PEBP and Medicare

PLAN YEAR 2016 July 1, 2015 - June 30, 2016

Public

Employees’

Benefits

Program

901 South Stewart Street, Suite 1001

Carson City, NV 89701

mservices@peb.state.nv.us

www.pebp.state.nv.us

775-684-7000 or 800-326-5496

Twitter@NVPEBP

Introduction……………………………………………………………………………… 1

Medicare Parts A and B…..…………………………………………………………….. 2

Coverage Options for Medicare Retirees and Dependents………………………………. 3

Required Action………………………………………………………………………….. 4

Retiree Ages into Medicare AFTER Retirement………………………………………… 6

Retiree and/or Dependent with Medicare Due to SSA Disability……………………….. 7

Dependent of a Non-Medicare Retiree Ages-in to Medicare…………………………….

8

Employee Retires at Age 65 or Older……………………………………………………. 9

OneExchange - Health Reimbursement Arrangement (OneExchange-HRA)………….. 10

PEBP Dental Plan Option………………………………………………………………... 11

Unsubsidized Dependent Rates………………………………………………………….. 11

Contact Information……………………………………………………………………… 12

Table of Contents

06242015

Introduction Welcome to the State of Nevada Public Employees’ Benefits Program (PEBP). PEBP provides a

variety of benefits to eligible retirees and dependents such as medical, dental, life insurance, and

other voluntary insurance products.

Certain medical plan options and eligibility changes will occur for retirees and dependents entitled

to Medicare Parts A and B. This document will explain the various coverage options available to

Medicare beneficiaries, including, when to enroll in Medicare and other required actions that will

need to be completed by the retiree and/or dependent.

For additional information on the items listed below, visit www.pebp.state.nv.us.

PEBP Master Plan Document

NRS Chapter 287 and NAC Chapter 287

Towers Watson OneExchange website: http://www.pebp.state.nv.us/Medicare_Exchange.htm

Voluntary product offerings

Online access to your account information

Frequently asked questions and answers

Retiree enrollment guide

Newsletters

Public Employees’ Benefits Program (PEBP)

For questions regarding voluntary PEBP Dental coverage, eligibility or to request publications or

enrollment forms, please call 775-684-7000 or 800-326-5496 or email

mservices@peb.state.nv.us. Member Services staff is available 8:00 a.m. to 5:00 p.m. Pacific

time, Monday through Friday, except holidays. To ensure you receive accurate and courteous

service, telephone calls may be monitored.

Towers Watson OneExchange (formerly Extend Health)

For questions related to medical, dental, prescription drug, and vision plans offered through the

Medicare exchange, please call OneExchange at 888-598-7545, or visit:

www.extendhealth.com/pebp

Effective July 1, 2015

PEBP will allow eligible Medicare retirees with Tricare or Tricare for Life to receive a monthly

HRA allocation based on their years of service/retirement date without enrolling in a medical plan

through Towers Watson’s OneExchange.

This publication is provided for informational purposes only. Any discrepancies in the content

herein and Chapters 287 of the Nevada Revised Statutes (NRS) and the Nevada Administrative

Code (NAC), the Social Security Administration, Centers for Medicare and Medicaid Services

(CMS), and the PEBP Master Plan Document shall be superseded by PEBP’s official documents

and State and Federal law.

1

2

Medicare Parts A and B

PEBP requires retirees and dependents of retirees to enroll in premium-free Medicare Part A and

purchase Medicare Part B within the timeframes outlined in this guide.

To determine your eligibility for premium-free Medicare Part A, contact the Social Security

Administration approximately three months before your 65th birthday at 1-800-772-1213.

You Are Entitled to Premium-Free Medicare Part A and Part B

Submit a copy of your Medicare Part A and Part B card to the PEBP office.

You are Entitled to Tricare or Tricare for Life and Medicare Part A and Part B

Submit a copy of your Tricare or Tricare for Life identification card and Medicare Parts A and B

card to the PEBP office.

You Are Not Entitled to Premium-Free Medicare Part A

Submit a copy of the Part A denial letter issued by the Social Security Administration and a copy

of your Medicare Part B card to the PEBP office.

Timeframe for Submitting Required Medicare Document(s) to the PEBP Office

For birthdays occurring on the first day of the month, submit a copy of your Medicare Part A

(or your premium-free Medicare Part A denial letter) and Medicare Part B card no later than

the last day of the month in which you turn 65.

For birthdays NOT occurring on the first day of the month, submit a copy of your Medicare

Part A (or your premium-free Medicare Part A denial letter) and Medicare Part B card no

later than the last day of the month, following your 65th birthday month.

