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Consumer Driven PPO High Deductible Health Plan
|
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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