Plan year 2019 benefit guide pebp state nv us

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Plan Year 2019 Benefit Guide

Learn About:

? New Hire Information ? Active State and Non-State Benefits ? Retiree Benefits ? Open Enrollment ? Compare Plan Options ? Premium Rates ? Member Resources

July 1, 2018 to June 30, 2019

901 S. Stewart St., Suite 1001 Carson City, NV 89701

T: 775-684-7000 | 1-800-326-5496 | F: 775-684-7028 pebp.state.nv.us

mservices@peb.state.nv.us

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Plan Year 2019 Benefit Guide Welcome to the Public Employees' Benefits Program. If you are a new employee, this guide provides a detailed overview of plan benefits for the 2019 plan year. For existing members and retirees, it offers the opportunity to compare benefit options and help you make possible changes to your coverage during Open Enrollment.

Contents

Welcome ......................................................................................................................................................... 6 New Employees ............................................................................................................................................ 7

Initial Enrollment ......................................................................................................................................... 7 Default Enrollment ...................................................................................................................................... 7 Start of Coverage ......................................................................................................................................... 7 Spouse, Domestic Partner and Dependent Eligibility ................................................................................ 8 Supporting Documentation......................................................................................................................... 9 HIPAA Special Enrollment Notice................................................................................................................ 9 Summary of Employee Benefit Options............................................................................................... 10 How to Enroll in a Plan: ............................................................................................................................. 11 Important Information about Your Coverage .......................................................................................... 12

Dual PEBP Coverage Not Permitted ....................................................................................................... 12 Moving Outside the Plan's Coverage Area............................................................................................. 12 Open Enrollment .................................................................................................................................... 12 Pre-Existing Conditions .......................................................................................................................... 12 Family Medical Leave Act ....................................................................................................................... 12 Leave Without Pay (LWOP) .................................................................................................................... 12

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Leave for Military Service/Uniformed Services Employment and Reemployment Rights Act (USERRA) ................................................................................................................................................................ 13 Workers' Compensation Leave .............................................................................................................. 13 PEBP Initial COBRA Notice - COBRA Continuation Rights ...................................................................... 13 Where Can I Find Information on Plan Rules and Benefits? .................................................................... 21 Introduction to Open Enrollment ........................................................................................................... 22 Retiree Late Enrollment ......................................................................................................................... 23 Your Responsibilities ................................................................................................................................. 23 Completing Changes for Open Enrollment ............................................................................................... 24 Consumer Driven Health Plan (CDHP) Overview .............................................................................. 26 Consumer Driven Health Plan Deductibles and Out-of-Pocket Maximums ............................................ 26 CDHP Summary of Benefits and Coverage (SBC)...................................................................................... 27 How the Consumer Driven Health Plan (CDHP) Works ............................................................................ 27 How the Plan Works Before and After You Meet Your Deductible ....................................................... 27 Health Reimbursement Arrangement (HRA) ......................................................................................... 27 HSA Eligibility.......................................................................................................................................... 27 Doctor on Demand ................................................................................................................................. 28 Disease Management............................................................................................................................. 28 Overview of Plan Design Changes for the CDHP ............................................................................... 28 Calendar Year 2018 Maximum HSA Contributions................................................................................... 28 Plan Year 2019 CDHP HSA/HRA Contributions......................................................................................... 28 Healthcare Bluebook ................................................................................................................................. 29 Smart 90 Pharmacy Network .................................................................................................................... 30 3D Mammograms ...................................................................................................................................... 30 Consumer Driven Health Plan Preventive Medication List ...................................................................... 30 Health Plan of Nevada HMO Plan Overview (Southern Nevada) .................................................. 31 Features of the Plan: ................................................................................................................................. 31 Overview of Plan Changes for the HMO .............................................................................................. 32 Hometown Health (HTH) ........................................................................................................................... 32 Health Plan of Nevada (HPN) .................................................................................................................... 32 Premier Exclusive Provider Organization (EPO) Plan Overview (Northern Nevada).................. 33 Highlights of the Plan ................................................................................................................................ 33 Eligible Medical Expenses.......................................................................................................................... 34 Non-Eligible Medical Expenses .......................................................................................................... 34 Overview of Plan Changes for the Premier (EPO) Plan...................................................................... 35

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Overview of Plan Changes for the Medicare Exchange...................................................................... 35 Plan Year 2019 Health Plan Comparison ............................................................................................... 36 Plan Year 2019 Prescription Plan Comparison...................................................................................... 38 Plan Year 2019 Vision Plan Comparison................................................................................................ 39 Plan Year 2019 Dental Plan Comparison ............................................................................................... 40 Retiree Benefits........................................................................................................................................... 41

Retiree Coverage Eligibility ....................................................................................................................... 41 Retiree Coverage for Employees Initially Hired On or After January 1, 2010 ......................................... 41 Retiree Coverage for Employees Initially Hired On or After January 1, 2012 ......................................... 41 Retiree Coverage for Employees Initially Hired Before January 1, 2012 ................................................. 41 Eligibility for Coverage for Survivors of Retirees...................................................................................... 41 Non-State Retiree Eligibility (NAC 287.542, 287.548) .............................................................................. 42 Disability Retirement................................................................................................................................. 42 Retiree Late Enrollment ............................................................................................................................ 42 Medicare Parts A and B ............................................................................................................................. 42