For retirees and covered dependents under age 65 who become eligible for Medicare due to

a disability, proof of Medicare Part A and B enrollment must be received within 60 days of

the Medicare Part A effective date.

For newly retiring employees, the Medicare Part A (or your premium-free Medicare Part A

denial letter) and Medicare Part B card within 60 days of your retirement coverage effective

date.

Retirees who are eligible to retain coverage under the PEBP CDHP or HMO plan receive a

Part B premium credit equal to the 2014 base cost of Medicare Part B coverage. The Part

B credit will not apply until the first of the month following PEBP’s receipt of the Part B

card or the effective date of Part B, whichever occurs later.

Failure to provide the required Medicare and Tricare (if applicable) verification will result

in termination of coverage, Basic Life Insurance, HRA contribution, and any voluntary

products.

3

Medicare Parts A and B

PEBP requires retirees and their covered dependents to enroll in premium-free Medicare Part A

and Part B by the last day of the 65th birthday month (for birthdays occurring between the second

day and the last day of the month) or no later than the last day of the month preceding the 65th

birthday (for birthdays occurring on the first day of the month). Note: Retiring employees aged

65 years or older are required to enroll in premium-free Part A and Part B to enroll in retiree

coverage.

Coverage Options for Medicare Retirees and Dependents Retirees and covered dependents with Medicare Parts A and B must enroll in a medical plan

through OneExchange. The following describes the coverage options based on the Medicare status

of a primary retiree and covered dependent (if any):

Retiree attains Medicare Parts A and B (no covered dependents)

Retiree must enroll in medical coverage through OneExchange to receive the

Exchange-Health Reimbursement Arrangement (Exchange-HRA), PEBP Dental coverage, and

Basic Life Insurance benefits (if applicable).

Retiree attains Medicare Parts A and B and has Tricare or Tricare for Life (no covered

dependents)

Retiree must submit a copy of the Parts A and B card and the Tricare or Tricare for Life card to

the PEBP office. Retiree may enroll in a medical plan through OneExchange; however, medical

coverage through OneExchange is not required to retain the monthly HRA funding.

Retiree attains Medicare Parts A and B and covers a dependent without Medicare.

Retiree may enroll in a medical plan through OneExchange and the non-Medicare dependent(s)

may stay on the CDHP or HMO plan as an unsubsidized dependent(s); or

Retiree may stay on the CDHP or HMO plan with the non-Medicare dependent(s) until spouse/

domestic partner enrolls in Medicare. In the case of a dependent child, the retiree may stay on a

PEBP plan until the child ceases to be an eligible dependent; or

Retiree may enroll in a medical plan through OneExchange and remove any covered

dependents from his or her plan.

Retiree is NOT entitled to Medicare covers a dependent with Medicare Parts A and B

Medicare dependent may enroll in a medical plan through OneExchange. The non-Medicare

retiree may stay on the CDHP or HMO coverage; or

Both the retiree and the Medicare dependent may remain on the CDHP or HMO coverage until

both become eligible for Medicare Parts A and B. In the case of a child, the retiree may retain

PEBP coverage until the child ceases to be an eligible dependent.

Retiree is Not Entitled to Premium-free Medicare Part A

Retiree may remain on the CDHP or HMO plan, but must purchase Medicare Part B.

4

Required Action

Retiree with Medicare Parts A and B (no covered dependents).

Retiree must enroll for medical coverage through OneExchange.

Submit a copy of the Medicare Parts A and B card to the PEBP office.

Contact OneExchange at 888-598-7545 to enroll in a medical, prescription drug,

vision and/or dental plan.

Complete the Retiree Benefit Enrollment and Change Form selecting Medicare Exchange with or

without PEBP Dental.

Submit the Retiree Benefit Enrollment and Change Form to the PEBP office.

Retiree with Medicare Parts A and B and Tricare or Tricare for Life (no covered dependents).

Retiree is not required to enroll in a medical plan through OneExchange, but must transition to

OneExchange to retain the monthly HRA funding.

Submit a copy of the Medicare Parts A and B card and Tricare card to the PEBP office.

Contact OneExchange at 888-598-7545.

Complete the Retiree Benefit Enrollment and Change Form.

Submit the Retiree Benefit Enrollment and Change Form to the PEBP office.

Retiree with Medicare Parts A and B and covers a dependent without Medicare.

If the retiree elects to enroll in medical coverage through OneExchange and retain coverage for the

non-Medicare dependent(s) on the CDHP or HMO plan, do the following:

Submit a copy of the Medicare Parts A and B card to the PEBP office.

Contact OneExchange at 888-598-7545 to enroll in a medical, prescription drug, vision and/or

dental plan.

