BENEFIT GUIDE
JULY 1, 2024 – JUNE 30, 2025
PLAN YEAR 2025
775-684-7000
702-486-3100
or 1-800-326-5496
https://pebp.nv.gov
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WELCOME TO THE PUBLIC EMPLOYEES’ BENEFITS PROGRAM
Every effort has been made to ensure the accuracy of the information contained in this interactive 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.
Please note that the information herein contains general plan benefits and may not include additional
provisions or exclusions. For more information and details on eligibility or plan benefits, refer to the applicable
Master Plan Document, Summary of Benefits and Coverage document or Evidence of Coverage. These
documents are available on PEBP’s website at https://pebp.nv.gov or by calling PEBP and requesting a copy be
mailed to you.
Should you have any questions regarding your benefits and/or eligibility you may send a secure message
through your E-PEBP Portal or contact the PEBP office at 775-684-7000, 702-486-3100 or 1-800-326-5496.
We encourage you to review key terms and definitions before you begin.
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TABLE OF CONTENTS
Benefits ………………………………..………………...………………………………………………...…………………………………..……5
Medical Benefits Overview ………………………..…………………………………………………………………………………..…….9
Dental Benefits Overview ………………………………………………………………………………………………………….…..…….14
Vision Benefits Overview ……………………………………………………………………………………………….……………..….….15
Prescription Benefits Overview …………………………………………………………………………………………………..…..…..16
Rates ………………………………………………………………………………………………………………………………….………….…….18
Active Employee Monthly Rates …………………………………………………………………………………….…………….……..19
Pre-Medicare Retiree Monthly Rates ……………………………………………………………………………………….….………20
Medicare Retiree Monthly Rates ……………………………………………………………………………………………..….…......22
Monthly Cobra Rates ……………………………………………………………………………………………………………….….………23
Eligibility ……………………………………………………………………………………………………………………………..……...….…..24
New Hire and Active Employee Eligibility ……………………………………………………………………………….…..….……25
Retiree Eligibility ………………………………………………………………………………………………………………………….….…..26
PEBP and Medicare Eligibility ……………………………………………………………………………………………………………...27
Dependent Eligibility …………………………………………………………………………………………………………………………..28
Enrollment …………………………………………………………………………………………………………………………………….……29
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New Hire Enrollment ………………………………………………………………………...……………………………….….……....….30
Retiree Enrollment ………………………………………………………………………...………………………………….….……….…..31
Open Enrollment ………………………………………………………………………...………………………………….……….…….…..33
Qualifying Life Events ………………………………………………………………………...…………………………….………….....…34
Supporting Documents ………………………………………………………………………...………………………….…………..……36
Spending Accounts ………………………………………………………………………...………………………………….……….….….37
Flexible Spending Accounts (FSA) ………………………………………………………………………...…………….……….…....38
Health Savings Accounts (HSA) ………………………………………………………………………...…….………….……….….….39
Health Reimbursement Arrangements (HRA) ……………………………………………………………………….....….….…40
HSA/HRA Employer Contributions ………….…………………………………………………………………………………….……41
Additional Benefits
(Disease Care Management, Carrum Health, Hinge Health, 2
nd
.MD, Telemedicine, Real Appeal, Voluntary
Benefits)………………….……………………………………………………………………...………………………………………….……...44
Contacts …………………………………………………..……...………………………………………………………………………….....…55
Important Information …………………………………………………….…………………...……………………………..….…..…...60
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BENEFITS
PEBP provides a comprehensive benefit package to eligible full-time employees that bundles together your medical,
prescription, dental, vision, and basic life insurance.
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. Please review this guide to get a general understanding of your retiree
plan options, dependent eligibility, enrollment timeframe, years of service subsidy, premium cost, and the steps to
enroll.
To review in-network medical, dental, vision or prescription plan comparison charts use the link icons below.
Remember, you will receive a discounted rate when using in-network providers (which means lower out-of-pocket
costs for you).
All plan comparison charts in this guide contain a general overview of in-network plan benefits and do not include
out-of-network benefit information or additional provisions and exclusions. To view more in-depth plan benefits
including out-of-network coverage, please refer to the Plan Comparison chart or the applicable master plan
document.
Medical
Dental
Vision
Prescription
Vision
Medical
Prescription
Dental
BENEFITS
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BENEFITS
Medical
Dental
Vision
Prescription
BENEFITS
Available to All Consumer Driven Health Plan (PPO), Low Deductible Plan (PPO),
Exclusive Provider Organization Plan (EPO) & Health Plan of Nevada (HMO) Participants
TRAVEL ASSISTANCE
Available to you and your eligible dependents when traveling 100 miles or more away from home or outside the country.
Here are just a few of the services UnitedHealthcare Global travel provides:
Travel assistance services
• Emergency travel arrangements
• Assistance in replacing lost or stolen travel documents
• Emergency translation services
Medical assistance services
• Worldwide medical and dental referrals
• Relay of insurance and medical information
• Assistance in replacing corrective lenses
Call Customer Service at 1-410-453-6330 or toll free at 1-800-527-0218
Email assist[email protected]
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BENEFITS
Medical
Dental
Vision
Prescription
BENEFITS
Available to All Consumer Driven Health Plan (PPO), Low Deductible Plan (PPO),
Exclusive Provider Organization Plan (EPO) & Health Plan of Nevada (HMO) Participants
Available to you and your eligible dependents:
• Mental health treatment, autism services and alcohol and substance use support
• Legal and financial consultations
• Help dial down stress, anxiety and depression – download the Sanvello® app. For community support and guided
journeys (upgrade to Sanvello Premium at no cost using your insurance > UnitedHealthcare > then input your
information as it appears on your PEBP insurance card)
THE MEMBER ASSISTANCE PROGRAM
Access your MAP benefit
by calling
1-877-660-3806, TTY 711.
Sanvello | On-demand
help for stress, anxiety,
and depression
Visit www.liveandworkwell.com
Register or enter anonymously
using access code FP3EAP.
This benefit does not replace the Employee Assistance Program (EAP) offered through State of Nevada Human Resources.
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BENEFITS
Medical
Dental
Vision
Prescription
As a retiree if for any reason you
leave your medical plan through Via
Benefits or PEBP, you will lose your
retiree basic life insurance.
It is important that your
Basic Life Insurance beneficiary
information is accurate and up to
date in your E-PEBP portal.
BENEFITS
Available to Consumer Driven Health Plan (PPO), Low Deductible Plan (PPO), Exclusive
Provider Organization Plan (EPO), Health Plan of Nevada (HMO) Participants &
Medicare Eligible Retirees Enrolled in Via Benefits or TRICARE for Life
BASIC LIFE INSURANCE
Basic Life Insurance
Class 1 (Employee)
Class 2 (Retiree)
State Active/Retiree
$25,000
$12,500
Non
-State Active/Retiree
$15,000
$7,500
• Class 1: Full-time employees of the State of Nevada (or any non-State agency approved by the PEBP board),
professional full-time employees of the Nevada System of Higher Education (under annual contract), and members of
the Nevada Senate or Assembly are all eligible for this benefit. Your employer pays the full cost of basic life insurance.
• Class 2: Retirees of the State of Nevada receiving PERS, or judge retirement benefits and legislators, certain
professional employees, and retirees eligible to join PEBP upon retirement. Reinstated retirees are not eligible for
basic life insurance benefits or voluntary life insurance coverage. Certain retirees pay a contribution toward the cost of
basic life insurance.
• State Active/Retiree: Those whose last employer is a State agency, NSHE, PERS, the Legislature, Legislative Counsel
Bureau or a State Board or Commission.
• Non-State Actives/Retirees: Those whose last employer is a non-State public entity (a local government that is
contracted with PEBP to provide coverage to their active employees pursuant to NRS 287.025).
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MEDICAL BENEFITS
Medical
Dental
Vision
Prescription
BENEFITS
• Available Nationwide
• Always paired with a:
o Health Savings Account (HSA); or a
o Health Reimbursement Arrangement (HRA)
Consumer Driven Health Plan Preferred Provider Organization (CDHP-PPO)
• Available Nationwide
Low Deductible Plan (LD-PPO)
• Available in Washoe, Carson, Douglas, Storey, Lyon, Churchill, Pershing,
Humboldt, Mineral, Lander, Eureka, White Pine, Lincoln and Elko
counties
Premier Plan Exclusive Provider Organization (Northern Nevada EPO)
• Available in Clark, Esmeralda, and Nye counties
Health Plan of Nevada Health Maintenance Organization (Southern Nevada HMO)
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MEDICAL BENEFITS
Medical
Dental
Vision
Prescription
BENEFITS
Consumer Driven Health Plan
Preferred Provider Organization (PPO) Nationwide
• A PPO has a contracted group or network of health care providers
(e.g., hospitals, physicians, laboratories) that provide health care
services and supplies at agreed upon discounted or reduced
rates.
• High-deductible plan which provides a Health Savings Account
(HSA) for eligible employees or a Health Reimbursement
Arrangement (HRA) for active employees as well as retirees who
are ineligible for the HSA.
Exclusive Provider Organization Plan
(EPO) Northern Nevada
• With an EPO you must use in-network health care providers that
participate in the plan.
• You do not need to select a primary care physician (PCP), nor do
you need to contact your PCP for referrals to specialists. However,
because you are responsible for choosing specialists and
hospitals, it is important to confirm with the provider that they
are in-network.
• Fixed copayments for most services.
• Only urgent/emergent services covered outside of service area.
Health Plan of Nevada
Health Maintenance Organization (HMO) Southern Nevada
• With an HMO you must use in-network health care providers that
participate in the plan.
• Primary care physician is required.
• Fixed copayments for most services.
• Only urgent/emergent services are covered outside of the service
area, except for covered dependents enrolled in an accredited
college, university or vocational school anywhere in the United
States.
Low Deductible Plan
Preferred Provider Organization (PPO) Nationwide
• A PPO has a contracted group or network of health care providers
(e.g., hospitals, physicians, laboratories) that provide health care
services and supplies at agreed upon discounted or reduced
rates.
• Low Deductible plan is a middle tier option that allows members
to access many benefits, such as doctor’s office visits, urgent
care, and prescription drugs for the cost of a copay with other
services subject to a low deductible.
• Low-deducible plans are not eligible for HSA contributions. You
can not contribute to an already established HSA.
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HOW COINSURANCE WORKS
Medical
Dental
Vision
Prescription
BENEFITS
Member pays 20% until
out-of-pocket max is met
Member pays 100%
until the deductible is
met
Plan pays 100%
once OOP max
has been met
Medical and Prescription Deductibles are combined
Those enrolled in the CDHP and State active employees enrolled in the LD, EPO and HMO plans have
HSA/HRA funds this plan year to help pay for qualifying out-of-pocket expenses like deductibles, coinsurance
and copays.
Coinsurance
The
portion of eligible medical expenses for which the covered person has financial responsibility. In
most
instances,
once your costs reach the deductible limit, the insurance company pays for covered
expenses
at
its level of coinsurance, and you pay at your level of coinsurance. The coinsurance varies depending
on
whether
in-network or out-of-network providers are used.
Deductible
The
amount of eligible medical, prescription drug and dental expenses you are responsible for
paying
before
the plan begins to pay benefits. The deductibles are discussed in the Medical Benefits
Overview
section
of this document. The dental deductibles are discussed in the Dental Benefits Overview.
