State workers gain with benefits changes

State workers will see several changes in their health benefits this year but, unlike some previous years, program director Leslie Johnstone said most will like the changes.

The biggest change by the Public Employee Benefits Program will be in handling claims by retirees who also qualify for Medicare. The state has been following the "integration method" of coordinating benefits, which means the state plan reimburses 80 percent of what Medicare doesn't pay.

On major medical claims, that can leave the insured with a substantial bill.

Johnstone said this year, PEBP will change to what is called the "standard method."

"That means the plan will pay substantially everything Medicare does not after the retiree has met their deductible," she said. "It will be a big benefit."

And the program is doing away with the monthly $70 checks to cover 80 percent of the Medicare Part B premium.

"Now we're simply going to reduce their premium by that amount," she said.

Johnstone said there will be about 1,300 retirees who don't like the change because they have a monthly premium which is less than the $70 check, which means they actually made money from the checks.

"We'll be reducing their premium down to zero. But we just don't think they should have a premium that's less than zero," she said.

She said several changes are coming in the pharmacy benefits. The plan will begin covering the cost of over-the-counter drugs when there is medicine which is effective and less expensive than the prescription variety. She said the best example is Prilosec OTC, a treatment for acid reflux.

"As more things become over-the-counter, it will be beneficial to the plan to open up those drug classes," Johnstone said.

To encourage more people to use generic drugs, she said the plan is eliminating the $50 deductible for generics. The deductible will still apply to formulary drugs.

"It could costs more if generic use doesn't change, but it pays for itself with just 1 percent more generic utilization," she said.

The practice is being dropped of reducing copay charges for members who mail-order three months of prescription drugs at a time. She said mail-order drugs are no longer significantly cheaper than pharmacy prices so the plan has less reason to push members toward greater use of mail-order houses.

The plan changes and rates for different employee groups will be presented at PEBP's March 1 meeting.

• Contact reporter Geoff Dornan at gdornan@nevadaappeal.com or 687-8750.