Most PEBB plans offer new benefits, stable premiums for 2014
Most of you will see more stable medical and dental 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 start January 1, 2014, unless otherwise noted. Cost-sharing for other benefits won’t change in 2014; you can view medical and dental benefits comparisons on PEBB’s website and at benefits fairs held in November.
Most 2014 premiums show little change
See 2014 premiums.
During this year’s procurement, the Health Care Authority kept the PEBB Program’s medical plan premium increases to less than 1 percent for non-Medicare retirees and 2.2 percent for Medicare retirees, on average. This is the lowest increase in many years without increases to 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)
- Premera Blue Cross Medicare Supplement Plan F
- Six plans’ premiums will have small to moderate increases:
- Group Health Classic
- Group Health Value
- Kaiser Permanente Classic (including Senior Advantage)
- Kaiser Permanente CDHP
- Uniform Medical Plan (UMP) Classic
- UMP CDHP
- One plan’s premiums will increase 6.8 percent:
- Group Health Medicare Plan
Some dental plans’ premiums will also change; however, retiree term life insurance benefits and monthly premium of $6.57 will stay the same in 2014.
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:
- 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.
The surcharges won’t apply if all covered family members are enrolled in Medicare A and B. More information will come by July 2014.
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 Washington State.
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), Original Medicare, and Value
(No benefit changes to Group Health's Medicare Advantage Plan)
- 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 care 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/.)
|Kaiser Permanente Senior Advantage (Medicare Advantage)
- The family out-of-pocket maximum of $3,000 is eliminated. The individual $1,500 out-of-pocket maximum applies to each account, regardless of the number of family members enrolled.
- You pay $20 copay per spinal manipulation visit.
|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 considerationof 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 are a retiree who enrolled a same-sex spouse who is enrolled in both Parts A and B of Medicare on your PEBB account, the state’s contributions toward the spouse’s health coverage are no longer considered taxable income. If your account indicates that you are married, the PEBB Program will not issue a 1099 for the 2013 tax year. If your account indicates that you have a state-registered domestic partner enrolled, the PEBB Program will issue a 1099 for the 2013 tax year.
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.
Members who have Medicare as their primary coverage are not eligible to contribute to an HSA or enroll in a consumer-directed health plan. Other exclusions apply.
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.