www.pebp.state.nv.us

 Home
_______________________

 About Us
_______________________

 PEBP Board
_______________________

 Fiscal & Utilization Reports
_______________________

 Laws and Regulations
_______________________

 Plan Contacts
_______________________

 Frequently Asked Questions
_______________________

 Community Resources
_______________________

 Search
_______________________

 Contact Us
_______________________
                         E-PEBP Portal   

rss

Twitter

 

Frequently Asked Questions

CONSUMER DRIVEN HEALTH PLAN (CDHP)

What is the Consumer Driven Health Plan (CDHP)?

The CDHP is a high deductible health plan with a deductible amount that qualifies you to open an HSA (if otherwise eligible). The CDHP complies with the Internal Revenue Service (IRS) requirements relating to high deductible health plan (HDHP) deductibles, maximum out-of-pockets, and annual HSA contribution limits. The CDHP has a $1,500 individual deductible (participant only tier) and a $3,000 family deductible (any tier with two or more members). The family deductible includes a $2,500 individual family member deductible.

What is the amount of the annual maximum out-of-pocket for covered benefits when using in-network providers?

*  Participant Only Tier (individual): $3,900

*  All other tiers: $7,800 

What expenses apply to the annual maximum out-of-pocket?

Deductible and coinsurance amounts accumulate toward the annual maximum out-of-pocket. Note: There are separate maximum out-of-pocket amounts for in-network and out-of-network providers.

Can the family maximum out-of-pocket be met by one person?

The family maximum out-of-pocket may be met by one individual or through a combination of claims incurred by all family members.

HEALTH SAVINGS ACCOUNT (HSA)

What is a Health Savings Account (HSA)?

An HSA is a trust or custodial account established exclusively to receive tax-favored contributions on behalf of eligible employees enrolled in an HSA-qualified high deductible health plan (HDHP). PEBP's Consumer Driven Health Plan meets the IRS requirements of a HDHP. 

Amounts contributed to an HSA accumulate on a tax-free basis and withdrawals are not subject to tax if they are used to pay for eligible medical expenses for you and your dependents. Contributions made in one year, and not used to pay expenses for that year, will roll over and may be used to pay medical expenses in later years.

An HSA is fully vested at all times and portable, meaning that it can move with you as your circumstances change.

IRS requires identification of HSA account owners and in some cases, employees may be required to provide additional identifying information. Failure to provide identity information within a specified timeframe will automatically convert the HSA  to an HRA. Questions regarding requests for identity should be directed to HealthSCOPE Benefits at 1-888-763-8232.

Are there eligibility requirements to establish an HSA?

Yes, to establish an HSA, you must meet the following eligibility requirements:

  • Must be covered under an HSA-qualified HDHP. This means you must be enrolled in the CDHP medical option to be eligible for an HSA

  • Cannot be enrolled in Medicare

  • Cannot be claimed as a dependent on someone else's tax return unless you are married filing jointly

  • Cannot be covered by another health plan that is NOT HSA-qualified (with some exceptions, including vision coverage, dental coverage or coverage for a specific disease state (such as cancer insurance)

  • You or your spouse has a Medical Flexible Spending Account (excludes Dependent Care or Limited Use Flexible Spending Accounts)

  • Your spouse has an HRA that can be used to pay for your medical expenses

  • You are on COBRA

  • You are retired

Scenario (Assumes all other eligibility requirements are met) Eligible to make or receive contributions to an HSA
You are enrolled in the CDHP plan only. Yes
You are enrolled in HPN or HHP HMO coverage. No
You are enrolled in the CDHP plan and have Medicare. No
You are enrolled in the CDHP and your spouse is also enrolled in an HSA-qualified high deductible health plan through his/her employer Yes
You have family CDHP coverage and your spouse has non-high deductible health plan coverage* for him/her and the children (i.e., you are not covered under your spouse's plan). Yes
You have family CDHP coverage and your spouse has non-high deductible health plan coverage* (e.g., HMO plan) and a limited purpose flexible spending account (FSA) or other reimbursement account (HRA). This is regardless of whether or not you are covered under your spouse's medical plan. No
You have family CDHP coverage and your spouse has family non-high deductible health plan coverage* which covers you. No

* Non-high deductible health plan coverage is a health plan that does not meet the IRS requirements for a high deductible health plan, such as a HMO plan, TRICARE, etc.

