above • Prostatecancerscreeningage50+above • PrescriptionDrugs(seeCopaymentsbelow) • AdultImmunizationsasrecommendedbytheAmericanAcademyofFamilyPhysicians
CopaymentsPrescriptionDrugsonthePreventiveDrugListarenotsubjecttothedeductible,butwillbecoveredwithnormalcopaysof$5,$20and$50,dependingontheirgeneric,preferredornon-preferredstatus.AllprescriptiondrugsnotonthePreventiveDrugListwillbecoveredwithnormalcopaysof$5,$20and$50,dependingontheirgeneric,preferredornon-preferredstatusafterthecombinedmedical/prescriptiondrugdeductibleismet.CopaymentspaidfordrugsonthePreventiveDrugListdonotcounttowardthedeductible.Allin-networkcopaymentscounttowardtheout-of-pocketmaximum.
out-of-Pocket maximumIn-networkbenefitshaveanout-of-pocketmaximumof$2,400employeeonly,and$4,800employeeandchild(ren),family,orfamilywithemployeespouseThisisacombinedmedicalandprescriptionout-of-pocketmaximum.Allin-networkcoinsuranceandcopaymentscounttowardthisout-of-pocketmaximum.Oncetheout-of-pocketmaximumissatisfied,in-networkservicesarecoveredat100%.
Thereisnoout-of-pocketmaximumforout-of-networkbenefitsinPlanC.Theout-of-networkbenefitremainsat80%,regardless of the amount paid in coinsurance and copayments by the member.
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network
ThisisaPreferredProviderBenefit(PPB)PlanwhichusesthesamenetworkasPEIA’sotherplans,andthesamerulesforusingnetworkproviders.PEIA’snetworkconsistsofWVproviders,somedirectlycontractedprovidersoutsideWV,andtheAetnaSignatureAdministrators(ASA)PreferredProviderOrganization.Out-of-statenetworkprovidersmaychange.Forexample,KingsDaughtersMedicalCenterandOurLadyofBellefontehospitalsinKentuckyandUniversityofPittsburghMedicalCenterremainout-of-networkforPEIA,regardlessoftheirnetworkstatuswiththeASAPPOnetwork.Also,PEIAdoesnotusetheASAPPOnetworkinGalliaorWashingtonCountyinOhio,orinBoydCounty,Kentucky.Forinformationaboutspecificproviders,contactWellsFargoat1-888-440-7342.
As with all PEIA PPB Plans, network requirements vary based upon the residency of the plan participant.
resident PPB Plan Participants PEIAPPBPlanparticipantswholiveinWestVirginiaoraborderingcountyofasurroundingstatemayaccesscarefrom anyofthefollowingproviderswithoutreceivingpriorapproval: • anyWestVirginiahealthcareproviderwhoprovideshealthcareservicesorsuppliestoaPEIAparticipant,or • anynetworkproviderlocatedinthoseborderingcounties.
Allservices,exceptemergencycare,providedoutsideofWestVirginiabeyondtheborderingcountiesrequireprior approval.
non-resident PPB Plan Participants
ForPEIAPPBPlanparticipantswhoresideoutsidetheStateofWestVirginia(beyondtheborderingcountiesof surroundingstates),PEIAhasmadespecialarrangements.ParticipantswholivemorethanonecountyoutsidetheState mayseekcarefromanynetworkprovider.Carefromnetworkprovidersdoesnotrequirepriorapproval,andthatcare willbecoveredatthein-networkbenefitlevel(typically80%).Precertificationofinpatientstaysandcertainoutpatient procedures is still required.
Out-of-networkcareiscareprovidedbyaproviderwhodoesnotparticipateinPEIA’snetwork,aswellascarefrom in-network,out-of-stateproviders(beyondtheborderingcountiesofsurroundingstates)thatisnotapprovedin advance. This includes providers who are Aetna ASA participating providers that are physically located beyond the borderingcountiesofsurroundingstates.Fornon-contractedproviders,PEIAwillpay80%ofwhatitwouldhavepaid iftheserviceshadbeenprovidedin-WestVirginia.Youwillberesponsibleforthe20%coinsuranceandforany amountsthatexceedtheWVPEIAfeeallowances.Thosebalancebillingamountsareconsiderednon-coveredservices, sotheydonotcounttowardthedeductible,andthereisnoout-of-networkout-of-pocketmaximum,sothereisno limittotheamountyoumayberequiredtopayunderthesecircumstances.Membersarealwaysresponsiblefor paying100%ofnon-coveredservices.
Health savings account*Ahealthsavingsaccount(HSA),isatax-advantagedmedicalsavingsaccountavailabletotaxpayersintheUnitedStateswhoareenrolledinaHighDeductibleHealthPlan(HDHP).Thefundscontributedtotheaccountarenotsubjecttofederalincometaxatthetimeofdeposit.Unlikeaflexiblespendingaccount(FSA),HSAfundsrolloverandaccumulateyeartoyearifnotspent.HSAsareownedbytheindividual,whichdifferentiatesthemfromtheemployer-ownedHealthReimbursementArrangement(HRA)thatisanalternatetax-deductiblesourceoffundspairedwithHDHPs.Fundsmaybeusedtopayforqualifiedmedicalexpensesatanytimewithoutfederaltaxliability.Withdrawalsfornon-medicalexpensesaretreatedverysimilarlytothoseinanIRAinthattheymayprovidetaxadvantagesiftakenafterretirementage, and they incur penalties if taken earlier.
PEIAismakingavailableanHSAprogramthroughFringeBenefitsManagementCompany(thevendorwhorunstheMountaineerFlexibleBenefitsPlan),butamembercansetupanHSAwithanycompanyorfinancialinstitutionthatoffers them – including local banks. To access the funds, the member will receive medical services, and pay for them with fundsfromtheHSA.WiththeHSAofferedbyFringeBenefitsManagementCompany,thememberwillreceiveadebitcardthatwilldrawfundsfromtheHSAtopayformedicalexpenses.Itisthemember’sresponsibilitytoaccounttotheIRSforhowthefundsarespent.
*Thissectionisinformationalonly.PEIAcannotgivetaxadvice.FormoreinformationonHSAsandtaxation,consultyourtaxadvisor.
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Wellness inCentiVes Coming July 1
EffectiveJuly1,2010,PEIAwillrolloutachangetotheImproveYourScoreprogram.Allpolicyholdersinthe
PEIA PPB Plan will be eligible for a premium incentive if they participate in a health screening at either a PEIA
Pathways to Wellness worksite or another PEIA approved participating medical facility. Those policyholders
whohavehadaPathwaystoWellnesshealthscreeningduringPlanYear2010(July1,2009–June30,2010)or
whohaveoneinPlanYear2011uptoApril30,2011,willbecreditedwithhavingparticipatedinthisprogram.
Those who participate in the Pathways to Wellness worksite screenings have their data reported to PEIA
automatically, and will not have to submit any further information.
The program requires health screenings every other year as a condition of receiving the incentive. Those
policyholders who are interested in participating in the Improve Your Score wellness incentive program, should
havetheirhealthscreeningcompletedanddocumentationsubmittedtoPEIAnolaterthanApril30,2011.
Instructions for submitting documentation will be made available later this year. Please do not submit anything
now!
ThischangeintheImproveYourScoreProgramcomeswiththreeimportantdifferences:
1) cashrebatesceaseeffectiveJuly1,2010;
2) participationwillcounttowardsapremiumdiscounteffectiveJuly1,2011;
3) screeningisrequiredeveryotheryearratherthanannually.
We will provide much more information in the coming months. Watch for it!
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BenefitsAt-AGlance
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the
pla
ns h
as s
peci
fic li
mita
tions
on
this
ben
efit.
Che
ck w
ith t
he p
lans
for
det
ails
.
15
Ben
efits
-at-
a-G
lan
ce
* T
his
is a
lim
ited
bene
fit.
One
or
mor
e of
the
pla
ns h
as s
peci
fic li
mita
tions
on
this
ben
efit.
Che
ck w
ith t
he p
lans
for
det
ails
.
16
Ben
efits
-at-
a-G
lan
ce
* T
his
is a
lim
ited
bene
fit.
One
or
mor
e of
the
pla
ns h
as s
peci
fic li
mita
tions
on
this
ben
efit.
Che
ck w
ith t
he p
lans
for
det
ails
.
17
Ben
efits
-at-
a-G
lan
ce
* T
his
is a
lim
ited
bene
fit.
One
or
mor
e of
the
pla
ns h
as s
peci
fic li
mita
tions
on
this
ben
efit.
Che
ck w
ith t
he p
lans
for
det
ails
.
18
Ben
efits
-at-
a-G
lan
ce
* T
his
is a
lim
ited
bene
fit.
One
or
mor
e of
the
pla
ns h
as s
peci
fic li
mita
tions
on
this
ben
efit.
Che
ck w
ith t
he p
lans
for
det
ails
.
