What's new in 2025!

What's new in 2025!

  • Increased Opt-Out Pay – The Opt-Out pay for waiving health coverage due to being enrolled in other group health coverage will increase to $150 for medical and $50 for dental per month (previously $130 and $20). Part-time employees will receive $105 for medical and $35 for dental per month. *Does not apply to DSG, SAA, and CDG.
  • Increased HSA County Contribution – Employees enrolled in one of the high deductible health plans will receive a County contribution into their Health Savings Account (HSA) of $700 annually ($29.17 per pay period) for single coverage and $1400 annually ($58.34 per pay period) for family coverage (previously $500 and $1000). *Does not apply to DSG, SAA, and CDG.
  • Kaiser and Regence Premiums no Longer the Same -  Previously, the County has averaged the cost of the Kaiser and Regence medical plans so that they were the same premium cost to employees no matter which carrier they chose. This removed premium cost as a factor when employees were making their plan selection. Starting in 2025, the premium costs will no longer be the average and each carrier’s plan will have a different premium that reflects the actual cost of the plan. There are several reasons for this transition: The two plans are now very similar in cost, removing the need to average out the premium cost. Also, Regence is a self-insured plan, which means that the County pays the actual cost of all medical claims.  In years where claims costs were lower, the extra employee premiums collected have been applied the next year to lower employee premium costs. Kaiser is an HMO plan, which means the County pays a certain amount per employee per month based on the tier of coverage they are enrolled in regardless of any actual costs associated with the services performed. Since the two plans were previously averaged, if the Regence plan costs were lower, those extra self-insured funds were subsidizing the Kaiser plan and lowering the cost of both plans. The Self-insurance Governing Board approved the change to have each plan stand-alone which is the best practice going forward so one plan is not subsidizing the other. *Does not apply to DSG, SAA, and CDG.
  • Increased Deductible and Out-of-Pocket Max for HDHP Plans – Per IRS rules, the deductible under the high-deductible plans (Kaiser and Regence) is increasing to $1,650 for employee only and $3,300 for family (previously $1,600/$3,200). The Out-of-Pocket max is also increasing to $3,300 for employee only and $6,600 for family (previously $3,200/$6,400).
  • Increased HSA Contribution Limits – The Health Savings Account (HSA) annual contribution limits are increasing to $4,300 for employee only and $8,550 for family (previously $4,150/$8,300).
  • Increased FSA Annual Contribution Limit – The Healthcare Flexible Spending Account (FSA) annual contribution limit is projected to increase to $3,300 (previously $3,200).

For Regence Members:

  • Added Enhanced Care Management Select – The Enhanced Care Management program delegates more nurse support, health coaches, and resources, increasing employee outreach and providing more support to those that have chronic and major health conditions. This program can lead to potential savings by giving employees additional tools and support to manage their conditions so that they avoid more serious and costly services down the road.
  • Added Enhanced Medication Support – The Enhanced Medication Support program gives employees more control and resources to manage their medications, including cost estimators, the ability to speak to pharmacists to compare medications or find less expensive alternatives, information about medications and side effects, and the option to receive text alerts with notifications of less expensive medication options or possible drug interactions. This program can lead to potential savings due to helping employees choose better and cheaper alternative medications.
  • No Balance Billing for Ground Ambulance – Per Washington Mandate SSB 5986, members will not be billed for any balance above applicable deductibles, copays, or coinsurance for out-of-network ground ambulance services.
  • Medications for HIV Post-Exposure – Per Washington Mandate SSB 6127, coverage is added for medications or therapies following a possible exposure to HIV under applicable deductibles, copays, and coinsurance.
  • Reducing cost of Inhalers and Epinephrine Autoinjectors  – As mandated by Washington SHB 1979, the cost share of certain corticosteroid inhalers for asthma and epinephrine autoinjector projects are capped at $35 copay for a 30-day supply with deductible waived.
  • Coverage for Non-Therapeutic CGM’s – Coverage is added for Non-Therapeutic Continuous Glucose Monitors (CGM) under regular plan cost shares.
  • Coverage added for Liposuction for Lipedema Treatment – Liposuction for the treatment of Lipedema is now covered under regular plan cost shares when medical policy criteria is met.

For Kaiser Members:

  • Medications for HIV Post-Exposure – Per Washington Mandate SSB 6127, coverage is added for medications or therapies following a possible exposure to HIV under applicable copays and coinsurance.
  • Primary Care Physician will be Assigned – Members without a designated primary care physician will be assigned to a Kaiser primary care physician under OR Senate bill 1529 and OR House Bill 4010.
  • KP at Home – The KP at Home benefit will be available in high-deductible plans. KP at Home is a program that provides hospital-level acute care and clinical services to members with certain diagnoses at home under the direction of a physician. When clinically appropriate, this benefit will provide an alternative to hospitalization and members will have the option to be treated in the comfort of their own home.
  • Durable Medical Equipment Cost Share – Durable Medical Equipment will change from 20% coinsurance to 30% coinsurance.

For Delta Dental Members:

  • Added Cone Beam Imaging – Cone Beam imaging is a 3-D image of teeth, soft tissues, and nerves, allowing dentists to better diagnose and treat complex dental cases such as impacted teeth, root canals, root grafting, or to plan for dental surgeries. Cone Beam Imaging will be covered at 100%. 
  • Added Coverage for Occlusal Guards for Bruxism – This adds coverage for customized mouth guards used to prevent damage from grinding and clinching teeth (Bruxism). These occlusal guards will be covered at 50%. 
  • Removed the cost of preventive appointments from the annual max – Currently, preventive appointments count towards the annual maximum, thus, lowering the available funds for other services throughout the year. With this change, the cost of preventive visits no longer count against the annual max, leaving the entire $3,000 of coverage for other types of services.

For VSP Members:

  • Increased Frame Allowance Frequency – The frame allowance frequency is being changed to every 12 months instead of every 24 months. That means employees can use the $300 frame allowance every year instead of every 2 years.

For Kaiser Vision Members:

  • Increased Frame Allowance Frequency – The frame allowance frequency is being changed to every 12 months instead of every 24 months. That means employees can use the $300 frame allowance every year instead of every 2 years.

If you have any questions about any of these changes, please contact the Benefits team at Benefits@clark.wa.gov.