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. You should review the documents applicable to your plan to help you understand and make the best use of the protection provided to you and your family through the Public Employees' Benefits Program.

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)
• Health and Welfare Benefits Plan Document
• Additional HSA/HRA Contribution FAQ
• Summary of Benefits and Coverage - Individual
• Summary of Benefits and Coverage - Family 

Hometown Health (HMO)

• Evidence of Coverage Certificate (EOC) Document
• Alternate HMO - Summary of Benefits and Coverage
• Standard HMO - Summary of Benefits and Coverage
• Prescription Drug Rider
• Prescription Drug Formulary
• Vision Summary of Benefits

Health Plan of Nevada (HMO)

• Evidence of Coverage Certificate (EOC) Document
• Alternate HMO - Summary of Benefits and Coverage
• Standard HMO - Summary of Benefits and Coverage
• Vision Plan Summary
• Preferred Drug List
• Timely access to care requirements
• Member Guide

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 
• Retiree Late 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. You should review the documents applicable to your benefits to help you understand and make the best use of the protection that's provided to you and your family through PEBP.

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 Medicare One Exchange Guide

HRA Contributions

The monthly tax-exempt contribution for Plan Year 2018 is $12 per month per year of service, beginning with five years ($60) to a maximum of twenty years of service ($240). Individuals who retired before January 1, 1994, will receive a flat $180 per month to the Exchange-HRA. Dependents do not receive their own Exchange-HRA and no additional funds are contributed for dependents.