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Consumer Driven PPO High Deductible Health Plan




For a detailed description of medical and dental plan benefits, life insurance, long-term disability, eligibility, and more view the
2012 Master Plan Document

Download the Plan Year 2012 Rates in pdf

Consumer Driven PPO PPO High Deductible Health Plan
Description (In-network) Individual Family (Any Tier with Dependents)
Annual Deductible (In-network) $1,900 $3,800
($2,400 Individual Family Member Deductible)
Co-insurance (In-network) 75% paid by plan after Deductible (In-Network/covered expenses) 75% paid by plan after Deductible
(In-Network/covered expenses)
Annual Out-of-Pocket (OOP) Maximum
(In-network)
$3,900 $7,800 (excludes Individual Family Member OOP)
Preventive Wellness Benefit 100% paid by plan (no deductible,
co-insurance or annual maximum)
100% paid by plan (no deductible,
co-insurance or annual maximum)
Lifetime Maximum No lifetime maximum No lifetime maximum
TMJ Coverage 50% paid by plan 50% paid by plan
Retail Pharmacy, 30-day supply Plan pays 75%  after deductible Paid at 75% by the plan, after deductible
Retail/Mail Order Pharmacy, 90-day supply of certain maintenance drugs Paid at 75% by the plan, after deductible Paid at 75% by the plan, after deductible
Vision Coverage Annual vision exams, paid at 75% by the plan, after deductible; no coverage for vision hardware (e.g., glasses/contacts) Annual vision exams, paid at 75% by the plan, after deductible; no coverage for vision hardware (e.g., glasses/contacts)
Lab Testing Plan pays 75% after deductible when performed at independent lab facilities or when performed in a hospital setting exclusively for pre-admission, urgent care, emergency room, and in-patient admissions only. Plan pays 75% after deductible when performed at independent lab facilities or when performed in a hospital setting exclusively for pre-admission, urgent care, emergency room, and in-patient admissions only.


Health Savings Account (HSA)

A health savings account is an IRS tax-advantaged medical savings account for HSA eligible employees enrolled in the CD PPO HDHP. Contributions deposited in an interest bearing or investment account are not subject to income tax. The accounts are also portable--meaning they are owned by the employee. So if the employee leaves employment with the State of Nevada, or from a participating local government employer, the account still belongs to the employee. Funds in the HSA may be used for qualified healthcare expenses (e.g., physician office visits, lab and diagnostic tests, dental procedures, vision exams and much more). IRS Publication 502 provides a listing of qualified healthcare expenses.  HSAs may not be used to pay monthly premiums to PEBP.

PPO Health Reimbursement Arrangement (PPO-HRA)

Retirees, surviving spouses/domestic partners and certain employees enrolled in the CD PP HDHP will receive a PPO Health Reimbursement Arrangement (PPO-HRA) instead of an HSA.  These accounts also provide a tax-free method for paying qualified healthcare expenses but belong to PEBP and are not portable--if the employee, retiree or survivor terminates coverage, the funds are returned to PEBP.  Whether using an HSA or PPO-HRA, the CD PPO HDHP provides a tax-deferred method of paying qualified healthcare expenses and gives the individual consumer more control on how health care dollars are spent.  With HSAs and HRAs, you choose whether to use the funds in the account to pay for healthcare costs, or pay them directly and save funds in the HSA or PPO-HRA for higher cost procedures in the future.


Health Savings Account Details and Eligibility Rules
Description Individual Family (Any Tier with Dependents)
PEBP Contribution $700 for Plan Year 2012 (new hires receive a prorated contribution based upon their eligibility) $700 and $200 for each dependent (maximum 3 dependents) (new hires receive a prorated contribution based upon their eligibility)
Pre-Tax Employee Contribution
through payroll deductions
Up to $2,350 (IRS Maximum of $3,050 less $700 PEBP contribution) 1 dependent: up to $5,250

2 dependents: up to $5,050
 
3+ dependents: up to $4,850

(IRS Maximum of $6,150 less PEBP contribution)
Additional $1,000 contribution for employees age 55 or older
Up to $3,350 (IRS Maximum of $4,050 less $700 PEBP contribution) 1 dependent: up to $6,250

2 dependents: up to $6,050
 
3+ dependents: up to $5,850

(IRS Maximum of $7,150 less PEBP contribution)
IRS  Eligibility Provisions Must have high deductible coverage; cannot have secondary coverage that is not a high deductible health plan e.g., Medicare, Tricare, Tribal, or other similar plan; cannot be claimed as a dependent on another person's tax return. Must have high deductible coverage; cannot have secondary coverage that is not a high deductible health plan e.g., Medicare, Tricare, Tribal, or other similar plan; cannot be claimed as a dependent on another person's tax return.
HSA Bank Account Employee must establish the HSA account at a PEBP-designated bank. Employee must establish the HSA account at a PEBP-designated bank.
Additional Information Annual tax filing requirements (IRS Form 8889); cannot use HSA funds to pay premiums; penalities apply if used for non-qualifying healthcare expenses. Annual tax filing requirements (IRS Form 8889); cannot use HSA funds to pay premiums; penalities apply if used for non-qualifying healthcare expenses.
PPO Health Reimbursement Arrangement Details and Eligibility Rules
Description Individual Family (Any Tier with Dependents)
PEBP Contribution $700 for Plan Year 2012 (new hires receive a prorated contribution based upon their eligibility) $700 and $200 for each dependent (maximum 3 dependents) (new hires receive a prorated contribution based upon their eligibility)
Participant Contributions Not allowed Not allowed
Account Ownership Owned by PEBP Owned by PEBP
Establish Account Account established by PEBP Account established by PEBP
Eligibility PPO primary participants (includes employees who do not qualify for the HSA, retiree, surviving spouse/DP). PPO primary participants (includes employees who do not qualify for the HSA, retiree, surviving spouse/DP).

 

 

 



 

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