Frequently Asked Questions

You may be eligible under the “Portability and/or Right to Convert” provisions. Details regarding these options are available in the policy Certificates located on The Standard’s website or view the Portability and Conversion FAQ. You must apply in writing to The Standard and pay the first premium within 31 days after your employment terminates.  For more information, contact The Standard at 888-288-1270.

The Medical FSA is a tax-advantaged account that allows employees to set aside a portion of earnings to pay for qualified health care expenses that are not paid by insurance (i.e. copayments, deductibles, and coinsurance). An FSA may also be used to pay for things like prescription eyeglasses and Lasik surgery. Generally, allowable items are the same as those allowed for the medical tax deduction.

The Limited Purpose FSA is a tax-advantaged account that allows employees to set aside a portion of earnings to pay for out-of-pocket dental and vision expenses. Employees who contribute to an HSA may also elect the Limited Purpose FSA.

A dependent care FSA provides a way to pay dependent care expenses and lower your taxable income. You direct part of your before-tax pay into a special account to pay work-related dependent care costs. You can use your account throughout the year to help pay for eligible expenses. Your expense must be for the purpose of allowing you and, if married, your spouse to be employed. For more information, contact HealthSCOPE Benefits at 888-763-8232.

You pay a small administration fee of $3.25 per month to participate in either one or both (health and/or dependent care) flexible spending accounts.

FSA dollars are “use-it-or-lose-it” funds. Account balances greater than $500 cannot be carried over from year to year. If you have any unused funds exceeding $500 at the end of the plan year (end of the grace period), those funds will be forfeited. That’s an IRS requirement.

Employees and eligible retirees enrolled in a PEBP-sponsored medical plan receive a Basic Life Insurance benefit as part of their benefit package. You may also apply for Voluntary Life coverage to supplement the Basic Life amount.

Employees may apply for any multiple of $10,000 up to a maximum of $500,000. Retirees may apply for any multiple of $5,000 up to a maximum of $50,000. Evidence of insurability may be required. If you have questions, contact The Standard at 888-288-1270.

Short Term Disability insurance is designed to pay you a benefit in the event you cannot work because of a covered illness, injury, or pregnancy. This benefit replaces a portion of your income to help you meet your financial commitments in time of need. For more information contact The Standard at 888-288-1270.

Voluntary Long Term Care insurance is available as a voluntary product option. For more information, NSHE employees can contact Nikki Pecorino at 775-813-5309, and employees working for a state agency can contact Karla DeCrescenzo at 775-722-5907.

To continue your LTC policy, you may elect converted coverage. This means that the coverage you had under this plan can continue on a direct-billed basis. Election for converted coverage must be made within 60 days of the date your PEBP active coverage terminates. To convert your LTC coverage, complete the Election to Continue Your Long Term Care Insurance Coverage Form located on this website.

Our HMO plan has a different provider for northern Nevada vs. southern Nevada.

If you’re in northern Nevada, the counties included are: Carson City, Churchill, Douglas, Elko, Eureka, Lander, Lincoln, Lyon, Humboldt, Mineral, Pershing, Storey, Washoe and White Pine Counties

If you’re in southern Nevada, the counties included are: Clark, Esmeralda and Nye Counties.

The name of your insurance plan is the Consumer Driven Health Plan (CDHP). This plan is a self-funded PPO plan offered by the state of Nevada Public Employees’ Benefits Program. The third party administrator, HealthSCOPE Benefits, pays the medical and vision claims for the CDHP. In order for your provider to identify your plan, you may want to refer to the plan as State of Nevada HealthSCOPE Benefits. Most providers are familiar with HealthSCOPE primarily because they pay the claims for the Consumer Driven Health Plan.

Doctor on Demand – (DOD) connects CDHP participants 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, watch the Doctor on Demand video here: http://www.doctorondemand.com/pebp. Beginning July 1, 2017, 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 for a psychiatry visit is $299 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.

Doctor on Demand – To get started today, download the Doctor on Demand Registration Guide to learn how to set up your account using a mobile device, tablet or desktop.

