PEB Board approves changes to drug coverage in UMP Classic Medicare for plan year 2025

On April 11, 2024, the Public Employees Benefits Board (PEB Board) met. Members attended in person at the Health Care Authority (HCA) in Olympia and remotely. The meeting was open to the public both in person and via Zoom.  

Meeting recap

Highlights are listed below. See the briefing book for all presentation materials.   

HCA staff introduced the following proposed resolutions:

  • PEBB 2024-23 — UMP Diagnostic and Supplemental Breast Exam Coverage
  • PEBB 2024-24 — UMP Diabetes Management Program

The Board approved the following resolutions:

  • PEBB 2024-01 through PEBB 2024-09 — Amending PEBB 2021-02 through -09 and -25 prior policy decisions relating to PEBB dual enrollment prohibitions to include PEBB Program vision
  • PEBB 2024-10 — Rescinding Resolution PEBB 2022-02, Employees may waive enrollment in dental
  • PEBB 2024-11 — Amending PEBB 2022-04, Deferring PEBB retiree insurance coverage when the subscriber becomes eligible for the employer contribution: PEBB retiree insurance coverage will be automatically deferred when the subscriber becomes eligible for the employer contribution towards PEBB or SEBB benefits. The subscriber will be exempt from the deferral form requirement.
  • PEBB 2024-12 — Fully Insured Vision Plans: The benefit design for the embedded refraction vision exam and hardware coverage for Employees and non-Medicare Retirees included in prior Board Policy decisions and resolutions is rescinded and replaced with the following: Beginning January 1, 2025, the PEBB Program will offer standalone fully-insured vision plans by EyeMed Vision, Davis Vision, and MetLife Vision as presented at the March 21, 2024 Board meeting.
  • PEBB 2024-13 — Default enrollment if an employee did not enroll in a PEBB vision plan during the annual open enrollment in 2024: All employees who are eligible for the employer contribution towards PEBB benefits as of December 31, 2024 and did not make an election during an enrollment period established by the Health Care Authority in 2024, will be auto-enrolled in a PEBB vision plan as designated by the director or designee with an effective date of January 1, 2025. Any dependents on the account that are enrolled in PEBB medical will be enrolled in the same PEBB vision plan as the subscriber.
  • PEBB 2024-14 — Non-Medicare Retiree Enrollment Requirement: A non-Medicare retiree must enroll in PEBB medical to be able to enroll in PEBB dental, in PEBB vision, or in both PEBB dental and PEBB vision.
  • PEBB 2024-15 — Amending PEBB 2021-12: Amending PEBB 2021-12 to read: The default election for an eligible employee who fails to timely elect coverage will be as follows:
    • Enrollment in employee-only medical coverage;
    • Enrollment in employee-only dental coverage;
    • Enrollment in employee-only vision coverage;
    • Enrollment in basic life insurance;
    • Enrollment in basic AD&D;
    • Enrollment in employer-paid long-term disability insurance; and
    • Enrollment in employee-paid long-term disability insurance at the 60% coverage level.
  • PEBB 2024-16 — Amending PEBB Policy Resolution “Error Correction” adopted on July 16, 2014: If an employing agency fails to enroll an employee in benefits, medical, dental, and vision enrollment will be effective the first day of the month following the date the enrollment error is identified, unless the Health Care Authority determines additional recourse is warranted. If the enrollment error is identified on the first day of the month, enrollment is effective that day.
  • PEBB 2024-17 — UMP Classic Medicare Part D Coverage: The UMP Classic Medicare prescription drug benefit will change from creditable drug coverage to Part D Medicare drug coverage effective January 1, 2025.
  • PEBB 2024-18 — Automatic Enrollment – UMP Classic Medicare – Annual Open Enrollment 2024: All Medicare enrollees who are enrolled in UMP Classic Medicare with creditable drug coverage as of December 31, 2024, where the subscriber did not make an election during the PEBB annual open enrollment period held in 2024, will be auto-enrolled in the UMP Classic Medicare with Medicare Part D drug coverage with an effective date of January 1, 2025.
  • PEBB 2024-19 — UMP Classic Medicare Enrollment: If a subscriber selects the Uniform Medical Plan (UMP) Classic Medicare plan, any non-Medicare enrollees on the account will be enrolled in the UMP Classic.
  • PEBB 2024-20— UMP Classic Medicare Enrollment During Gap Month(s): If a subscriber elects to enroll in the Uniform Medical Plan (UMP) Classic Medicare plan, and the required forms are received by the PEBB Program after the date the PEBB retiree insurance coverage is to begin, the subscriber and their enrolled dependents will be enrolled in transitional UMP coverage during the gap month(s) prior to when the UMP Classic Medicare plan begins.
  • PEBB 2024-21 — Amending PEBB 2022-03 Medicare Advantage Prescription Drug plan enrollment during gap month(s): If a subscriber elects to enroll in a Medicare Advantage Prescription Drug (MA-PD) plan, and the required forms are received by the PEBB Program after the date the PEBB retiree insurance coverage is to begin, the subscriber and their enrolled dependents will be enrolled in transitional coverage as designated by the director or designee during the gap month(s) prior to when the MA-PD coverage begins.
  • PEBB 2024-22 — When a subscriber is involuntarily terminated by a Medicare Part D plan: When a subscriber or their dependent must be disenrolled by a Medicare Part D plan as required by federal law, the subscriber and their enrolled dependents will be enrolled in a PEBB medical plan as designated by the director or designee. The new medical plan coverage will begin the first day of the month following the date the UMP Classic Medicare plan is terminated.

HCA staff provided presentations on the following:  

  • Follow up on March PEB Board meeting 
  • Update on the supplemental budget, including final funding rates and conference budget funding 
  • Vision benefit design update, proposed changes to the PEBB Program vision benefit, overview of vision plan service areas, and the Board unanimously voted to approve the resolutions
  • Update on annual rulemaking
  • Update on UMP benefit design, including coverage for diagnostic and supplemental breast exams and a diabetes management program
  • UMP Medicare Part D plan option timeline, resolutions, and the Board unanimously voted to approve the resolutions 
    • Beginning in January 2025, UMP Classic Medicare subscribers will have Part D drug coverage instead of creditable drug coverage. This change was made to make the UMP Classic Medicare plan more affordable. By having Part D drug coverage, the plan will be eligible for additional federal subsidies and will benefit from the upcoming Medicare drug negotiations. 
    • The changes to the covered drugs and pharmacy networks have been designed to be minimal. 

Next meeting

The next public meeting of the PEB Board is scheduled for May 9, 2024, at 9 a.m. Board members and the public may attend in person (masks are optional) or virtually via Zoom. A link or call-in number for virtual attendance will be noted on the meeting agenda and posted on the PEB Board Meetings and materials webpage.