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MEDICAL EXPENSE OVERVIEW (IN-NETWORK)
Medical
Dental
Vision
Prescription
BENEFITS
MEDICAL PLAN
DESIGN FEATURES
CONSUMER DRIVEN
HEALTH PLAN
(PPO)
LOW DEDUCTIBLE PLAN
(PPO)
EXCLUSIVE PROVIDER
ORGANIZATION PLAN
(EPO)
HEALTH PLAN OF NEVADA
(HMO)
Service Areas
In
-Network
Global Global
Northern Nevada Southern Nevada
Annual Deductible
(medical and
prescription
combined)
$1,600 Individual
$3,200 Family
$0
$100 Individual
$200 Family / $100
Individual Family Member
N/A with exception of Tier 4
prescription drug coverage
(see prescription overview)
Out
-of-Pocket
Maximum
$4,000 Individual
$8,000 Family / $6,850
Individual Family Member
$4,000 Individual
$8,000 Family / $4,000
Individual Family Member
$5,000 Individual
$10,000 Family / $5,000
Individual Family Member
$5,000 Individual
$10,000 Family / 5,000
Individual Family Member
HSA/HRA
PEBP Contribution
*for State Active
Employees
(Prorated after 7/1)
Base $600
Up to an additional $500*
Up to $500*
Up to $500* Up to $500*
Medical Coinsurance
20% after Deductible 20% after Deductible 20% after Deductible N/A
Primary Care
Office Visit
20% after Deductible $30 Copay $20 Copay $25 Copay
Specialist Visit
(No
Referral Required)
20% after Deductible $50 Copay $40 Copay
$25 Copay with a referral
$40 Copay
without
a referral
Urgent Care Visit
20% after Deductible $80 Copay $50 Copay $50 Copay
ER Visit
20% after Deductible $750 Copay $600 Copay $600 Copay
The information in the table shown contains a general overview of plan benefits and does not include additional provisions or exclusions.
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MEDICAL BENEFITS OVERVIEW (OUT-OF-NETWORK)
Medical
Dental
Vision
Prescription
BENEFITS
MEDICAL PLAN
DESIGN FEATURES
CONSUMER DRIVEN
HEALTH PLAN
(PPO)
LOW DEDUCTIBLE PLAN
(PPO)
EXCLUSIVE PROVIDER
ORGANIZATION PLAN
(EPO)
HEALTH PLAN OF NEVADA
(HMO)
Service Areas
Out
-of-Network
Global Global
Urgent and Emergent Urgent and Emergent
Annual Deductible
(medical and
prescription combined)
$1,600 Individual
$3,200 Family
$500 Individual
$1,000 Family
N/A
N/A
Out
-of-Pocket
Maximum
$10,600 Individual
$21,200 Family
$10,600 Individual
$21,200 Family
N/A N/A
Medical Coinsurance
50% after Deductible
50% of the Allowable
Maximum Charge*
N/A N/A
Primary Care
Office Visit
50% after Deductible 50% after Deductible* Not Covered Not Covered
Specialist Visit
(No
Referral Required)
50% after Deductible 50% after Deductible* Not Covered Not Covered
Urgent Care Visit
50% after Deductible
$80 Copay subject to
Maximum Allowable Charge*
$50 Copay
Subject to Maximum
Allowable Charge*
ER Visit
20% after Deductible
$750 Copay subject to
Maximum Allowable Charge*
$600 Copay
$600 Copay subject to
Allowable maximum Charge*
*Out-of-Network health care providers have no agreements with the Plan and are generally free to set their own charges for the services or supplies
they provide. The Plan will pay benefits based on the Maximum Allowable Charge on non-discounted medically necessary services or supplies, subject
to the Plan’s copays, deductibles, and coinsurance. Except for services subject to the No Surprises Act, out-of-network health care providers can bill
the participant for any balance that may be due in addition to the amount paid by the Plan (called balance billing).
The information in the table shown contains a general overview of plan benefits and does not include additional provisions or exclusions.
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DENTAL BENEFITS OVERVIEW
All Consumer Driven Health Plan, Low Deductible, Exclusive Provider Organization Plan,
Health Plan of Nevada, and Medicare Eligible Retirees Enrolled in Via Benefits or
TRICARE for Life
BENEFIT CATEGORY
In-Network Out-of-Network
Maximum
$2,000 per person
$2,000 per person
$100 per person or
$300 per family (3 or more)
$100 per person or
$300 per family (3 or more)
-rays (2/plan year)
•
Covered 100%
•
Not subject to deductible
•
Does not apply towards individual plan year max
•
Covered 80%
•
Not subject to deductible
•
Does not apply towards individual plan year max
-mouth X-rays
You pay 20% coinsurance after deductible is met
You pay 50% coinsurance after deductible is met
You pay 50% coinsurance after deductible is met
You pay 50% coinsurance after deductible is met
Not
Covered – See FSA section for orthodontia options
Not
Covered– See FSA section for orthodontia options
*
Allowable fee schedule applies
The plan will reimburse at the U&C rates for participants in the Las Vegas area using an out
-of-network provider within the in-network service area; OR
For services received out
-of-network, outside of Nevada.
Medical
Dental
Vision
Prescription
Find an In-Network Dental
Provider
The information in the table shown contains a general overview of plan benefits and does not include additional provisions or exclusions.
BENEFITS
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VISION BENEFITS OVERVIEW
Medical
Dental
Vision
Prescription
For an additional premium you
may purchase a voluntary
vision buy-up plan during
open enrollment, new hire, or
a qualifying life event by
logging on to your E-PEBP
Portal > PEBP+ Voluntary
Benefits
BENEFITS
VISION PLAN
DESIGN FEATURES
CONSUMER DRIVEN
HEALTH PLAN
(PPO)
LOW DEDUCTIBLE
(PPO)
EXCLUSIVE PROVIDER
ORGANIZATION PLAN
(EPO)
HEALTH PLAN OF NEVADA
(HMO)
Vision Network
PEBP does not maintain a
network specific to vision
c
are
PEBP does not maintain a
network specific to vision care
PEBP does not maintain a
network specific to vision
c
are
EyeMed
Vision Exam
(limited to one exam per Plan
Year, per covered individual)
Plan pays 80% after
deductible
$10 Copay
Maximum Benefit of $100
$10 Copay
Maximum Benefit of $100
$10 Copay
Maximum Benefit of $100
every 12 months
Lenses
Not Covered
$10 Copay
every 24 months
Maximum Benefit of $100
$10 Copay
every 24 months
Maximum Benefit of $100
$10 Copay
every 12 months
(subject to limitations)
Frames
Not Covered
$100 maximum allowance
every 24 months
Contact Lenses
(in lieu of lenses and frames)
Not Covered
$10 Copay
every 24 months
(Maximum Benefit of $100)
$10 Copay
every 24 months
(Maximum Benefit of $100)
$10 Copay every 12 months
Maximum Benefit of $250
(subject to limitations)
To view more in
-depth plan benefits as well as out-of-network coverage, please refer to the Plan Comparison chart or the applicable master plan
document at
https://pebp.nv.gov.
The information in the table shown contains a general overview of plan benefits and does not include additional provisions or exclusions.
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PRESCRIPTION BENEFITS OVERVIEW
Medical
Dental
Vision
Prescription
BENEFITS
RETAIL
PRESCRIPTION
DRUG BENEFITS
CONSUMER DRIVEN
HEALTH PLAN
(PPO)
LOW DEDUCTIBLE PLAN
(PPO)
EXCLUSIVE PROVIDER
ORGANIZATION PLAN
(EPO)
HEALTH PLAN OF NEVADA
(HMO)
Preferred
Generic*
20% after Deductible
$10 Copay 30-day
$20 Copay 90
-
day retail/mail
$10 Copay 30-day
$20 Copay 90-day retail/mail
$10 Copay 30-day
$25 Copay 90-day retail/mail
Preferred Brand*
20% after Deductible
$40 Copay 30-day
$80 Copay 90
-
day retail/mail
$40 Copay 30-day
$80 Copay 90-day retail/mail
$40 Copay 30-day
$100 Copay 90
-
day retail/mail
Non
- Preferred/
Non
-
Formulary Brand
You pay 100% of the cost of
medication
$75 Copay 30-day
$150 Copay 90
-
day retail/mail
$75 Copay 30-day
$150 Copay 90
-
day retail/mail
$75 Copay 30-day
$150 Copay 90
-
day retail/mail
Specialty
You pay
30
% after deductible;
for drugs not on the SaveOnSP
program, there is $100
min/$250 max
You pay
30
% after deductible;
for drugs not on the SaveOnSP
program, there is $100
min/$250 max
You pay
30
% after deductible;
for drugs not on the SaveOnSP
program, there is $100
min/$250 max
You pay 20%
after deductible
(30-day mail only)
ACA Preventive
Medications
$0 $0
$0 $0
CDHP Preventive
Medications
Up to 20% Coinsurance
Not subject to Deductible
N/A N/A N/A
Smart90 Required
(For 90
-Day Medications)
Yes Yes Yes No
Locate a Pharmacy
OR
Price a Medication Tool
www.express-
scripts.com/NVPEBP
www.express-
scripts.com/NVPEBP
www.express-
scripts.com/NVPEBP
www.myhpnstateofnevada
.com/Pharmacy-Benefits
*
CDHP, LD, and EPO plans are required to use Express Advantage Network (EAN) Pharmacies: If you fill your prescription at a non-EAN pharmacy you will pay
$10
more for your prescription. To avoid the $10 upcharge, use an EAN pharmacy for your short-term prescriptions.
The information in the
table shown contains a
general overview of plan
benefits and does not
include additional
provisions or exclusions.
Medical and Prescription
deductible are combined.
If you have met your
OOPM you pay $0.
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PRESCRIPTION BENEFITS OVERVIEW
Medical
Dental
Vision
Prescription
BENEFITS
Available to Consumer Driven Health Plan (PPO), Low Deductible Plan (PPO) & Exclusive
Provider Organization Plan (EPO) Participants
Specialty Drug Program
Specialty drugs are used to treat complex conditions, such as cancer, hemophilia, hepatitis C, immune deficiency, multiple sclerosis, rheumatoid
arthritis, etc. Certain drugs fall into a category called specialty drugs. Specialty drugs and prescriptions are generally limited to a 30-day supply.
Specialty drugs are available only through the Accredo, the Plan’s Specialty Pharmacy. Through Accredo, patients receive an enhanced level of
individual service such as one-on-one clinical support, a resource to help manage possible side effects and (for certain conditions) Accredo nurses
to help administer your medication. Plan participants are encouraged to register with the Accredo Specialty Pharmacy before filling their first
prescription for a specialty drug. Check with Express Scripts to determine if your prescription is considered specialty.
Just like your medical plan covers visits to your
doctor, your Express Scripts prescription plan
covers the medication your doctor prescribes.
Price Your Medication Tool
Open Enrollment - Pharmacy Benefit Plans
(express-scripts.com)
PLEASE NOTE:
You must use a Smart 90
pharmacy to fill your
prescriptions, which include
most major retail pharmacies,
excluding CVS and Walgreens.
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
18
RATES
This section features monthly plan rates based upon your employment status (i.e. active employees, pre-Medicare
retirees, Medicare retirees), medical plan option, and coverage tier (e.g., employee or retiree only, employee or retiree
and spouse/domestic partner, etc.).
State employees on Leave Without Pay (LWOP), active legislators, and employees on military leave do not receive a
subsidy. This means both the employee and employer portions are included in the employee monthly premium.
Survivors and unsubsidized dependents are also not eligible for a subsidy. Please view all rates on the PEBP website for
unsubsidized premium amounts.
