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Board preview: proposed 2027 non‑Medicare premiums, $841 EMC and new PIA reimbursement rules
Summary
Staff presented proposed 2027 non‑Medicare premiums with a proposed Employer Medical Contribution (EMC) of $841 and explained the legislature's Public Employee Access and Affordability (PIA) law that caps in‑network hospital reimbursement at 200% of Medicare while raising primary‑care/behavioral‑health reimbursement floors.
Sarah Whitley presented the proposed 2027 non‑Medicare premiums and explained how the employer medical contribution (EMC) is calculated and applied across plan options. She said the proposed EMC for 2027 is $841, about a 2.5% increase from 2026.
"The employer medical contribution, otherwise known as the EMC, is established in the collective bargaining agreements and is an amount equal to 85% of the total bid rate for the self insured uniform medical plan or UMP Classic," Whitley said, and walked the board through a sample calculation. She explained that the EMC is subtracted from each plan's bid rate to derive the employee contribution.
Whitley and staff described the public employee access and affordability program (PIA), enacted as Senate Bill 5083 and codified in RCW 41.05.028, which imposes caps on in‑network inpatient and outpatient hospital reimbursement (200% of Medicare) starting 01/01/2027, sets minimum reimbursement floors for primary care and behavioral health (150% of Medicare), and includes out‑of‑network caps and balance billing protections. Staff said PIA is a tool intended to both contain unit costs and reinvest in primary and behavioral health services to support long‑term value.
Draft premium tables and tiered premium changes are in the meeting appendix; staff will bring formal premium resolutions to the board for action on July 9.
