Eligibility

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.

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.

Yes. If you do not qualify for premium-free Medicare Part A, you will be able to maintain your PEBP CDHP, EPO 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.

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.

Unsubsidized Dependents Covered under a PEBP Plan

• An unsubsidized dependent is an otherwise eligible spouse/domestic partner or dependent child who remains covered under PEBP while the primary Plan participant transitions medical coverage to the Medicare Exchange.
• Termination of a primary participant’s coverage will result in termination of the unsubsidized dependents.
• Unsubsidized dependents enrolled in the CDHP, Premier (EPO) Plan or HMO Plan can decline their coverage at any time (coverage ends the last day of the month of notification).

Unsubsidized Dependents Covered under the Medicare Exchange

• An unsubsidized dependent is an otherwise eligible spouse/domestic partner who transitions to the Medicare Exchange and elects PEBP dental coverage, while the primary Plan participant remains covered under a PEBP Plan.
• Termination of a primary participant’s coverage will result in termination of the unsubsidized dependent.
• Unsubsidized dependents enrolled in the Medicare Exchange with PEBP dental coverage can decline their coverage at any time (coverage ends the last day of the month of notification).

Employees with an initial hire date on or after January 1, 2012 may enroll in retiree coverage but will not qualify for a retiree premium subsidy or Exchange HRA contribution.

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.

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.

No. A dependent cannot be covered under two PEBP plans at the same time.

Newborn dependent child(ren) will automatically be covered under PEBP from the date of birth to 31 days following the date of birth. To continue coverage beyond the initial coverage period, enrollment must be completed within 60 days of the newborn’s date of birth.

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.

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.

You will not have to wait until Open Enrollment to add your spouse/domestic partner. The loss of employer-sponsored group coverage is a qualified family status event. However, you must submit a request within 60 days of the date your spouse/domestic partner’s other coverage ended.

No, PEBP does not require active employees aged 65 or older to enroll in Medicare until they retire.

The covered dependents of a deceased active employee who had 10 or more years of service credit may continue coverage by re-joining the program as a survivor within 60 days of the employee’s death.