PEBP Premier Plan (EPO)
PEBP Premier Plan (EPO)
This plan is only available to participants residing or working in the following fourteen northern Nevada counties: Carson City, Churchill, Douglas, Elko, Eureka, Humboldt, Lander, Lincoln, Lyon, Mineral, Pershing, Storey, Washoe and White Pine.
It is recommended that those interested in enrolling in the Premier (EPO) Plan review and compare plan benefits to ensure the plan is right for you. Please refer to the PEBP Premier Plan Master Plan Document for more information on coverage and benefits.
- Open access (referrals not required to see an in-network specialist)
- Hometown Health Network coverage
- No primary care physician is required
- Low, fixed out-of-pocket costs
- No annual deductibles
- No claim forms
- No pre-existing condition exclusions or limitations
- 100% preventive care benefit
- Healthcare Bluebook – Shop and Compare Tool
- Members may be balance billed if an out-of-network provider is used for emergent or urgent care services. See commonly used health coverage and medical terms for definition of balance billing.
- Large pharmacy network including a mail-order prescription program
- Specialty drugs through Accredo at 30% coinsurance
- Online web portal to view submitted claims
- Infusion services must be performed at an exclusive facility
- Hip and Knee replacement surgeries must be performed at an exclusive facility. See Exclusive Hospital and Out-Patient Surgery Center section below for additional information.
- Vision benefits will include one vision exam per plan year with a $10 copay up to $100 and a maximum $100 benefit for prescription eyeglasses or contact lenses every 24 months with a $10 copay
- Routine lab tests must be performed at a contracted free-standing laboratory facility
- Travel reimbursement will be offered for specific medical procedures
- Added benefits include:
- Obesity Care Management Program
- Doctor on Demand Telemedicine
- Healthcare Bluebook Shop and Compare Tool
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 copay for a primary care visit is $10; the copay for a psychology visit is $25 for a 25 minute appointment and a $35 copay for a 50 minute appointment; the copay of a psychiatry visit is $35 for an initial 45 minute appointment and a $25 copay for a 15 minute follow-up appointment. View the Doctor on Demand 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. If you would like more information on how Healthcare Bluebook works click here.
Inpatient and Out-Patient Surgery Performed at Exclusive Hospitals and Out-Patient Surgery Centers
Prior authorization is required for all elective inpatient and outpatient surgeries. The utilization management company will make a prior authorization determination based on type of surgery, covered benefits, medical necessity, provider quality, cost, and location. If you choose to have your surgery performed at a non-exclusive provider/facility, you will be responsible for the inpatient or outpatient copayment amount (as applicable), including any amount that exceeds this Plan’s reference-based pricing. Note: Amounts exceeding this Plan’s reference-based pricing will not apply to your annual out of pocket maximum.
Out-Patient Infusion Services Performed at Exclusive Hospitals and Infusion Centers
Prior authorization is required for all outpatient infusion services. The utilization management company will review the request based on covered benefits, medical necessity, provider quality, cost, and location. If you choose to receive your infusion at a non-exclusive hospital or infusion center, you will be responsible for the infusion therapy copayment and any amount that exceeds this Plan’s reference-based pricing. Amounts exceeding this Plan’s reference-based pricing will not apply to your annual out of pocket maximum.