19
Ben
efits
-at-
a-G
lan
ce
20
Ben
efits
-at-
a-G
lan
ce
21
Ben
efits
-at-
a-G
lan
ce
22
monday, april 5 9:00am-2:00pmCharleston StateCapitolComplexCapitolComplex,Bldg.7CapitolRoom
monday, april 53:00-7:00pm Charleston CharlestonCivicCenterParlor A 200CivicCenterDrive
tuesday, april 6 3:00-7:00pmParkersburg ComfortSuitesofParkersburgI-77andWV14(exit170)MineralWells
Wednesday, april 73:00-7:00pmmartinsburg HolidayInn300FoxcroftAvenue
thursday, april 89:00am-2:00pm morgantown TheEricksonAlumniCenter,WVURubyGrandHall
thursday, april 83:00-7:00pm morgantown RamadaInnI-68Exit1,US119N.
monday, april 123:00-7:00pm WheelingNorthernCommunityCollegeMarketStreet
tuesday, april 133:00-7:00pm Beckley TamarackConferenceCenterBoardRoomOneTamarackPark
thursday, april 153:00-7:00pm Huntington Big Sandy Superstore Arena 1CivicCenterDrive
2010 Benefit fairs: sites and datesIn an effort to reduce costs, PEIA has cut back the number of benefit fairs this year by eliminating ones that have not beenwellattendedforthelastseveralyears.Weapologizeifthefairyou’vevisitedinthepastisn’tavailablethisyear,butyoucanalwaysgetinformationaboutplansbycallingtheirtoll-freephonenumbersaslistedonthebackoftheShopper’s Guide.
managed Care Plans’ enrollment area
TheHealthPlan’sEnrollmentAreaconsistsofthefollowingcountiesinWestVirginia,Maryland,OhioandPennsylvania:
West VirGiniaBarbourBrookeCalhounDoddridgeGilmerHancockHarrisonLewisMarionMarshallMonongaliaOhioPleasantsPrestonRandolphRitchieTaylorTuckerTyler
UpshurWebsterWetzelWirtWood
marYlandGarrett
oHioBelmontColumbianaGuernseyHarrisonJeffersonMonroeMuskingumNobleTrumbullWashington
PennsYlVaniaBeaverFayetteGreeneWashington
PremiumsandRatesEmployeesandRetirees
24
mo
nth
ly P
rem
ium
s: e
mp
loye
e o
r em
plo
yee/
Ch
ildPr
emiu
ms
for
emp
loye
es o
f St
ate
agen
cies
, co
lleg
es a
nd
un
iver
siti
es a
nd
co
un
ty b
oar
ds
of
edu
cati
on
are
bas
ed o
n t
he
emp
loye
e’s
ann
ual
sal
ary.
Th
e p
rem
ium
s lis
ted
her
e ar
e ch
arg
ed m
on
thly
. fo
r th
e Pe
ia P
PB P
lan
s, t
he
ou
t-o
f-n
etw
ork
ded
uct
ible
an
d o
ut-
of-
po
cket
max
imu
m a
mo
un
ts a
re d
ou
ble
th
e in
-net
wo
rk
amo
un
ts li
sted
bel
ow
.
The
pre
miu
mt
able
slo
ok
ab
itd
iffe
ren
tth
isy
ear
bec
ause
we
hav
ech
ose
nt
op
rin
to
nly
th
est
and
ard
pre
miu
m.
Ify
ou
are
to
bac
co-f
ree,
yo
um
ays
ub
trac
t$2
5fo
rem
plo
yee
on
lyc
ove
rag
ean
d$
50f
or
emp
loye
e/ch
ildc
ove
rag
efr
om
th
ep
rem
ium
pri
nte
db
elo
w.
We
set
the
pre
miu
ms
up
th
isw
ayin
an
tici
pat
ion
of
the
chan
ges
co
min
gn
ext
year
th
atw
illa
llow
ad
dit
ion
alp
rem
ium
dis
cou
nts
fo
rLi
vin
gW
ills
and
fo
rkn
ow
ing
ab
ou
tyo
ur
mo
difi
able
hea
lth
ris
kfa
cto
rs.
See
pag
e10
fo
rd
etai
lsa
nd
wat
chf
or
mo
rein
form
atio
nc
om
ing
th
iss
um
mer
.
*To
bac
co-f
ree
pla
nm
emb
ers
sub
trac
t$2
5fr
om
th
ep
rem
ium
fo
rem
plo
yee
on
lyc
ove
rag
eo
r$5
0fr
om
th
eem
plo
yee/
child
,fam
ilyo
rfa
mily
wit
he
mp
loye
esp
ou
sep
rem
ium
.To
qu
alif
yfo
rth
eTo
bac
co-f
ree
Pref
erre
d
Prem
ium
fo
ral
lof
Plan
Yea
r20
11,y
ou
an
da
llen
rolle
df
amily
mem
ber
sm
ust
hav
eb
een
to
bac
co-f
ree
by
Jan
uar
y1,
201
0.If
yo
ur
tob
acco
sta
tus
has
no
tch
ang
ed,y
ou
do
no
tn
eed
to
co
mp
lete
aT
ob
acco
Affi
dav
it.W
ew
illa
ssu
me
you
rst
atu
sh
asn
ot
chan
ged
fro
mt
he
last
pla
ny
ear.
Ify
ou
rto
bac
cos
tatu
sh
asc
han
ged
,yo
uM
UST
su
bm
ita
to
bac
coa
ffid
avit
.Se
ep
age
4,it
ems
6an
d7
.
No
te: Y
ou
can
do
yo
ur
enro
llmen
to
nlin
eat
an
yti
me
Ap
ril1
-30,
just
go
to
ww
w.w
vpei
a.co
ma
nd
clic
ko
nt
he
“On
line
Op
enE
nro
llmen
t”b
utt
on
.If
you
use
dt
he
site
last
yea
r,ju
ste
nte
ryo
ur
e-m
aila
dd
ress
an
d
pas
swo
rdt
op
roce
ed.I
fyo
ud
on
’tr
emem
ber
yo
ur
pas
swo
rd,c
ho
ose
“Fo
rgo
tPa
ssw
ord
?”.I
fyo
ud
idn
’tu
set
he
site
last
yea
r,cl
ick
on
“N
eed
to
Reg
iste
r?”
and
fo
llow
th
ein
stru
ctio
ns.
25
mo
nth
ly P
rem
ium
s: f
amily
or
fam
ily/e
mp
loye
e sp
ou
sePr
emiu
m f
or
emp
loye
es o
f St
ate
agen
cies
, co
lleg
es a
nd
un
iver
siti
es a
nd
co
un
ty b
oar
d o
f ed
uca
tio
n a
re b
ased
on
th
e em
plo
yee’
s an
nu
al s
alar
y. T
he
pre
miu
ms
liste
dh
ere
are
char
ged
mo
nth
ly.F
or
the
PEIA
PPB
Pla
ns,
th
eo
ut-
of-
net
wo
rkd
edu
ctib
lea
nd
ou
t-o
f-p
ock
etm
axim
um
am
ou
nts
are
do
ub
let
he
in-n
etw
ork
am
ou
nts
list
ed b
elo
w.
The
pre
miu
mt
able
slo
ok
ab
itd
iffe
ren
tth
isy
ear
bec
ause
we
hav
ech
ose
nt
op
rin
to
nly
th
est
and
ard
pre
miu
m.
Ify
ou
are
to
bac
co-f
ree,
yo
um
ays
ub
trac
t$5
0fo
rfa
mily
or
fam
ilyw
ith
em
plo
yee
spo
use
co
vera
ge
fro
mt
he
pre
miu
mp
rin
ted
bel
ow
.W
ese
tth
ep
rem
ium
su
pt
his
way
ina
nti
cip
atio
no
fth
ech
ang
es
com
ing
nex
tye
art
hat
will
allo
wa
dd
itio
nal
pre
miu
md
isco
un
tsf
or
Livi
ng
Will
san
df
or
kno
win
ga
bo
ut
you
rm
od
ifiab
leh
ealt
hr
isk
fact
ors
.Se
ep
age
10f
or
det
ails
an
d w
atch
fo
r m
ore
info
rmat
ion
co
min
g t
his
su
mm
er.
*To
bac
co-f
ree
pla
nm
emb
ers
sub
trac
t$2
5fr
om
th
ep
rem
ium
fo
rem
plo
yee
on
lyc
ove
rag
eo
r$5
0fr
om
th
eem
plo
yee/
child
,fam
ilyo
rfa
mily
wit
he
mp
loye
esp
ou
sep
rem
ium
.To
qu
alif
yfo
rth
eTo
bac
co-f
ree
Pref
erre
d
Prem
ium
fo
ral
lof
Plan
Yea
r20
11,y
ou
an
da
llen
rolle
df
amily
mem
ber
sm
ust
hav
eb
een
to
bac
co-f
ree
by
Jan
uar
y1,
201
0.If
yo
ur
tob
acco
sta
tus
has
no
tch
ang
ed,y
ou
do
no
tn
eed
to
co
mp
lete
aT
ob
acco
Affi
dav
it.W
ew
illa
ssu
me
you
rst
atu
sh
asn
ot
chan
ged
fro
mt
he
last
pla
ny
ear.
