1. Comprehensive Health Insurance Plan Plan Year 2018 (July 1, 2017 - June 30, 2018)
Medical
Vision
Dental
Term Life Insurance
Long Term Disability

2. Comprehensive Health Insurance
Provided by the State of Nevada, Public Employees’ Benefits Program (PEBP)
Comprehensive Package includes medical, dental, vision, life insurance, and long term disability insurance.
Medical Insurance
Consumer Driven PPO High Deductible Health Plan (CD PPO HDHP or PPO)
Health Maintenance Organization (HMO)
Dependent Coverage Available

3. Enrollment
Online enrollment through E-PEBP must take place within 15 days from your contract effective date.
Default enrollment will automatically occur after the 15 day time frame.
Dependent coverage will be paid in full by the employee.
Insurance Premiums will be deducted monthly on a pre-tax basis.

4. Dependent Coverage
Coverage can be extended to your legal spouse as long as he or she does not have access to their own health insurance coverage through their employer.
Children can be covered up to the age of 26.
If you wish to add your dependents to your insurance, you will be required to provide documentation that proves the relationship (marriage certificate, State of Nevada registration of Domestic Partnership, Birth Certificate, Adoption Paperwork, (No Exceptions).

5. Life and Long Term Disability

6. Life and Long Term Disability
Term Life Insurance
$25,000
Long Term Disability Insurance
180 day waiting period
Pays up to 60% of gross monthly earnings capped at $7,500 per month

7. P.E.B.P Medical Plan Options

8. Medical Plan Options Choice of three medical plans:
Statewide Consumer Driven PPO High Deductible Health Plan (PPO)
$1500 individual / $3000 Family deductible
Standard Health Maintenance Organization (HMO)
Alternate Health Maintenance Organization (HMO)
Hometown Health HMO – Northern Nevada
Health Plan of Nevada HMO – Southern Nevada

9. Selecting a Medical Plan: PPO
Preferred Provider Organization (PPO)
A medical plan that allows you total flexibility in your choice of medical providers and/or facilities
The PPO has two difference payment schedules, one for the “preferred” or in-network providers and one for “non-preferred” or out-of-network providers.
In State Network – Hometown Health and Sierra Health-Care Options
Out of State = Aetna
To be a “preferred provider” medical providers agree to provide services at a discounted rate.
When you use a “non preferred” provider, your share of the cost is a higher percentage than when you use the services of a “preferred” provider.
The PPO requires you to satisfy a deductible and share the cost of your medical treatment (co-insurance)
Provides Worldwide coverage.

10. Selecting a Medical Plan: HMO
Health Maintenance Organization (HMO)
The HMOs are fully insured products offered by Hometown Health (in the North) and Health Plan of Nevada (in the South)
An HMO uses a pre-defined group of doctors, facilities, and other healthcare professionals---you MUST use these providers (except for emergency situations)
Services usually limited to geographic location (HHP-Northern Nevada, HPN- Southern Nevada)
Concentrates on preventive care and early intervention to keep costs low
You must choose a Primary Care Physician (PCP) for each member in your family, this doctor will manage your healthcare needs
No Deductible
All Services are based on co-payments (a flat dollar amount paid at time of service)
Provides nationwide and worldwide care for emergency and urgent care

11. Standard HMO vs. Alternate HMO
The Standard HMO is an Open Access Plan offered to members who work or reside in in the state of Nevada. This HMO Plan allows you to self refer to specialists on the preferred provider list. The monthly premium is slightly higher than the premium for the Alternate HMO, but the co-payments for medical services will be at a lower rate.
The Alternate HMO is offered to members who work or reside Nevada but is only available in specific counties: Northern Nevada Counties include Washoe, Carson, Douglas, Storey, Lyon, and Churchill. Southern Nevada Counties include Clark, Nye, and Esmeralda. The Alternate HMO plan is NOT open access and requires that you get a referral to a specialist on the preferred provider list prior seeking medical treatment. The monthly premium is slightly lower, however the co-payments will be at a higher rate than the standard HMO.
Participants on the Standard HMO and the Alternate HMO must designate a preferred provider from the Preferred Provider Directory in order for medical services to be covered by the plan.