Each monthly premium rate pays for coverage for the same month, including retirees. Payments are not made in
advance. The monthly premium includes medical, dental, prescription and vision coverage as well as basic life
insurance for eligible participants.
Central Payroll Employees:
There is a 50/50 split of premiums for central payroll employees between the first and second paycheck of each
month. If enrolled in an FSA or HSA, deductions are taken from the second check of the month.
Active Employee
Pre-Medicare Retiree
Medicare Retiree
COBRA
RATES
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
19
ACTIVE EMPLOYEE MONTHLY RATES
Active Employee
Pre-Medicare Retiree
Medicare Retiree
COBRA
RATES
State Employee Rates
Effective July 1, 2024 –
June 30, 2025
CONSUMER DRIVEN HEALTH PLAN
(PPO)
LOW DEDUCTIBLE PLAN
(PPO)
EXCLUSIVE PROVIDER
ORGANIZATION PLAN (EPO)
HEALTH PLAN OF NEVADA (HMO)
Employee Only
$55.26 $85.26 $181.24
Employee + Spouse/DP
$271.27 $331.28 $523.25
Employee + Child(ren)
$136.26 $177.52 $309.50
Employee + Family
$352.28 $423.54 $651.51
Non-State Employee Rates
Effective July 1, 2024 –
June 30, 2025
CONSUMER DRIVEN HEALTH PLAN
(PPO)
LOW DEDUCTIBLE PLAN
(PPO)
EXCLUSIVE PROVIDER
ORGANIZATION PLAN (EPO)
HEALTH PLAN OF NEVADA (HMO)
Employee Only
$997.33 $1,063.39 $1,075.11
Employee + Spouse/DP
$1,979.98 $2,112.10 $2,135.54
Employee + Child(ren)
$1,365.83 $1,456.66 $1,472.77
Employee + Family
$2,348.47 $2,505.37 $2,533.20
Non-State Employee rates are unsubsidized rates. Employees working for a non-state agency should contact their agency to inquire about premium
subsidies.
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
20
PRE-MEDICARE RETIREE MONTHLY RATES
Active Employee
Pre-Medicare Retiree
Medicare Retiree
COBRA
RATES
• For participants who retired before January 1, 1994, the participant premium for the selected plan and tier is shown above.
• For participants who retired on or after January 1, 1994, add or subtract the appropriate subsidy from the Years of Service
(YOS) table to the participant premium in the selected plan and tier.
• Retirees with less than 15 years of service, who were initially hired by their last employer on or after January 1, 2010, and who
are not disabled, do not receive a years of service or base subsidy and do not qualify for a Medicare Exchange HRA.
• Retirees who were initially hired on or after January 1, 2012, do not receive a years of service subsidy, the base subsidy, or an
Exchange HRA, and will be charged the full unsubsidized rate.
• For retirees on the CDHP, LD, EPO, or HMO plan who are enrolled in Medicare Part B, subtract up to an additional $135.50
from the base premium.
State Retiree and Survivor Rates
(Non-Medicare)
Effective July 1, 2024 –
June 30, 2025
CONSUMER DRIVEN
HEALTH PLAN
(PPO)
LOW DEDUCTIBLE PLAN
(PPO)
EXCLUSIVE PROVIDER
ORGANIZATION PLAN
(EPO)
HEALTH PLAN OF
NEVADA (HMO)
Retiree Only
$263.82 $293.82 $389.80
Retiree + Spouse/DP
$635.73 $695.72 $887.69
Retiree + Child(ren)
$403.26 $444.52 $576.52
Retiree + Family
$775.18 $846.44 $1,074.41
Surviving/Unsubsidized
Dependent
$708.40 $747.22 $846.32
Surviving/Unsubsidized
Spouse + Child(ren)
$970.98 $1,024.36 $1,160.62
Retirees Enrolled in the
CDHP/LD PPO/EPO/HMO
Years of
Service
Premium
Differential
5
+$400.50
6
+$360.45
7
+$320.40
8
+$280.35
9
+$240.30
10
+$200.25
11
+$160.20
12
+$120.15
13
+$80.10
14
+$40.05
15 (base)
-
16
-$40.05
17
-$80.10
18
-$120.15
19
-$160.20
20
-$200.25
Your hire date is considered the
date which you began working
for a PEBP participating
employer. Many employers
may participate in PERS, but do
not participate in PEBP.
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
21
PRE-MEDICARE RETIREE MONTHLY RATES
Active Employee
Pre-Medicare Retiree
Medicare Retiree
COBRA
RATES
• For participants who retired before January 1, 1994, the participant premium for the selected plan and tier is shown above.
• For participants who retired on or after January 1, 1994, add or subtract the appropriate subsidy from the Years of Service
(YOS) table to the participant premium in the selected plan and tier.
• Retirees with less than 15 years of service, who were initially hired by their last employer on or after January 1, 2010, and
who are not disabled, do not receive a years of service or base subsidy and do not qualify for a Medicare Exchange HRA.
• Retirees who were initially hired on or after January 1, 2012, do not receive a years of service subsidy, the base subsidy, or an
Exchange HRA, and will be charged the full unsubsidized rate.
• For retirees on the CDHP, LD, EPO, or HMO plan who are enrolled in Medicare Part B, subtract up to an additional $135.50
from the base premium.
Non-State Retiree and Survivor Rates
(Non-Medicare)
Effective July 1, 2024 –
June 30, 2025
CONSUMER DRIVEN
HEALTH PLAN
(PPO)
LOW DEDUCTIBLE PLAN
(PPO)
EXCLUSIVE PROVIDER
ORGANIZATION PLAN
(EPO)
HEALTH PLAN OF
NEVADA (HMO)
Retiree Only
$263.82 $293.82 $389.80
Retiree + Spouse/DP
$635.73 $695.72 $887.69
Retiree + Child(ren)
$403.26 $444.49 $576.52
Retiree + Family
$775.18 $846.44 $1,074.41
Surviving/Unsubsidized
Dependent
$990.86 $1,056.92 $1,068.64
Surviving/Unsubsidized
Spouse + Child(ren)
$1,359.36 $1,450.18 $1,466.30
Retirees Enrolled in the
CDHP/LD PPO/EPO/HMO
Years of
Service
Premium
Differential
5
+$400.50
6
+$360.45
7
+$320.40
8
+$280.35
9
+$240.30
10
+$200.25
11
+$160.20
12
+$120.15
13
+$80.10
14
+$40.05
15 (base)
-
16
-$40.05
17
-$80.10
18
-$120.15
19
-$160.20
20
-$200.25
Your hire date is considered the
date which you began working
for a PEBP participating
employer. Many employers
may participate in PERS, but do
not participate in PEBP.
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
22
RETIREE MEDICARE MONTHLY RATES
Active Employee
Pre-Medicare Retiree
Medicare Retiree
COBRA
Plan Year 2025 PEBP Dental Rates
Medicare Retirees Enrolled with Via Benefits
Effective July 1, 2024 – June 30, 2025
State Retiree Non-State Retiree
Retiree Only
$50.66 $44.99
Retiree + Spouse/DP*
$101.32 $89.98
Surviving/Unsubsidized Spouse/DP*
$50.66 $44.99
*Spouse/DP must be enrolled in Medicare in order to elect PEBP dental.
RETIREE MEDICARE EXCHANGE (VIA BENEFITS) HRA CONTRIBUTION ELIGIBILITY
• Exchange participants who retired BEFORE January 1, 1994, receive the 15-year (base) HRA contribution.
• Exchange participants who retired ON OR AFTER January 1, 1994, receive the HRA contribution that
corresponds to the number of years the retiree worked for a Nevada public entity.
• Retirees with less than 15 years of service, who were hired by their last employer BETWEEN January 1,
2010, and December 31, 2011, and who are not disabled do not receive an Exchange HRA contribution.
• Retirees who were initially hired ON OR AFTER January 1, 2012, do not receive an Exchange HRA.
• Health Reimbursement Arrangement (HRA) funds through the Consumer Driven Health Plan (CDHP) are
not transferable to an HRA through the Medicare Exchange. If a retiree on the CDHP terminates
coverage or transitions to the Medicare Exchange, any remaining funds in the CDHP HRA account revert
to PEBP. To find out your Consumer Driven Health Plan HRA balance please call HSA Bank at 1-833-228-
9364.
• On May 31st, each year there is an $8,000 cap placed on the available Medicare Exchange HRA balance.
RATES
Additional
information regarding
Medicare Enrollment is in the
Plan Year 2025
PEBP & Medicare Guide.
PY 2025 Via Benefits HRA
Contribution
Years of Service Contribution
5 $65
6 $78
7 $91
8 $104
9 $117
10 $130
11 $143
12 $156
13 $169
14 $182
15 $195
16 $208
17 $221
18 $234
19 $247
20 $260
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
23
MONTHLY COBRA RATES
Active Employee
Pre-Medicare Retiree
Medicare Retiree
COBRA
Effective July 1, 2024 –
June 30, 2025
CONSUMER DRIVEN
HEALTH PLAN
(PPO)
LOW DEDUCTIBLE
(PPO)
EXCLUSIVE PROVIDER
ORGANIZATION PLAN (EPO)
HEALTH PLAN OF NEVADA
(HMO)
State Employee
Employee
$729.18
$768.77
$869.86
Employee + Spouse/DP
$1,443.37
$1,522.58
$1,724.75
Employee + Child(ren)
$997.01
$1,051.46
$1,190.44
Employee + Family
$1,711.19
$1,805.26
$2,045.32
State Retiree
Retiree
$722.58
$762.17
$863.26
Retiree + Spouse/DP
$1,436.77
$1,515.96
$1,718.13
Retiree + Child(ren)
$990.39
$1,044.84
$1,183.84
Retiree + Family
$1,704.58
$1,798.65
$2,038.71
Spouse/DP Only
$722.57
$762.16
$863.25
Spouse/DP + Child(ren)
$990.40
$1,044.85
$1,183.83
Non
-State Employee
Employee
$1,017.28
$1,084.66
$1,096.61
Employee + Spouse/DP
$2,019.58
$2,154.34
$2,178.25
Employee + Child(ren)
$1,393.15
$1,485.79
$1,502.23
Employee + Family
$2,395.44
$2,555.48
$2,583.86
Non
-State Retiree
Retiree
$1,010.68
$1,078.06
$1,090.01
Retiree + Spouse/DP
$2,012.98
$2,147.73
$2,171.64
Retiree + Child(ren)
$1,386.54
$1,479.18
$1,495.63
Retiree + Family
$2,388.83
$2,548.88
$2,577.25
Spouse/DP Only
$1,010.68
$1,078.06
$1,090.01
Spouse/DP + Child(ren)
$1,386.55
$1,479.18
$1,495.63
COBRA participants do not
qualify for life insurance and do
not receive a subsidy.
RATES
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
24
ELIGIBILITY
New Hire and Active Employee
Retiree Eligibility
PEBP and Medicare
Dependents
Employees working in a full-time position (80+ hours a month) with a state agency, participating non-state agency,
or the Nevada System of Higher Education (NSHE).
• Retirees with 5 or more years of service credit (or 8 years of service credit for retired Legislators) are eligible for
retiree coverage if the employee’s last employer is participating in PEBP with their active employees.