Ify
ou
rto
bac
cos
tatu
sh
asc
han
ged
,yo
uM
UST
su
bm
ita
to
bac
coa
ffid
avit
.Se
ep
age
4,it
ems
6an
d7
.
No
te:Y
ou
can
do
yo
ur
enro
llmen
to
nlin
eat
an
yti
me
Ap
ril1
-30,
just
go
to
ww
w.w
vpei
a.co
ma
nd
clic
ko
nt
he
“On
line
Op
enE
nro
llmen
t”b
utt
on
.If
you
use
dt
he
site
last
yea
r,ju
ste
nte
ryo
ur
e-m
aila
dd
ress
an
d
pas
swo
rdt
op
roce
ed.I
fyo
ud
on
’tr
emem
ber
yo
ur
pas
swo
rd,c
ho
ose
“Fo
rgo
tPa
ssw
ord
?”.I
fyo
ud
idn
’tu
set
he
site
last
yea
r,cl
ick
on
“N
eed
to
Reg
iste
r?”
and
fo
llow
th
ein
stru
ctio
ns.
26
no
n-s
tate
ag
enci
es: P
eia
PPB
Pla
ns
No
n-S
tate
ag
enci
esa
rec
ou
nti
es,c
itie
s,t
ow
ns,
an
do
ther
go
vern
men
tb
od
ies
and
ag
enci
est
hat
qu
alif
yfo
rco
vera
ge
un
der
PEI
Ap
urs
uan
tto
th
eW
est
Vir
gin
ia
Co
de.
By
law
,th
ese
agen
cies
det
erm
ine
ho
wm
uch
of
the
tota
lmo
nth
lyP
EIA
pre
miu
mw
illb
ep
aid
by
thei
rac
tive
em
plo
yees
.Em
plo
yees
sh
ou
ldc
hec
kw
ith
th
eir
emp
loye
r to
det
erm
ine
wh
at t
hei
r m
on
thly
em
plo
yee
con
trib
uti
on
will
be
for
the
vari
ou
s p
lan
s an
d c
ove
rag
e ty
pes
.
PEIA
has
mad
eit
th
eem
plo
yee’
so
pti
on
to
ch
oo
seP
EIA
PPB
Pla
nA
,Bo
rC
or
any
of
the
man
aged
car
ep
lan
sav
aila
ble
iny
ou
rar
ea,a
lth
ou
gh
yo
ur
emp
loye
rm
ayc
ho
ose
to
lim
itt
he
amo
un
tp
aid
to
war
dt
he
pre
miu
m.C
hec
kw
ith
yo
ur
ben
efit
coo
rdin
ato
rto
see
ho
wm
uch
(if
an
y)y
ou
rem
plo
yer
will
be
pay
ing
to
war
d t
he
pre
miu
m f
or
the
pla
n y
ou
’ve
cho
sen
.
The
char
tb
elo
wd
etai
lst
he
pre
miu
ms,
ded
uct
ible
san
do
ut-
of-
po
cket
max
imu
ms
for
the
two
PPB
pla
no
pti
on
s.R
emem
ber
th
att
he
ou
t-o
f-n
etw
ork
ded
uct
ible
an
do
ut-
of-
po
cket
max
imu
ma
mo
un
tsa
red
ou
ble
th
ein
-net
wo
rka
mo
un
tsli
sted
int
he
char
ts.
Prem
ium
s, d
edu
ctib
les
and
ou
t-o
f-Po
cket
max
imu
ms
no
n-s
tate
ag
ency
: man
aged
Car
e Pl
ans
Toe
nro
llin
on
eo
fth
em
anag
edc
are
pla
ns
liste
db
elo
w,y
ou
mu
stli
vein
th
ep
lan
’se
nro
llmen
tar
ea.C
hec
kth
ech
art
on
pag
e19
to
see
ify
ou
qu
alif
yfo
rth
ep
lan
yo
u’r
e co
nsi
der
ing
. Th
e PE
IA P
PB P
lan
s’ e
nro
llmen
t ar
ea is
un
limit
ed, s
o y
ou
will
no
t fi
nd
it o
n t
he
char
t.
The
Hea
lth
Pla
nd
oes
no
to
ffer
dis
cou
nte
dp
rem
ium
sto
to
bac
co-f
ree
mem
ber
s.
Prem
ium
s, d
edu
ctib
les
and
ou
t-o
f-Po
cket
max
imu
ms
*To
bac
co-f
ree
pla
nm
emb
ers
sub
trac
t$2
5fr
om
th
ep
rem
ium
fo
rem
plo
yee
on
lyc
ove
rag
eo
r$5
0fr
om
th
eem
plo
yee/
child
,fam
ilyo
rfa
mily
wit
he
mp
loye
esp
ou
sep
rem
ium
.To
qu
alif
yfo
rth
eTo
bac
co-f
ree
Pref
erre
d
Prem
ium
fo
ral
lof
Plan
Yea
r20
11,y
ou
an
da
llen
rolle
df
amily
mem
ber
sm
ust
hav
eb
een
to
bac
co-f
ree
by
Jan
uar
y1,
201
0.If
yo
ur
tob
acco
sta
tus
has
no
tch
ang
ed,y
ou
do
no
tn
eed
to
co
mp
lete
aT
ob
acco
Affi
dav
it.W
ew
illa
ssu
me
you
rst
atu
sh
asn
ot
chan
ged
fro
mt
he
last
pla
ny
ear.
Ify
ou
rto
bac
cos
tatu
sh
asc
han
ged
,yo
uM
UST
su
bm
ita
to
bac
coa
ffid
avit
.Se
ep
age
4,it
ems
6an
d7
.
No
te:Y
ou
can
do
yo
ur
enro
llmen
to
nlin
eat
an
yti
me
Ap
ril1
-30,
just
go
to
ww
w.w
vpei
a.co
ma
nd
clic
ko
nt
he
“On
line
Op
enE
nro
llmen
t”b
utt
on
.If
you
use
dt
he
site
last
yea
r,ju
ste
nte
ryo
ur
e-m
aila
dd
ress
an
d
pas
swo
rdt
op
roce
ed.I
fyo
ud
on
’tr
emem
ber
yo
ur
pas
swo
rd,c
ho
ose
“Fo
rgo
tPa
ssw
ord
?”.I
fyo
ud
idn
’tu
set
he
site
last
yea
r,cl
ick
on
“N
eed
to
Reg
iste
r?”
and
fo
llow
th
ein
stru
ctio
ns.
27
no
n-m
edic
are
ret
iree
PPB
Pla
n P
rem
ium
sTh
ese
pre
miu
ms
are
off
ered
to
ret
ired
po
licyh
old
ers
wh
oa
ren
ot
yet
elig
ible
fo
rM
edic
are.
To
en
roll
inT
he
Hea
lth
Pla
n,y
ou
mu
stli
vein
th
ep
lan
’se
nro
llmen
tar
ea.C
hec
kth
ech
art
on
pag
e16
.Th
ePE
IAP
PBP
lan
’se
nro
llmen
tar
eais
un
limit
ed,s
oy
ou
will
no
tfi
nd
ito
nt
he
char
t.
Ify
ou
are
usi
ng
acc
rued
leav
e,1
00%
or
50%
of
thes
ep
rem
ium
sis
bei
ng
pai
db
yyo
ur
form
ere
mp
loye
r.
Prem
ium
s, d
edu
ctib
les
and
ou
t-o
f-Po
cket
max
imu
ms
1Th
isr
ate
assu
mes
on
ep
erso
no
nM
edic
are.
Ify
ou
hav
em
ore
th
ano
ne,
su
btr
act
$22
for
each
ad
dit
ion
alM
edic
are
Mem
ber
.2
Thes
era
tes
are
also
pro
vid
edt
oa
lln
on
-Med
icar
ere
tire
esw
ho
ret
ired
pri
or
toJ
uly
1,1
997,
to
all
no
n-M
edic
are
surv
ivin
gd
epen
den
tsa
nd
to
all
no
n-M
edic
are
dis
abili
tyr
etir
ees.
