Plan year 2018 open enrollment pebp

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Plan Year 2018 Open Enrollment

Open Enrollment

Compare Plan Options Learn About Your Benefits Review New Premium Rates Read Important Notices

Making changes? Don't wait -- Open Enrollment ends May 31, 2017

901 S. Stewart St., Suite 1001 Carson City, NV 89701 (775) 684-7000 . (800) 326-5496 . Fax: (775) 684-7028 pebp.state.nv.us mservices@peb.state.nv.us NVPEBP

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Effective July 1, 2017- June 30, 2018

Plan Year 2018 Open Enrollment

Welcome to the Public Employees' Benefits Program Open Enrollment for Plan Year 2018. Open Enrollment gives you the opportunity to review your benefit options and make changes to your coverage based on your current needs.

Introduction to Open Enrollment... ....................................................... .............1 Online Changes and Your Responsibilities........................................................... 2 Completing Changes for Open Enrollment ........................................................... 3 Consumer Driven Health Plan (CDHP) Overview ............................................... 4 Overview of CDHP Plan Design Changes ............................................................ 6 University of Nevada, Reno School of Medicine.................................................. 7 CDHP Preventive Medication List ........................................................................ 8 Overview of HMO Plan Changes........................................................................ 10 Hometown Health Plan Overview............................... ..............................11 Health Plan of Nevada Overview ....................................................................... 12 Health Plan Comparison...................................................................................... 13 Prescription Plan Comparison ............................................................................ 15 Vision Plan Comparison...................................................................................... 16 Dental Plan ......................................................................................................... 17 Health Plan Options for Retirees with Medicare Parts A and B ......................... 18 Flexible Spending Account ................................................................................. 19 Basic Life Insurance ........................................................................................... 20 Voluntary Life and Short-Term Disability Insurance ......................................... 21 State Employee Rates .......................................................................................... 22 State Active Legislators, Leave without Pay, Military Employee Rates ............ 24 State Retiree and Survivor Rates......................................................................... 25 State Retiree Years of Service Subsidy ............................................................... 27 Non-State Employee and Retiree Rates .............................................................. 28 Non-State Retiree Years of Service Subsidy....................................................... 30 Exchange-HRA Years of Service Contribution .................................................. 31 Optional Dental Coverage for Medicare Exchange Retirees .............................. 32 COBRA Rates ..................................................................................................... 33 Important Notices ................................................................................................ 34 Vendor Contact List ........................................................................................... 38 Plan Year 2018 Open Enrollment Schedule........................................................ 40

The information in this guide is for informational purposes only. Any discrepancies between the benefits described herein and the PEBP Master Plan Document for Plan Year 2018 or the HMO Plan Evidence of Coverage Certificate(s) shall be superseded by the plan's official documents.

04-04-2017

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Introduction to Open Enrollment

Open Enrollment is May 1 - May 31, 2017. Open Enrollment gives you the opportunity to reevaluate your benefits and make changes for the plan year beginning July 1, 2017. This Open Enrollment is a passive enrollment, meaning you are not required to complete an election unless you wish to make changes or enroll in a voluntary product as shown below:

You MUST take action if you want to do any of the following:

Change your current plan election (e.g., CDHP to/from HMO plan) Change to/from the HSA to/from HRA Enroll in or update voluntary HSA contributions (CDHP participants only) Add or delete your dependent(s) Decline coverage Enroll in a voluntary product (e.g., Voluntary Life Insurance, Short-Term Disability

Insurance) Enroll/re-enroll in Flexible Spending (new elections are required each plan year) Enroll in PEBP dental coverage (this option is only available to individuals enrolled in

medical coverage through OneExchange) Decline PEBP dental coverage (this option is only available to individuals enrolled in

medical coverage through OneExchange)

You DO NOT need to take action if you:

Want to remain on the CDHP with a Health Savings Account (HSA) Want to remain on the CDHP with a Health Reimbursement Arrangement (HRA) Want to remain on your current Hometown Health Plan Want to remain on your current Health Plan of Nevada Health Plan Want to remain in declined coverage status Do not want to add or delete dependents

Open Enrollment Deadline

Open Enrollment changes may be completed online through the PEBP website or by submitting the Open Enrollment form to the PEBP office. Open Enrollment submissions must be received in the PEBP office or postmarked by May 31, 2017.

If you are adding dependents, please submit copies of the required supporting certified documents to the PEBP office by June 15, 2017. Supporting documents may be faxed to (775) 684-7028, emailed to mservices@peb.state.nv.us or mailed to the PEBP office at the address located on the front of this guide.

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Online Changes

Your Responsibilities

Changes that may be completed online: Change health plan option Add or delete a dependent Designate a beneficiary for your Health

Savings Account (HSA) Modify voluntary HSA contributions Update address/contact information

Changes that may not be completed online: Enroll in Flexible Spending (medical, dental

and/or dependent care) Enroll in a voluntary product Cancel a voluntary product Initial enrollment in retiree coverage

To ensure you receive and maintain benefits for which you are eligible, please familiarize yourself with these important guidelines:

If you do not make any changes during Open Enrollment, your current coverage will continue after July 1, 2017 and you will be responsible for paying the Plan Year 2018 premium rates for coverage.

If adding dependent(s) during Open Enrollment, you must submit a copy of the required supporting documents (certified marriage certificate, certified birth certificate, etc.) to the PEBP office by June 15, 2017.

If you experience a change of address, you must submit your new address to PEBP within 30 days of the change.

Initial enrollment in COBRA Name change

If you experience a mid-year qualifying family status change that affects your benefits, you must notify PEBP within 60 days.