• Retirees must also be receiving retirement benefit distributions from one or more of the following:
o Public Employees' Retirement System (PERS)
o Legislators' Retirement System (LRS)
o Judges' Retirement System (JRS)
o Retirement Plan Alternative (RPA) for professional employees of the Nevada System of Higher Education
o A long-term disability plan of the public employer
Retiree Coverage
Any of the following individuals as defined by (NAC 287.312) will be considered for coverage: dependent
child(ren)/stepchild(ren), adopted child(ren), child(ren) under permanent legal guardianship, disabled dependent
child(ren), spouse or domestic partner. Adding eligible dependents will require supporting documentation.
Eligible Dependent
Active Employee
ELIGIBILITY
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
25
NEW HIRE AND ACTIVE EMPLOYEE ELIGIBILITY
New Hire Start of Coverage
Employees working in a full-time position with a state agency, participating non-state agency, or the Nevada System of
Higher Education (NSHE) are eligible for benefits on:
• The first day of full-time employment or the date of the contract, if that date is the first day of the month; or
• The first day of the month immediately following the first day of full-time employment or contract date if the
first day of employment/contract date is on or after the second day of the month.
• As a new benefits-eligible employee you must enroll or decline coverage online at https://pebp.nv.gov and
upload any required supporting documents (if adding dependents) to your E-PEBP portal no later than the last
day of the month your coverage is scheduled to become effective. See the Enrollment section for more
details.
Default Enrollment
Failure to enroll or decline coverage within the specified timeframe will result in your coverage being defaulted
to self-only coverage on the Consumer Driven Health Plan (CDHP) with a Health Reimbursement Arrangement (HRA).
Employees enrolled in the CDHP will pay a monthly premium for that coverage, retroactive to the coverage effective
date based on the date of hire. Once you have been defaulted onto the plan, you will be unable to change or remove
coverage until open enrollment or because of a qualifying life event.
Active Employee Leave of Absence
Employees working for a participating local government will need to contact their Human Resources office for Leave of
Absence, such as FMLA, LWOP or Military leave eligibility.
New Hire and Active Employee
Retiree Eligibility
PEBP and Medicare
Dependents
ELIGIBILITY
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
26
RETIREE ELIGIBILITY
Your hire date is considered the date which you began working for a PEBP participating employer. Many employers may
participate in PERS, but do not participate in PEBP.
A state or non-state retiree or surviving spouse, can reinstate insurance one time. Please review the Retiree Enrollment section
of this guide for additional information on retiree late enrollment.
The final Years of Service (YOS) audit is performed by the Public Employees’ Retirement System (PERS), Nevada System of
Higher Education (NSHE), or other participating retirement plan. Once PEBP receives your YOS form, PEBP works directly with
your retirement plan(s) to determine how many qualifying years of service you have. Until the YOS audit is received by PEBP
your subsidy or Exchange HRA (if applicable) may be delayed, and that while the subsidy or Exchange HRA will be backdated,
participants may be paying costs up front for up to several months.
New Hire and Active Employee
Retiree Eligibility
PEBP and Medicare
Dependents
RETIREES INITIAL
HIRE DATE,
RETIREMENT DATE
AND EARNED
YEARS OF
SERVICE ARE
NEEDED TO
DETERMINE
ELIGIBILITY
Retiree Coverage for Employees
Initially Hired Between
January 1, 2010 – December 31, 2011
Must have at least 15 years of service to
qualify for a subsidy or Exchange HRA
Retiree Coverage for Employees
Initially Hired On or After
January 1, 2012
May participate but will not qualify for a
subsidy or an Exchange HRA, and will be
charged the full unsubsidized rate
Retiree Coverage for Employees
Initially Hired Before
January 1, 2010
May participate and may qualify
for a subsidy or Exchange HRA
ELIGIBILITY
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
27
PEBP AND MEDICARE ELIGIBILITY
New Hire and Active Employee
Retiree Eligibility
PEBP and Medicare
Dependents
ELIGIBILITY
Additional
information regarding Medicare
Enrollment is in the
Plan Year 2025
PEBP & Medicare Guide.
Active Employee (65 or older)
• PEBP does not require active employees to obtain Medicare until approximately 90 days prior to their retirement. If Medicare is
obtained, you must provide a copy of your Medicare card to PEBP.
• Employees enrolled in the CDHP with a Heath Savings Account (HSA) and enrolled in Medicare are not permitted, in accordance with IRS
guidelines, to contribute to an HSA.
Retiree or Newly Retiring
• Retirees and their covered dependents and the survivors of such retirees, aged 65 (or under age 65 if approved for Social Security
Disability benefits), must enroll in premium-free Medicare Part A (if eligible) and purchase Medicare Part B.
• Must enroll in a medical plan through Via Benefits if eligible for premium free Medicare Part A.
Retiree attains Medicare Parts A+B and covers a dependent without Medicare
• Retiree may enroll in a medical plan through Via Benefits and the non-Medicare dependent may decline/terminate PEBP coverage or
retain coverage under the CDHP, LD, EPO or HMO plan as an unsubsidized dependent.
• Retiree may stay on the CDHP, LD, EPO, or HMO plan with the non-Medicare dependent(s) until dependent(s) ceases to be an eligible
dependent. The retiree may receive a Medicare Part B premium credit.
Retiree with TRICARE for Life
• Retirees and their covered dependents and the survivors of such retirees, aged 65 (or under age 65 if approved for Social Security
Disability benefits), must enroll in premium-free Medicare Part A (if eligible) and purchase Medicare Part B.
• Member must send PEBP a copy of the Military ID Card (front and back).
Retiree is not yet eligible for Medicare and covers a dependent with Medicare Parts A+B
• Medicare dependent may enroll in a medical plan through Via Benefits. The non-Medicare retiree may stay on the CDHP, LD, EPO, or
HMO plan.
• Both the retiree and dependent may stay on the CDHP, LD, EPO, or HMO plan until both become eligible for Medicare Parts A+B.
Spouse or Domestic Partner
• Medicare requirements also apply to covered spouses and domestic partners.
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
28
DEPENDENT ELIGIBILITY
New Hire and Active Employee
Retiree Eligibility
PEBP and Medicare
Dependents
Legal Spouse or Domestic Partner
• If they are not eligible for group coverage through their
own employer. An exception may apply if the employer-
group health coverage is determined to be significantly
inferior. Significantly inferior plans offer 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.
Child(ren)/Stepchild(ren) - Birth to Age 26
• May be covered from birth through the last day of the
month the child reaches age 26.
Disabled Dependent Child(ren)
• A child of any age with a disability incapable of self-
support, provided such condition occurs before age 26.
• After age 26, proof is required that the dependent has
maintained continuous medical coverage with no break in
service and the completion of the Certification of Disabled
Dependent Child Form by the participant and the child’s
physician.
Child(ren) under Legal Guardianship
• Children under permanent legal guardianship to age 19.
• To continue coverage after 18 to age 26, the child must be:
‒ Unmarried
‒ Reside with participant
‒ Full-time student
‒ Claimed on tax return
• Recertification is required every 2 years.
Dependent
Eligibility
A dependent of two PEBP participants cannot be covered under more than one PEBP medical plan at the same time. A child
that is covered as a dependent under a PEBP participant who becomes eligible for PEBP coverage as a primary participant may
enroll as a primary participant or decline primary participant coverage and remain as a dependent of another PEBP primary
participant’s plan.
Supporting documents are
required to be uploaded into
your E-PEBP Portal to add
eligible dependents.
For more information about
dependent eligibility and
supporting document
requirements view the
Enrollment and Eligibility
Master Plan Document.
ELIGIBILITY
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
29
ENROLLMENT
New Hires
Retirees
Open Enrollment
Qualifying Life Events
Supporting Documents
ENROLLMENT
Compare plans and
complete your
enrollment event
Upload supporting
documents
Elect beneficiaries for
basic and voluntary life
insurance
Send PEBP a secure
message
Enroll in voluntary
products
Visit
https://pebp.nv.gov
Click on
“E-PEBP Portal”
to access your
online account
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
30
NEW HIRE ENROLLMENT
Employees working in a full-time position with a state agency, participating non-state agency, or the Nevada System of
Higher Education (NSHE) are eligible for benefits on the first day of the month concurrent with or following the date of
hire.
If you are eligible for benefits and do not make benefit elections by the last day of the month coverage is scheduled to
begin, you will automatically be enrolled in self-only coverage through the Consumer Driven Health Plan (CDHP) with a
Health Reimbursement Arrangement (HRA), and basic life insurance.
Employees enrolled in the CDHP will pay a monthly premium for that coverage, retroactive to the coverage effective
date based on the date of hire. Once you have been defaulted into the plan, you will be unable to change or remove
coverage until open enrollment or because of a qualifying life event.
As a new benefits-eligible employee you must enroll or decline coverage online in your E-PEBP Portal at
https://pebp.nv.gov and upload any required supporting documents (if adding dependents) no later than the last day
of the month your coverage is scheduled to become effective.
New Hires
Retirees
Open Enrollment
Qualifying Life Events
Supporting Documents
Date of Hire Coverage Effective
Enrollment Must
be Completed By
Supporting
Documents are
Required By (if any)
Default Coverage will be
Processed by PEBP
January 1
st
January 1
st
January 31
st
January 31
st
February 1
st
retroactive to
January 1st
January 14
th
February 1
st
February 28
th
February 28
th
March 1
st
retroactive
to February 1
st
ENROLLMENT
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
31
RETIREE ENROLLMENT
Required forms can be accessed on PEBP’s website under the Retiring Before Age 65, Retiring After Age 65, or the Forms pages
of PEBP’s website. You may also call the Member Services Unit to request the forms be mailed to you.
You will need to complete these forms within 60 days after your retirement date. Retirement coverage starts on the first day of
the month concurrent with or following your date of retirement.
New Hires
Retirees
Open Enrollment
Qualifying Life Events
Supporting Documents
ENROLLMENT
Retiring Before Age 65 Retiring After Age 65
•
Complete your Retiree Benefit Enrollment and Change
Form (RBECF) and Years of Service (YOS) forms and
return to PEBP
•
You may remain on the CDHP, LD, EPO or HPN until you
reach Medicare age
• Contact the Social Security Administration approximately
90 days prior to retirement and enroll in Medicare free
Part A (as eligible) and purchase Medicare Part B
•
Complete your RBECF and YOS forms and return these
along with a copy of your Medicare card to PEBP
•
Enroll in a supplemental medical plan with Via Benefits
• TRICARE For Life participants are not required to enroll in
a plan with Via Benefits, but must submit a copy of their
military identification card (front and back) to PEBP
There are some exceptions to
the rules. For more
information about retiree
eligibility and requirements
view the PEBP and Medicare
Guide.
Submit your forms by mail or
on our website at
https://pebp.nv.gov > Contact
Us > Secure Document Upload
Form.
The final Years of Service (YOS) audit is performed by the Public Employees’ Retirement System (PERS), Nevada System of
Higher Education (NSHE), or other participating retirement plan. Once PEBP receives your YOS form, PEBP works directly with
your retirement plan(s) to determine how many qualifying years of service you have.
Until the YOS audit is received by PEBP, your subsidy or Medicare monthly HRA contribution (if applicable) may be
delayed, and that while the allocation will be backdated, participants may be paying costs up front for up to several
months. Retirees who are eligible for HRA funding will receive an HRA informational kit from Via Benefits upon completion of
enrollment in a supplemental medical plan. HRA funding is concurrent with the medical plan effective date through Via
Benefits.
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
32
RETIREE LATE ENROLLMENT
In accordance with Nevada Revised Statute 287.0475, a retired public officer or employee, or the surviving spouse or
domestic partner of such retiree, can reinstate insurance, except basic life insurance, once during a PEBP open
enrollment period. Eligibility and enrollment are subject to review and approval. Please review the Enrollment and
Eligibility Master Plan Document for additional details.
