Most PEBB plans offer new benefits, stable premiums for 2014
Most of you will see more stable medical plan premiums in 2014, and new medical benefits that reflect the state’s interest in helping you and your family be proactive in your health and well-being. In addition, new state and federal health care reforms will expand coverage and apply more of your costs toward your out-of-pocket maximum next year.
All changes described below are effective January 1, 2014, unless otherwise noted. Cost-sharing for other benefits won’t change in 2014; you can view medical benefits comparisons online and at benefits fairs held in November.
Most medical plan premiums show little change
See 2014 medical plan premiums
During this year’s procurement, the Health Care Authority kept the PEBB Program’s medical plan premium increases to an average of 1.8 percent. This is the lowest increase in many years without increases in copays, coinsurance, or deductibles.
In 2014, you will see the following medical plan premium changes:
- Two plans’ premiums will decrease:
- Group Health Consumer-Directed Health Plan (CDHP)
- Group Health Value
- Four plans’ premiums will have small increases:
- Group Health Classic, Kaiser Permanente CDHP
- Uniform Medical Plan (UMP) Classic
- UMP CDHP
- One plan’s premiums will increase more:
- Kaiser Permanente Classic.
Life and long-term disability insurance benefits and premiums will not change in 2014. Dental benefits will also remain the same for 2014; there are no employee premiums for dental insurance.
Premium surcharges effective July 1, 2014
See Announcement: Premium surcharges start July 1, 2014
Legislative changes will require some members to pay a premium surcharge starting July 1, 2014. More information will be available before July 2014.
- A monthly $25-per-account surcharge will apply if you or one of your enrolled family members uses tobacco products.
- A monthly $50 surcharge will apply if you enroll your spouse or state-registered domestic partner, and the spouse or partner has waived enrollment in other employer-sponsored coverage that is comparable to PEBB coverage.
New benefit focuses on diabetes prevention and control
In an effort to curb the onset of diabetes, the PEBB Program will offer the NOT ME Diabetes Prevention Program to Group Health and Uniform Medical Plan (UMP) members who have prediabetes or high blood sugar, and are not enrolled in Medicare. (If you’re enrolled in Kaiser Permanente, please contact your plan to enroll in its prediabetes coaching program.)
The free program is a 16-week series of one-hour sessions taught by trained health coaches at YMCAs and community centers throughout the state. NOT ME will also offer onsite lab testing to screen employees for diabetes and prediabetes at participating state agency and higher-education workplaces in 2014.
In addition, UMP will offer the NOT ME Diabetes Control Program for its members who already have diabetes and are not enrolled in Medicare. The free program includes a quarterly session with a registered pharmacist who is trained in helping members manage diabetes.
Other benefit and cost-sharing changes for PEBB's medical plans in 2014*
|Group Health Classic,
Consumer-Directed Health Plan (CDHP),
- The annual deductible, all copays, and all coinsurance for covered services will apply to the annual out-of-pocket maximum. (See what doesn't apply)
- Acupuncture: Visit limit is eliminated for treatment of chemical dependency.
- Cochlear implants:
- Outpatient: You pay $15 copay per primary care office visit, and $30 copay per specialist office visit (deductible applies to both).
- Inpatient: You pay $150 copay up to $750 per person per admission (deductible applies).
- Outpatient services: The plan will cover routine services provided during a clinical trial; your cost-sharing applies based on service.
- Prescription drugs: The plan will cover preferred prescription drugs provided during a clinical trial; your cost-sharing applies based on drug tier.
- Rehabilitation: No visit limits for rehabilitation due to cancer, pulmonary, respiratory disease, or other chronic conditions.
- Vision hardware: Coverage for members ages 18 and under will change in 2014 to comply with health reform requirements, but details were not available at the time of printing. Check with Group Health for more information.