3
*To
bac
co-f
ree
pla
nm
emb
ers
sub
trac
t$2
5fr
om
th
ep
rem
ium
fo
rem
plo
yee
on
lyc
ove
rag
eo
r$5
0fr
om
th
eem
plo
yee/
child
,fam
ilyo
rfa
mily
wit
he
mp
loye
esp
ou
sep
rem
ium
.To
qu
alif
yfo
rth
eTo
bac
co-f
ree
Pref
erre
dP
rem
ium
fo
ral
lof
Plan
Yea
r20
11,y
ou
an
da
llen
rolle
df
amily
mem
ber
sm
ust
hav
eb
een
to
bac
co-f
ree
by
Jan
uar
y1,
201
0.If
yo
ur
tob
acco
sta
tus
has
no
tch
ang
ed,y
ou
do
no
tn
eed
to
co
mp
lete
aT
ob
acco
A
ffid
avit
.We
will
ass
um
eyo
ur
stat
us
has
no
tch
ang
edf
rom
th
ela
stp
lan
yea
r.If
yo
ur
tob
acco
sta
tus
has
ch
ang
ed,y
ou
MU
STs
ub
mit
at
ob
acco
affi
dav
it.
See
pag
e4,
item
s6
and
7.
No
te:Y
ou
can
do
yo
ur
enro
llmen
to
nlin
eat
an
yti
me
Ap
ril1
-30,
just
go
to
ww
w.w
vpei
a.co
ma
nd
clic
ko
nt
he
“On
line
Op
enE
nro
llmen
t”b
utt
on
.If
you
use
dt
he
site
last
yea
r,ju
ste
nte
ryo
ur
e-m
aila
dd
ress
an
d
pas
swo
rdt
op
roce
ed.I
fyo
ud
on
’tr
emem
ber
yo
ur
pas
swo
rd,c
ho
ose
“Fo
rgo
tPa
ssw
ord
?”.I
fyo
ud
idn
’tu
set
he
site
last
yea
r,cl
ick
on
“N
eed
to
Reg
iste
r?”
and
fo
llow
th
ein
stru
ctio
ns.
spec
ial n
oti
ce f
or
no
n-m
edic
are
ret
iree
s w
ith
med
icar
e d
epen
den
ts:
PEIA
has
co
ntr
acte
dw
ith
oth
erv
end
ors
to
pro
vid
em
edic
ala
nd
pre
scri
pti
on
dru
gb
enefi
tst
oM
edic
are-
elig
ible
ret
ired
em
plo
yees
an
dM
edic
are-
elig
ible
d
epen
den
tso
fre
tire
de
mp
loye
es.T
hes
eb
enefi
tsa
ref
or
mem
ber
sw
ho
sep
rim
ary
insu
ran
ceis
Med
icar
e.B
ecau
seM
edic
are
trea
tse
ach
Med
icar
eb
enefi
ciar
yas
an
ind
ivid
ual
,an
dd
oes
no
tre
cog
niz
e“f
amily
”p
lan
s,t
his
ch
ang
ep
rese
nts
so
me
un
iqu
ech
alle
ng
esf
or
PEIA
wh
ena
fam
ilyh
asb
oth
no
n-M
edic
are
and
M
edic
are
mem
ber
s.In
th
ese
case
s,t
he
no
n-M
edic
are
fam
ilym
emb
ers
will
co
nti
nu
eth
eir
cove
rag
ew
ith
PEI
A,a
nd
th
eM
edic
are
ben
efici
ary
will
rec
eive
b
enefi
tsf
rom
th
eH
um
ana
Med
icar
eA
dva
nta
ge
pla
n.F
or
det
ails
of
the
Med
icar
eb
enefi
ciar
y’s
pla
nd
esig
n,s
eep
age
29.
Ify
ou
are
an
on
-Med
icar
ere
tire
ew
ith
Med
icar
ed
epen
den
ts,t
hen
th
en
on
-Med
icar
eb
enefi
ciar
yw
illh
ave
esse
nti
ally
th
esa
me
ben
efits
as
bef
ore
,bu
tth
eM
edic
are
ben
efici
ary
will
hav
ea
$25
ded
uct
ible
an
dt
he
$750
ou
t-o
f-p
ock
etm
axim
um
sh
ow
nin
th
eM
edic
are
Ret
iree
Ben
efit
Des
ign
ch
art
on
pag
e29
.R
emem
ber
,fo
rn
on
-Med
icar
efa
mily
mem
ber
s,t
he
fam
ilyd
edu
ctib
leis
$75
0,b
ut
asa
lway
s,n
oin
div
idu
alin
th
efa
mily
can
mee
tm
ore
th
anh
alf
of
the
fam
ily
ded
uct
ible
.Fo
rm
ore
info
rmat
ion
on
ho
wt
he
med
ical
ded
uct
ible
wo
rks,
see
th
eSu
mm
ary
Plan
Des
crip
tio
n.
non-medicare retiree managed Care Premiums
28
1Theseratesarealsoprovidedtoallnon-MedicareretireeswhoretiredpriortoJuly1,1997,toallnon-Medicaresurvivingdependentsandtoallnon-Medicaredisability retirees. Note:YoucandoyourenrollmentonlineatanytimeApril1-30,justgotowww.wvpeia.comandclickonthe“OnlineOpenEnrollment”button.Ifyouusedthesitelastyear,justenteryoure-mailaddressandpasswordandproceed.Ifyoudon’trememberyourpassword,choose“ForgotPassword?”Ifyoudidn’tusethesitelastyear,clickon“NeedtoRegister?”andfollowtheinstructions.
retired employee assistance ProgramsRetiredemployeeswhosetotalannualincomeislessthan250%ofthefederalpovertylevel(FPL)mayreceiveassistancein paying a portion of their PEIA monthly health premium based on years of active service, through a grant provided by thePEIAcalledtheRetiredEmployeePremiumAssistanceprogram.ApplicantsmustbeenrolledinthePEIAPPBPlan,theSpecialMedicarePlanorHumana’sMedicareAdvantageplan.
Managedcareplanmembersarenoteligibleforthisprogram.Retiredemployeesusingaccruedsickand/orannualleavetopaytheirpremiumsarenoteligibleforthisprogramuntiltheiraccruedleaveisexhausted.Applicationsaremailedtoall eligible retired employees each spring.
Medicare-eligibleretireeswith15ormoreyearsofservicewhoqualifyforPremiumAssistancemayalsoqualifyforBenefitAssistance.BenefitAssistancereducesthemedicalandprescriptionoutofpocketmaximumsandmostcopayments.ItisdescribedindetailintheEvidenceofCoverageprovidedbyHumana.Foradditionaldetailorforacopyof the application, call PEIA’s customer service unit.
medicare retiree BenefitsPEIAhascontractedwiththreedifferentvendorstoprovidebenefitstoMedicare-eligibleretiredemployeesandMedicare-eligibledependentsofretiredemployees.
1. Humana,Inc.providesmedicalbenefitsthroughitsMedicareAdvantageplans.Reachthemat1-800-783-4599.2. CoventryHealthCarewillprovideprescriptionbenefitsthroughitsAdvantraRxplanthroughtheendofthisplan year(June30,2010).Reachthemat1-888-816-7671.3. ExpressScripts,Inc.willprovideprescriptionbenefitsbeginningJuly1,2010.Reachthemat1-866-591-3881.
ThesebenefitsareformemberswhoseprimaryinsuranceisMedicare.BecauseMedicaretreatseachMedicarebeneficiaryasanindividual,anddoesnotrecognize“family”plans,thischangepresentssomeuniquechallengesforPEIAwhenafamilyhasbothMedicareandnon-Medicaremembers.Inthesecases,theMedicarebeneficiarywillreceivebenefitsfromthecontractedMedicareAdvantageplanand,andthenon-MedicarefamilymemberswillcontinuetheircoverageinthePEIAPPBPlan.Medicareeligiblememberscancontactthesevendorsatthenumberslistedabovewithanyquestions.
Benefits for medicare Beneficiaries
HumanaprovidesMUCHmoreinformationtoMedicareretirees,buthereisageneraloverviewofhowthemedicalbenefitsworkforeachMedicarebeneficiaryandfortheirnon-Medicaredependents,ifany.
So,whentheMedicarebeneficiaryusesmedicalservices,therewillbea$25deductible,andthentherewillbecopaymentsforsomeservices.TheMedicarebeneficiary’scopaymentswilladduptoamaximumof$750perplanyear.ThePlanYearstillrunsfromJuly1toJune30.AnyproviderthatacceptsMedicaremaybeusedbythoseenrolledintheHumanaplan.TheMedicareretiree’snon-Medicaredependentswillhavethebenefitsshowninthelastcolumnofthechart.ThesearethesamebenefitsprovidedunderPEIAPPBPlanA.SeetheBenefitsAt-A-Glancechartsonpages12-21for details.