New Hires
Retirees
Open Enrollment
Qualifying Life Events
Supporting Documents
ENROLLMENT
Retiree Late Enrollment Timeline
Contact PEBP
Between
Complete
Enrollment and
submit Late
Enrollment forms
including Medicare
and TRICARE For Life
cards (if applicable)
Supporting
Documents for
Dependents are Due
Enrollment Effective
April 15
th
and
May 15
th
May 31
st
June 15
th
July 1
st
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
33
OPEN ENROLLMENT
The annual PEBP open enrollment (OE) period provides participants the opportunity to reevaluate benefits. Participants are not
required to complete an open enrollment election if they want to remain on the same plan and coverage tier. To make plan
changes outside of the open enrollment period, you must experience a qualifying life event. *PEBP makes every effort to adhere
to the OE schedule. Due to the complexities of the Plan, the PEBP Board and the Legislature, the OE dates are subject to change.
New Hires
Retirees
Open Enrollment
Qualifying Life Events
Supporting Documents
ENROLLMENT
Coverage Tiers
• Participant Only
• Participant + Spouse
• Participant + Child(ren)
• Participant + Family
Allowable Changes
• Change plan option
• Add or remove dependent(s)
• Switch from the CDHP HRA to the CDHP HSA (if
eligible) or vice versa
• Elect or decline voluntary benefits
• Decline coverage
• Change employee HSA contribution (anytime)
• Beneficiary designation (anytime)
• Enroll in an FSA
Changes become
effective on
July 1
st
Deadline to complete
open enrollment
elections is
May 31
st
Deadline to Submit
Supporting Documents is
June 15
th
*Open enrollment is
usually held between
May 1
st
and May 31
st
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
34
QUALIFYING LIFE EVENTS
Federal regulations generally require that plan coverage remain in effect, without change, throughout the plan year
unless a qualifying life event occurs mid-year.
The plan must be notified by completing an online event through your E-PEBP Portal within 60 days of the qualifying
event date. If the online event, including uploading any required supporting documents, is not completed within the
specific timeframe as outlined in the Eligibility and Enrollment Master Plan Document, the request will not be
accepted, and the change cannot be made until the subsequent open enrollment period.
Some examples of eligible qualifying life events include:
• Marriage, divorce, or annulment
• Beginning or ending of domestic partnership
• Birth, adoption, or permanent guardianship of a child
• Dependent gaining own group coverage
• Dependent losing own group coverage
• Moving out of the EPO or HMO coverage area
For more details view the Enrollment and Eligibility Master Plan Document at https:///pebp.nv.gov or log on to your E-
PEBP Portal and select Enroll or Make Changes.
New Hires
Retirees
Open Enrollment
Qualifying Life Events
Supporting Documents
ENROLLMENT
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
35
QUALIFYING LIFE EVENTS
New Hires
Retirees
Open Enrollment
Qualifying Life Events
Supporting Documents
ENROLLMENT
Life Event How to Update Eligibility Period
Adoption
E
-PEBP Portal (Enroll & Make Changes)
60 days of the event date
Birth
E
-PEBP Portal (Enroll & Make Changes)
60 days of the event date
Divorce
E
-PEBP Portal (Enroll & Make Changes)
60 days of the event date
Establish Domestic Partner
E
-PEBP Portal (Enroll & Make Changes)
30 days before and 60 days after the event date
Marriage
E
-PEBP Portal (Enroll & Make Changes)
30 days before and 60 days after the event date
Medicare Eligibility Change
E
-PEBP Portal (Enroll & Make Changes)
35 days before and 60 days after the event date
Dependent Dies
E
-PEBP Portal (Enroll & Make Changes)
60 days of the event date
Dependent Gains Coverage
E
-PEBP Portal (Enroll & Make Changes)
60 days before and 60 days after the event date
Dependent
Loses Coverage
E
-PEBP Portal (Enroll & Make Changes)
60 days before and 60 days after the event date
Terminate Domestic Partnership
E
-PEBP Portal (Enroll & Make Changes)
60 days of the event date
Anytime Change How to Update Timeframe
Change Beneficiary Designation
E
-PEBP Portal (Enroll & Make Changes)
Anytime
EE HSA Contribution Change (CDHP only)
E
-PEBP Portal (Enroll & Make Changes)
Anytime
Voluntary Benefit Change
E
-PEBP Portal (Enroll & Make Changes)
Anytime
Update Phone Number, Email Address or
Mailing Address
Call PEBP or send a secure message in your E
-PEBP Portal (Contact
Us/Message Center)
Within 30 days of the event date
Name Change
Submit supporting document using PEBP’s Secure Document Upload
Form on PEBP’s
Contact Us page and include the name we have on file
(previous name)
•
Updated Driver’s License or State issued ID
•
Updated Social Security Card
Within 30 days of the event date
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
36
SUPPORTING DOCUMENTS
New Hires
Retirees
Open Enrollment
Qualifying Life Events
Supporting Documents
• Copy of certified marriage certificate
• Social Security Number
Spouse
• Copy of certified domestic partner certificate
• Social Security Number
Domestic Partner
• Copy of certified birth certificate
• Social Security Number
PEBP will need the above information as well as additional documentation as applicable:
o Adopted Child: Adoption Decree signed by judge
o Stepchild: Copy of marriage certificate/domestic partner certificate
o Disabled child over age 26: Certification of Disabled Dependent Child and verification child has had
continuous health insurance since age 26
o Permanent legal guardianship: Copy of legal guardianship papers signed by a judge
Child(ren)
All foreign documents must
be translated into English.
Social Security numbers are
required for all dependents. If
your dependent is not
eligible for a social security
number, they may still be
added to your plan if you
complete and return the SSN
Questionnaire that PEBP
sends to you within the
required timeframe. Without
proper documentation
dependents will not be added
to your plan.
ENROLLMENT
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
37
SPENDING ACCOUNTS
Flexible Spending Accounts
Health Savings Accounts
Health Reimbursement
Arrangements
HSA/HRA Employer
Contributions
FSAs are available to any eligible active employee regardless of the plan they choose, excluding the Nevada System of
Higher Education employees who have a separate plan with their employer. Medical FSAs are not available to CDHP
employees who have an HSA. FSAs give you a tax break on your eligible health care and dependent care expenses by
having tax-free FSA contributions taken from your paycheck. By electing to direct a portion of your salary through an
FSA, you essentially bank your money in a tax-free account. The money is used to pay for expenses that would otherwise
be paid out of your take-home pay.
You can use your Health Care FSA debit card to pay for your eligible medical, dental, and vision expenses. Or you can
submit claims to request reimbursement for your eligible health care and dependent care expenses online via your E-
PEBP Portal. Use the single sign on feature to access your UMR portal.
Flexible Spending Accounts (FSA)
The Consumer Driven Health Plan (CDHP) with a Health Savings Account (HSA) helps you save tax-free money for
current and future health care expenses. You can contribute, up to a certain amount regulated by the IRS each year, and
PEBP will contribute a base amount as well. Your account balance rolls over from year to year and never expires so you
can use the funds into retirement. State Active Employees receive additional funding for Plan Year 2025. Use the single
sign-on feature in your E-PEBP portal to access your HSA Bank account.
Health Savings Account (HSA)
The Consumer Driven Health Plan (CDHP) with a Health Reimbursement Arrangement (HRA) is for those that do not
meet the eligibility requirements to enroll in a Health Savings Account (HSA). The HRA is funded by PEBP the same way
an HSA is; however, participant contributions are not allowed. For retirees transitioning onto a Medicare Exchange plan,
any remaining funds in the HRA account revert to PEBP. State Active Employees enrolled in the LD, EPO and HMO plans
receive funds for Plan Year 2025. Use the single sign on feature in your E-PEBP portal to access your HSA Bank account.
Health Reimbursement Arrangement (HRA)
Find a full list of qualified
health care expenses at
www.irs.gov/publications/p502/
FSA
HSA/HRA
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
38
FLEXIBLE SPENDING ACCOUNTS (FSA)
FSA Comparison
Health Care FSA Limited Purpose FSA Dependent Care FSA
Examples of
Covered Expenses
Qualified medical, dental and vision
expenses such as:
• Chiropractor
• Glasses
• Contact lenses
• Orthodontia
• Copays
Qualified dental and vision expenses
such as:
• Vision exams
• LASIK surgery
• Glasses
• Contact lenses
• Dental cleanings and fillings
• X-rays
• Orthodontia
Qualified dependent care expenses
such as certain:
• Preschool expenses
• Nursery school expenses
• Childcare in your home
• Licensed home childcare
Day care expenses are limited to care
for children under age 13.
Your expense must be for the purpose
of allowing you and, if married, your
spouse to be employed.
IRS Annual Allowed Maximum
Calendar Year Contribution
$3,200
$3,200
$5,000 per household ($2,500 if
married and file separate tax returns)
Can you have an HSA?
No
Yes
Yes
Do funds roll over from year to year
Carry over up to $640. Funds more
than $640 are forfeited. Account must
be depleted by July 1
st
if employee
switches to CDHP HSA.
Carry over up to $640. Funds more
than $640 are forfeited.
No carry over.
All excess funds are forfeited.
Who is Eligible?
Fulltime active employees covered under the PEBP Consumer Driven Health Plan (CDHP), Low Deductible Plan (LD),
Exclusive Provider Organization Plan (EPO) or Health Plan of Nevada (HPN). Special rules apply if you go out on a leave of
absence. There is a $3.15 per month administration fee. Non
-state and NSHE employees are ineligible for the PEBP
sponsored FSA but may be eligible through a similar program offered by their employer.
Enrollment is not automatic.
You must re-enroll each open enrollment period if you want to participate in a Flexible Spending Account.
Flexible Spending Accounts
Health Savings Accounts
Health Reimbursement
Arrangements
HSA/HRA Employer
Contributions
FSA
HSA/HRA
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
39
CDHP HEALTH SAVINGS ACCOUNTS (HSA)
If you select the Consumer Driven Health Plan with an HSA, you can use a Health Savings Account to pay for eligible out-of-
pocket health care expenses now or save for future expenses.
Participants will receive a base contribution of $600, plus State Active Employees receive an additional one-time contribution.
Health Savings Accounts:
• Receive tax-free contributions from PEBP
• Employees may voluntarily contribute to their HSA through pre-tax payroll deductions
• Use your HSA funds to pay out-of-pocket medical expenses during the deductible and/or
coinsurance phase of benefits
• Employee contributions are tax deductible from gross income
• Funds grow-tax deferred
• Funds carry over from one year to the next (no “use-it-or-lose-it” provision)
• To be eligible to establish and contribute to an HSA on a pre-tax basis, employees must meet eligibility requirements:
Flexible Spending Accounts
Health Savings Accounts
Health Reimbursement
Arrangements
HSA/HRA Employer
Contributions
1. You are an active employee covered under the Consumer Driven Health Plan (CDHP)
2. You cannot have other coverage (Medicare, TRICARE, Tribal, HMO, COBRA etc.) unless the coverage is also an IRS
qualified high deductible health plan
3. You or your spouse cannot be enrolled in a Medical Flexible Spending Account (FSA) or Health Reimbursement
Arrangement, but you may be enrolled in a Limited Purpose or Dependent Care FSA
4. You cannot be claimed on someone else's tax return (excludes joint returns)
FSA
HSA/HRA
A Triple Tax Advantage:
1. Pre-tax
contributions
2. Tax-free interest
and investment
earnings
3. Tax-free payments
for qualified
medical expenses
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
40
HEALTH REIMBURSEMENT ARRANGEMENTS (HRA)
If you select the Consumer Driven Health Plan with an HRA, you can use a Health Reimbursement Arrangement to pay
for eligible out-of-pocket health care expenses. HRA’s are funded by PEBP; participant contributions are not allowed.