12. State Employee PPO/HMO rates
Monthly Health Insurance Premiums – Active Employees
State of Nevada Public Employees’ Benefits Program
Plan Year 2018: July 1, 2017 –June 30, 2018
Statewide PPO
Statewide
Standard HMO
Alternate HMO
Employee Only
$41.91
$173.63
$168.09
Employee + Spouse/Domestic Partner
$171.50
$485.90
$469.75
Employee + Child(ren)
$92.72
$319.89
$308.24
Employee + Family
$222.09
$637.15
$609.91

13. Which Plan is Right for You?
The PEBP Plans, including PPO and HMO Plans Offer:
Quality Health Care Coverage
NO Pre-Existing Condition Limitations
Reasonable Office Visit Co-Payments
Disease Management Programs

14. Summary of PPO Plan

15. Summary of Medical Benefits: North and South PPO Plan
Individual Deductible
$1,500
Family Deductible
$3,000
H.S.A. / H.R.A. Contributions (pro-rated for coverage starting later than 7/1/2017)
$700 + $200 for each dependent (max of 3 dependents)
Primary Care Visit
20 % after deductible
Specialist Visit
20% after deductible
Urgent Care
Emergency Room
Hospital (inpatient or outpatient)
Wellness
Covered 100% if in Network
(services subject to the CDC Prevention Guidelines)

16. Health Savings Account (HSA) Health Reimbursement Arrangement (HRA)
PURPOSE
Tax exempt account to pay for qualifying health care expenses such as doctor’s visits, lab tests, diagnostic tests, prescription drugs, coinsurance, dental procedures, vision exams, etc.
ELIGIBILITY
Employee enrolled in the CD PPO HDHP; and
Not covered by another health plan that is not a high deductible health plan; and
Is not enrolled in Medicare, Tricare, Tribal, or other similar plan
Cannot be claimed as a dependent on another person’s tax return.
Any PPO Participant that is not eligible for the HSA (all PPO Retirees; some PPO Employees)
DIFFERENCES
An interest bearing of investment account established by the employee and administered by a bank. HSAs are portable and owned by employee.
HRAs are established on behalf of an individual to help pay for qualifying health care expenses. PEBP-owned and funded
Tax-exempt contributions
Maximum carryover limit and rules (to be established by PEBP Board in future plan years).
PEBP CONTRIBUTION
Employee Only: $700 – pro-rated for first year
Dependents: $200 for each dependent (up to 3 dependents)
pro-rated for first year
EMPLOYEE CONTRIBUTIONS
Calendar Year Maximum Contributions
For Employee Only Coverage
or for Family (two or more)
These maximums INCLUDE the PEBP contribution. NO

17. Understanding the PPO PLAN
Plan pays 100%
after a participant pays $3,900 max out of pocket and a family pays $7,800 max out of pocket (Deductible counts toward max out of pocket)
Participant Pays $0
After annual Max
Participant pays 20%
of costs
Includes PCP, Specialist and Urgent Care
Plan Pays 80%
Deductible
$1,500 Individual/$3,000 Family
Participant Responsible for 100% of costs, including pharmacy
Plan Pays $0
HSA fund to offset all medical service costs
Wellness
Participant pays $0 for in-network covered services
Plan pays 100%

18. Summary of HMO Plan

19. Summary of HMO Plans in Northern Nevada
Benefit
Standard HMO Plan
(Hometown Health)
Alternate HMO Plan
Individual Deductible
N/A
Family Deductible
Primary Care Visit
$25 Copay
$5 Copay
Specialist Visit
$45 Copay
$25 Copay (referral required)
Urgent Care
$50 Copay
Emergency Room
$300 Copay
$1000 Copay
Hospital (Inpatient)
$500 Copay per admit
$1000 per day (not to exceed $3000 per admission)
Hospital (Outpatient)
$350 Copay
ACA Preventive Services
(Wellness)
No Charge (if in Network)
Out of Pocket Maximum
$7150 Individual/$14,300 Family

20. Summary of HMO Plans in Southern Nevada (Health Plan of Nevada)
Benefit
Standard HMO Plan
(Health Plan of Nevada)
Alternate HMO Plan
Individual Deductible
N/A
Family Deductible
Primary Care Visit
$25 Copay
$5 Copay
Specialist Visit
$45 Copay
$25 Copay (referral required)
Urgent Care
$30 Copay
Emergency Room
$300 Copay
$1000 Copay
Hospital (Inpatient)
$500 per Admission
$1000 per day (not to exceed $3000 per admission)
Hospital (Outpatient)
$50 Copay
ACA Preventive Care
(Wellness)
No charge (in Network)
No Charge (in Network)
Out of Pocket Maximum
$7,150 Individual, $14,300 Family

21. Summary Plan Benefits: Pharmacy

22. Prescription Plan Comparison
Features
PPO Plan
Standard HMO
Alternate HMO
Preferred Generic
20% after deductible $7
$25
Preferred Brand
$40
$50
Non-Formulary
$75
Specialty
40% Co insurance
ACA Preventive $0
PPO Preventive
20% co insurance (not subject to deductible
N/A
*NEW* The Preventive Drug Benefit provides PPO Participants access to some preventive medications without having to meet the deductible. Co insurance will not apply to the deductible but it will apply toward the plan year out of pocket maximum. Contact Express Scripts for more information at (855)