29
service description medicare retiree non-medicare retiree Plan Year 2011 Benefit Plan Year 2011 Benefit
annual deductible $25 $400
Primary Care office Visit $10 $15
specialty office Visit $20 $20
emergency room $50 $25copayment+deductible
+20%coinsurance
Hospital inpatient care $100peradmission Deductible
+20%coinsurance
outpatient and office surgery $50 $50copayment+deductible
+20%coinsurance
other services (testing, etc) $0 Deductible
+20%coinsurance
medical out-of-Pocket maximum $750 $750single
and$1,500family
Prescription drug deductible $75 $75
Generic drugs Copayment $5 $5
Preferred drug Copayment $15 $15
non-preferred drug Copayment $50 $50
specialty drug Copayment $50 $50
medicare retiree ratesIfyouareaMedicareretireewithNon-Medicaredependents,thentheMedicarebeneficiarywillhavea$25deductibleandthe$750out-of-pocketmaximumshownintheMedicareRetireeBenefitDesignchartonthepreviouspage.Thenon-MedicaredependentscoveredbytheMedicarepolicyholderwillhavethedeductibleandout-of-pocketmaximumshowninthechartonthepreviouspage,andthebenefitsdescribedintheBenefitsAt-A-Glancechartsonpages12-21.
Peia PPB medicare retiree rates
1ThispremiumrateassumesonepersononMedicare.Ifyouhavemorethanone,subtract$22foreachadditionalMedicareMember.2ThispremiumrateassumestwopeopleonMedicare.Ifyouhavemorethantwo,subtract$22foreachadditionalMedicareMember.3ThesepremiumratesarealsoprovidedtoallMedicareretireeswhoretiredpriortoJuly1,1997,toallMedicaresurvivingdependentsandtoallMedicaredisabilityretirees.4*Tobacco-freeplanmemberssubtract$25fromthepremiumforemployeeonlycoverageor$50fromtheemployee/child,familyorfamilywithemployeespousepremium.ToqualifyfortheTobacco-freePreferredPremiumforallofPlanYear2011,youandallenrolledfamilymembersmusthavebeentobacco-freebyJanuary1,2010.Ifyourtobaccostatushasnotchanged,youdonotneedtocompleteaTobaccoAffidavit.Wewillassumeyourstatushasnotchangedfromthelastplanyear.Ifyourtobaccostatushaschanged,youMUSTsubmitatobaccoaffidavit.Seepage4,items6and7.
Note:YoucandoyourenrollmentonlineatanytimeApril1-30,justgotowww.wvpeia.comandclickonthe“OnlineOpenEnrollment”button.Ifyouusedthesitelastyear,justenteryoure-mailaddressandpasswordandproceed.Ifyoudon’trememberyourpassword,choose“ForgotPassword?”Ifyoudidn’tusethesitelastyear,clickon“NeedtoRegister?”andfollowtheinstructions.
30
31
Co
Br
aC
OB
RA
en
titl
ese
mp
loye
es,r
etir
ede
mp
loye
es,a
nd
co
vere
dd
epen
den
t(s)
to
co
nti
nu
em
edic
alc
ove
rag
e,f
or
18o
r36
mo
nth
s,in
cer
tain
cas
esw
hen
co
vera
ge
wo
uld
oth
erw
ise
term
inat
e,p
rovi
ded
th
eem
plo
yee,
ret
ired
em
plo
yee,
an
d/o
rd
epen
den
t(s)
pay
sth
efu
llp
rem
ium
.Th
ep
rem
ium
sfo
rC
OB
RA
co
vera
ge
are
set
by
Fed
eral
law
.
Wel
lsF
arg
oT
PAh
and
les
CO
BR
Ae
nro
llmen
tfo
ral
lpla
ns
and
will
co
nta
cty
ou
ify
ou
bec
om
eel
igib
le.
The
char
tso
np
ages
24-
25s
ho
wt
he
tota
lmo
nth
lyp
rem
ium
sfo
rC
OB
RA
en
rolle
es.D
uri
ng
Op
enE
nro
llmen
tyo
uh
ave
the
rig
ht
toc
ho
ose
an
yp
lan
fo
rw
hic
hy
ou
ar
eel
igib
lef
or
the
nex
tp
lan
yea
r.To
en
roll
ino
ne
of
the
man
aged
car
ep
lan
s,y
ou
mu
stli
vein
th
ep
lan
’sen
rollm
ent
area
.Th
ePE
IAP
PBP
lan
s’e
nro
llmen
tar
eais
u
nlim
ited
.
Sin
ceC
OB
RA
mem
ber
sca
nn
ot
use
th
eo
nlin
een
rollm
ent
syst
em,W
ells
Far
go
TPA
will
mai
ltra
nsf
erf
orm
sto
all
enro
lled
CO
BR
Am
emb
ers.
Ify
ou
wan
tto
ch
ang
ep
lan
s,y
ou
mu
stc
om
ple
tea
nd
ret
urn
th
etr
ansf
erf
orm
to
Wel
lsF
arg
ob
efo
reA
pri
l30,
201
0.
mai
l th
e fo
rm t
o:
Wel
ls f
arg
o C
oB
ra
dep
t., P
.o. B
ox
2981
. Ch
arle
sto
n, W
V 2
5332
Co
Br
a r
ates
fo
r st
ate
ag
enci
es, C
olle
ges
, un
iver
siti
es a
nd
Co
un
ty B
oar
ds
of
edu
cati
on
Co
Br
a r
ates
fo
r n
on
-sta
te a
gen
cies
*To
bac
co-f
ree
pla
nm
emb
ers
sub
trac
t$2
5fr
om
th
ep
rem
ium
fo
rem
plo
yee
on
lyc
ove
rag
eo
r$5
0fr
om
th
eem
plo
yee/
child
,fam
ilyo
rfa
mily
wit
he
mp
loye
esp
ou
sep
rem
ium
.To
qu
alif
yfo
rth
eTo
bac
co-f
ree
Pref
erre
d
Prem
ium
fo
ral
lof
Plan
Yea
r20
11,y
ou
an
da
llen
rolle
df
amily
mem
ber
sm
ust
hav
eb
een
to
bac
co-f
ree
by
Jan
uar
y1,
201
0.If
yo
ur
tob
acco
sta
tus
has
no
tch
ang
ed,y
ou
do
no
tn
eed
to
co
mp
lete
aT
ob
acco
Affi
dav
it.W
ew
illa
ssu
me
you
rst
atu
sh
asn
ot
chan
ged
fro
mt
he
last
pla
ny
ear.
Ify
ou
rto
bac
cos
tatu
sh
asc
han
ged
,yo
uM
UST
su
bm
ita
to
bac
coa
ffid
avit
.Se
ep
age
4,it
ems
6an
d7
.
OptionalLifeInsurance
33
Pl
an 1
Pl
an 2
Pl
an 3
Pl
an 4
Pl
an 5
Pl
an 6
Pl
an 7
Pl
an 8
Pl
an 9
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e a
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un
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nth
ly
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ou
nt
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nth
ly
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nt
of
mo
nth
ly
am
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nt
of
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nth
ly
am
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nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
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ou
nt
of
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nth
ly
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nt
of
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nth
ly
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vera
ge
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ium
C
ove
rag
e Pr
emiu
m
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vera
ge
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ium
C
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rag
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m
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vera
ge
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ium
C
ove
rag
e Pr
emiu
m
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vera
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ium
C
ove
rag
e Pr
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m
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vera
ge
Prem
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Und
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an 1
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an 1
2 Pl
an 1
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an 1
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an 1
5 Pl
an 1
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an 1
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an 1
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e a
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t o
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nth
ly
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nt
of
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nth
ly
am
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nt
of
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nth
ly
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nt
of
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nth
ly
am
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nt
of
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nth
ly
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nt
of
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nth
ly
am
ou
nt
of
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nth
ly
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ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
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ove
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ove
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ove
rag
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Prem
ium
Und
er 3
0 $1
00,0
00
$5.5
0 $1
50,0
00
$8.2
5 $2
00,0
00
$11.
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$16.
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80
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60
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$9
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39.3
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60-6
4 $1
00,0
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30
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00,0
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$174
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04.0
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00,0
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62.3
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65-6
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0 $1
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00
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52.7
5 $2
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70 &
Ove
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0 $8
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$3
29.9
4 $2
02,5
00
$371
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12.4
3
act
ive
emp
loye
e’s
op
tio
nal
lif
e an
d a
d&
d in
sura
nce
: to
Ba
CC
o-f
ree
The
Tob
acco
-Fre
era
tes
are
char
ged
to
th
ose
wh
oh
ave
sub
mit
ted
an
affi
dav
its
tati
ng
th
att
he
po
licyh
old
erd
oes
no
tu
set
ob
acco
.If
you
rto
bac
cos
tatu
sh
as
no
t ch
ang
ed, y
ou
do
no
t n
eed
to
co
mp
lete
a T
ob
acco
Affi
dav
it.
We
will
ass
um
e yo
ur
stat
us
has
no
t ch
ang
ed.
Toq
ual
ify
for
the
Tob
acco
-fre
ePr
efer
red
Pre
miu
mf
or
allo
fPl
anY
ear
2011
,yo
ua
nd
all
enro
lled
fam
ilym
emb
ers
mu
sth
ave
bee
nt
ob
acco
-fre
eb
yJa
nu
ary
1,2
010.
