For answers to frequently asked questions regarding the opt-in Diabetes Care Management Program and Obesity Care Management Program, please click here.

Primary participants on the CDHP are eligible to receive an additional $200 HSA/HRA contribution. To receive the supplemental contribution for Plan Year 2019 (PY19), a participant will need to complete two sets of requirements:

 

$100

Complete 4 preventive requirements:

1. Annual wellness physical exam
2. Annual wellness lab work
3. Dental exam
4. Dental cleaning

 

$100

1. Complete the Healthcare Bluebook Guided Tour

AND

2. Complete the registration for Doctor on Demand

For more information on this benefit, click here.

Doctor on Demand – (DOD) connects CDHP and Premier (EPO) Plan 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 – and see a short video showing what an experience is like, go to: http://www.doctorondemand.com/pebp.  

If you are a CDHP participant, Doctor On Demand medical visits are $49 per visit. Visits with a psychologist are $79 for 25 minutes and $119 for 50 minutes. Psychiatric 45 minute initial visit is $229 and $99 for a 15 minute follow-up visit. For additional information you may also view the CDHP flyer.

If you are a Premier (EPO) Plan participant, Doctor On Demand medical visits are $10 per visit. Visits with a psychologist are $25 for 25 minutes and $35 for 50 minutes. Psychiatric 45 minute initial visit is $35 and $25 for a 15 minute follow-up visit. For additional information you may also view the Premier (EPO) Plan flyer

To get started, text the word PEBP to 68-398.

 

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, dental 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.

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 1-888-763-8232, press 2 then press “#” then press 3#.

The FSA is a use it or lose it account 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 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.

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.

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.

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

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.)

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.

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

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.

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.

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 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.

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.

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

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

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. Please visit www.irs.gov for additional information.

HSA elections may be modified any time throughout the year.

To modify your election, you may log into your E-PEBP Portal by clicking on the orange log in icon on the top right of the screen.

  • Once you are logged in, select the link for HealthSCOPE Benefits on the right side of the screen.
  • Click on FSA/HSA & HRA under Resources on the right hand side.
  • Click on HRA/HSA Administration.
  • In order to view your contribution amount, click on the Change HSA Election option on the left hand side of the page.
  • Read and follow the prompts on the HSA Enrollment Eligibility page in order to view and change your contribution amount.

Yes, 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.

  2018 Calendar Year  2018 Catch-Up (age 55+) 2017 Calendar Year 2017 Catch-Up (age 55+)
Single  $3,450 $1,000 $3,400 $1,000
Family $6,850 $1,000 $6,750 $1,000

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 the EPO or 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.

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.

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

  • The employee is covered under other medical insurance coverage unless that medical insurance coverage: (1) is also a High Deductible Health Plan as defined by the IRS; (2) covers a specific disease state (such as cancer insurance); or (3) only reimburses expenses after the Deductible is met,
  • The employee can not be claimed as a dependent on someone else’s tax return unless the employee is Married Filing Jointly;
  • The employee or the employee’s Spouse cannot have a Medical Flexible Spending Account (excludes Dependent Care or Limited Use Flexible Spending Accounts);
  • The employee’s Spouse cannot have an HRA that can be used to pay for the medical expenses of the employee;
  • The employee is NOT on COBRA;
  • The employee is NOT enrolled in Tribal coverage;
  • The employee is NOT enrolled in Medicare;
  • The employee is NOT enrolled in TRICARE or TRICARE for Life;
  • The employee is NOT retired.

 

A Health Savings Account is a tax-exempt account that you can use to pay or reimburse yourself for certain medical expenses you incur.

HSAs are employee-owned accounts, meaning the funds in the HSA remain with the employee and will carry over from one year to the next (i.e., will not be forfeited unless there is no account activity for a 3-year period then the funds will be considered abandoned per NRS 120A.500 and subject to forfeiture by the State). Contributions to the HSA grow tax free and are portable. When an employee retires or terminates employment, the employee keeps the funds in the HSA. The employee can continue to use the funds in the HSA for health care and other qualified medical expenses after employment ends.

There are limits on the amount an eligible individual can contribute to an HSA based on the employee’s coverage tier. For example, “self-only” or “Family” coverage.

  • Self-only coverage means an eligible individual (employee)
  • Family coverage means an eligible employee covering at least one dependent (whether that dependent is an eligible individual (for example, if the dependent has Medicare) if that other person is claimed on your tax return and not claimed as a tax dependent on someone else’s return.

You must be an eligible individual to qualify for an HSA. Employees may not establish or contribute to a Health Savings Account if any of the following apply:

  • The employee is covered under other medical insurance coverage unless that medical insurance coverage: (1) is also a High Deductible Health Plan as defined  by the IRS; (2) covers a specific disease state (such as cancer insurance); or (3) only reimburses expenses after the Deductible is met;
  • The employee is enrolled in Medicare;
  • The employee is enrolled in Tricare;
  • The employee is enrolled in Tribal coverage;
  • The employee can be claimed as a dependent on someone else’s tax return unless the employee is Married Filing Jointly;
  • The employee or the employee’s Spouse has a Medical Flexible Spending Account (excludes Dependent Care or Limited Use Flexible Spending Accounts);
  • The employee’s Spouse has an HRA that can be used to pay for the medical expenses of the employee; The employee is on COBRA; or
  • The employee is 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.

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.