1. Health Insurance Changes Information Session
Presenters:
Tina Petrie, Director of Salary Administration and Benefits
Kathy Eghoian, Senior Specialist - Benefits

2. Information Session Goals
Discuss Changes Effective 07/01/2011
Q & A

3. Everyone Must Enroll Online This Year
If you plan to make a change, decline coverage, continue with your existing coverage, or continue to decline coverage, you will have to take action during Open Enrollment.
Deadline May 31, 2011

4. Everyone Must Enroll Online This Year - Continued
If you do not take any action, you will automatically be enrolled in (defaulted) in the Consumer Driven PPO High Deductible Plan with a PPO-HRA, Participant Only Coverage at $43.90 per month.

5. What is a PPO Plan
A network of doctors and healthcare facilities that provides medical services at discounted rates.
The Consumer Driven PPO High Deductible Health Plan allows participants the choice of using contracted (in-network) or non-contracted (out-of-network) medical providers, both in-state (Nevada) and out-of-state.
The CD PPO HDHP plan offers access to services worldwide.

6. CD PPO HDHP Plan Annual Deductible
Single coverage individuals: $1,900.00
Two or more persons: $3, family deductible.
The deductible applies when two or more individuals are covered on the plan. The Plan will begin to pay benefits for one individual in the family once that person meets the $2,400 Individual Family Medical Deductible. The balance of the Family Deductible ($1,400) must be met by one or more other members of the family before the Plan will pay benefits for those other family members.

7. Deductible Amounts Plan Year 2011
Deductible Type
Individual
Family
Annual Medical
(CD PPO HDHP)
$1,900.00
$3,800.00
Annual Dental
(CD PPO HDHP and HMO)
$100.00
$ (3 or more )
Annual Prescription (CD PPO HDHP)
$1,900 (Part of Medical)
$3,800 (Part of Medical)

8. Coinsurance
A coinsurance is the portion of the expense the employee is responsible for paying after the deductible.
The maximum coinsurance amount you pay during the year excluding copayments is called the out-of-pocket expense ($3,900 individual/$7,800 family – per plan year).
Note: Standard amounts charged by non-contracted healthcare providers are referred to as Usual and Customary charges.

9. The Health Maintenance Organization (HMO Plan)
Name of Plan for Southern Nevada is Health Plan of Nevada (HPN)
Fully insured plan which uses a pre-defined group of doctors, facilities, and other health care professionals. (Note: out -of -pocket maximum is $6,800 per person per calendar year).
Participants choose a Primary Care Physician who coordinates their medical treatment .
The HMO Plan is limited to a specific service area (Southern Nevada only).
The plan is not portable for those traveling out of the Southern Nevada area. (Exceptions will be made for out of area medical emergencies only).

10. Scope of Dental Coverage
Regardless of the medical plan chosen all employees participate in
a self-funded PPO dental plan (Diversified Dental Services).
Coverage is offered for preventive services (routine exams and up to 4 cleanings per year) In-network provider service is paid at 100%.
Coverage is offered for basic services (full mouth x-rays, fillings, simple extractions, root canals) The plan pays for in-network service 75% (after deductible).
Coverage is offered for major services (single crown, bridgework, dentures, tooth implants) The plan pays for in-network service 50% (after deductible).

11. Pharmacy Plan Comparison Retail Pharmacy - 30 day supply
Category
CD PPO HDHP Plan
Health Plan of Nevada
Preferred Generic (Tier 1)
25% after deductible
$7 copayment
Preferred Brand (Tier 2)
$35 copayment
Non-Preferred (Tier 3)
100% of contracted price
Does not apply to deductible or out of pocket
$55 copayment
Specialty Drugs
25% after deductible – available in 30 day supply only through Walgreen pharmacies
Applicable retail pharmacy copayment will apply

12. Pharmacy Plan Comparison Mail Order - 90 day supply
Category
Self-Funded PPO Plan
Health Plan of Nevada
Preferred Generic (Tier 1)
25% after deductible
$14 copayment
Preferred Brand (Tier 2)
$70 copayment
Non-formulary (Tier 3)
100% of contracted price - does not apply to deductible or out of pocket
Not available through mail order
Specialty Drugs
25% after deductible, available in 30 day supply only through Walgreens mail order
Applicable retail pharmacy copayment applies, copayment applies

13. Vision Plan Comparison
Category
CD PPO HDHP Plan
Health Plan of Nevada
(Must use provider on EyeMed Vision Care list)
Vision exam
One exam every 12 months, paid at 75% Usual & Customary (U&C) after deductible
$10 copayment every 12 calendar months
Hardware (frames, lenses, contacts)
N/A
$10 copayment/lenses frames - $100 allowance, contacts $115 in lieu of glasses

14. CD PPO HDHP Wellness/Preventive Care Benefit (Only for the CD PPO HDHP Plan)
The CD PPO HDHP Wellness Benefit provides a(per person, per plan year) benefit to participants and their covered dependents. Preventive care benefits are not subject to the plan year deductible.
The Wellness Benefit is available only when using in-network PPO providers. ( Note: Wellness benefits are healthcare services that are not provided as a result of illness, injury or congenital defect.)