What is the HSA last-month rule?

If you are an eligible individual on the first day of the last month of your tax year (December 1), you are considered to be an eligible individual for the entire year.

What is the HSA testing period?

If an employee is eligible to contribute to the HSA on the first day of the last month of the tax year (generally December 1), the employee may contribute up to the annual maximum if the employee is eligible to contribute to the HSA through the end of the following year (the testing period). If the employee is not eligible during the entirety of the testing period, any amount contributed to the HSA in excess of the prorated annual maximum will be treated as taxable income in the following tax year and will be subject to a penalty. The testing period begins with the last month of your tax year and ends on the last day of the 12th month following that month (for example, December 1, 2013 - December 31, 2014). If you fail to remain an eligible individual during this period, other than because of death or becoming disabled, you will have to include in income the total contributions made that would not have been made except for the last month rule. You include this amount in income in the year in which you fail to be an eligible individual. This amount is also subject to a 10% additional tax.



HSACONTRIBUTIONS

How much can I contribute annually to my HSA?

The amount you or any other person can contribute to your HSA depends on the type of CDHP coverage you have (individual or family), your age, and the date you become eligible, and the date you cease to be an eligible individual. The HSA contribution limits are set by the IRS and for calendar year 2014, the maximum contribution limits are $3,300 for an individual and $6,550 for a family (two or more members). Eligible individuals age 55 or older on December 31st may contribute an additional $1,000. Note: PEBP contributions count toward these limits. Caution: As mentioned earlier, the maximum contribution limits are subject to an individual's eligibility based on the last month rule and testing period as discussed below. For more information, visit www.IRS.gov or contact HealthSCOPE Benefits at 888-763-8232.

If my spouse and I both have HDHP medical coverage, how much can each of us contribute to an HSA?

If each spouse has separate coverage under a participant-only HDHP, each spouse may contribute the maximum annual contribution ($3,300 in 2014) into an HSA in his/her own name. If both spouses are covered under family HDHP, they may contribute a total of $6,550 to an HSA in 2014. If both spouses are over the age of 55, and both have HSAs in their own name, both spouses may also make the full "catch-up" contribution ($1,000). 

Who can make contributions to the HSA?

Employees have the option to self-contribute to the HSA through direct payroll deduction or by sending a check to HealthSCOPE Benefits for deposit. If sending a check, the HSA Contribution Form must be completed and sent along with the check to HealthSCOPE Benefits (HSB). To make changes online, login to the E-PEBP Portal at www.pebp.state.nv.us, then select HealthSCOPE Benefits.

Can employees make a one-time deposit to their HSA instead of having payroll deductions?

Yes. Employees have the option of making a one-time deposit by sending a check to HealthSCOPE Benefits for deposit into the HSA.


How do I change my HSA contribution?

Change your HSA election by using one of the following options:

  1. Log on to the HSA section of the HealthSCOPE Benefits website and select "Change an Election."

  2. Call HealthSCOPE Benefits at 888-763-8232 to request a form to change the election.

  3. Contact HealthSCOPE Benefits via email at pebphsahra@healthscopebenefits.comand request a form to change the election.


HSA DISTRIBUTIONS

Can the HSA be used for medical expenses incurred before establishing the HSA? For example, expenses incurred for an employee while he or she is covered under the HMO plan, then later changes to the CDHP.

The HSA can only be used for expenses incurred on or after the date the HSA was established.


HSA DEBIT CARD

What can the debit card be used for?


The IRS regulates what is considered an eligible expense. According to IRS Publication 502, medical expenses are the cost of diagnosis, cure, mitigation, treatment, prevention of disease, and the costs for treatments affecting any part or function of the body. Medical expenses incurred primarily to alleviate or prevent a physical or mental defect or illness. They do not include expenses that are merely beneficial to general health, such as vitamins or vacation. Examples of eligible medical expenses include:

  • Payments for legal medical services rendered by physicians, surgeons, dentists and other medical practitioners


  • Cost of medically necessary equipment and supplies


  • Diagnostic devices

  • Specific information can be found at HealthSCOPE Benefits. Information can also be found at www.IRS.gov.