Medicare Enrollment.............................................................................................................................. 42 Enrollment Timeframe ........................................................................................................................... 43 Allowable Coverage Changes for New Retirees ..................................................................................... 44 When Retiree (CDHP, Premier EPO or HMO) Coverage Starts .............................................................. 44 Retirees with TRICARE for Life and Medicare Parts A and B.................................................................. 44 Declining (terminating) Retiree Coverage.............................................................................................. 44 Plan Options for Retirees .......................................................................................................................... 44 Coverage Options for Medicare Retirees ................................................................................................. 45 Exchange Health Reimbursement Arrangement...................................................................................... 47 Eligible Medical Expenses for Exchange-HRA Retirees .......................................................................... 48 Summary of Benefits for Pre-Medicare Retirees.......................................................................................... 48 Summary of Benefits for Retirees with Medicare Parts A and B ................................................................. 50 Premium Cost, Premium Subsidy Adjustment, and Exchange HRA Contribution................................... 51 Retiree Years of Service Subsidy ............................................................................................................ 52 Years of Service Certification Form Codes (YOSC) ................................................................................. 52 Other Benefits................................................................................................................................................ 54 Flexible Spending Account ........................................................................................................................ 54 Health Care FSA ......................................................................................................................................... 54 Limited Purpose FSA.................................................................................................................................. 54 Dependent Care FSA.................................................................................................................................. 54

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Basic Life Insurance and Long-Term Disability ......................................................................................... 55 Group Life and Long-Term Care Portability and Conversion Options...................................................... 56 Voluntary Life and Short-Term Disability Insurance ................................................................................ 57 Active Employee Voluntary Life Insurance ............................................................................................... 57 Active Employee Voluntary Short-Term Disability Insurance.................................................................. 58 Retiree Voluntary Life Insurance .............................................................................................................. 58 Plan Year 2019 Monthly Premium Rates................................................................................................ 59 State Employee Rates................................................................................................................................ 59 State Active Legislators, Employees on Leave Without Pay, and Employees on Military Leave............ 59 State Employee with Domestic Partner Rates.......................................................................................... 60 State Active Legislators, Employees on Leave Without Pay, and Employees on Military Leave............ 60 State Retiree and Survivor Rates .............................................................................................................. 61 State Retiree with Domestic Partner Rates .............................................................................................. 62 Non-State Employee Rates........................................................................................................................ 63 Non-State Retiree and Survivor Rates ...................................................................................................... 64 COBRA Rates .............................................................................................................................................. 65 State and Non-State Retiree Years of Service Subsidy............................................................................. 66 Exchange-HRA Years of Service Contribution........................................................................................... 67 Optional Dental Coverage for Medicare Exchange Retirees.................................................................... 68 Vendor Contact List ................................................................................................................................... 69 Discrimination is Against the Law.............................................................................................................. 71 Discrimination is Against the Law (con't) ................................................................................................. 72 Legal Notices ............................................................................................................................................... 73

The information in this guide is for informational purposes only. Any discrepancies between the benefits described herein and the PEBP Master Plan Document(s) for Plan Year 2019, the HMO Plan Evidence of Coverage Certificate shall be superseded by the plan's official documents.

Legal Notices

Please refer to PEBP's Health and Welfare Wrap Plan, which includes the HIPAA Privacy Notice, for all legal notices pertaining to this document. You can also view PEBP's Privacy Notice here. This document and other materials are available at pebp.state.nv.us. You may also request a copy of the HIPAA Privacy Notice or any other document by calling PEBP Member Services at 775684-7000 or 1-800-326-5496 or email at mservices@peb.state.nv.us.

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Welcome

Welcome to the State of Nevada Public Employees' Benefits Program (PEBP). PEBP provides a comprehensive benefit package to eligible employees offering medical, prescription drug, dental, vision, $25,000 basic life, and long-term disability insurance. In addition to these core benefits, employees enrolled in a PEBP medical plan are eligible to purchase voluntary products such as supplemental life insurance, short-term disability, long-term care and auto/homeowners' insurance. State employees may also enroll in Medical, Limited Purpose and Dependent Care Flexible Spending accounts. If you are newly retiring from the State of Nevada or a participating local government entity, you may have the option to enroll in retiree coverage offered by PEBP. After reading this guide, you will have an understanding of your retiree plan options, dependent eligibility, enrollment timeframe, years of service subsidy, premium cost, and the steps to enroll. The information contained herein is intended to provide a summary of the main features of the benefits available to eligible employees. The benefits and premiums described herein are subject to change beginning July 1 of each plan year. For a detailed description of benefits, visit the PEBP website at pebp.state.nv.us. Every effort has been made to ensure the accuracy of the information contained in this document. In the event of any discrepancies between the information in this document and the Master Plan Document(s) or Evidence of Coverage applicable to each plan, the plan documents will govern. Should you have any questions regarding your benefits and/or eligibility contact the PEBP office at 775-684-7000 or 1-800-326-5496. For more information and details on eligibility or plan benefits, please refer to the applicable Master Plan Document, Summary of Benefits and Coverage document or Evidence of Coverage. These documents are available at pebp.state.nv.us and by request by calling PEBP.

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