Pre-Medicare Retiree Plan Documents

Below, you will find Plan Documents and Evidence of Coverage Certificates (EOC) that provide helpful information regarding the terms, conditions, and administration of your benefits.

Consumer Driven Health Plan (CDHP)

• Master Plan Document for the Consumer Driven Health Plan (CDHP) for Medical, Vision, Prescription Drug, Health Savings Account (HSA), and Health Reimbursement Arrangement (HRA)
• Wellness Benefits Guide
• Summary of Benefits and Coverage - Individual
• Summary of Benefits and Coverage - Family 
• Glossary of Health Coverage and Medical Terms

Hometown Hometown Health (HMO) Plan

• Evidence of Coverage Certificate (EOC) Document
• Prescription Drug Rider
• Prescription Drug Formulary
• Vision Summary of Benefits
• Glossary of Health Coverage and Medical Terms
• Summary of Benefits and Coverage

Health Plan of Nevada (HMO) Plan

• Evidence of Coverage Certificate (EOC) Document
• Summary of Benefits and Coverage
• Vision Plan Summary
• Timely access to care requirements

HIPAA Privacy and Security Requirements for PEBP Benefits

• HIPAA Privacy and Security Requirements for PEBP Benefits

Enrollment and Eligibility

• Enrollment and Eligibility Master Plan Document
• Retiree Enrollment Guide
• Qualifying Life Events

PPO Dental Plan, Life Insurance and Long Term Disability Insurance

• Master Plan Document for the Self-Funded PPO Dental Plan and Summary of Benefits for Life and Long Term Disability Insurance

Basic Life Insurance Certificate for Eligible Retirees

• Basic Life Insurance Certificate (for eligible retirees)

Medicare Retiree Plan Documents

The Public Employees' Benefits Program offers a Voluntary PPO Dental Plan to Medicare retirees enrolled in a medical plan through the Medicare Exchange. Eligible retirees also receive a Health Reimbursement Arrangement (HRA) which may be used to reimburse the retiree for health care premiums, dental premiums, Medicare Part B premiums, and out-of-pocket health care expenses.  Below, you'll find documents that provide further detail on each of your benefit options.

PPO Dental Plan, Life Insurance and Long Term Disability Insurance

• Master Plan Document for the Self-Funded PPO Dental Plan and Summary of Benefits for Life and Long Term Disability Insurance

Health Reimbursement Arrangement for Medicare Exchange Retirees

• Summary Plan Description for Health Reimbursement Arrangement for Medicare Exchange Enrollees

Basic Life Insurance Certificate

• Basic Life Insurance Certificate (for eligible retirees)

Retiree Resources

• Retiree Enrollment Guide
• PEBP and OneExchange Guide
• PEBP and Medicare Guide