23. STANDARD and ALTERNATE HMO Plan $25 copay with a maximum benefit
Vision Plan Comparison
Plan
Design
Features
PPO Plan
STANDARD and ALTERNATE HMO Plan
Hometown Health
(Northern Nevada)
Health Plan of Nevada
(Southern Nevada)
Eye Exams
$25 copay with a maximum benefit
of $95 per annual exam
$15 Co-payment
every 12 months
$10 Copayment
Frames/Lenses/Contacts
NO BENEFIT
Frames: 35% off retail price
Standard Plastic lenses: $50 to $130 copayment depending on lens type
Conventional contact lenses: 15% off retail
$10 Copayment for glasses ($100 allowance) Or
Contacts in lieu of glasses ($115 allowance)

24. Dental Benefits *Same dental plan Deductible $100 per person
for CD HD PPO
& HMO
Dental Benefits
Diversified Dental
Network
Dental Features
In-Network
Out-of Network
Deductible
$100 per person
$300 family
Plan Year Max
$1,500 Preventive Care
$1,000 + Preventive Care
Prevention Care
Four cleanings per year, exams; bitewing x-rays; fluoride
Participant pays $0, no deductible
Participant pays 20%- no deductible
Basic Services
Fillings, extractions, root canals, full mouth x-rays
Participant pays 20% after deductible
Participant pays 50% after deductible
Major Services
Bridges, crowns, dentures, tooth implants
Participants pays 50% after deductible

25. Insurance Plan Side-by-Side Comparison

26. Summary of PPO V.S. HMO Plans in Northern Nevada
Benefit
Consumer Driven PPO Plan
Standard HMO Plan
(Hometown Health)
Alternate HMO Plan
Individual Deductible
$1500
N/A
Family Deductible
$3000
Primary Care Visit
20% coinsurance after deductible
$25 Copay
$5 Copay
Specialist Visit
$45 Copay
$25 Copay (referral required)
Urgent Care
$50 Copay
Emergency Room
$300 Copay
$1000 Copay
Hospital (Inpatient)
$500 Copay per admit
$1000 per day (not to exceed $3000 per admission)
Hospital (Outpatient)
$350 Copay
ACA Preventive Services
(Wellness)
No Charge (if in Network)
Out of Pocket Maximum
$3900 Individual
$7800 Family
$7150 Individual/$14,300 Family
H.S.A./H.R.A
$700 Employee
$200 for Dependent (up to limit)

27. State Employee PPO/HMO rates
Monthly Health Insurance Premiums – Active Employees
State of Nevada Public Employees’ Benefits Program
Plan Year 2018: July 1, 2017 –June 30, 2018
Statewide PPO
Statewide
Standard HMO
Alternate HMO
Employee Only
$41.91
$173.63
$168.09
Employee + Spouse/Domestic Partner
$171.50
$485.90
$469.75
Employee + Child(ren)
$92.72
$319.89
$308.24
Employee + Family
$222.09
$637.15
$609.91

28. Questions to Consider When Choosing a Plan
Are your doctors and healthcare facilities contracted with the plan?
Do you or your eligible dependents live or work in the service area of the plan? Must reside in Nevada to elect the HMO coverage.
Are your prescriptions covered under the formulary?
Are your specific medical needs covered under the plan?

29. Switching Between Plan Options
Open Enrollment= May 1st – 31st
Switch between plans
Add/Delete dependents without a life event change
If you move to an area not serviced by the plan in which you are currently enrolled.

30. Adding / Deleting Dependents: Mid Year Qualifying Event
A Qualifying life status change is an event that allows you to make changes to your benefits without having to wait for Open Enrollment.
Employees have 60 days from the qualified event to make changes to their benefit coverage .
This includes changing dependent coverage for Section 125 Pre-Tax deductions.
The following are considered a qualifying family status change:
Adding Dependents : Marriage; Birth, adoption, legal guardianship; Receiving a Qualified Medical Child Support Order; Dependent Looses medical insurance.
Deleting Dependents: Divorce or annulment; Death of a dependent; Dependent becomes disabled; Spouse obtains coverage through their employer; You or your spouse becomes eligible for Medicare; Change of address resulting from a move from the health coverage network area.

31. Declining/Waiving Health Insurance
If you are considering declining health insurance because you have other coverage, it is important to remember that you will be declining the entire comprehensive medical package that includes Long Term Disability, Life Insurance, Medical, Dental, and Vision Insurance.

32. BCN Benefits Office 70 Artemesia Way, Room1 Reno, Nevada Phone: (775) Fax: (775)