Participants will receive a base contribution of $600, plus State Active Employees receive an additional one-time contribution.
Health Reimbursement Arrangement (HRA):
• Receive tax-free contributions from PEBP
• HRA funds may be used to pay for out-of-pocket qualified health expenses
• HRA’s are not portable; funds revert to PEBP if an employee’s coverage is terminated for any reason,
including a transition into a Medicare Exchange plan
• You are a retiree
• You have other coverage (Medicare, TRICARE or TRICARE for Life, Tribal, HMO, COBRA, etc.)
• You or your spouse are enrolled in an HRA
• You are claimed on someone else’s tax return (excludes joint returns)
Flexible Spending Accounts
Health Savings Accounts
Health Reimbursement
Arrangements
HSA/HRA Employer
Contributions
You may enroll in the CDHP with an HRA if you are not
eligible for the CDHP HSA due to the following requirements:
FSA
HSA/HRA
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
41
CDHP BASE HSA/HRA CONTRIBUTION
Flexible Spending Accounts
Health Savings Accounts
Health Reimbursement
Arrangements
HSA/HRA Employer
Contributions
Plan Year 2025
CDHP
HSA/HRA Base*
Contribution
Employee/Retiree Only $600
*Base contribution is the amount approved by the PEBP Board for plan year 2025 for
CDHP primary participants. Base contributions for new hires enrolled in the CDHP on
August 1, 2024 – June 1, 2025, are prorated.
Base contribution applies to State and non-State active employees, and retirees
enrolled in the CDHP on July 1, 2024.
FSA
HSA/HRA
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
42
HSA/HRA EMPLOYER CONTRIBUTIONS
Flexible Spending Accounts
Health Savings Accounts
Health Reimbursement
Arrangements
HSA/HRA Employer
Contributions
Plan Year 2025
HSA/HRA Annual
Contribution
Limits
CDHP (PPO)
HSA/HRA Account
Low Deductible
Plan (PPO) HRA
Account
Exclusive Provider
Organization
(EPO) HRA
Account
Health Plan of
Nevada (HMO)
HRA Account
Base Employer
Contribution for
Participant
$600 N/A N/A N/A
*One-Time
Employer
Contribution for
State Active
Employees
$300 (EE)
$400 (E+C, E+S)
$500 (E+F)
$300 (EE)
$ 400(E+C, E+S)
$500 (E+F)
$300 (EE)
$400 (E+C, E+S)
$500 (E+F)
$300 (EE)
$400 (E+C, E+S)
$500 (E+F)
Total Employer
Contribution
Amount
Up to $1,100 Up to $500 Up to $500 Up to $500
Allocations Tiers for
State Active Employees:
EE = Employee Only
E+C = Employee + Child(ren)
E+S = Employee + Spouse
E+F = Employee + Family
*One-time supplemental HSA/HRA contributions apply to State Active Employees
enrolled in the CDHP, LD, EPO and HPN plans on July 1, 2024. Prorated supplemental
contributions for all employer contributions apply after July 1, 2024.
FSA
HSA/HRA
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
43
HSA/HRA FAQS
Flexible Spending Accounts
Health Savings Accounts
Health Reimbursement
Arrangements
HSA/HRA Employer
Contributions
FSA
HSA/HRA
HRA funds may transfer between the PEBP plans (CDHP, LD, EPO,
HMO); however, HRA funds are forfeited when a retiree moves to the
Via Benefits (Medicare Exchange).
What will happen to my HRA when
I switch from the CDHP to another
plan?
HRA rules require claims to be submitted for reimbursement within
365 days of the date the expenses incurred. View HSA Bank’s HRA
Reimbursement Request Form for supporting document
requirements when submitting for reimbursement.
Do I have to submit reimbursement
requests for HRA funds within a
specified period?
State active employees enrolled in the CDHP, LD, EPO and HPN plans
will receive a one-time HSA/HRA contribution of up to $500 for plan
year 2025. In addition, all CDHP participants will also receive an
employer contribution of $600 in HSA/HRA funds.
I thought an HRA required a high deductible
health plan (HDHP) like the CDHP. Do I
receive the one-time funds if I’m enrolled in
the LD, EPO or HMO plan?
HSA Bank administers these accounts. You can access your account
by using the single sign-on feature in your E-PEBP portal. Eligible
retirees enrolled with Via Benefits may have an Exchange-HRA
administered by Via Benefits.
Who administers HSAs and HRAs
for those enrolled in the CDHP, LD,
EPO and HMO plans?
The “Years of Service” HRA contribution remains at $13 per month,
per year of service. There is an $8,000 roll over cap each year. Please
see Medicare Exchange HRA Contribution section for more
information.
If I have Medicare and am on a
plan with Via Benefits how much
will I be receiving for my monthly
HRA?
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
44
ADDITIONAL BENEFITS
In this section you can explore additional benefits offered through PEBP.
Disease Care Management
Carrum Health
Hinge Health
2
nd
.MD
Telemedicine
Real Appeal
Voluntary Benefits
ADDITIONAL
BENEFITS
Disease Care Management
Second MD
Hinge HealthCarrum Health
Telemedicine
Voluntary BenefitsReal Appeal
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
• Obesity Care Management Program – This is a voluntary “opt-in” program that provides, but is not limited to,
medically supervised weight loss program, nutritional counseling, weight-loss medications.
Low Deductible (PPO)
DISEASE CARE MANAGEMENT
45
• Diabetes Care Management Program – This is a voluntary “opt-in” program that provides, but is not limited to, the
ability to purchase diabetes related medications, such as insulin, at a copay and not be subject to deductible or
coinsurance.
• Obesity Care Management Program – This is a voluntary “opt-in” program that provides, but is not limited to,
medically supervised weight loss program, nutritional counseling, weight-loss medications.
• Preventive Drug Program – Plan pays 80-100% of the cost of preventive drugs identified by Express Scripts.
Consumer Driven Health Plan (PPO)
• Obesity Care Management Program – This is a voluntary “opt-in” program that provides, but is not limited to,
medically supervised weight loss program, nutritional counseling, weight-loss medications.
Exclusive Provider Organization Plan (EPO)
• Disease Management Program – This program provides a personalized care plan to help self-manage asthma or
diabetes. This program is for eligible members at no cost. It's designed to provide support and does not replace the
treatment plans put into place by a provider. Always talk to a provider about any important health issues.
https://www.myhpnstateofnevada.com/Disease-Management.
Health Plan Of Nevada (HMO)
For the CDHP, LD, and EPO
Plans, contact UMR to get
started. The pharmacy
benefit manager is
Express Scripts.
ADDITIONAL
BENEFITS
Disease Care Management
Carrum Health
Hinge Health
2
nd
.MD
Telemedicine
Real Appeal
Voluntary Benefits
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
CARRUM HEALTH
46
ADDITIONAL
BENEFITS
Disease Care Management
Carrum Health
Hinge Health
2
nd
.MD
Telemedicine
Real Appeal
Voluntary Benefits
Higher Quality. Lower costs. Surgery and cancer care have never been better.
Carrum Health is a value-based Centers of Excellence platform that negotiates directly with top healthcare providers to offer
upfront bundled payments to employers. Their unique approach ensures patients receive more appropriate care that is better,
less expensive, and easier for everyone.
For Consumer Driven
Health Plan (CDHP), Low
Deductible Plan (LD), and
Exclusive Provider
Organization Plan (EPO)
participants.
Participants may use the Centers of Excellence Benefit for procedures such as: Total,
partial, and revision hip and knee replacement surgery; Spinal fusion surgery; Bariatric
(weight loss) surgery; Other orthopedic and spine procedures (e.g., hand, wrist, elbow,
shoulder, ankle, foot); Cardiac (heart) surgery ; and Oncology.
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
HINGE HEALTH
Take Control of Your Pain
Consumer Driven Health Plan (CDHP), Low Deductible Plan (LD), and Exclusive Provider Organization Plan (EPO)
participants and your eligible dependents have access to Hinge Health’s programs for muscle and joint pain for
$0 copay. Hinge Health is moving people beyond pain by transforming the way it is treated and prevented by
connecting people, digitally and in person, with expert clinical care. Using advanced technology and AI, a team
of clinical experts guides people through personalized care directly from their phone. It is proven to reduce pain
by 68%, prevent 42% of new opioid prescriptions, and avoid one in two unnecessary surgeries. Scan the QR
code to learn more or apply at hinge.health/nevadapebp or call (855)902-2777. Participants must be 18 years
and older.
Sign up for help with any of the following:
• Addressing pain or limited movement
• Recovery from a past injury
• Reducing stiffness in achy joints
Each program is custom tailored. You could receive:
• Virtual visits anytime, anywhere
• Unlimited 1-on-1 health coaching
• Motion-tracking technology for instant form correction
ADDITIONAL
BENEFITS
Disease Care Management
Carrum Health
Hinge Health
2
nd
.MD
Telemedicine
Real Appeal
Voluntary Benefits
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
HINGE HEALTH
ADDITIONAL
BENEFITS
Scan the QR code to learn more or apply at hinge.health/nevadapebp or call (855)902-2777.
Disease Care Management
Carrum Health
Hinge Health
2
nd
.MD
Telemedicine
Real Appeal
Voluntary Benefits
Specializing in Women’s Health
Pelvic Trainer Device for Pelvic Floor Strengthening
Personalized pelvic floor care: Members receive a
pelvic floor trainer, where clinically indicated.
Pelvic floor strengthening: Pelvic trainer offers
gamified Kegel exercises and immediate feedback
on contraction strength and quality.
Comprehensive exercise therapy: Pelvic trainer
works synergistically with whole body pelvic floor
physical therapy, resulting in enhanced pelvic
healthcare.
• FDA Registered
• Offered at no additional cost where clinically
indicated
• No member-level data sharing
• Patented detection of incorrect and harmful
pelvic floor contractions
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
CARRUM HEALTH AND HINGE HEALTH
ADDITIONAL
BENEFITS
Disease Care Management
Carrum Health
Hinge Health
2
nd
.MD
Telemedicine
Real Appeal
Voluntary Benefits
Integrated clinical workflows enable end-to-end visibility and support of
participants throughout their care journey.
Hinge Health participant interested in surgery:
Carrum Health participant inquiring about surgery for MSK pain:
Ineligible for MSK
surgery or
recommended
for conservative
treatment
MSK patients
who require
pre/post-op care
Bariatric patients
with unresolved
MSK pain
Introduced to
Hinge Health
Completed
clinical
questionnaire
Enrolled in
appropriate
program
Virtual PT, health
coaching,
exercise therapy,
education
Exhausted
conservation
options
Along Hinge’s
pre/post-op
pathway
Introduced to
Carrum
Health
Surgery
scheduled
Pre-op care Surgery Post-op care
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
2
ND
.MD
An exclusive membership for Consumer Driven Health Plan (CDHP), Low Deductible Plan (LD), and
Exclusive Provider Organization Plan (EPO) participants with 2nd.MD, a virtual expert consultation and
medical navigation service for $0 copay.
