Frequently Asked Questions
Please select the category your question fits under to the left or simply browse through all of the questions below. If you have any other questions, please feel free to give us a call at (775) 684-7000 or (800) 326-5496.
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.
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.
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 $5,000 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.
I have a Long Term Care (LTC) Insurance policy through UNUM. I am terminating employment. May I continue paying for this policy when I retire?
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.
I want to make an appointment at the Doctor’s office and I have the Consumer Driven Health Plan (CDHP), what is the name of my plan?
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.
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.
I am retired with Medicare. I will be transitioning to the Medicare Exchange. May I keep the PEBP Dental plan?
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.
I am enrolled in the Medicare Exchange with an HRA. How long do I have to request reimbursement 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.
What happens to my HSA if I am no longer an eligible individual? For example, if I change coverage from the CDHP to an HMO or if I enroll in Medicare?
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.
If I am enrolled in single coverage under the CDHP, can HSA funds be used for my spouse or eligible dependents that are not covered under my health plans?
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.
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.
|Calendar Year 2017||Calendar Year 2017 Catch-Up (age 55+)||Calendar Year 2016||Calendar Year 2016 Catch-Up (age 55+)|
My spouse is a state employee with an HRA. I am a new employee and plan to enroll in the CDHP with an HSA, am I eligible to contribute to an HSA?
I am retired and have Tricare for Life. Am I required to enroll in a medical plan through the Medicare Exchange to receive a Years of Service HRA contribution?
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.
I am 24 years old and covered as a child under my parent’s PEBP plan. If I become eligible for PEBP benefits as a state employee, will I need to enroll in my own coverage?
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.
My spouse is covered under his/her employer’s group health plan, may I cover my spouse on my plan as well?
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.
I am covered under the HMO plan in Northern Nevada. However, I am moving to Las Vegas. May I keep my Northern Nevada HMO Plan?
I was initially hired on or after January 1, 2012. Will I be eligible for the retiree health insurance premium subsidy at retirement?
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.
How do I notify Medicare that I have current group drug coverage through my employer since I am 65 but an active employee?
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.
Is there a cost difference between using an outpatient lab at a hospital versus a free-standing lab such as LabCorp 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.
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.
My spouse is covered under his/her employer’s group health plan. If he/she loses coverage from his/her employer, do I need to wait until open enrollment to add him/her as a dependent on my plan?
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.