Obesity Care Management Program providers can be found on PEBP’s Find a Provider page.
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.
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 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.
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.
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.
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.
I want to make an appointment at the doctor’s office and I have the Consumer Driven Health Plan (CDHP PPO), what is the name of my plan?
Effective July 1, 2022 for the Consumer Driven Health Plan (PPO) the HealthSCOPE Benefits Aetna Signature Administrators Network is being replaced.
HealthSCOPE Benefits is changing its name to UMR. Northern Nevada and out-of-state members will utilize the UMR UnitedHealthcare Choice Plus Network. Southern Nevada members will utilize the UMR Sierra Health-Care Options. PPO members are encouraged to confirm the network status of provider(s) before receiving health care services beginning July 1, 2022. You can search for in-network providers on the Find a Provider page.
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.
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. 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.
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.
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.
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.
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.
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.
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?
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.
If I use funds from my HSA for medical expenses, can I claim them as a deduction on my income tax?
No. Since eligible expenses are paid with tax-free dollars from your HSA, you cannot claim the same expenses on your income tax return.
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?
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. Please visit www.irs.gov for additional information.
As an active employee enrolled in the Consumer Driven Health Plan with a Health Savings Account (HSA) you can update your employee pre-tax HSA contribution in your E-PEBP portal. For instructions on how to complete this event visit our How Tos page.
Yes, employees can contribute up to $3,650 in 2022 for self-only coverage or up to $7,300 for family coverage. If you’re 55 or older at the end of the year you can put in an extra $1,000 in catch-up contributions. These amounts include the total amount you can contribute, including any employer provided amounts. These amounts are subject to change each year. Keep in mind that the HSA is tied to the CDHP and the participation period of 07/01 to 06/30, PEBP’s plan year, which is why ongoing contributions put in now would only go until the end of the plan year, in the event that a member changes their coverage for the following plan year.
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 the LD, EPO, 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.
To calculate your personal contribution limit:
1. Take the total annual contribution limit based on your coverage type (individual or family)
2. Divide that amount by 12
3. Multiply it by the number of months that you qualify that year
For example, see the chart below where the contribution limits for 2022 are $3,650 for the individual and $7,300 for the family. Active employees aged 55 and older are allowed an additional $1,000 catch-up amount of $4,650 and $8,300, respectively. Keep in mind that contribution limits also include employer contributions from PEBP.
|Number of months||Individual||Family|
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, 2022, and retained coverage under that plan through December 1, 2022, you are covered per the last-month rule. This means you are considered an eligible employee for the entire year in 2022. This allows you to contribute up to the 2022 contribution limit. However, you must also take into consideration the testing period. The testing period is a major drawback to the last month rule. It means that you must remain eligible for the HSA until December 31st of the following year. The only exceptions include death or disability.
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. 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.
Yes, however, PEBP does not maintain a network specific to vision care. Out-of-network providers will be paid at usual and customary rate (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 but you can use your HSA/HRA funds to help cover these costs.