HRA funds may be used to pay for out-of-pocket qualified health expenses
HRA debit card
HRAs are not portable; funds revert to PEBP if an employee’s coverage is terminated under the CDHP
Annual Vision Exam (paid at 100% of Usual and Customary, maximum $95 per plan year, $25 copay)
Prescription drug coverage (subject to deductible and annual maximum out-of-pocket)
Preventive Drug Plan – Provides plan participants access to certain preventive medications without having to meet a deductible, and will instead only be subject to coinsurance. The drugs covered under this benefit include categories of prescription drugs that are used for preventive purposes or conditions, such as hypertension, asthma or high cholesterol. For more information on this benefit, see the Express Scripts Preventive Drug Flyer.
Diabetes Care Management Program – This is an opt-in program that is offered to all CDHP participants and their covered dependents. Provides participants in the program the ability to purchase diabetes related medications, such as insulin, at a co-pay and not be subject to deductible or co-insurance. For more information on the Diabetes Care Management Program as well as the Obesity Care Management Program, click here.
Diabetic Supplies – Receive an annual glucose monitor and/or a 90 day supply of test strips, Lancets, and Insulin Syringes – $50 copayment applies to each 90-day mail order supply item. If the actual cost is less, you pay the actual cost. There is no cost for the blood glucose monitor (out-of-network subject to deductible and co-insurance).
Doctor on Demand– (DOD) connects you face-to-face with a board-certified doctor or licensed psychologist (by appointment) on your smartphone, tablet or computer through live video. To learn more, visit http://www.doctorondemand.com/pebp. The cost for a primary care visit is $49; the cost for a psychology visit is $79 for a 25 minute appointment and $119 for a 50 minute appointment; the cost of a psychiatry visit is $229 for an initial 45 minute appointment and $99 for a 15 minute follow-up appointment. View the Doctor on Demand FAQ or flyer for more information. To get started, text the word PEBP to 68-398.
Healthcare Bluebook– (HCBB) helps you compare the quality and cost of medical services. By using this service to select care at certain high quality, low cost in-network providers, participants may receive a financial incentive. This new benefit will be available by application on your smartphone or tablet as well as on any computer or by phone. Once you login be sure to click on the guided tour icon below the search bar for your chance to add additional HSA/HRA money to your HealthSCOPE account. If you would like more information on how Healthcare Bluebook works click here.
Hip and Knee Surgeries – If you are planning to have hip or knee replacement surgery, you will need to confirm if your doctor performs surgery at one of our exclusive facilities. For an updated list of exclusive facilities, please click here. If your doctor does notperform surgery at an exclusive facility, you will have two options to receive the care you need:
Option 1: You can select a new doctor who performs surgery at an exclusive facility. PEBP’s Utilization Management vendor Hometown Health Partners, who pre-certifies your surgery, will assist you in locating a high quality doctor who performs surgery at an exclusive facility. The facility will be reimbursed at 80 percent coinsurance after deductible and 100% after satisfying your maximum out-of-pocket level for the year
Option 2: You can choose to have your hip or knee replacement surgery at a non-exclusive facility. By choosing a non-exclusive facility, we will pay the non-exclusive facility the same amount we would pay an exclusive facility, whether it is in- network or out-of-network. Choosing this option will result in your responsibility to pay any amount above what the plan pays for your surgery.
If you have any questions, please contact PEBP’s Utilization Management vendor, Hometown Health Providers at 775-982-3232 or 1-888-323-1461.