15. Self-funded PPO Wellness/Preventive Care Benefit (Only for the CD PPO HDHP Plan)
For example, the following preventive screenings are covered under the PPO Wellness Benefit:
Physical Exam, Screening Lab and X-rays
Well-child Examinations and Immunizations
Prostate Screening (e.g., PSA blood test)
Hypertension Screening
Screening Mammogram
Pelvic Exam and Pap Smear
Skin Cancer Screening

16. Life Insurance
Through The Standard Insurance Company, the employee has a $10,000 basic life insurance policy.

17. Long Term Disability
Through The Standard Insurance Company, the employee, as part of the benefits package, has eligibility for Long Term Disability.
The monthly LTD benefit amount is 60% of monthly earnings up to a maximum of $7,500 per month (less any deductible sources of income and disability earnings).
The minimum monthly payment after subtracting deductible sources of income is $100.00

18. Medical Plan Comparison
Benefit Category
CD PPO HDHP Plan
Health Plan of Nevada
Medical deductible
Amount You Pay In-Network
$1,900 individual
$3,800 family
(per plan year)
No deductible
Out-of-pocket maximum
$3,900 person
$7,800 family
$6,800 person
(per calendar year)
Hospital inpatient
25% coinsurance after deductible
$200 copayment per admission
Outpatient Same Day Surgery
$50 copayment per admission

19. Medical Plan Comparison (continued)
Benefit Category
CD PPO HDHP Plan
Health Plan of Nevada
Primary care visit
25% coinsurance after deductible
$15 copayment
Specialist visit
Urgent Care visit
Emergency room visit
$50 copayment, plus $25 physician copayment
General laboratory services
No charge

20. Monthly Premiums for Plan Year July 1, 2011
COVERAGE
CD PPO HDHP
Deductible
$1,900/$3,800
HMO
No Deductible
EMPLOYEE
$43.90
$116.57
EMPLOYEE + SPOUSE
$198.40
$338.16
EMPLOYEE + CHILD(REN)
$91.71
$225.25
EMPLOYEE + FAMILY
$246.23
$446.84

21. Monthly Premiums for Plan Year July 1, 2011 Domestic Partners
EMPLOYEE/DOMESTIC PARTNER (DP) COVERAGE
CD PPO HDHP
Deductible $1,900/$3,800
HMO
EMPLOYEE PLUS DP
$611.91
$641.67
EMPLOYEE + DP’S CHILD(REN)
$219.67
$374.10
EMPLOYEE + CHILDREN OF BOTH
$91.71
$225.25
EMPLOYEE + DP + EMPLOYEE’S CHILD(REN)
$659.81
$750.35
EMPLOYEE + DP + DP’S CHILD(REN)
$787.77
$899.20
EMPLOYEE + DP + CHILDREN OF BOTH

22. What is a Health Savings Account? (HSA)
A Health Savings Account (HSA) is an account owned by the employee that is used to pay for eligible health care expenses.
The employer can contribute funds to the HSA and the employee may also contribute money to the account on a pre-tax basis.
Contributions, investment earnings and distributions are tax free as long as the money is used only for eligible healthcare expenses.
Funds deposited in the HSA can be carried over from year to year.

23. Eligibility for Health Savings Account (HSA)
Must be covered under a high deductible plan
You are not enrolled in Medicare
You cannot be claimed as a dependent on someone else’s tax return

24. Health Savings Account Summary for Active Employees
Accounts are owned by the employee
Annual contribution limits to the HSA (combination of employer and employee). For example, the following limits are for 2011:
$3,050 for Employee
$6,150 for Family
Income tax reporting requirements
Portable –If you leave, the money is yours to take with you
Only used for medical related costs without incurring tax and/or penalty

25. Specific Plan Design Changes
Medical Plan Changes
Eliminate lab tests performed at hospitals except for pre-admit, urgent care, emergency room and in-patient admissions
Reduce TMJ coverage from 80% to 50%
Allow for 90 day supply of certain retail drugs
Eliminate vision coverage except for annual eye exam
Eliminate coverage for spouse/domestic partner with other employer based coverage
Remove “or as needed” from Wellness/Preventive guidelines

26. Other Benefit Changes Federal Healthcare Reform Act
Coverage will be available for dependent children to age 26 regardless of full time student status
Lifetime limits removed

27. Questions?
PEBP Website (
2012 Open Enrollment Guide
Frequently Asked Questions
Board Meeting Information
Legislative Updates
If you have any questions after this session, please contact the Office of Human Resources at x5800 or
Thank you.