Every year, PEBB must stay under a 3.4% cost growth cap imposed by the legislature. This is a continual challenge with increasing health care inflation.

This year, health care rates increased $21.4 million above the 3.4% cap.  The largest cost driver is specialty pharmaceutical drugs. To reduce costs, the PEBB board took a balanced approach using PEBB reserves and changes in the plan design to hold down costs.

The Board prioritized maintaining the low-cost plans. Our Union drives this priority every year with the Board. This allowed members to continue paying the lower premium share.

The percent you pay for your health care is maintained for 2025:

For state workers:
·      1% premium share for the lower cost plans – Providence Choice, Moda, & Kaiser deductible
·      5% premium share for the more expensive plans – Providence Statewide & Kaiser HMO/Traditional

For higher education:
·      SEIU workers pay 3% for the lowest cost plan where they live or work.  The  Kaiser Deductible plan is the lowest cost plan for those who get their health care in the Kaiser service area.  For employees outside the Kaiser service area, both Moda & Providence Choice will be the lowest cost plans. They will cost exactly the same in 2025.
·      There is a 5% premium share for the more expensive plans – Providence Statewide & Kaiser HMO/Traditional
·      Our Union continues to have a low wage worker subsidy in place in our Union contract to offset the higher premium share for Higher Education workers.

The Board also prioritized minimal cost shifting around co-pays and deductibles.  All plans keep the same co-pays and deductibles with one exception.  Some drug copays will change in the Kaiser HMO plan. Generic drugs copays will increase from $1 to $5. Brand drug copays will increase from $15 to $25.  This aligns the Kaiser HMO/Traditional plan with the Kaiser deductible plan drug benefits.

Finally, due to PEBB benefits enrollment system upgrades, open enrollment will not be mandatory for most employees this year.  Most current benefit elections will rollover into 2025 UNLESS you actively change them. There is one exception. Federal rules require annual enrollment in Flexible Spending Accounts (FSA).  You must complete open enrollment if you want to enroll in a:
·      Health Care FSA,
·      Dependent Care FSA, or
·      Commuter account.

Mandatory open enrollment for everyone will resume in the fall of 2025 for the 2026 plan year.

Ongoing discussion around GLP-1 drugs like Ozempic and Wegovy for weight loss

PEBB is not expanding coverage to GLP-1 drugs for weight loss in 2025.  Cost is the biggest deciding factor since the 2025 renewal came in well above the 3.4% legislative cap. The board could not justify increasing deductibles, co-pays, and premium share for all members to afford to offer weight loss drugs.  This is really a challenge. As a Union, we are discussing pushing for legislative relief from the 3.4% growth cap. This will allow the board flexibility to consider benefits that come with significant cost increases.  In other words, we can’t currently afford to offer GLP-1 drugs for weight loss. Given the budget implications, large plan cuts would be needed to pay for them.

Research continues to come out on these drugs. We know this will continue to impact how providers prescribe them.  As they learn more, these weight loss drugs may be offered to people with certain health conditions before they are prescribed widely to all members struggling with obesity.

Additional plan design changes for 2025 include the following:

·      All the health care plans will offer an 8-visit plus birth/delivery doula benefit.  Over time, this should bring health care costs down leading to healthier outcomes for birthing people and their babies.
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All plans are adding additional weight loss supports:

• Providence and Moda are adding “Mighty Health,” and Kaiser Permanente is adding Omada.

All plans will be expanding the fertility benefit at a minimal cost increase to cover medically necessary cryopreservation (medically necessary egg or sperm freezing).

• Providence is updating its formulary value drug list. This should result in savings on many commonly used medications. Providence will provide details. Moda is partnering with Costco to allow members to fill prescriptions at Costco retail pharmacies without a Costco membership.
• Moda will be offering an additional virtual network of primary care doctors called Teladoc. This will increase accessibility to primary care nationwide.
• Kaiser dental will increase the cost sharing for mouthguards from 10 to 35 percent. Mouthguards can be replaced every 5 years.
• Delta Dental is covering extra services for members with intellectual or developmental disabilities.
• VSP Plus Plan (Vision coverage) will increase the contact lens allowance to $225 to match the fame allowance in the Plus plan.