Travel Assistance is available when you travel more than 100 miles from home or internationally for up to 180 days for business or pleasure. This program is designed to help you respond to medical care situations and other emergencies you and your family may experience while traveling. The program also offers aid before and during your trip, including:

• Passport, visa, weather and current exchange information, health hazards advice and inoculation requirements,
• Emergency ticket, credit card and passport replacement, funds transfer and missing baggage
• 24/7 365 phone access to registered nurses for health and medication information, symptom decision support, and help understanding treatment options
• Emergency evacuation to the nearest adequate medical facility and medically necessary repatriation to your home, and a host of other services shown in the Travel Assistance brochure.

Simply print and carry the Travel Assistance card on the back of this brochure which provides more detailed information. Active employees and retirees enrolled in a PEBP-sponsored medical plan are eligible for this benefit.

Note » Life Services Toolkit is available to active employees and retirees enrolled in a PEBP-sponsored medical plan. Reinstated retirees are not eligible for this benefit.

With an FSA, you can set aside up to $2,600 (annual deduction limitation per employee) a year pre-tax to pay for out-of-pocket medical expenses, including orthodontic care. If you spread the treatment plan over two years, you could use up to $5,100 in FSA funds to cover the orthodontic bills. The tax savings could cover from 18 to 25 percent of the cost (depending on your tax bracket).

See the  FSA flyer to learn how you can offset costs for orthodontic services.

The Life Services Toolkit provides eligible participants with access to the following online tools and services:

• Estate Planning Assistance
• Financial Planning
• Health and Wellness
• Identity Theft Protection
• Funeral Arrangements (calculate funeral costs, find funeral-related services and make decisions in advance)

To learn more about the support tools available and the beneficiary services, please see the Life Services Toolkit Flyer.

Note » Life Services Toolkit is available to active employees and retirees enrolled in a PEBP-sponsored medical. Reinstated retirees are not eligible for this benefit.

Beginning in Plan Year 2018, primary participants on the CDHP are eligible to receive an additional $200 HSA/HRA contribution once four wellness requirements are complete. For information on this benefit, click here.

Requests for reimbursement must be submitted within one year (12 months) from the date the service(s) where incurred.

The HealthCare FSA is a tax-free account that allows a person to pay for essential health care expenses that are not covered or are partially covered by your medical, pharmacy, dental and vision plans. For more information regarding the FSA contact HealthSCOPE Benefits at 888-763-8232 then press 2 then press “#” then press 3.

*The FSA is a use it or lose it and the HSA/HRA rolls over from year to year, month to month. The FSA does allow up to $500 to roll over from year to year.

*An HRA is a Health Reimbursement Arrangement with only PEBP contributions. You are not eligible to make your own contributions to this account. If you leave State Services this money will go back to the State. Everyone on the CDHP/PPO plan is eligible for an HRA.

*An HSA is a Health Savings Account that also receives tax-free contributions from PEBP but also allows the participant to make voluntarily contribute to their HSA through pre-tax payroll deductions. If you leave State Service the money will stay with you until it is spent by you. Not everyone is eligible for an HSA.

Health Reimbursement Arrangements (HRAs) are PEBP-owned pass-through accounts established on behalf of eligible CDHP primary participants. HRA funds may be used to pay for qualified medical expenses.

You are eligible for an HRA if you are enrolled in the CDHP and have primary or secondary coverage that is not a qualifying high deductible health plan (e.g., Medicare, Tricare for Life, etc.)

The PEBP Dental Plan is available to Medicare Exchange retirees as a voluntary option.

Yes. If you do not qualify for premium-free Medicare Part A, you will be able to maintain your PEBP CDHP or HMO plan. However, you will be required to submit verification that you do not qualify for premium-free Part A. You will also be required to purchase Part B Medicare at age 65 if you are retired.

The Exchange-HRA has a timely filing period of 365 days from the date of service.

