Health Reimbursement Arrangement
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.
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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, 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.
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.
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?
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 However, you would need to pay ordinary tax and an additional penalty of 20% on any funds that are withdrawn for an ineligible expense.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.
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 EPO or if I enroll in Medicare?
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.
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?
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.
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.