STAFF WRITER
The Public Employees Insurance Agency gained about 440policyholders during a recent enrollment period to push membershipina new preferred provider benefit plan to about 79,000. The plan goesinto effect July 1.
The plan has higher deductibles and co-payments to help keepPEIA's indemnity, or fee-for-service plan, operating in the blacknext fiscal year.PEIA Director Robert Ayers said Wednesday 1,230 memberstransferred back to the indemnity plan from managed-careorganizations, but 790 policyholders switched from the indemnityplanto HMOs.If a substantial number had switched back to PEIA, the financiallystrapped plan could have been thrown into a deficit next fiscalyear.HMOs will be providing health-care coverage for between 17 percentand 18 percent of PEIA's total enrollment.Ayers said PEIA will be covering 216,000 people through itsindemnity plan and HMOs.PEIA has a low family premium rate. Some of the HMOs lostfamilies because they have higher rates.Ayers said Carelink lost 150 members, including 130 familypolicyholders. It also lost in the employee-with-child category butgained in single coverage.Advantage Health Plan lost 120 members, including 80 families and10 in employees with child.Prime One, a statewide HMO, lost 70 members, but gained 40 familypolicyholders. Ayers said Prime One lost a substantial number a yearago when it raised its family rate from $50 to $160 a month.This year, Prime One lowered its family rate to $130-to-$140 amonth, Ayers said. The HMO lost several employees who had coveragefor children.The Health Plan of the Upper Ohio Valley gained 20 members butlost eight with family coverage. Optimum Choice lost 30 but gained acouple of members in the employee-with-child category.The average family premium in PEIA's plan is $43.80 a month foremployees whose salaries range between $18,000 and $30,000.Ayers said he expected PEIA's indemnity plan to gain between 800and 1,000 members, but the net amount was only 440.In addition, about 100 employees who had only basic life insuranceswitched into PEIA's health plan, Ayers said.PEIA is going to have to raise its premium for family coveragedown the road, he said, or eventually a large number of HMOpolicyholders will switch.If PEIA's existing coverage is unchanged over the next five to sixyears, its cost will just about double, he said.PEIA is currently paying out nearly $400 million a year. Ayerssaid the total will go to about $650 million in five years 'ifeverything stays as it is today.'PEIA has enough money to pay its bills this fiscal year, whichends June 30, he said.The Legislature ordered PEIA's finance board to come up with afive-year plan. Ayers said he has been meeting with representativesof the West Virginia Education Association and the AFL-CIO to gettheir input.To contact staff writer Fanny Seiler, call 348-5198.
