Eligibility

Our HMO plan has a different provider for northern Nevada vs. southern Nevada.

If you’re in northern Nevada, the counties included are: Carson City, Churchill, Douglas, Elko, Eureka, Lander, Lincoln, Lyon, Humboldt, Mineral, Pershing, Storey, Washoe and White Pine Counties

If you’re in southern Nevada, the counties included are: Clark, Esmeralda and Nye Counties.

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.

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.)

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.

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 PEBP’s CDHP or HMO plan.

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.

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. 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’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.