Complete the Retiree Benefit Enrollment and Change Form selecting Medicare Exchange with or

without PEBP Dental.

If the retiree wishes to continue coverage for the non-Medicare dependent(s) on the CDHP or

HMO plan, contact PEBP at 775-684-7000 or 800-326-5496 to request the Benefit Enrollment and

Change Form for Unsubsidized Dependents. Note: Failure to submit this form to the PEBP office

will result in termination of coverage for all dependent(s).

Retiree without Medicare covers a dependent with Medicare Parts A and B

If the Medicare dependent wishes to enroll in a medical plan through OneExchange, do the

following:

Medicare dependent contacts OneExchange at 888-598-7545 to enroll in a medical, prescription

drug, vision and/or dental plan; and

If electing PEBP dental coverage, contact the PEBP office to request the Benefit Enrollment and

Change Form for Unsubsidized Dependents; or

If both the retiree and the Medicare dependent are staying on the CDHP or HMO coverage,

submit a copy of the dependent’s Medicare Parts A and B or if not eligible for Part A, a copy of

the Part B card to the PEBP office.

5

Required Action (continued)

Retiree is not entitled to premium-free Medicare Part A

Retiree may remain on the CDHP or HMO coverage with his or her dependent(s) if

applicable.

Retiree must purchase Medicare Part B; and

Obtain a Part A denial letter from the Social Security Administration; and

Submit copies of both documents to the PEBP office as follows:

For birthdays occurring on the first day of the month, the documents must be received

no later than the last day of the month the individual turns 65.

For birthdays NOT occurring on the first day of the month, submit the documents no

later than the last day of the month, following the 65th birthday month.

For newly retiring employees, submit the documents within 60 days of retirement

coverage effective date.

Active employee’s dependent ages-in to Medicare Parts A and B

If the Medicare dependent wishes to enroll in a medical plan through OneExchange, do the

following:

Medicare dependent contacts OneExchange at 888-598-7545 to enroll in a medical,

prescription drug, vision and/or dental plan; and

If electing PEBP dental coverage, contact the PEBP office to request the Benefit

Enrollment and Change Form for Unsubsidized Dependents; and

Employee completes the Benefit Enrollment and Change Form dropping the Medicare

dependent for his or her coverage.

6

Retiree Ages into Medicare AFTER Retirement

Birthday

Month

If your birthday

is on the first day

of the month see

below*

1

Medicare

Parts

A and B

3

You

complied

with 1 and 2

4

You did not

comply with

1 and 2

2

OneExchange

and PEBP

Enroll in

Medicare during

one of the following

months:

OneExchange

coverage

must start no

later than the

first day of

the following

month:

PEBP coverage

terms no later

than the last day

of this month:

Enroll in

OneExchange no

later than this month:

January Oct - Jan 31 Jan, Feb Jan 31 Jan 31

February Nov - Feb 28 Feb, Mar Feb 28 Feb 28

March Dec - Mar 31 Mar, Apr Mar 31 Mar 31

April Jan - Apr 30 Apr, May Apr 30 Apr 30

May Feb - May 31 May, Jun May 31 May 31

June Mar - Jun 30 Jun, Jul Jun 30 Jun 30

July Apr - Jul 31 Jul, Aug Jul 31 Jul 31

August May - Aug 31 Aug, Sept Aug 31 Aug 31

September Jun - Sep 30 Sept, Oct Sep 30 Sep 30

October Jul - Oct 31 Oct, Nov Oct 31 Oct 31

November Aug - Nov 30 Nov, Dec Nov 30 Nov 30

December Sep - Dec 31 Dec, Jan Dec 31 Dec 31

*For Medicare purposes, individuals attain age 65 the day before their actual 65th birthday and

Part A is effective on the first day of the month upon attainment of age 65.

*For individuals whose 65th birthday is on the first day of the month, Part A is effective on the

first day of the month preceding their birth month. For example, if an individual's birthday is

on December 1, Part A is effective on November 1, for Medicare purposes he or she attained

age 65 on November 30. For birthdays that occur on the first day of the month, use the

preceding month on the table to determine your enrollment period with Medicare and

OneExchange.