Ify
ou
rto
bac
cos
tatu
sh
asn
ot
chan
ged
,yo
ud
o
no
tn
eed
to
co
mp
lete
aT
ob
acco
Affi
dav
it.W
ew
illa
ssu
me
you
rst
atu
sh
asn
ot
chan
ged
fro
mt
he
last
pla
ny
ear.
Ify
ou
rto
bac
cos
tatu
sh
asc
han
ged
,yo
uM
UST
su
bm
ita
to
bac
coa
ffid
avit
.Se
ep
age
4,it
ems
6an
d7
.
34
Pl
an 1
Pl
an 2
Pl
an 3
Pl
an 4
Pl
an 5
Pl
an 6
Pl
an 7
Pl
an 8
Pl
an 9
ag
e a
mo
un
t o
f
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
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ove
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ium
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ove
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emiu
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Prem
ium
Und
er 3
0 $5
,000
$0
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000
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0 $1
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39
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000
$136
.62
Pl
an 1
0 Pl
an 1
1 Pl
an 1
2 Pl
an 1
3 Pl
an 1
4 Pl
an 1
5 Pl
an 1
6 Pl
an 1
7 Pl
an 1
8
ag
e a
mo
un
t o
f
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
Co
vera
ge
Prem
ium
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ove
rag
e Pr
emiu
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ium
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ove
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emiu
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ge
Prem
ium
C
ove
rag
e Pr
emiu
m
Co
vera
ge
Prem
ium
C
ove
rag
e Pr
emiu
m
Co
vera
ge
Prem
ium
Und
er 3
0 $1
00,0
00
$8.2
0 $1
50,0
00
$12.
30
$200
,000
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6.40
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50,0
00
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50
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50,0
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70
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50,0
00
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90
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22.6
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00,0
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86.2
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00,0
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00,0
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27.0
5 $2
00,0
00
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11.7
5 $3
00,0
00
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,000
$2
96.4
5 $4
00,0
00
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$3
81.1
5 $5
00,0
00
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65-6
9 $6
5,00
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4.24
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0 $1
26.3
6 $1
30,0
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10.6
0 $1
95,0
00
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94.8
4 $2
60,0
00
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,500
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79.0
8 $3
25,0
00
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70 &
Ove
r $4
5,00
0 $1
70.7
8 $6
7,50
0 $2
56.1
6 $9
0,00
0 $3
41.5
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12,5
00
$426
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,000
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12.3
3 $1
57,5
00
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,000
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83.1
0 $2
02,5
00
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.49
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,000
$8
53.8
8
act
ive
emp
loye
e’s
op
tio
nal
lif
e an
d a
d&
d in
sura
nce
: to
Ba
CC
o u
ser
35
ret
ired
em
plo
yee’
s o
pti
on
al l
ife
insu
ran
ce: t
oB
aC
Co
-fr
eeTh
eTo
bac
co-F
ree
rate
sar
ech
arg
edt
ot
ho
sew
ho
hav
ep
revi
ou
sly
sub
mit
ted
an
affi
dav
its
tati
ng
th
att
he
po
licyh
old
erd
oes
no
tu
set
ob
acco
.If
you
rto
bac
co
stat
us
has
no
t ch
ang
ed, y
ou
do
no
t n
eed
to
co
mp
lete
a T
ob
acco
Affi
dav
it.
We
will
ass
um
e yo
ur
stat
us
has
no
t ch
ang
ed f
rom
th
e la
st p
lan
yea
r.
Toq
ual
ify
for
the
Tob
acco
-fre
ePr
efer
red
Pre
miu
mf
or
allo
fPl
anY
ear
2011
,yo
ua
nd
all
enro
lled
fam
ilym
emb
ers
mu
sth
ave
bee
nt
ob
acco
-fre
eb
yJa
nu
ary
1,2
010.
Ify
ou
rto
bac
cos
tatu
sh
asn
ot
chan
ged
,yo
ud
o
no
tn
eed
to
co
mp
lete
aT
ob
acco
Affi
dav
it.W
ew
illa
ssu
me
you
rst
atu
sh
asn
ot
chan
ged
fro
mt
he
last
pla
ny
ear.
Ify
ou
rto
bac
cos
tatu
sh
asc
han
ged
,yo
uM
UST
su
bm
ita
to
bac
coa
ffid
avit
.Se
ep
age
4,it
ems
6an
d7
.
Pl
an 1
Pl
an 2
Pl
an 3
Pl
an 4
Pl
an 5
ag
e a
mo
un
t o
f
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
am
ou
nt
of
mo
nth
ly
Co
vera
ge
Prem
ium
C
ove
rag
e Pr
emiu
m
Co
vera
ge
Prem
ium
C
ove
rag
e Pr
emiu
m
Co
vera
ge
Prem
ium
Und
er 3
0 $5
,000
$0
.33
$10,
000
$0.6
5 $1
5,00
0 $0
.98
$20,
000
$1.3
0 $3
0,00
0 $1
.95
30-3
4 $5
,000
$0
.44
$10,
000
$0.8
7 $1
5,00
0 $1
.31
$20,
000
$1.7
4 $3
0,00
0 $2
.61
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37
other life insurance rates: actives and retireesPEIA offers basic decreasing term life insurance, optional life insurance and dependent life insurance. This is not open enrollmentforlifeinsurance.LifeInsuranceOpenEnrollmentisconductedapproximatelyevery5years.Ifyouwanttomake changes in your life insurance, check your Summary Plan Description and Life Insurance Booklet for details of your rights, then contact your benefit coordinator for the appropriate forms. Basiclifeinsurancepremiumsforactiveemployeesarepaidbytheemployer.Retireespaythemonthlypremiumlistedbelow for their basic life insurance. We’ve provided these rates for informational purposes only. Dependentlifeinsurancepremiumsarepaidbytheactiveorretiredpolicyholder.Theratesarelistedbelowforyourinformation. Optionallifeinsurancepremiumsarepaidbytheactiveorretiredpolicyholder.Theratesarelistedontheprecedingpages. Foracompletedescriptionofthelifeinsurancebenefits,pleaseseetheLife Insurance Booklet.
active employee’s Basic life and ad&d insurance rates
retired employee’s Basic life insurance rates
age amount of Coverage monthly Premium
Under65 $10,000 $5.06
65-69 $6,500 $3.29
70&Over $5,000 $2.53
age amount of Coverage monthly Premium
Under67 $5,000 $4.35
67&Over $2,500 $2.18
active employee dependent life and ad&d insurance Premiums
retiree dependent life insurance Premiums
Plan Who is Covered? Coverage monthly amount Premium
Plan1 Spouse/EachChild $5,000/$2,000 $2.15
Plan2 Spouse/EachChild $10,000/$4,000 $4.31
Plan3 Spouse/EachChild $15,000/$7,000 $6.46
Plan4 Spouse/EachChild $20,000/$10,000 $8.61
Plan Who is Covered? Coverage monthly amount Premium
Plan1 Spouse/EachChild $5,000/$2,000 $3.52
Plan2 Spouse/EachChild $10,000/$4,000 $7.03
Plan3 Spouse/EachChild $15,000/$7,000 $10.56
Plan4 Spouse/EachChild $20,000/$10,000 $14.07
actives retirees
actives retirees
PremiumConversionPlan
39
Peia’s Premium Conversion Plan: make Your Choices for Plan Year 2011It’sopenenrollmenttimeforPEIA’sSection125PremiumConversionPlan,anIRS-approvedplanwhichallowseligiblepublicemployeestopayhealthandlifeinsurancepremiumswithpre-taxdollars.Throughthisplanyourpremiumsforhealthcoverageandlifeinsurancearedeductedfromyourpaybeforetaxesarecalculated,soyourtaxableincomeislower,andyoupaylesstax.
EachyearatthistimeweholdanOpenEnrollmentperiodtoallowyoutomakechangesinyourcoverageortogetinoroutofthePremiumConversionPlan.
ThissectionanswersCommonlyAskedQuestionsaboutthePremiumConversionPlanandwillservetoguideyouthroughthe enrollment process.
Commonly asked QuestionsWho participates in the Premium Conversion Plan?
IfyouareanactiveemployeeofaStateAgency,college,oruniversity(exceptWVU)oroneofthecountyboardsofeducationthatparticipatesinPEIA’sPremiumConversionplan,andyoupaypremiumsforhealthorlifeinsurance,thosepremiumsaredeductedbeforetaxesarecalculated,unlessyousignedaformwaivingyourparticipationinthisplan.Youmayhavebeenintheprogramforseveralyearswithoutrealizingit.Todetermineifyouarepayingyourpremiumsbeforeoraftertax,checkyourpaystuborcontactyourpayrolloffice.
When is open enrollment?
OpenEnrollmentisfromApril1-30,2010forPlanYear2011(July1,2010-June30,2011).
are there rules i have to follow?
