• I want to make an appointment at the Doctor’s office and I have the Consumer Driven Health Plan (CDHP), what is the name of my plan?

    The name of your insurance plan is the Consumer Driven Health Plan (CDHP). This plan is a self-funded PPO plan offered by the state of Nevada Public Employees’ Benefits Program. The third party administrator, HealthSCOPE Benefits, pays the medical and vision claims for the CDHP. In order for your provider to identify your plan, you may want to refer to the plan as State of Nevada HealthSCOPE Benefits. Most providers are familiar with HealthSCOPE primarily because they pay the claims for the Consumer Driven Health Plan.  

    CDHP CDHP HRA CDHP HSA
  • What are the coverage areas for the HMO plan?

    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.

  • I have a Long Term Care (LTC) Insurance policy through UNUM. I am terminating employment. May I continue paying for this policy when I retire?

    To continue your LTC policy, you may elect converted coverage. This means that the same coverage you had under this plan can continue on a direct-billed basis. Election for converted coverage must be made within 60 days of the date your PEBP active coverage terminates. To convert your LTC coverage, complete the Election to Continue Your Long Term Care Insurance Coverage Form located on this website.  

    Voluntary Products
  • Does PEBP offer Long Term Care Insurance?

    Voluntary Long Term Care insurance is available as a voluntary product option. For more information, NSHE employees can contact Nikki Pecorino at 775-813-5309, and employees working for a state agency can contact Karla DeCrescenzo at 775-722-5907.

    Voluntary Products
  • What does Short Term Disability provide?

    Short Term Disability insurance is designed to pay you a benefit in the event you cannot work because of a covered illness, injury, or pregnancy. This benefit replaces a portion of your income to help you meet your financial commitments in time of need. For more information contact The Standard at 888-288-1270.

    Voluntary Products
  • May I purchase Voluntary Life Insurance?

    Employees and eligible retirees enrolled in a PEBP-sponsored medical plan receive a Basic Life Insurance benefit as part of their benefit package. You may also apply for Voluntary Life coverage to supplement the Basic Life amount. Employees may apply for any multiple of $10,000 up to a maximum of $500,000. Retirees may apply for any multiple of $5,000 up to a maximum of $50,000. Evidence of insurability may be required. If you have questions, contact The Standard at 888-288-1270.

  • What are the risks of participating in a health care or dependent care FSA?

    FSA dollars are "use-it-or-lose-it" funds. Account balances greater than $500 cannot be carried over from year to year. If you have any unused funds exceeding $500 at the end of the plan year (end of the grace period), those funds will be forfeited. That's an IRS requirement.

    Voluntary Products
  • Is there a cost to participate in the FSA?

    You pay a small administration fee of $3.25 per month to participate in either one or both (health and/or dependent care) flexible spending accounts.

    Voluntary Products
  • What is a Dependent Care Flexible Spending Account (Dependent Care FSA)?

    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 eligble expenses.. Your expense must be for the purpose of allowing you and, if maried, your spouse to be employed. For more information, contact HealthSCOPE Benefits at 888-763-8232.

    Voluntary Products
  • What is a Limited Purpose Flexible Spending Account (Limited Purpose FSA)?

    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.

    Voluntary Products
  • What is a Medical Flexible Spending Account (Medical FSA)?

    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.

    Voluntary Products
  • Do I have the option to keep my Basic Life and Voluntary Life Insurance coverage if I retire?

    You may be eligible under the "Portability and/or Right to Convert" provisions. Details regarding these options are available in the policy Certificates located on The Standard's website. You must apply in writing to The Standard and pay the first premium within 31 days after your employment terminates.  For more information, contact The Standard at 888-288-1270.

    Voluntary Products
  • How long do I have to submit an eligible receipt for reimbursement from my HRA?

    Requests for reimbursement must be submitted within one year (12 months) from the date the service(s) where incurred.

    CDHP HRA
  • Is an HSA the same as a Medical Flexible Spending Account (FSA) or Health Reimbursement Arrangement (HRA)?