7

Retiree and/or Dependent with Medicare Due to SSA Disability

Medicare Effective

Date

Medicare becomes

effective on the 1st day

of the following month:

1

OneExchange

and PEBP

2

You complied with 1

3

You did not comply

with 1 and 2

Enroll in

OneExchange no

later than this

month:

OneExchange coverage must

start no later than the first day

of the following month:

PEBP coverage terms

no later than the last

day of this month

January Jan 31 Jan, Feb Jan 31

February Feb 28 Feb, Mar Feb 28

March Mar 31 Mar, Apr Mar 31

April Apr 30 Apr, May Apr 30

May May 31 May, Jun May 31

June Jun 30 Jun, Jul Jun 30

July Jul 31 Jul, Aug Jul 31

August Aug 31 Aug, Sept Aug 31

September Sep 30 Sept, Oct Sep 30

October Oct 31 Oct, Nov Oct 31

November Nov 30 Nov, Dec Nov 30

December Dec 31 Dec, Jan Dec 31

Retiree and/or dependent becomes eligible for Medicare Parts A and B due to receiving

benefits from the Social Security Administration.

The above individuals will be required to contact OneExchange to determine availability of

medical plan options and enrollment. However, if there is at least one individual covered on

the retiree’s coverage who does not have Medicare, this requirement may be waived for all

covered participants in the same coverage tier.

8

Dependent of a Non-Medicare Retiree Ages into Medicare

*For Medicare purposes, individuals attain age 65 the day before their actual 65th birthday and

Part A is effective on the first day of the month upon attainment of age 65.

*For individuals whose 65th birthday is on the first day of the month, Part A is effective on the

first day of the month preceding their birth month. For example, if an individual's birthday is

on December 1, Part A is effective on November 1, for Medicare purposes he or she attained

age 65 on November 30. For birthdays that occur on the first day of the month, use the

preceding month on the table to determine your enrollment period with Medicare and

OneExchange.

Birthday

Month

If your birthday is

on the first day of

the month see

below*

1

Medicare

Parts

A and B

3

You complied

with 1 and 2

4

You did not

comply with

1 and 2

2

OneExchange

and PEBP

Enroll in

Medicare during

one of the following

months:

OneExchange

coverage must start

no later than the first

day of the following

month:

You cannot

enroll through

OneExchange

until the retiree

ages-in or Open

Enrollment

Enroll in

OneExchange

no later than

this month:

January Oct - Jan 31 Jan, Feb - Jan 31

February Nov - Feb 28 Feb, Mar - Feb 28

March Dec - Mar 31 Mar, Apr - Mar 31

April Jan - Apr 30 Apr, May - Apr 30

May Feb - May 31 May, Jun - May 31

June Mar - Jun 30 Jun, Jul - Jun 30

July Apr - Jul 31 Jul, Aug - Jul 31

August May - Aug 31 Aug, Sept - Aug 31

September Jun - Sep 30 Sept, Oct - Sep 30

October Jul - Oct 31 Oct, Nov - Oct 31

November Aug - Nov 30 Nov, Dec - Nov 30

December Sep - Dec 31 Dec, Jan - Dec 31

9

Employee Retires at Age 65 or Older

Month of

retirement

1

Medicare

Parts

A and B

3

You complied

with 1 and 2

4

You did not

comply with

1 and 2

2

OneExchange

and PEBP

Enroll in

Medicare prior to or

during

one of these

months:

OneExchange

coverage must

start no later than

the first day of

the following:

PEBP coverage

terms no later

than the last day

of the following:

Enroll in

OneExchange no

later than the

following:

January Oct - Mar Feb, Mar or Apr Jan, Feb or Mar Mar 31

February Nov - Apr Mar , Apr or

May Feb, Mar or Apr Apr 30

March Dec - May Apr, May or Jun Mar, Apr or May May 31

April Jan - Jun May, Jun or Jul Apr, May or Jun Jun 30

May Feb - Jul Jun, Jul or Aug May, Jun or Jul Jul 31

June Mar - Aug Jul, Aug or Sept Jun, Jul or Aug Aug 31

July Apr - Sept Aug, Sept or Oct Jul, Aug or Sept Sept 30

August May - Oct Sept, Oct or Nov Aug, Sept or Oct Oct 31

September Jun - Nov Oct, Nov or Dec Sept, Oct or Nov Nov 30

October Jul - Dec Nov, Dec or Jan Oct, Nov or Dec Dec 31

November Aug - Jan Dec, Jan or Feb Nov, Dec or Jan Jan 31

December Sep - Feb Jan 1, Feb or

Mar Dec, Jan or Feb Feb 28

Generally, the effective date of your retirement is the first day of the month following the

month you terminate employment.

Example: Employee terminates employment November 14 and retires November 15. The

effective date of retiree health insurance coverage is December 1. In this example, the Medi-

care retiree must enroll in medical coverage through OneExchange by January 31 for cover-

age to begin February 1. Failure to enroll as indicated on the table above will result in termi-

nation of coverage.

