The Public Employees Insurance Agency’s finance board adopted its 2026 fiscal year plan on Thursday – including a much-disputed hike to premiums and other costs for current members.
After weeks of public hearings, the board made two amendments to the proposed plan.
First, the board eliminated proposed changes to income tiers. In the proposal, rates would have been broken up by five instead of ten income categories. Those making less would be grouped in with those making more, paying higher rates.
Second, the board voted to keep the current retiree premium and benefit assistance program. Director of PEIA Brian Cunnignham said the program provides financial assistance in paying for PEIA costs to retirees in certain income brackets.
“We’ve really dug deep to try to find a way to provide some support for retirees,” Cunningham said.
Board members said the benefit program is currently underused, with roughly 2,200 out of 40,000 PEIA retirees enrolled, encouraging retirees that qualify to apply.
While the board discussed other changes in response to public hearing comments — like a bigger increase for brand name copays in order to maintain lower generic copays, or changing the administrative fee — they did not adopt those changes, pointing to a need to increase revenue and maintain long-term fiscal security for participating agencies.
Premiums will increase by 12 to 16 percent. Some copays are more than doubling. And average deductibles and out of pocket maximums will increase by more than $300.
West Virginia Education Association (WVEA) President Dale Lee — who was a member of Gov. Justice’s 2018 to 2019 PEIA task force — attended the meeting after speaking at a series of PEIA public hearings.
Lee said WVEA plans to join with the American Federation Teachers – West Virginia union to lobby lawmakers for PEIA funding during the legislative session, citing issues with the passage of Senate Bill 268 in 2023. The bill included a requirement for insurance companies to spend at least 80 percent of the money they make from premiums on health care costs and quality improvement activities.
“I think there’s still major problems with the plan,” Lee said. “We’ve had record surpluses in the past five years that could have been used to offset some of these increases to the employees. But with the hard, fast 80/20 that doesn’t help. It also ties the hand of the Finance Board.”
The plan takes effect in July unless the legislature passes any funding changes.