CHARLESTON, W.Va. — Gov. Jim Justice has made a recommendation to make health care availability more flexible border county residents who are insured by PEIA.

A task force to study the Public Employees Insurance Agency appears primed to embrace the recommendations.

“It will provide greater flexibility,” said task force member Amy Loring, a human resources specialist for Berkeley County Schools.

“And it will help those who have long-term health issues with their current providers, that they don’t have to switch and find new providers who don’t have their health history.”

Loring and other task force members have consistently advocated for an even playing field for residents who need the convenience or availability of cross-border healthcare.

As described by leaders of the committee, the governor’s proposal would affect contiguous counties all around West Virginia’s border.

“So everybody will be clear, and I’m sure some will not, we’re talking about counties adjacent to West Virginia,” said Chief of Staff Mike Hall.

He added, “If you’re anywhere in the state you can go to any of these hospitals that are in the network and are in adjacent counties.”

Hall described about a $9 million additional cost to provide greater flexibility for health care across the border.

The overall cost is about $18 million, but state leaders are also counting on about $9 million in savings provided by the state’s recent switch to a new third party administrator contract.

The Governor’s letter included the following recommendations:

  • Move Plan A benefits back to 80/20 coinsurance in West Virginia contiguous counties
  • Move Plan B benefits back to 70/30 coinsurance in West Virginia contiguous counties
  • Remove facility fee limits from out-of-state facilities
  • 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
  • And the governor asked the coverage committee to review the wellness plans to further incentivize our members to seek better health outcomes

“I believe these recommendations address the issues that will benefit PEIA recipients the most,” Justice said.

“These changes, along with my proposal for $100 million to the PEIA stabilization fund over the next two years, will go a long way to fixing PEIA.”

Justice established the task force following the statewide teachers walkout earlier this year.

Teachers complained of spiraling out-of-pocket costs compared to their flat wages. They also complained that wellness efforts through the program were too punitive.

The PEIA Task Force began with a series of public meetings all across the state, then started focusing on changes to the plan and its cost structure.

The PEIA Task Force intends to wrap up its work this coming Monday, meeting and providing recommendations to the PEIA Finance Board, to the governor and to the Legislature.

“I appreciate the many hours of hard work all the members of the PEIA Task Force have put into this project and I look forward to seeing the final report in the coming days,” Justice stated.

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