- Group Health CDHP only: Preventive care under the extended network is not covered, except for screening mammograms (annual deductible and coinsurance apply).
|Kaiser Permanente Classic and Consumer-Directed Health Plan (CDHP)
- Kaiser Permanente Classic only: The annual deductible, all copays, and all coinsurance (except for prescription drugs, pediatric oral screenings, hearing aids, tooth injuries, vision hardware, out-of-area student coverage, and self-referral to chiropractic care) will apply to the annual out-of-pocket maximum. (See what doesn't apply)
- Kaiser Permanente CDHP only: The annual deductible, all copays, and all coinsurance will apply to the annual out-of-pocket maximum. (See what doesn't apply)
- Hearing exams: You pay $30 copay per exam (subject to deductible for Kaiser Permanente CDHP only).
- Vision exams: You pay $20 copay per exam for members ages 18 and under (subject to deductible for Kaiser Permanente CDHP only).
- Vision hardware: No charge for one pair of frames and lenses or contact lenses, once every 24 months for members ages 18 and under.
- Members’ $65 copay for tobacco cessation class is eliminated.
- No dollar limit on essential health benefits. (For a list of essential health benefits, visit www.healthcare.gov/what-does-marketplace-health-insurance-cover/.)
|Uniform Medical Plan (UMP) Classic and UMP Consumer-Directed Health Plan (CDHP)
- UMP Classic only: The annual medical deductible and all copays will apply to the annual out-of-pocket maximum, in addition to the coinsurance for in-network services. As in 2013, prescription drug costs do not count toward the annual out-of-pocket maximum. (See what doesn't apply)
- UMP CDHP only: As in 2013, the annual medical deductible, all copays, and all coinsurance will apply to the annual out-of-pocket maximum. (See what doesn't apply)
- Ancillary charge for brand-name prescription drugs is eliminated.
- Bariatric surgery (applies to non-Medicare members only): The criteria for consideration of coverage changes from body mass index (BMI) of 40 to:
- BMI of 40, or
- BMI of 35 – 39 with diabetes or two related conditions that have documented evidence of failure to control.
Coverage of gastric sleeve is permitted if recommended by the performing facility.
- Contact lens fitting fees have a maximum plan payment of $65.
- Preventive care services performed by a non-network provider will be paid at 100 percent of billed charges if there is no network provider available.
- Vision hardware for members ages 18 and under:
- Eyeglasses: You pay nothing for one pair (frames and lenses) per year.
- Contact lenses: You pay 15 percent of billed charges.
*Your cost-sharing for prescription drugs can change at any time as drugs move into different coverage tiers.
How repeal of the Defense of Marriage Act affects PEBB members
In June, the U.S. Supreme Court ruled Section 3 of the Defense of Marriage Act invalid. The U.S. Department of the Treasury and Internal Revenue Service (IRS) have since announced that for federal tax purposes, the IRS will recognize a marriage performed in a state (or any other domestic or foreign jurisdiction) where same-sex marriage is legal, even if the state in which the spouses live does not.
If you enrolled a same-sex spouse and/or your spouse’s children on your PEBB coverage who were not declared as your tax dependents, the cost of their coverage has been considered taxable income. You may now declare these family members as your tax dependents and the cost of their PEBB coverage will not be considered taxable income. To change your tax status for the remainder of the 2013 tax year, please contact your employer’s personnel, payroll, or benefits office.
This ruling may provide certain retroactive relief, so the PEBB Program recommends that you contact your tax advisor or the IRS for assistance.
See Announcement: How repeal of the Defense of Marriage Act affects PEBB members
HSA contribution limits increase for 2014
For 2014, the annual health savings account (HSA) contribution limit is $3,300 (individuals) and $6,550 (you and one or more family members). This is an increase of $50 and $100, respectively, from 2013 contribution limits. If you are age 55 or above, you may contribute up to $1,000 more annually in addition to these limits.
New flexible spending account and DCAP vendor
Flex-Plan Services, Inc. has been selected as the new vendor to provide PEBB’s flexible spending account (FSA) and Dependent Care Assistance Program (DCAP). ASIFlex, PEBB’s current vendor, will continue to provide services through 2013, including the grace period.
New name for dental plan administrator
Washington Dental Service administers both DeltaCare and Uniform Dental Plan (UDP). Recently, Washington Dental Service changed its name to Delta Dental of Washington. You will see Delta Dental of Washington associated with both DeltaCare and UDP on the 2014 enrollment forms, on our website, and in the plans’ materials.