Yes.TheIRSsetslimitsontheprogram,andsaysthatifyouagreetoparticipateintheplan,youcanonlychangetheamountofpre-taxpremiumyoupayduringOpenEnrollment.UndertheIRSrules,youmustpaythesameamountof premium each month during the year, unless you have a qualifying event and the consistency rule is satisfied. Documentationoftheseeventsisrequired.
Qualifyingeventsare: • marriageordivorceoftheemployee; • deathoftheemployee’sspouseordependent; • birth,placementforadoption,oradoptionoftheemployee’schild; • commencementorterminationofemploymentoftheemployee’sspouseordependent; • achangefromfull-timetopart-timeemploymentstatus,orviceversa,bytheemployeeorhisorherspouse,or dependent; • commencementoforreturntoworkfromanunpaidleaveofabsencetakenbytheemployeeorspouse; • asignificantchangeinthehealthcoverageoftheemployeeorspouseattributabletothespouse’semployment; • annulment; • changeintheresidenceorworksiteoftheemployer,spouse,ordependent; • lossoflegalresponsibilitytoprovidehealthcoverageforachildorfosterchildwhoisadependent; • adependentloseseligibilityduetoageorstudentstatus;or • employmentchangeduetostrikeorlock-out.
AsofJuly1,2006,theIRSchangedthedefinitionofa“qualifiedchild”fortaxpurposes.Thischangemayaffectyourabilitytopaypremiumsforfamilycoverageonapre-taxbasis.Afterage24,full-timestudentsmustmeettheFederalIRSdefinitionofa“qualifiedrelative”toqualifyforcoverageasadependentunderyourplan.Formoreinformation,visitour website at www.wvpeia.com.
ConsistencyRule:Thechangeinbenefitelectionsmustbeonaccountof,andconsistentwith,achangeinstatusthataffects eligibility for coverage under the cafeteria plan.
open enrollment under other employer’s Plan
You may make a change in your plan when your spouse or dependent changes coverage during his or her plan’s open enrollmentif: • theotheremployer’splanpermitsmid-yearchangesunderthisevent,and • theotheremployer’splanyearisdifferentfromPEIA’s.
Youmaymakeachangeinyourcoverage(addadependent,forexample)thatincreasesyourinsurancepremium,orthathas no effect on your premium, without having one of these events, but you’ll pay any resulting increased premium on anafter-taxbasisuntilthenextOpenEnrollmentperiod.
YoumaynotmakeachangeinyourcoveragethatreducesthepremiumyoupayuntilthenextOpenEnrollmentperiodunless you have a qualifying event.
To make a change in your coverage, go to www.wvpeia.comandclickonthe“OnlineOpenEnrollment”buttonorgetaChange-in-Statusformfromyourbenefitcoordinator.
What should i do if i want to get in or out of the Premium Conversion Plan?
Youhavefourchoices: (1) IfyouoptedoutofthePremiumConversionPlanpreviously,andyouwanttostayout,youdon’thavetodo anything.YouwillremainoutofthePremiumConversionPlanforthecomingyear. (2) IfyouoptedoutofthePremiumConversionPlanpreviously,andwantbackin,completetheformonpage42,sign, dateandreturnittoyourpayrollclerkbyApril30,2010. (3) IfyouareinthePremiumConversionPlan,andwanttostayin,youdon’tneedtodoanything.Youwillremainin thePremiumConversionPlanforthecomingyear. (4) IfyouareinthePremiumConversionPlanandyouwanttooptoutandpaytaxesonyourpremiums,completethe formonpage42,andreturnittoyourbenefitcoordinatorbyApril30,2010.
Can i make changes in my coverage now?
Yes.DuringOpenEnrollmentyoucanaddordropdependentsforanyreason.Gotowww.wvpeia.com and click on the “OnlineOpenEnrollment”button,orcompleteaChange-In-StatusformorcallPEIAforaTobaccoAffidavitandOpenEnrollmentTransferForm,andgetittoyourbenefitcoordinatorbyApril30,2010.
Can i make changes during the plan year?
TheIRSregulationssaythatyouhavetopaythesameamountofpremiumthroughouttheplanyear,unlessyouhaveaqualifying event, which causes your premium to change.
PEIAwantsyoutohavetheflexibilitytomakechangesinyourPEIAPPBPlancoverageduringtheyear,soweallowyouto make certain changes in your covered dependents during the plan year, as long as those changes don’t affect the amountofpremiumyouarepaying.Otherchangesrequireaqualifyingevent.
The managed care plans may have more stringent rules about adding and dropping dependents during the plan year, so be sure to check your plan’s certificate of coverage to know the rules.
IfachangeinyourPEIAPPBPlancoverageduringtheplanyearwillalterthepremium(andyoudidn’thaveaqualifyingevent),thefollowingwillhappen: • Ifthepremiumwillgoup,thenyouwillhavetopaytheadditionalpremiumwithafter-taxdollars. • Ifyourpremiumwillgodown,wecannotallowyoutomakethechangeanddropthedependent,becauseyou would be paying premiums for coverage you were not getting from the PEIA PPB Plan.
ThisonlyappliesifyoudonothaveoneofthequalifyingeventslistedonPage41.
What if i added dependents to my coverage during this past plan year?
Ifyouaddeddependentswithoutavalidfamilystatuschangeduringthisplanyear,thepost-taxpremiumswillautomaticallybedeductedonapre-taxbasisstartingJuly1,2010,unlessyoucompletetheformonPage42indicatingthatyoudonotwishtopayyourpremiumspre-tax,andsubmitittoyourbenefitcoordinatornolaterthanApril30,2010.
40
41
What do i do if i have a qualifying event during the plan year?Go to www.wvpeia.comandclickonthe“OnlineOpenEnrollment”button,orcontactyourbenefitcoordinatorforaChange-In-Statusform,complete,sign,andreturnittoyourbenefitcoordinatorduringthemonthofthefamilystatuschange event or the following two calendar months. You will need to include documentation of the Status change as indicated in the chart below.
Will i have to pay taxes on the premiums later?
BecausethisisanIRS-approvedprogram,youneverhavetopaytaxesonthemoneyyousavethroughthePremiumConversionPlan.
Why would i want to opt out of the plan?
Ifyouarefewerthantenyearsfromretirement,youmaywanttooptout.SinceyourSocialSecuritytaxisassessedafteryourpremiumsaredeductedunderthePremiumConversionPlan,youcontributelesstoSocialSecurity,anditcould lower your benefits upon retirement. Generally, the amount you save through premium conversion outweighs the amountyouloseinSocialSecurity.Ifyouhavequestions,consultyourtaxadvisor.
Premium Conversion Plan form / Plan Year 2011
I, ............................................................................................................ , wish to make the following change in my Premium Conversion Plan participation:
Opt INTO the Plan. I understand that by participating in this plan, I will reduce my tax liability, but I may be limiting my ability to make changes in my coverage throughout the plan year.
Opt OUT of the Plan. I understand that by opting out of the plan, I am agreeing to pay my premiums on a post-tax basis, thereby increasing my tax liability. This election may not be changed until the next open enrollment.
.................................................................................................................................................................... ..........................Employee’s Signature Date
Please return to your Benefit Coordinator. do not mail it to Peia!!!
42
What if i have more questions?
IfyouhavequestionsaboutthePremiumConversionPlan,pleaseconsultyourtaxadvisor.
should i have two plans?
If you have two insurance plans, you may want to consider whether it makes sense to keep them both. If both you and your spouse work outside the home and have group health coverage through your employers, you need to look carefully at the plans you have to be sure you are getting value for the premiums you are paying. The two issues you need to deal withrelatetoCoordinationofBenefits.Youneedtodetermine:(1)whichplanisprimaryandwhichissecondary;and(2)howtheplanspayassecondarypayers.
Coordination of Benefits (CoB)
CoordinationofBenefitsistheprocessusedbyinsurancecompaniestodeterminewhichplanwillpayfirst,andhowmuchitwillpay.ThekindofCOByouhavedependsonthekindofplanyou’rein.
By law, the PEIA PPB Plan coordinates benefits with all other insurance plans – even medical payments made under an automobile policy, or other individual policy. The only plans we don’t coordinate benefits with are individual policies whichmakeperdiempaymentsoflessthan$100andhavelimitedbenefits.PEIAusesthe“carveout”methodforcoordinating benefits as the secondary plan, which means that if the other plan pays as much as PEIA would have paid, then we pay nothing.
TheHMOsofferedbyPEIAuse“traditional”CoordinationofBenefits,whichmeansthattheymaypayupto100%forservices, but you will have to follow their rules to receive benefits.
Why bring this up now?
WeknowthatmostpeoplewhoencounterproblemswiththePremiumConversionPlanwanttomakechangesbecausetheydidn’tunderstandhowthePEIAPPBPlanworksasasecondarypayer.OftentheywanttodropthePEIAPPBPlanasasecondarycoverage,butsincetheyareinthePremiumConversionPlan,andthisisnotconsideredaqualifyingevent,we can’t allow it during the plan year.
