The Public Employees Insurance Agency is proposing increasing premiums by 14% for state employees and by 16% for local government employees during the 2026 fiscal year. (Lori Kersey | West Virginia Watch)
West Virginia state and county employees would pay more for their health care next fiscal year under a proposal presented Thursday to the Public Employees Insurance Agency finance board.
The agency is proposing increasing premiums by 14% for state employees and by 16% for local government employees during the 2026 fiscal year, which starts July 1, 2026.
The agency also proposed a 12% increase in premiums for retirees.
Both state and county employees would see an increase of 40% in their out-of-pocket maximum as well as increase in co-pays. A monthly spousal surcharge for state employees would more than double, from $147 to $350.
Altogether, the increases are projected to equal roughly $113 million. Speaking to the board about the reasons for the cost increases, PEIA director Brian Cunningham pointed to inflation of prescription drug costs as well as increases in their use.
Cunningham told the board there’s “no single fix,” to PEIA’s problem with rising costs.
“PEIA has a multifaceted problem, we’ve seen growth in expense, or growth in the cost of reimbursement to providers,” Cunningham said. “We see substantial growth in cost of prescription drugs. So what we as a team here at PEIA are seeking to do with the support of the board is to take a multi faceted approach to the fix.”
That includes strategies to encourage members to use lower-cost generic drugs, he said. Cunningham said a number of other initiatives to tackle rising costs are in the works.
In addition to prescription drug inflation, Cunningham also pointed to recent legislation. Senate Bill 268, which passed during the 2022 legislative session, resulted around $70 million increase in pay to health care providers and mandated that a spousal surcharge be the actuarial value of covering the spouse. The surcharge is for members whose spouses are offered employer-sponsored insurance coverage but choose to get coverage through a plan offered by PEIA.
The bill also increased premium rates to get back to an 80/20 employer/employee premium split.
Speaking before the finance board meeting Thursday, Dale Lee, president of the West Virginia Education Association teachers union, called the proposed premium increases “unacceptable.”
“The employees: our educators, our teachers, our service professionals, our state workers, state police and everybody else who can make so much more money crossing the state line and driving 30 more minutes, that’s exactly what we’re going to see happen, particularly in these border counties,” Lee said. “We’re struggling to get educators in our school system right now…You put a 40% increase in cost shift to them. They can’t take that. We can’t take that.”
Fred Albert, president of the American Federation of Teachers West Virginia, said the proposed premium increases are unfair to state employees, some of whom are not paid what they deserve.
“You’ve heard this many, many, many, many times before, the PEIA benefits were given over the years in lieu of a pay raise,” Albert said. “And while we have had some pay raises here in the last five years, it’s just not enough to make a difference when you’re now paying higher premiums, higher co-pays, and you will be paying even more. Then your take home is not increasing, so you’re not realizing and paying increase.”
“I get tired of hearing people say, ‘Well, you didn’t go into teaching to get rich,’” Albert said. “No, maybe not, not in money. You get rich in other ways. But we didn’t go into it to be poor, either. We need to be able to raise a family, live a comfortable life and retire with dignity. But this is going to be devastating.”
The PEIA finance board is planning public hearings around the state next month to hear from participants about the proposal. The meetings are planned for 6 p.m. at the following locations. Registration begins at 5:30 p.m.
Nov. 7 at the Beckley-Raleigh Convention Center, 200 Armory Drive, Beckley
Nov. 12 at the Holiday Inn Martinsburg, 301 Foxcroft Avenue, Martinsburg
Nov. 14 at the The Highlands Event Center, 355 Wharton Circle, Suite 253, Triadelphia
Nov. 18 Virtually by computer or smartphone at this link. People can also join the virtual meeting by phone by calling 1-413-350-0825 with the PIN 426 346 783#.
Nov. 19 at The Erickson Alumni Center in Morgantown, and
Nov. 21 at the Culture Center, 1900 Kanawha Boulevard East, Charleston
The board is expected to vote on the proposed increases at its Dec. 5 meeting.
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