Will employees receive a 1099 for tax filing?

Employees will receive Form 1099-SA with information on distributions and Form 1099-INT with information on interest earnings. These forms are provided to the employee in January each year.

HEALTH REIMBURSEMENT ARRANGEMENT

What is a Health Reimbursement Arrangement?

HRAs are PEBP-owned pass-through accounts established on behalf of eligible CDHP primary participants. HRA funds may be used to pay for qualified health care expenses. HRA funds carry over from year to year. (The PEBP Board may establish a carryover limit in future plan years.)

Who is eligible for the HRA?

HRA is offered to retirees and certain active employees enrolled in the CDHP. 

What are qualified medical expenses?

Qualified medical expenses are amounts paid for medical care as defined by the IRS (provided reimbursements for such paid amounts are not received from any other source, including insurance.) Qualified medical expenses include payment of deductibles, coinsurance, dental, and vision costs incurred by the participant, a covered spouse or any other dependent claimed on the primary participant's annual tax return. Participants on the CDHP may not use HRA funds to pay premiums.

TOWERS WATSON'S ONE-EXCHANGE HEALTH REIMBURSEMENT ARRANGEMENT FOR ELIGIBLE MEDICARE RETIREES

Who is eligible for the Medicare Exchange HRA?

Eligible retirees covered through the Medicare Exchange receive a Medicare Exchange HRA.

What qualifying health care expenses are eligible for reimbursement through the Medicare Exchange HRA?

Qualified medical expenses are amounts paid for medical care as defined by the IRS (provided reimbursements for such paid amounts are not received from any other source, including insurance.) Qualified medical expenses include payment of deductibles, coinsurance, dental, and vision costs incurred by the participant, their covered spouse and/or dependent children. The Medicare Exchange HRA may also be used for reimbursement of medical, dental and pharmacy premiums.



CONSUMER DRIVEN HEALTH PLAN (CDHP) - WELLNESS BENEFIT

Will the CDHP cover wellness/preventive care?

The CDHP covers eligible wellness/preventive care services at the 100% benefit level when using in-network providers.

Whose responsibility is it to ensure the provider bills the wellness benefit correctly?

The physician makes the determination regarding the purpose of the visit (e.g., was the visit for screening purposes only or was the visit a follow up for a known medical condition?). However, it is the patientís responsibility to inform their physician and the physicianís billing staff about the wellness benefits.


Will the CDHP cover vaccinations for overseas travel?

Generally, vaccinations required for overseas travel are covered under the CDHP wellness benefit. However, most of the vaccines required for overseas travel are not available through a primary care physician. Contact your local health department for information about the various vaccines they offer. Local health departments will not submit billing claims to HealthSCOPE Benefits; thus, the member has the responsibility of submitting a paper claim (accompanied by an itemized receipt indicating the name and location of the entity who administered the vaccines, the vaccine type, dose and cost for each immunization and proof of your payment) for reimbursement.

Are routine laboratory tests covered under the CDHP?

Routine lab tests associated with wellness services as defined by the CDC are covered under the wellness benefit if performed at a free-standing laboratory facility. Lab tests not associated with wellness services are subject to deductible and coinsurance. Please note lab tests provided in a hospital setting are not covered--except when lab tests are performed for pre-admission testing, inpatient admission, and urgent or emergency care. Exceptions to this provision applies for participants residing in rural areas where there are no free-standing laboratories within 50 miles; thus, requiring lab services to be performed in a hospital setting.

Is there a cost differential between using an outpatient hospital lab verses a free-standing lab such as Lab Corp or Quest?

Generally, hospitals charge substantially more for these services than stand-alone laboratories. Some physicians may refer a patient to the hospital for lab testing; however, to reduce out-of-pocket costs, the member should request a referral to a stand-alone laboratory.



Home Page

Member Services

PEBP Board

Updated September 8, 2014



 


Home/a>    Site Map    Search    Contact Us    Privacy Notice    Comments and Questions

State of Nevada Home Page