DuringOpenEnrollment(April1-30,2010),youcanmakeanychanges,evenifthey’renottheresultofqualifyingevents.
Where can i learn more about CoB?
Ifyou’reinthePEIAPPBPlan,readyourSummaryPlanDescriptionfordetailsofPEIA’sCoordinationofBenefitspolicy.Ifyou’re in a managed care plan, read your certificate of coverage or check with your plan for more details.
Living Wills and AdvanceDirectivesforEndofLifeCare
living Wills and advance directives for Health Care decision-making
Asyoumayhavereadrecently,beginninginPlanYear2012,(July1,2011),PEIAwillofferapremiumdiscounttopolicyholders who have completed a Living Will. To get the discount, the policyholder will have to submit an affidavit thatwillbemailedtoeverypolicyholderinlate2010.TheaffidavitswillbeduebeforetheendofOpenEnrollmentNEXTYEAR.
Rightnow,we’djustliketostartthediscussion.Wewantyoutobeginthinkingaboutandtalkingwithyourfamilyabout a Living Will. You can even go ahead and complete the form we’ve included in this Shopper’s Guide. We’ve includeditforyourconvenience.ThereareotherformsavailablefromtheWestVirginiaCenterforEndofLifeCareatwww.wvendoflife.org.
PEIA does not want to see a copy of your Living Will. PEIA is not concerned about the contents of your Living Will. PEIA simply wants you to think about what your wishes are, and then make them known to your loved ones and your health care providers.
ThefollowingpagescontainacopyoftheWestVirginiaCombinedLivingWillandMedicalPowerofAttorneyform.PEIAbelievesitisimportantforeverymemberoftheplantoconsiderhavingaLivingWill,andhereiswhy:
As an adult, you have the right to make your own health care decisions. You have the right to know about proposed treatments , alternative treatments and their risks and benefits. You have the right to ask questions, and then you have the right to decide whether you want the treatment or not. Your right to accept medical or surgical treatment also includes the right to refuse it.
Butwhatifyoubecomeincapableofmakinghealthcaredecisionsforyourselfbecauseofinjuryorillness?Whowilldecidewhattypesoftreatmentyoureceive?Youcanremaininchargeofyourhealthcare,evenafteryoucannolongermake decisions for yourself, by creating a document called an “advance directive.”
WestVirginialawrecognizestwotypesofwrittenadvancedirectivesforhealthcaredecision-making:theLivingWillandtheMedicalPowerofAttorney.BothformshaveaspecialsectionforyoutowriteinspecificcommentsaboutcircumstancesinwhichyouwouldnotwantCPR,afeedingtube,dialysis,ortreatmentwithabreathingmachine.Youcan use these documents to let your family and your health care providers know your decisions for health care if you becomeunabletodecideforyourself.YoucanappointsomeoneyouknowandtrustasyourMedicalPowerofAttorneyrepresentative to ensure that your choice or decision is honored.
Well-respectedorganizationsfromtheAmericanMedicalAssociationtotheAmericanAcademyofFamilyPhysicianstotheAARPsupporttheideaofAdvanceDirectives.
WeencourageyoutolearnmoreaboutthisimportanttopicbyvisitingtheWestVirginiaCenterforEndofLifeCareatwww.wvendoflife.org.
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STATE OF WEST VIRGINIA COMBINED MEDICAL POWER OF ATTORNEY AND LIVING WILL
ThePersonIWanttoMakeHealthCareDecisionsForMeWhenICan’tMakeThemforMyselfAndTheKindofMedicalTreatmentIWantandDon’tWantIfIHaveaTerminalConditionorAmInaPersistentVegetativeState
Dated:______________________________,20______
I,___________________________________________________________________________________________________________________,hereby
(Insertyournameandaddress)
appoint as my representative to act on my behalf to give, withhold or withdraw informed consent to health care decisions in the event that I am not able to do so myself.
ThepersonIchooseasmyrepresentativeis:
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________(Insertthename,address,areacodeandtelephonenumberofthepersonyouwishtodesignateasyourrepresentative)
ThepersonIchooseasmysuccessorrepresentativeis:
If my representative is unable, unwilling or disqualified to serve, then I appoint
_____________________________________________________________________________________________________________________________
(Insertthename,address,areacodeandtelephonenumberofthepersonyouwishtodesignateasyoursuccessorrepresentative)
Thisappointmentshallextendto,butnotbelimitedto,healthcaredecisionsrelatingtomedicaltreatment,surgicaltreatment,nursingcare,medication,hospitalization,careandtreatmentinanursinghomeorotherfacility,andhomehealthcare.Therepresentativeappointedbythisdocumentisspecificallyauthorizedtobegrantedaccesstomymedicalrecordsandotherhealthinformation and to act on my behalf to consent to, refuse or withdraw any and all medical treatment or diagnostic procedures, or autopsy if my representative determines that I, if able to do so, would consent to, refuse or withdraw such treatment or procedures. Suchauthorityshallinclude,butnotbelimitedto,decisionsregardingthewithholdingorwithdrawaloflife-prolonginginterventions.
I appoint this representative because I believe this person understands my wishes and values and will act to carry into effect the health care decisions that I would make if I were able to do so, and because I also believe that this person will act in my best interest when my wishes are unknown. It is my intent that my family, my physician and all legal authorities be bound by the decisions that are made by the representative appointed by this document, and it is my intent that these decisions should not be the subject of review by any health care provider or administrative or judicial agency.
It is my intent that this document be legally binding and effective and that this document be taken as a formal statement of my desire concerning the method by which any health care decisions should be made on my behalf during any period when I am unable to make such decisions.
Inexercisingtheauthorityunderthismedicalpowerofattorney,myrepresentativeshallactconsistentlywithmyspecialdirectivesorlimitations as stated below.
IamgivingthefollowingSPECIALDIRECTIVESORLIMITATIONSONTHISPOWER:(Commentsabouttubefeedings,breathingmachines, cardiopulmonary resuscitation, dialysis, mental health treatment, funeral arrangements, autopsy, and organ donation may beplacedhere.MyfailuretoprovidespecialdirectivesorlimitationsdoesnotmeanthatIwantorrefusecertaintreatments).
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1.IfIamverysickandnotabletocommunicatemywishesformyselfandIamcertifiedbyonephysicianwhohaspersonallyexaminedme,tohaveaterminalconditionortobeinapersistentvegetativestate(Iamunconscious)andamneitherawareofmyenvironmentnorabletointeractwithothers,)Idirectthatlife-prolongingmedicalinterventionthatwouldservesolelytoprolongthemdyingprocess or maintain me in a persistent vegetative state be withheld or withdrawn. I want to be allowed to die naturally and only be given medications or other medical procedures necessary to keep me comfortable. I want to receive as much medication as is necessary to alleviate my pain.
2.Otherdirectives _____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
THISMEDICALPOWEROFATTORNEYSHALLBECOMEEFFECTIVEONLYUPONMYINCAPACITYTOGIVE,WITHHOLDORWITHDRAWINFORMEDCONSENTTOMYOWNMEDICALCARE.
_____________________________________________________________________________
Signature of the Principal
I did not sign the principal’s signature above. I am at least eighteen years of age and am not related to the principal by blood or marriage. I am not entitled to any portion of the estate of the principal or to the best of my knowledge under any will of the principal or codicil thereto, or legally responsible for the costs of the principal’s medical or other care. I am not the principal’s attending physician, nor am I the representative or successor representative of the principal.
Witness_________________________________________DATE___________
Witness_________________________________________DATE___________
STATEOF_________________________________________________________COUNTYOF______________________________________________
I,_______________________________________,aNotaryPublicofsaidCounty,docertifythat_____________________________,asprincipal,
and________________________________________and__________________________________,aswitnesses,whosenamesaresignedtothe
writingabovebearingdateonthe_____dayof______________,20___,havethisdayacknowledgedthesamebeforeme.
Givenundermyhandthis_____dayof_________________,20___.Mycommissionexpires:_______________________________
_____________________________________________________________________________
SignatureofNotaryPublic
Notes
Notes
Notes
Notes
Type of PlanPlanName,WebAddress&MailingAddress PhoneNumber
TheHealthPlan• www.healthplan.org52160NationalRoadEastSt.Clairsville,OH43950-9365
PEIA • www.wvpeia.com60157thStreet,SE,Suite2Charleston,WV25304-2345
1-888-847-79021-740-695-3585
1-877-676-5573
HMO
PPB Plan
PRSRTSTDU.S.POSTAGE
PAIDCHARLESTON,WV
PERMITNO.55
Public employeesinsurance agency60157thStreet,SE/Suite2Charleston,WestVirginia25304-2345
to learn more about a PlanIf you need a copy of a provider directory, or if you have specific questions about medical or prescription
drugcoverageunderanyoftheplansoffered,callthetoll-freenumbersbelowforyouranswers.