The Medicare Exchange HRA is a pass-through account for Medicare retirees enrolled in a medical plan through the Medicare Exchange. Contributions to the Medicare Exchange are determined by the years of service and date of retirement of eligible retirees. HRA funds may be used to reimburse retirees for qualified medical expenses, health plan premiums, and Medicare Part B premiums.

In general, you must be a United States citizen, green card holder, or a United States resident to participate. An HSA cannot be opened without a verifiable United States residential address and a valid United States Social Security Number.

If you are no longer an eligible individual, you can still receive tax-free distributions to pay or reimburse your qualified medical expenses. However, you can no longer contribute money to your HSA.

HSA funds are portable. At retirement, you will retain any funds in your HSA. You may also continue to use HSA money to pay for out-of-pocket health care expenses.

An HSA allows you to withdraw funds for any reason. However, you would need to pay ordinary tax and an additional penalty of 20% on any funds that are withdrawn for an ineligible expense.

You are responsible for determining if an expense is an eligible medical expense and maintaining receipts for tax reporting and potential IRS audit purposes. At age 65, funds can be withdrawn for any reason and only ordinary tax applies.

HSA funds can be used for you, your spouse, or eligible dependents (as identified on your Federal tax return) even if they are not covered under your CDHP coverage.

Verification of expenses is not required for HSAs. However, total withdrawals from your HSA are reported to the IRS on Form 1099-SA. You are responsible for reporting qualified and non-qualified withdrawals when completing your taxes. You are also responsible for saving all receipts as verification of expenses in the case of an IRS audit.

No. Since eligible expenses are paid with tax-free dollars from your HSA, you cannot claim the same expenses on your income tax return.

The Last-Month Rule states that if you are covered by an HSA-eligible health plan on the first day of the last month of a given year, you are considered an eligible individual for the entire year. In turn, you can then contribute to the HSA for that full year.

Example: If you enrolled in the CDHP on July 1, 2015 and retained coverage under that plan through December 1, 2015, you are covered per the Last-Month Rule. This means you are considered an eligible employee for the entire year in 2015. This allows you to contribute up to the 2015 contribution limit. However, you must also take into consideration the Testing Period.

Under the Testing Period, if you use the Last Month Rule, you must also remain an eligible individual (retain your same coverage under the CDHP or other high-deductible health plan) for the following 12 months. If you fail to remain an eligible individual (i.e., if you change coverage from the CDHP to an HMO or enroll in Medicare, etc.) any “extra” contributions you made as a result of the Last-Month Rule must be included in your gross income. Also, a 20% additional tax applies to this amount. Your excess contributions are determined by the contribution limit divided by 12 months, compared to your time eligible.

HSA contribution limits are set by the IRS and may change from year to year. The combined contribution limits from all sources (PEBP, employee, family, etc.) are listed in the table below.

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HSA elections may be modified any time throughout the year. To modify your election, log in to your HealthSCOPE Benefits account or email pebphsahra@healthscopebenefits.com.

You can spend your HSA dollars on qualifying medical expenses for yourself, or anyone you claim as a dependent on your personal income tax — even if that person is not covered by your CDHP coverage.

No. If your spouse has a Medical Flexible Spending Account you are disqualified from establishing and/or contributing to an HSA.

If your spouse has an HRA, you are disqualified from establishing and/or contributing to an HSA per the IRS.

An otherwise eligible retiree who has Tricare for Life and Medicare Parts A and B will not be required to enroll in a medical plan through the Medicare Exchange. However, before PEBP will authorize the Years of Service HRA funding, PEBP will require a copy of the retiree’s military ID card and Medicare Parts A and B card.

If a child (age 26 or younger) is enrolled as a dependent of a PEBP participant and becomes eligible for their own PEBP coverage as a primary participant, the child has the option to remain as a dependent OR enroll on their own as a primary participant.  If the child enrolls as a primary participant, they must be removed as a dependent from their parent’s coverage.

Newborn dependent child(ren) will automatically be covered under PEBP from the date of birth to 31 days following the date of birth. To continue coverage beyond the initial coverage period, enrollment must be completed within 60 days of the newborn’s date of birth.