    While an HSA is similar to a Medical FSA and HRA, there are several key differences. For example, an HSA has no "use-or-lose" provision, as funds automatically carry over from year to year. The HSA is also portable if employment changes and funds can be invested. However, since an HSA provides an attractive tax benefit, the IRS sets the annual contribution limits, limits the types of other plans that can be offered alongside an HSA, and requires that the HSA be combined with an HSA-compatible health plan such as the CDHP.

    CDHP HSA
  • 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.

    CDHP HSA
  • How are HSA withdrawals monitored? Is there an expense verification process like an FSA or 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.

    CDHP HSA
  • 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.

    CDHP HSA
  • What happens if I use my HSA funds for ineligible expenses?

    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.

    CDHP HSA
  • What happens to my HSA funds when I retire?

    HSA funds are portable. At retirement, you will retain any funds in your HSA. You may also continue to use HSA money to pay for out-of-pocket health care expenses.

    CDHP HSA
  • What happens to my HSA if I am no longer an eligible individual? For example, if I change coverage from the CDHP to an 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.

    CDHP HSA
  • Do I need to be a United States citizen to open and contribute to an HSA?

    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.

    CDHP HSA
  • What is the Medicare Exchange Health Reimbursement Arrangement (HRA)?

    The Medicare Exchange HRA is a pass-through account for Medicare retirees enrolled in a medical plan through the Medicare Exchange. Contributions to the Medicare Exchange are determined by the years of service and date of retirement of eligible retirees. HRA funds may be used to reimburse retirees for qualified medical expenses, health plan premiums, and Medicare Part B premiums.

    Medicare
  • I am enrolled in the Medicare Exchange with an HRA. How long do I have to request reimbursement from the date-of-service?

    The Exchange-HRA has a timely filing period of 365 days from the date of service.

    Medicare
  • I will not qualify for premium-free Medicare Part A. May I maintain my PEBP CDHP or HMO coverage?

    Yes. If you do not qualify for premium-free Medicare Part A, you will be able to maintain your PEBP CDHP or HMO plan. However, you will be required to submit verification that you do not qualify for premium-free Part A. You will also be required to purchase Part B Medicare at age 65 if you are retired.

    Medicare
  • I am retired with Medicare. I will be transitioning to the Medicare Exchange. May I keep the PEBP Dental plan?

    The PEBP Dental Plan is available to Medicare Exchange retirees as a voluntary option.

    Medicare
  • How do I know if I am eligible for a CDHP HRA?

    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.)

    CDHP HRA
  • What is the Consumer Driven Health Plan Health Reimbursement Arrangement (HRA)?

    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.

    CDHP HRA
  • 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.

    CDHP HSA
  • If my spouse has a Medical Flexible Spending Account, am I eligible to contribute to an HSA?

    No. If your spouse has a Medical Flexible Spending Account you are disqualified from establishing and/or contributing to an HSA.

    CDHP HSA
  • What can I use the HSA debit card for?

    You can spend your HSA dollars on qualifing 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.

    CDHP HSA
  • Can I change my HSA contribution election mid-year?

    HSA elections may be modified any time throughout the year. To modify your election, log in to your HealthSCOPE Benefits account or email pebphsahra@healthscopebenefits.com.

    CDHP HSA
  • Do HSAs have annual contribution limits?

    HSA contribution limits are set by the IRS and may change from year to year. The combined contribution limits from all sources (PEBP, employee, family, etc.) are listed in the table below.

      Calendar Year 2016 Calendar Year 2016 Catch-Up (age 55+) Calendar Year 2015 Calendar Year 2015 Catch-Up (age 55+)
    Single  $3,350 $1,000 $3,350 $1,000
    Family $6,750 $1,000 $6,650 $1,000

    CDHP HSA
  • What is the HSA testing period?

    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 an 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.

    CDHP HSA
  • What is the "Last-Month Rule" as it pertains to an HSA?

    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, 2015 and retained coverage under that plan through December 1, 2015, you are covered per the Last-Month Rule. This means you are considered an eligible employee for the entire year in 2015. This allows you to contribute up to the 2015 contribution limit. However, you must also take into consideration the Testing Period.