10

OneExchange - Health Reimbursement Arrangement

(OneExchange-HRA)

Retirees enrolled in a medical plan through OneExchange receive a monthly years of service

contribution to an Exchange Health Reimbursement Arrangement (OneExchange-HRA).

The monthly tax-exempt contribution is $11 per month, per year of service, beginning with

five years ($55) to a maximum of twenty years of service ($220). Individuals who retired

before January 1, 1994, receive a flat $165 per month. Note: Employees hired after January

1, 2010, who retire with fewer than 15 years of service do not qualify for the OneExchange-

HRA contribution.

Retirees with an employment hiring date on or after January 1, 2012, dependents and survi-

vors do NOT qualify for the One-Exchange HRA.

The OneExchange-HRA funds may be used for reimbursement of qualified health, dental,

and pharmacy expenses, Medicare Part B premiums and qualifying out-of-pocket health care

expenses for both retirees and their dependents as defined by IRS Publication 502 available

at www.irs.gov.

Retiring employees aged 65 or older will receive HRA funding concurrent with the medical

plan effective date through OneExchange.

I M P O R T A N T !

Eligible retirees who enroll in and maintain coverage in a medical plan through

OneExchange receive a Years of Service OneExchange-HRA contribution based upon the

retirement date and years of service (earned service credit only). Contributions commence

concurrent with the effective date of the medical coverage through OneExchange.

HRA Contribution Eligibility (NRS 287.046 (6) (a) (b): To receive the PEBP HRA contri-

bution, an eligible retiree must enroll in and maintain an individual medical insurance policy

through the PEBP sponsored Towers Watson OneExchange. If the eligible retiree does not

enroll and maintain medical coverage as described above, the eligible retiree will NOT re-

ceive the HRA contribution amount and will lose their PEBP sponsored benefits entirely.

This policy also applies to eligible retirees who have health coverage under TRICARE or

under a policy or plan provided by his or her spouse’s or domestic partner’s employer.

Please note that during the Medicare Open Enrollment Period which is held each year from

October 15 through December 7, you may be inundated with mailings and solicitations from

other insurance companies and brokers that offer the same medical plans as OneExchange.

However, these companies and individuals are not associated with PEBP or OneExchange,

and changing your medical plan outside of OneExchange will terminate your association

with PEBP. To ensure you continue receiving these benefits, you must continue your current

medical coverage or select a different medical plan through OneExchange (you must be en-

rolled in a medical plan through OneExchange to remain eligible for HRA and life insur-

ance benefits).

11

PEBP Dental Plan Option

Retirees and covered spouses/domestic partners enrolled in a medical plan through

OneExchange who want to elect the PEBP Dental Plan must complete the Retiree Benefit

Enrollment and Change Form (or Benefit Enrollment and Change Form for Unsubsidized

Dependents) and select Exchange with PEBP Dental. The completed form must be received

in the PEBP office on or before the medical plan effective date through OneExchange.

By electing the PEBP Dental Plan you will be required to maintain dental coverage through-

out the Plan year unless you terminate your medical plan through OneExchange. Changes to

the PEBP Dental Plan may be completed during PEBP’s annual open enrollment period.

Unsubsidized Rates

State Retiree Dependents PPO Plan HMO

Child or Spouse/Domestic Partner 580.78 730.30

Children 765.62 1,052.65

Spouse/DP + Child(ren) 765.62 1,052.65

Unsubsidized Rates

Non-State Retiree Dependents

PPO Plan HMO

Child or Spouse/Domestic Partner 957.06 777.70

Children 1,700.53 1,152.52

Spouse/DP + Child(ren) 1,700.53 1,152.52

Voluntary Dental Coverage Option for Medicare Retirees Optional dental coverage for participants enrolled in an OneExchange Medical Plan

Voluntary Dental Coverage State Retiree Rate Non-State Retiree Rate

Retiree only 35.34 35.75

Retiree + Spouse/DP 70.67 71.51

Surviving/Unsubsidized Spouse/DP 35.34 35.75

To enroll in PEBP dental coverage, select Exchange with PEBP dental when

completing your enrollment form. Note: Retirees paid through PERS will pay their

monthly premium through PERS deductions.

Unsubsidized Dependent Rates

12

Contact Information

Public Employees’ Benefits Program 901 South Stewart Street, Suite 1001

775-684-7000 or 800-326-5496

www.pebp.state.nv.us

mservices@peb.state.nv.us

Towers Watson OneExchange 888-598-7545

www.ExtendHealth.com/PEBP

Social Security Administration 800-772-1213

www.ssa.gov

Centers for Medicare and Medicaid Services 800-633-4227

www.cms.gov