The following policy decisions, acts, disclosures, and documents are public information pertaining to your health care rights that you have a right to know, access, and understand:
PEBP’s Annual Notices document includes: Women’s Health and Cancer Rights Act; HIPPA Notice of Special Enrollments; Medicare Part D Credible or Non-Credible Coverage Notice; CHIP Notice– Medicaid and Children’s Health Insurance; Newborns’ and Mothers’ Health Protection Act; HIPPA Privacy Notice; Exchange Notice (Notice of Coverage Options); and, Portability of Life Insurance. This mandatory notice must be sent out every three years and was last sent on 08/2021.
Balance Billing: Your Rights and Protections Against Surprise Medical Bills:
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. Please click here to see this notice.
Diversity and Inclusion Liaison:
Senate Bill 222 (SB222), signed into law by Governor Steve Sisolak during the 2021 Nevada Legislative Session, requires all state agencies that interact with or offer programs and services affecting minority groups to designate a Diversity and Inclusion Liaison (DIL) within that agency.
Diversity and Inclusion Liaison
901 S Stewart St, Ste 1001
Carson City, NV 89701
Transparency and Coverage Rule:
Through UnitedHealthcare, UMR creates and publishes the Machine-Readable Files (MRF) on behalf of PEBP. On November 12, 2020, the Departments of Health and Human Services, Labor and the Treasury finalized the Transparency in Coverage Rule that requires health insurers and group health plans to create a member-facing price comparison tool and post publicly available MRFs that include in-network negotiated payment rates and historical out-of-network charges for covered items and services, including prescriptions drugs. To link to the MRF, please click on the URL provided: Transparency in Coverage (uhc.com)
National Defense Authorization Act:
On January 28, 2008, President Bush signed into law H.R. 4986, the National Defense Authorization Act (NDAA). Section 585 of the NDAA amends the Family and Medical Leave Act of 1993 (FMLA) to permit a “spouse/domestic partner, son, daughter, parent, or next of kin” to take up to 26 workweeks of leave to care for a “member of the Armed Forces, including a member of the National Guard or Reserves, who is undergoing medical treatment, recuperation, or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list, for a serious injury or illness.”
The NDAA also permits an employee to take FMLA leave for “any qualifying exigency (as the Secretary [of Labor] shall, by regulation, determine) arising out of the fact that the spouse/domestic partner, or a son, daughter, or parent of the employee is on active duty (or has been notified of an impending call or order to active duty) in the Armed Forces in support of a contingency operation.”
You can read more about the National Defense Authorization Act by visiting the US Department of Labor website and typing “NDAA” in the Search Box.
Heroes Earning Assistance and Relief Tax (HEART) Act:
The Heroes Earnings Assistance and Relief Tax Act of 2008 (HEART Act) requires employers to provide certain retirement and welfare benefits for returning military personnel and their beneficiaries. For more information on the HEART Act, visit the IRS website and type “HEART Act” in the Search Box.
Uniformed Services Employment and Reemployment Rights Act:
The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA, 38 U.S.C. § 4301-4335) is a federal law intended to ensure that persons who serve or have served in the Armed Forces, Reserves, National Guard or other “uniformed services:” (1) are not disadvantaged in their civilian careers because of their services; (2) are promptly reemployed in their civilian jobs upon their return from duty; and (3) are not discriminated against in employment based on past, present, or future military service. For more information about USERRA, please visit the US Department of Labor website.
The Americans with Disabilities Amendments Act:
Effective January 1, 2009, the Americans with Disabilities Amendments Act of 2008 (ADA Amendments Act) changed the language regarding any conditions that substantially limit and emphasizes that the definition of disability should be construed in favor of broad coverage for individuals to the maximum extent permitted by the terms of the ADA and shall not require extensive analysis. The provisions of the ADA Amendments Act were designed to essentially overturn several Supreme Court decisions and make it easier for an individual seeking protection under the ADA to establish that he or she has a disability within the meaning of the ADA. You can read more about the ADA and the Amendments Act by visiting the US Equal Employment Opportunity Commission.
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008:
This legislation requires that full parity be established between mental health/substance abuse benefits and other surgical and medical benefits offered under a healthcare plan. You can find more information on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 at the Centers for Medicare and Medicaid Services and typing “MHPAEA” in the Search Box.
Genetic Information Nondiscrimination Act of 2008:
The Genetic Information Nondiscrimination Act of 2008 (GINA) was enacted May 21, 2008. Title I (regarding genetic nondiscrimination in group health plans) was effective for plan years beginning after May 21, 2009. Title II (regarding genetic nondiscrimination in employment) became effective November 21, 2009. GINA amended the Employee Retirement Income Security Act of 1974 (ERISA), the Internal Revenue Code and the Public Health Service Act to prevent group health plans and health insurance companies from basing enrollment decisions, premium costs or participant contributions on genetic information. Group health plans and group insurers are prohibited from requiring that individuals undergo genetic testing. Employers are also prevented from conditioning hiring or firing decisions on the basis of genetic information. Lastly, GINA will extend medical privacy and confidentiality rules to the disclosure of genetic information.
Currently, neither the State of Nevada nor PEBP use genetic information for employment or benefits determination. You can read more about GINA by visiting the National Human Genome Research Institute.
Health Insurance Portability and Accountability Act (HIPAA) Privacy Practices:
The HIPAA Privacy Rule provides federal protections for personal health information and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other purposes. You have the right to a paper copy of this notice. To make such a request, submit a written request to:
HIPAA PEBP Privacy Officer
PEBP Quality Control Officer
901 S. Stewart St., Ste 1001
Carson City, NV 89701
For more information, please visit https://www.hhs.gov/ocr/index.html
Privacy Notice – Disclosure and Access to Medical Information:
Effective July 1, 2021 this Disclosure and Access to Medical Information notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please click here to view the privacy notice for PY 2022 (7/1/21 – 6/30/22).
Women’s Health and Cancer Rights Act of 1998:
Your plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services. This includes all stages of reconstruction and surgery to achieve symmetry between the breasts, prosthesis, and complications resulting from a mastectomy, including lymph edema.
If you have questions about coverage of mastectomies and reconstructive surgery, please call your plan administrator for additional information:
- Consumer Driven Health Plan, Low Deductible PPO Plan, and Premier Plan: HealthScope Benefits at 1-888-763-8232
- Health Plan of Nevada: 702-242-7300 or 1-800-777-1840
Newborns’ and Mothers’ Health Protection Act of 1996:
Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). For more information, please visit the US Department of Labor and type “Newborns’ and Mothers’ Health Protection Act” in the Search Box.
Important Notice About Your Plan Year 2022 Prescription Drug Coverage and Medicare:
This notice has information about your current prescription drug coverage and your options under Medicare’s prescription drug coverage. This information can help you decide whether you want to join a Medicare drug plan. If you are considering joining a Medicare drug plan, you should compare the drug formulary and the costs of your prescription drug plan to the Medicare prescription drug plans in your area. The following notices provide important information about your current prescription drug plan and how enrolling in a Medicare prescription drug plan can affect your coverage.
- CDHP Medicare Creditable Coverage Letter (Actives/Retirees)
- LD PPO Medicare Creditable Coverage Letter (Actives/Retirees)
- EPO Medicare Creditable Coverage Letter (Actives/Retirees)
- HPN Medicare Creditable Coverage Letter (Actives/Retirees)
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP):
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. To learn more and see State information on eligibility click here.
Discrimination is Against the Law:
View PEBP’s Non-Discrimination Notice dated June 2022.