Spouse or Domestic Partner Coverage

Spouses and domestic partners, as determined by the laws of the State of Nevada, are eligible for coverage under the PEBP Plan. Spouses and domestic partners that are eligible for health coverage through their current employer are typically not eligible for coverage under the PEBP Plan. If your spouse's or domestic partner's employer-sponsored health coverage satisfies PEBP's definition of "significantly inferior coverage" you may be able to enroll or continue coverage for your spouse or domestic partner. For more information, contact Member Services at (775) 684-7000 or (800) 326-5496 or email mservices@peb.state.nv.us.

Declining PEBP coverage (CDHP, HMO or medical coverage through OneExchange) will result in termination of Basic Life, Long-Term Disability, Voluntary Life and Short-Term Disability Insurance, and HSA/HRA funding (if applicable). Additionally, if you are a retiree you may permanently lose the option to re-enroll in PEBP.

If your Voluntary Life insurance ends or reduces for any reason other than failure to pay premiums, the Right to Convert provision allows you to convert your Voluntary Life coverage to certain types of individual polices without having to provide evidence of insurability. You must apply for conversion with your carrier and pay the required premium within 31 days after group coverage ends or reduces.

PEBP does not require active employees to obtain Medicare. If you do become eligible for Medicare, you must provide a copy of your Medicare card to PEBP.

If you are an active employee with an HSA and enroll in Medicare, or your spouse has an HRA you are no longer eligible to contribute to an HSA.

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Completing Changes for Open Enrollment

1. PEBP Online Enrollment Tool

Go to pebp.state.nv.us and click the orange "Login" button at the top right of the webpage. Follow the instructions to complete enrollment changes before May 31, 2017.

2. Open Enrollment Form

Open Enrollment forms may be requested by calling (775) 684-7000 or (800) 326-5496 or via email at mservices@peb.state.nv.us.

Completed forms (originals only) must be received in the PEBP office by May 31, 2017 or postmarked no later than May 31, 2017 for changes or updates to apply. Late forms, faxed forms, or scanned copies will not be accepted.

3. Documentation to Add Dependents

If you wish to add dependents to your coverage during Open Enrollment for coverage effective July 1, 2017, you will be required to submit supporting documentation (e.g., copy of certified marriage certificate, certified birth certificate, etc.) to the PEBP office by June 15, 2017. For more information regarding supporting documents and eligibility, please refer to the PEBP Enrollment and Eligibility Document at pebp.state.nv.us.

4. Flexible Spending Accounts (FSA) Enrollment

Active employees who wish to enroll in the Health Care, Limited Purpose or Dependent Care Flexible Spending Account must complete the paper Flexible Spending Account (FSA) form. Completed forms must be submitted to HealthScope Benefits by May 31, 2017 or postmarked by May 31, 2017. To download the FSA form which contains mailing and faxing information, visit pebp.state.nv.us.

5. Voluntary Life and Short-Term Disability Insurance

To enroll or make changes to Voluntary Life or Short-Term Disability Insurance, visit or call The Standard at (888) 288-1270.

Health Savings Account (HSA)

Employees who are currently contributing money to their HSA through automatic payroll deductions will continue with the same deduction amount after July 1, 2017 for Plan Year 2018.

Exception: ANY change made to an employee's coverage during Open Enrollment (via online or paper form) will automatically reset the HSA election to zero. However, employees may enter a new HSA election online when completing the Open Enrollment event or by contacting HealthScope Benefits at (888)763-8232.

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Consumer Driven Health Plan Overview

The Consumer Driven Health Plan (CDHP) is a high deductible health plan combined with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA). HSAs and HRAs allow individuals to pay for qualifying out-of-pocket health care expenses on a tax-free basis. Under the CDHP, both medical and pharmacy costs are subject to the annual deductible. Deductibles accumulate on a plan year basis and reset to zero at the start of each new plan year.

Consumer Driven Health Plan Deductibles and Out-of-Pocket Maximums:

Deductible Type

In-Network Deductible (participating provider benefit)

Out-of-Network Deductible

Annual Medical and Prescription Drug Deductible

$1,500 Individual

$1,500 Individual

$3,000 Family

$3,000 Family

$2,600 Individual Family Member $2,600 Individual Family

Deductible

Member Deductible

Annual Out-of-Pocket Maximum

$3,900 Individual

$10,600 Individual

$7,800 Family

$21,200 Family

$6,850 Individual Family Member

Deductible

The deductibles for Individual and Family coverage accumulate separately for in-network provider expenses and out-of-network provider expenses.

The Individual Deductible applies when only one person is covered under the CDHP.

The Family Deductible applies when an employee/retiree covers at least one other individual on the their plan. For example, when an employee/retiree covers a spouse or a child. An individual family member on a family plan will be subject to a $6,850 out-of-pocket max.

The Family Deductible can be met by any combination of eligible medical and prescription drug expenses from two or more members of the same family coverage unit. For the Family Deductible, under no circumstances will a single individual be required to pay more than $2,600 toward the deductible (this is called the $2,600 Individual Family Member Deductible).

The A nnual Out-of-Pocket Maximum is a combination of covered out-of-pocket expenses, including deductibles and coinsurance. The Family Out-of-Pocket Maximum can be met by one covered family member or by any combination of expenses incurred by all covered family members. In and Out-of-Network Maximums are not combined to reach the A nnual Out-of-Pocket Maximum.

Services received from out-of-network providers are subject to Usual and Customary (U&C) provisions, meaning charges are subject to the maximum allowance under the plan and covered individuals will be responsible for any amount the providers charge in excess of the maximum allowance.

CDHP Summary of Benefits and Coverage (SBC)

The SBC provides a summary of the key features of the CDHP's covered benefits, cost-sharing provisions, coverage limitations and exceptions. The SBC is available on the PEBP website at pebp.state.nv.us.

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