No. A dependent cannot be covered under two PEBP plans at the same time.

A spouse or domestic partner who is eligible for other employer group coverage is not eligible for coverage as a dependent under this plan. Exceptions may apply if the employer group coverage is determined to be significantly inferior. “Significantly inferior” refers to a plan that offers limited benefits, such as a mini-med plan or a catastrophic plan with a $5,000 or greater individual deductible and the plan is not coupled with an HSA or HRA.

HMO participants who move outside of their designated HMO plan’s coverage area must select a new medical plan to coincide with their new coverage area.

Employees with an initial hire date on or after January 1, 2012 may enroll in retiree coverage but will not qualify for a retiree premium subsidy or Exchange HRA contribution.

An unsubsidized dependent is an otherwise eligible spouse/domestic partner who transitions to the Medicare Exchange and elects PEBP dental coverage, while the primary plan participant remains covered under PEBP’s CDHP or HMO plan.

A Health Savings Account (HSA) is a tax advantaged savings account for qualifying medical expenses. The funds contributed to an account are not subject to federal income tax at the time of deposit. To be an eligible individual and qualify for an HSA per the IRS guidelines:

• You must be an active employee enrolled in the CDHP
• You cannot have secondary coverage unless your secondary coverage is also a high deductible health plan
• You cannot be claimed on another person’s tax return (excludes joint returns)
• Your spouse (if applicable) cannot have a Medical FSA or HRA that can be used to pay for your out-of-pocket medical expenses
• You are not enrolled in Medicare or COBRA
• If you do not qualify for an HSA at initial enrollment or on the first day of the plan year (July 1) you cannot change from the HRA to an HSA mid-year
• You are not enrolled in Tricare or Tricare for Life
• You are not retired

To be eligible to establish and contribute to an HSA on a pre-tax basis, you must meet the following criteria:

–  You are covered by an IRS qualified high deductible health plan – such as PEBP’s CDHP medical plan.
–  You are not covered by a non-IRS qualified high-deductible health plan – such as a spouse’s PPO or HMO medical plan.
–  You are not enrolled in Medicare.
–  You are not enrolled in TRICARE or TRICARE for life.
–  You have not received care from a Veterans Administration (VA) medical facility within the past three months.
–  You or your spouse cannot be enrolled in a Medical Flexible Spending Account or HRA which may be used to pay your out-of-pocket health care expenses.
–  You are not retired.

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. 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 apply 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.

PEBP will send out a Credible Coverage notice each August.  Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

The Consumer Driven Health Plan (CDHP) is a qualified high-deductible health plan coupled with a tax-favored health savings account (HSA) or health reimbursement arrangement (HRA). Individuals covered as “self-only” have an individual deductible amount and those covered as “family” (self plus one other individual) have a family deductible.

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.

Yes, however, PEBP does not maintain a network specific to vision care. Out-of-network providers will be paid at Usual and Customary (U&C). One annual vision exam, maximum annual benefit $95 per plan year after the $25 copayment.  There is no benefit for hardware including contacts, glasses, and lenses.

Employees hired on the first day of the month are eligible for benefits on their date of hire. Employees hired on the second day through the last day of the month are eligible for benefits on the first day of the month following their date of hire. For example, if you were hired on June 1, your benefit eligibility would begin that day. If you were hired on June 2, your benefit eligibility would begin July 1.

You will not have to wait until Open Enrollment to add your spouse. The loss of employer-sponsored group coverage is a qualified family status event. However, you must submit a request within 60 days of the date your spouse’s other coverage ended.

Yes, PEBP requires all retirees who are eligible for premium-free Medicare Part A to enroll in Part A coverage. PEBP also requires retirees to purchase Medicare Part B coverage at age 65 (or under age 65 if Medicare eligible due to a disability), regardless of whether a retiree qualifies for free Part A.

No, PEBP does not require active employees aged 65 or older to enroll in Medicare until they retire.

The covered dependents of a deceased active employee who had 10 or more years of service credit may continue coverage by re-joining the program as a survivor within 60 days of the employee’s death.