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.

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.

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.

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.

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.

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.

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+)
Single  $3,400 $1,000 $3,350 $1,000
Family $6,750 $1,000 $6,650 $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 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.

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, 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.

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

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.