Connect with 2
nd
MD’s Care Team:
Call: 1.866.269.3534
Visit: www.2nd.MD/pebp
Download the 2nd.MD App
50
• “Do I have the right diagnosis?”
• “Am I getting the best treatment for my
medical condition?”
• “Is this surgery or procedure the best
option for me?”
• “Is the medicine I’m taking right for me?”
Connects you with the
leading specialists in
their respective fields to
answer questions, like:
ADDITIONAL
BENEFITS
Disease Care Management
Carrum Health
Hinge Health
2
nd
.MD
Telemedicine
Real Appeal
Voluntary Benefits
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
TELEMEDICINE
For Consumer Driven Health Plan (CDHP), Low Deductible Plan (LD), and Exclusive Provider Organization
Plan (EPO) participants. Telemedicine (virtual medicine) is covered when using in-network providers who
offer telemedicine. It is also available through Doctor on Demand.
51
In a true medical emergency
such as
chest pains, shortness of
breath or broken bones, dial
911 or seek immediate
medical attention, as
appropriate.
ADDITIONAL
BENEFITS
Some of the conditions that can be treated:
• Cold & Flu
• Asthma & Allergies
• Bronchitis & Sinus Issues
• Rashes & Skin Issues
• Eye Issues
• Anxiety
• Depression
Connect with Doctor on Demand:
Call: 1-800-997-6196
Visit: https://doctorondemand.com/
Email: support@doctorondemand.com
CDHP:
Urgent Medical Care
$49
Mental Health Therapy
$79 (25 minutes)
LD:
Urgent Medical Care
$10
Mental Health Therapy
$20 (25 minutes)
$30 (50 minutes)
EPO:
Urgent Medical Care
$10
Mental Health Therapy
$20 (25 or 50 minutes)
Disease Care Management
Carrum Health
Hinge Health
2
nd
.MD
Telemedicine
Real Appeal
Voluntary Benefits
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
TELEMEDICINE
For Health Plan of Nevada (HPN) participants. Telemedicine (virtual medicine) is covered when using in-
network providers who offer telemedicine. It is also available through NowClinic for $0 copay.
52
In a true medical emergency
such as
chest pains, shortness of
breath or broken bones, dial
911 or seek immediate
medical attention, as
appropriate.
ADDITIONAL
BENEFITS
NOWCLINIC® VIRTUAL VISITS
Secure video chat with a provider from your computer or mobile
device for a $0 copay.
No appointment needed to get care for non-life-threatening and
non-urgent medical conditions, such as:
Appointment required for consultations, follow up care or meetings
scheduled by providers, including:
▪ Allergies
▪ Bladder infection
▪ Bronchitis
▪ Pink eye
▪ Sinus infections
▪ Viral illnesses
▪ Behavioral health
▪ Specialties
▪ Health education
▪ Case management
Enroll and get care. Download the NowClinic app or go to
NowClinic.com and sign up. Visit your health plan’s website to learn
how to schedule an appointment and get information on same-day
medication delivery using NowClinic.
24/7 ADVICE NURSE
Get health care advice at no additional cost to you.
If you’re unsure about your condition, our 24/7 advice nurse
may be able to help. Our nurse is available to answer
questions, provide self-care advice and help you decide
whether to seek care, or schedule an appointment with your
provider.
URGENT CARE HOUSE CALL
Get on-demand health care at home. Urgent care house calls can
treat most things urgent care centers can for the same cost and
it’s available seven days a week.
Some of the things home urgent care visits can help with:
• Migraine headaches
• Cuts that need stitches and skin infections
• Urinary tract infections
• Flu and pneumonia
• Dehydration, IV placements and IV fluids
• Asthma attacks, COPD and respiratory infections
Call 1-800-288-2264
(This number is listed on the
back of your ID card)
Disease Care Management
Carrum Health
Hinge Health
2
nd
.MD
Telemedicine
Real Appeal
Voluntary Benefits
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
REAL APPEAL
Available to all Consumer
Driven Health Plan (CDHP),
Low Deductible Plan (LD),
Exclusive Provider Organization
Plan (EPO) and Health Plan of
Nevada (HPN) participants for
$0 copay.
ADDITIONAL
BENEFITS
Visit enroll.realappeal.com to get started.
With Real Appeal, You’ll Learn Ways to:
• Eat healthier
• Stay active
• Fit healthy choices into your lifestyle
• Stay motivated
• Develop lasting, healthy habits
What You Need to Register:
• PEBP insurance card
• Personal calendar— to choose your
weekly online session day and time
• Shipping address— to receive
success Kit after attending your first
online session.
Live Online Sessions
Join weekly online group sessions led by a coach, with the
flexibility to reschedule anytime.
Tailored to You
You are not visible in the online group sessions and can
choose how you’d like to participate.
Stay on Track
Use our fitness, food and weight trackers to stay on top of
your progress and hit your goals.
Success Kit
A Success Kit with food and weight scales, and more,
shipped to you after you attend your first session.
Disease Care Management
Carrum Health
Hinge Health
2
nd
.MD
Telemedicine
Real Appeal
Voluntary Benefits
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
54
VOLUNTARY BENEFITS
Voluntary benefits are offered to all participants who are eligible for benefits, except for some products that may not apply or be
available to retirees. To learn more about these voluntary benefits, or to start shopping, log into your E-PEBP Portal.
Active Employees: Even if you
have chosen to decline your
PEBP health insurance benefits,
you can still sign up for any of
these voluntary benefits for
yourself or any of your
dependents.
*Participants must be enrolled
on $5,000 Voluntary Life
Insurance (VLI) to enroll their
dependents in VLI
ADDITIONAL
BENEFITS
Voluntary Products
Enroll During Open
Enrollment or
Qualifying Life Event
Anytime
Accident Insurance X
Buy-Up Vision Plan (VSP) X
Critical Illness Plan X
Hospital Indemnity Plan X
Legal Plan X
Long Term Disability X
Short Term Disability X
Voluntary Life Insurance* X
Auto, Home and Renters
Insurance
X
Identity Theft Protection X
Pet Insurance X
Disease Care Management
Carrum Health
Hinge Health
2
nd
.MD
Telemedicine
Real Appeal
Voluntary Benefits
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
55
CONTACTS
The links on the left will guide to PEBP’s third-party administrators contact information.
Contact PEBP
Log on to your E-PEBP Portal to send a secure message.
Call Member Services: 775-684-7000, 702-486-3100 or 1-800-326-5496.
Need to update your contact information?
Send a secure message through your E-PEBP portal with your new address and/or phone number, or call PEBP
and a Member Service Representative will update your information for you. Email addresses can be updated at
the initial log-in for your E-PEBP portal.
Need to submit documentation to PEBP?
If you are sending supporting documents, please upload them into your E-PEBP Portal. Trouble uploading
supporting documents to your E-PEBP portal? Visit https://pebp.nv.gov > Contact Us > Submit Supporting
Documents > Secure Supporting Document Upload Form.
CDHP and LD Plan
Exclusive Provider Organization
Plan
Health Plan of Nevada
Additional Contacts
CONTACTS
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
56
CONSUMER DRIVEN HEALTH PLAN (PPO) AND LOW DEDUCTIBLE PLAN (PPO)
SERVICE RESOURCE OR VENDOR WEBSITE PHONE NUMBER
•
Medical, Dental and Vision Benefits
and Claims
•
ID Cards
•
FSA
•
Find a Medical Provider
•
Disease Care Management
UMR
PO Box 8022
Wausau, WI 54402
-8022
Log on to your E
-PEBP Portal and select UMR
1
-888-7NEVADA (1-888-763-8232)
Group Number: 76414946
Find a Dental Provider
Diversified Dental Services
5470
Kietzke Lane, Suite 300
Reno, NV 89511
Find a Provider tool at
https://pebp.nv.gov or
www.ddsppo.com
Customer Service:
1-866-270-8326
•
Prescription Drug Coverage
•
Specialty Drug Coverage
•
Find a Pharmacy
•
Price a Medication Tool
Express Scripts
P.O. Box
66566
St. Louis,
MO 63166-6566
Log on to your E
-PEBP Portal and select Click here to
access Express Scripts,
under Quick Link
Express Scripts
1
-855-889-7708
Benefits and Prescriptions
1
-800-282-2881
Specialty Pharmacy
- Accredo
1
-877-ACCREDO (1-877-222-7336)
Utilization and
Case Management
Sierra Health
-Care Options, Inc
PO Box 15645
Las Vegas, NV 89144
-5648
Fax: 1
-800-288-2264
Customer Service: 1
-888-323-1461
•
Basic Life Insurance
•
Member Assistance Program (MAP)
•
Travel Assistance
UnitedHealthcare Specialty Benefits
P.O. Box 7149
Portland, ME 04112
-7149
https://pebp.nv.gov/Plans/basic
-life-insurance/
Customer Service: 1
-888-763-8232
Voluntary Products
Corestream
Log on to your E
-PEBP Portal
Customer Service: 1
-775-249-0716
Telemedicine
Doctor on Demand
www.doctorondemand.com/pebp
1
-800-997-6196
HSA/HRA
HSA Bank
Myaccounts.hsabank.com
1
-833-228-9364
CDHP and LD Plan
Exclusive Provider Organization
Plan
Health Plan of Nevada
Additional Contacts
CONTACTS
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
57
EXCLUSIVE PROVIDER ORGANIZATION PLAN (EPO)
NORTHERN NEVADA
SERVICE RESOURCE OR VENDOR WEBSITE PHONE NUMBER
•
Medical, Dental and Vision Benefits
and Claims
•
ID Cards
•
Flexible Spending Accounts
•
Find a Medical Provider
•
Disease Care Management
UMR
PO Box 8022
Wausau, WI 54402
-8022
Log on to your E
-PEBP Portal and select UMR
1
-888-7NEVADA (1-888-763-8232)
Group Number: 76414946
Find a Dental Provider
Diversified Dental Services
5470
Kietzke Lane, Suite 300
Reno, NV 89511
Find a Provider tool on
https://pebp.nv.gov or
www.ddsppo.com
Customer Service:
1-866-270-8326
•
Prescription Drug Coverage
•
Specialty Drug Coverage
•
Find a Pharmacy
•
Price a Medication Tool
Express Scripts
P.O. Box
66566
St. Louis,
MO 63166-6566
Log on to your E
-PEBP Portal and select Click here to
access Express Scripts,
under Quick Link
Express Scripts
1
-855-889-7708
Benefits and Prescriptions
1
-800-282-2881
Specialty Pharmacy
- Accredo
1
-877-ACCREDO (1-877-222-7336)
Utilization and
Case Management
Sierra Health
-Care Options, Inc
PO Box 15645
Las Vegas, NV 89144
-5648
Fax: 1
-800-288-2264
Customer Service: 1
-888-323-1461
•
Basic Life Insurance
•
Member Assistance Program
•
Travel Assistance
UnitedHealthcare Specialty Benefits
P.O. Box 7149
Portland, ME 04112
-7149
https://pebp.nv.gov/Plans/basic
-life-insurance/
Customer Service: 1
-888-763-8232
Voluntary Products
Corestream
Log on to your E
-PEBP Portal
Customer Service: 1
-775-249-0716
Telemedicine
Doctor on Demand
www.doctorondemand.com/pebp
1
-800-997-6196
HRA
HSA Bank
Myaccounts.hsabank.com
1
-833-228-9364
CDHP and LD Plan
Exclusive Provider Organization
Plan
Health Plan of Nevada
Additional Contacts
CONTACTS
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
58
HEALTH PLAN OF NEVADA (SOUTHERN NEVADA HMO)
