Health Reimbursement Arrangement
Obesity Care Management Program providers can be found on PEBP’s Find a Provider page.
A flexible spending account is a financial account you put money into that you can use to pay certain out-of-pocket healthcare and dependent care costs. You don’t pay taxes on this money. With an FSA, you can set aside up to $2,850 in pre-tax wages during 2022 for out-of-pocket medical expenses. The amount limits are subject to change annually. Depending on your tax bracket the tax savings could cover from 18 to 35 percent of the cost. What many people don’t know is that your FSA funds can help offset the high cost of orthodontic services as well.
Single Year Savings Comparison
Without an FSA:
$212.50 Monthly budget for orthodontic expenses
– $46.75 Taxes deducted on $212.50
$165.75 Amount left for out-of-pocket orthodontic expenses
With an FSA:
$212.50 Monthly FSA deposit for orthodontic expenses
– $0.00 Taxes deducted on $212.50
$212.50 Amount left for out-of-pocket orthodontic expenses
Annual Savings (Example):
$46.75 x 12 = $561
Use $561 towards orthodontic expenses from income tax savings using a flexible spending account.
Doctor on Demand – (DOD) connects CDHP, LD and 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.
Effective 7/1/2022 for plan year 2023:
If you’re a CDHP (PPO) participant, DoD medical visits are $49 per visit. Visits with a psychologist are $79 for 25 minutes and $129 for 50 minutes. Psychiatric 45-minute initial visit is $229 and $99 for a 15-minute follow-up visit.
If you’re a LD (PPO) participant, DoD medical visits are $10 per visit. Visits with a psychologist are $25 for 25 minutes and $30 for 50 minutes. Psychiatric 45-minute initial visit is $30 and $20 for a 15-minute follow-up visit.
If you’re a Premier Plan (EPO) participant, DoD medical visits are $10 per visit. Visits with a psychologist are $20 for 25 minutes and $20 for 50 minutes. Psychiatric 45-minute initial visit is $20 and $20 for a 15-minute follow-up visit.
To learn more – and see a short video showing what an experience is like, go to: http://www.doctorondemand.com. For technical support information please click here.
If you reside in southern Nevada, coverage is administered by the Health Plan of Nevada (HMO) and is only available to participants residing in the following counties: Clark, Esmeralda and Nye Counties.
If you reside in northern Nevada, coverage is administered by the Premier (EPO) Plan and is only available to participants residing in the following fourteen northern Nevada counties: Carson City, Churchill, Douglas, Elko, Eureka, Humboldt, Lander, Lincoln, Lyon, Mineral, Pershing, Storey, Washoe and White Pine.
FSA dollars are “use-it-or-lose-it” funds. In 2022, account balances greater than $570 cannot be carried over from year to year. If you have any unused funds exceeding the limit at the end of the plan year (end of the grace period), those funds will be forfeited per IRS requirements.
You pay a small administration fee of $3.15 per month to participate in either one or both (medical and/or dependent care) flexible spending accounts.
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. Members can enroll in an FSA during a new hire event, open enrollment, or during a qualifying life event. For more information, contact UMR at 1-888-763-8232.
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. For more information, contact UMR at 1-888-763-8232.
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 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. The FSA plan year is July 1 through June 30 of the following year. Flexible Spending Account open enrollment is usually held in May each year. To participate in an FSA, you must enroll within 60 days of your hire date or during open enrollment each year for the upcoming plan year. For more information regarding FSAs contact UMR at 1-888-763-8232.
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 allows for a limited amount of funds 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 contributions 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 revert to the State. Everyone enrolled in the CDHP PPO plan is eligible for an HRA.
What happens to my HSA if I am no longer an eligible individual? For example, if I change coverage from the CDHP to the LD, EPO or HMO, or if I enroll in Medicare?
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.
I am covered under the EPO plan in Northern Nevada. However, I am moving to Las Vegas. May I keep my Northern Nevada EPO Plan?
EPO and HMO participants who move outside of their designated plan’s coverage area must select a new medical plan to coincide with their new coverage area within 30 days. Contact PEBP Members Services to notify them and discuss your options.
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.
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. Most hospital based lab services except for pre-admission testing, urgent care, and emergency lab room services are not covered. Laboratory outpatient services at a free standing, in-network facility such as Lab Corp or Quest are subject to the deductible and/or co-insurance/co-payment.