    CDHP HSA
  • Am I eligible to make or receive contributions to an HSA?

    Scenario (Assumes all other eligibility requirements are met)  Eligible to make or receive contributions
    You are enrolled in the CDHP plan only. Yes
    You are enrolled in HPN or HHP HMO coverage. No
    You are enrolled in the CDHP plan and have Medicare. No
    You are enrolled in the CDHP and your spouse is also enrolled in an HSA-qualified high deductible health plan through his/her employer. Yes
    You are covered under a spouse's Medical FSA or HRA. Note: Your spouse has an HRA which may be used to pay your out-of-pocket medical expenses disqualifies you from establishing an HSA. No
    You are enrolled in a Medical FSA. No
    You are enrolled under a spouse's health plan that is not an HSA-compatible health plan. No
    If you are enrolled Tricare or Tricare for life. No

    CDHP HSA
  • What is a Health Savings Account (HSA)?

    A Health Savings Account (HSA) is a tax advantaged savings account for qualifying medical expenses. The funds contributed to an account are not subject to federal income tax at the time of deposit.

    CDHP HSA
  • What is an unsubsidized dependent?

    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.

    Medicare
  • I was initially hired on or after January 1, 2012. Will I be eligible for the retiree health insurance premium subsidy at retirement?

    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.

    Eligibility
  • I am covered under the HMO plan in Northern Nevada. However, I am moving to Las Vegas. May I keep my Northern Nevada HMO Plan?

    HMO participants who move outside of their designated HMO plan’s coverage area must select a new medical plan to coincide with their new coverage area.

    Eligibility
  • My spouse is covered under his/her employer's group health plan, may I cover my spouse on my plan as well?

    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.

    Eligibility
  • Are dependents allowed to be covered under two PEBP plans?

    No. A dependent cannot be covered under two PEBP plans at the same time.

    Eligibility
  • If I have a newborn child, will he or she automatically be added to my health plan?

    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.

    Eligibility
  • I am 24 years old and covered as a child under my parent's PEBP plan. If I become eligible for PEBP benefits as a state employee, will I need to enroll in my own coverage?

    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.

    Eligibility
  • I am retired and have Tricare for Life. Am I required to enroll in a medical plan through the Medicare Exchange to receive a Years of Service HRA contribution?

    An otherwise eligible retiree who has Tricare for Life and Medicare Parts A and B will not be required to enroll in a medical plan through the Medicare Exchange. However, before PEBP will authorize the Years of Service HRA funding, PEBP will require a copy of the retiree's military ID card and Medicare Parts A and B card.

    Medicare
  • I am retired with Medicare and will transition to the Medicare Exchange. May I continue PEBP's Dental Plan?

    Yes, PEBP offers the Dental Plan to retirees enrolled in medical coverage through the Medicare Exchange.

    Medicare
  • I am a surviving spouse of a deceased active employee, can I maintain my insurance coverage?

    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.

    Eligibility
  • Are active employees required to enroll in Medicare at age 65?

    No, PEBP does not require active employees aged 65 or older to enroll in Medicare until they retire.

    Medicare
  • Are retirees required to enroll in Medicare at age 65?

    Yes, PEBP requires all retirees who are eligible for premium-free Medicare Part A to enroll in Part A coverage. PEBP also requires retirees to purchase Medicare Part B coverage at age 65 (or under age 65 if Medicare eligible due to a disability), regardless of whether a retiree qualifies for free Part A.

    Medicare
  • My spouse is covered under his/her employer's group health plan. If he/she loses coverage from his/her employer, do I need to wait until open enrollment to add him/her as a dependent on my plan?

    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.

    Eligibility
  • What is the benefit waiting period for a new-hire employee?

    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 eligibilty would begin that day. If you were hired on June 2, your benefit eligibilty would begin July 1.

    Eligibility
  • Is vision care covered under the CDHP?

    Yes, the CDHP allows for one vision screening exam per plan year.

    CDHP
  • 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.

    CDHP
  • Are routine laboratory tests covered under the CDHP?

    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.

    CDHP
  • What is the Consumer Driven Health Plan (CDHP)?

    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.

    CDHP