SERVICE RESOURCE OR VENDOR WEBSITE PHONE NUMBER
•
Medical and Vision Benefits and
Claims
•
Medical ID Cards
•
Find a Medical Provider
•
Disease Care Management
Health
Plan of Nevada
2720 N.
Tenaya Way
Las Vegas, NV 89128
-0424
Log on to your E
-PEBP Portal or visit
https://www.myhpnstateofnevada.com/
1
-702-242-7300 or 1-800-777-1840
Flexible Spending Accounts
UMR
Log on to your E
-PEBP Portal and select Click here to
access UMR,
under Quick Links or call UMR
1
-888-7NEVADA (1-888-763-8232)
Dental ID Cards
UMR
Log on to your E
-PEBP Portal and select Click here to
access UMR,
under Quick Links or call UMR
1
-888-7NEVADA (1-888-763-8232)
Find a Dental Provider
Diversified Dental Services
5470
Kietzke Lane, Suite 300
Reno, NV 89511
Log on to your E
-PEBP Portal or visit
www.ddsppo.com
Customer Service:
1-866-270-8326
•
Prescription Drug Coverage
•
Specialty Drug Coverage
•
Find Pharmacy Network Providers
•
Price a Medication Tool
Optum RX
P.O. Box
2975
Mission, KS 66201
www.myhpnstateofnevada.com/Pharmacy
-Benefits
1
-800-788-4863
•
Basic Life Insurance
•
Travel Assistance
UnitedHealthcare Specialty Benefits
P.O. Box 7149
Portland, ME 04112
-7149
https://pebp.nv.gov/Plans/basic
-life-insurance/
Customer Service: 1
-888-763-8232
Voluntary Products
Corestream
Log on to your E
-PEBP Portal
Customer Service: 1
-775-249-0716
Telemedicine
NowClinic
https://www.myhpnstateofnevada.com/Virtual
-Visits
1
-877-550-1515
HRA
HSA Bank
Myaccounts.hsabank.com
1
-833-228-9364
CDHP and LD Plan
Exclusive Provider Organization
Plan
Health Plan of Nevada
Additional Contacts
CONTACTS
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
59
ADDITIONAL CONTACTS AND RESOURCES
SERVICE RESOURCE OR VENDOR WEBSITE PHONE NUMBER
Medicare Exchange and
HRA Funding
Via Benefits
10975 Sterling View Drive, Suite A1
South Jordan, UT 84095
www.my.viabenefits.com/pebp
General: 1
-888-598-7545
HRA Assistance: 1
-844-266-1395
Medicare Eligibility
Social Security Administration
www.ssa.gov
1
-800-772-1213
Medicare Services
Centers for Medicare Services
www.cms.gov
1
-800-633-4227
PEBP Dental ID Cards
UMR
Log on to your E
-PEBP Portal or call UMR
1
-888-7NEVADA (1-888-763-8232)
Find a PEBP Dental Provider
(Via Benefits Medicare Retirees)
Diversified Dental Services
5470
Kietzke Lane, Suite 300
Reno, NV 89511
Log on to your E
-PEBP Portal or visit
www.ddsppo.com
Customer Service:
1-866-270-8326
Basic Life
Insurance
UnitedHealthcare Specialty Benefits
P.O. Box 7149
Portland, ME 04112
-7149
https://pebp.nv.gov/Plans/basic
-life-insurance/
Customer Service: 1
-888-763-8232
Voluntary Products
Corestream
Log on to your E
-PEBP Portal
Customer Service: 1
-775-249-0716
Retirement (PERS)
Public Employees’ Retirement System
Carson City and Las Vegas Locations
www.nvpers.org
Toll Free: 1
-866-473-7768
Carson City: 775
-687-4200
Las Vegas: 702
-486-3900
Deferred Compensation
Nevada Public Employees' Deferred
Compensation Program
100 N. Stewart St., Suite 100
Carson City, NV 89701
www.defcomp.nv.gov
1
-775-684-3398
CDHP and LD Plan
Exclusive Provider Organization
Plan
Health Plan of Nevada
Additional Contacts
CONTACTS
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
60
KEY TERMS AND DEFINITIONS
Annual/Annually
For the purposes of this Plan, annual refers to the 12
-month period starting July 1 through
June 30.
Base Plan
The self
-funded Consumer Driven Health Plan (CDHP). The base plan is also defined as the
“default plan.”
Coinsurance
The
portion of eligible medical expenses for which the covered person has
financial
responsibility
. In most instances, once your costs reach the deductible limit, the
insurance
company
pays for covered expenses at its level of coinsurance, and you pay at your level
of
coinsurance
. The coinsurance varies depending on whether in-network or out-of-
network
providers
are used.
Copayment, Copay
The
fixed dollar amount you are responsible for paying when you incur an eligible
medical
expense
for certain services, generally those provided by network health care
practitioners,
hospitals
(or emergency rooms of hospitals), or health care facilities. This can be in
addition
to
coinsurance amounts due on the same incurred charges. Copayments are limited
to
certain
benefits under this program.
Deductible
The
amount of eligible medical, prescription drug and dental expenses you are
responsible
for
paying before the plan begins to pay benefits.
Exclusions
Specific conditions, circumstances, and limitations for which the plan does not provide plan
benefits.
Formulary
A list of generic and brand name drug products available for use by participants.
Key Terms and Definitions
PY25 Summary of Changes
IMPORTANT
INFORMATION
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
61
KEY TERMS AND DEFINITIONS
Health
Reimbursement
Arrangement
A
Health Reimbursement Arrangement (HRA) is an employee-funded spending account that can be
used
to
pay qualified medical expenses. The HRA is 100% funded by the employer. The terms of
these
arrangements
can provide first dollar medical coverage until the funds are exhausted or
insurance
coverage
kicks in. The contribution amount per employee is set by the employer, and the
employer
determines
what the funds can be used to cover and if the dollars can be rolled over to the next year.
In
most
cases, if the employee leaves the employer, they can't take remaining HRA funds with them.
Health Savings
Account
An account that allows individuals to pay for current health expenses and save for future qualified medical
and retiree health expenses on a tax
-free basis.
In
-Network Provider
A
provider that the network, or one of its rental networks, have contracted or made arrangements
with
to
provide health services to covered individuals at a discounted rate. To determine if a provider is an in
-
network
provider log onto your E-PEBP portal and use the UMR single sign on feature. Then click
the
“Find
a Provider” tab. You may also call the number of the back of your ID card and a customer
service
representative
can locate an in-network provider for you.
Out
-of-Pocket
Maximum
The
maximum amount of coinsurance each covered person or family is responsible for paying during
a
plan
year before the coinsurance required by the plan ceases to apply. When the out-of-pocket
maximum
(OOPM)
is reached, the plan will pay 100% of eligible covered expenses for the remainder of the
plan
year
.
Premium
The amount you pay to obtain a health insurance plan. Most participant premiums are automatically
deducted from their paycheck. The premium is separate from the deductible, copay, coinsurance and
OOPM.
Usual and Customary
The amount paid for a medical care, treatment, or supplies in a geographic area based on what providers
in that area usually charge for the same or similar service. The U&C amount is used to determine the
allowed amount the plan will pay.
Key Terms and Definitions
PY25 Summary of Changes
IMPORTANT
INFORMATION
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
62
PLAN YEAR 2025 SUMMARY OF CHANGES
Key Terms and Definitions
PY25 Summary of Changes
IMPORTANT
INFORMATION
DESCRIPTION OF CHANGE
CDHP
LD EPO
HPN
1.
Increase deductible as required for the Health Savings Account to $1,600 for single tier
coverage and $3,200 for spouse, children and family tiers.
2.
Integrated HRA
: LD, EPO and HPN State Active Employees will receive an integrated
HSA/HRA employer contribution effective July 1, 2024. Participants have flexibility to
change health plans during open enrollment while retaining existing HRA dollars.
3.
Plan Year 2025 *
One-Time HRA or HSA contribution: Applies to State Active Employees
enrolled in the CDHP, LD, EPO or HPN on July 1, 2024
. Prorated contributions apply
participants enrolled 8/1/24
– 6/1/25.
• $ 300 Employee Only,
• $ 400 Employee + Child(ren)/Spouse,
• $ 500 Employee + Family
*One
-time contribution applies to Plan Year 2025 only. Future one-time contributions
are at the discretion of the PEBP Board and/or Legislature; therefore, are not
guaranteed for future plan years.
4.
PY 2025 CDHP “
base” HSA or HRA contribution: Applies to participants enrolled in the
CDHP on 7/1/24. Prorated contribution applies for CDHP participants enrolled 8/1/24 –
6/1/25.
• $600 Participant Only
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
63
PLAN YEAR 2025 SUMMARY OF CHANGES
Key Terms and Definitions
PY25 Summary of Changes
IMPORTANT
INFORMATION
DESCRIPTION OF CHANGE
CDHP
LD EPO
HPN
5.
For
services requiring precertification's Outpatient and Physician Surgery,
When
outpatient
and physician surgery is performed at an In-Network,
contracted
ambulatory
surgical center (ASC) by an In-Network, contracted physician,
prior
authorizations
is not required.
However,
when services are not performed at an In-Network, contracted
ASC,
procedures
will require prior authorization. This is commonly referred to as
Site
of
Service.
Prior
authorization for dialysis has been removed.
6.
Contracting
with Carrum Health effective July 1
st
. Carrum Health is a
value-
based
Centers of Excellence platform that negotiates directly with
top
healthcare
providers to offer upfront bundled payments to employers.
Their
unique
approach ensures patients receive more appropriate care that is
better,
less
expensive, and easier for everyone. This benefit is coordinated with
Hinge
Health
to offer additional value and targeted care.
7.
Bring plans into compliance under the Mental Health Parity and Addiction
Equity Act of 2008 (MHPAEA).
• Modify or remove certain exclusions/limitations
• Clarify certain day limits or visit limits
• Clarify certain benefit descriptions
• Reassign certain benefit classifications
• Other considerations
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
64
PLAN YEAR 2025 SUMMARY OF CHANGES
Key Terms and Definitions
PY25 Summary of Changes
IMPORTANT
INFORMATION
DESCRIPTION OF CHANGE
CDHP
LD EPO
HPN
8.
For Specialty Drugs part of the
SaveOnSP program, the coinsurance applies (CDHP 30
%,
LD 30%, EPO
30%).
For Specialty Drugs not part of the
SaveOnSP program, the respective coinsurance
applies with a copay limitation $100 minimum and a maximum of $250.
9.
Travel Benefit to allow for reimbursement up to U.S. General Service Administration
rates.
This change will allow reimbursement for meals, travel, and lodging for the
member and one companion. This benefit would apply to these specific medically
approved services:
• Bariatric • Hip/Knee
• Organ/Tissue Transplant • Abortion
BENEFITS RATES ELIGIBILITY ENROLLMENT
FSA
HSA/HRA
ADDITIONAL
BENEFITS
CONTACTS
PUBLIC EMPLOYEES' BENEFITS PROGRAM PLAN YEAR 2025 BENEFIT GUIDE
IMPORTANT
INFORMATION
E-PEBP
PORTAL
65
Public Employees’ Benefits Program
3427 Goni Road, Suite 109
Carson City, NV 89706
Log on to your E-PEBP Portal to Send a Secure Message
Call Member Services: 775-684-7000, 702-486-3100
or 1-800-326-5496
https://pebp.nv.gov
Revised 4/2024