Presenters:Tina Petrie, Director of Salary Administration and

BenefitsKathy Eghoian, Senior Specialist - Benefits

Information Session Goals

Discuss Changes Effective 07/01/2011

Q & A

Everyone Must Enroll Online This Year

If you plan to make a change, decline coverage, continue with your existing coverage, or continue to decline coverage, you will have to take action during Open Enrollment.

Deadline May 31, 2011

Everyone Must Enroll Online This Year - Continued

If you do not take any action, you will automatically be enrolled in (defaulted) in the Consumer Driven PPO High Deductible Plan with a PPO-HRA, Participant Only Coverage at $43.90 per month.

What is a PPO PlanA network of doctors and healthcare facilities

that provides medical services at discounted rates.

The Consumer Driven PPO High Deductible Health Plan allows participants the choice of using contracted (in-network) or non-contracted (out-of-network) medical providers, both in-state (Nevada) and out-of-state.

The CD PPO HDHP plan offers access to services worldwide.

CD PPO HDHP Plan Annual Deductible

Single coverage individuals: $1,900.00Two or more persons: $3,800.00 family

deductible.The deductible applies when two or more

individuals are covered on the plan. The Plan will begin to pay benefits for one individual in the family once that person meets the $2,400 Individual Family Medical Deductible. The balance of the Family Deductible ($1,400) must be met by one or more other members of the family before the Plan will pay benefits for those other family members.

Deductible AmountsPlan Year 2011

Deductible Type Individual Family

Annual Medical (CD PPO HDHP)

$1,900.00 $3,800.00

Annual Dental (CD PPO HDHP and HMO)

$100.00 $300.00 (3 or more )

Annual Prescription (CD PPO HDHP)

$1,900 (Part of Medical)

$3,800 (Part of Medical)

CoinsuranceA coinsurance is the portion of the expense

the employee is responsible for paying after the deductible.

The maximum coinsurance amount you pay during the year excluding copayments is called the out-of-pocket expense ($3,900 individual/$7,800 family – per plan year).

Note: Standard amounts charged by non-contracted healthcare providers are referred to as Usual and Customary charges.

The Health Maintenance Organization (HMO Plan)

Name of Plan for Southern Nevada is Health Plan of Nevada (HPN)

Fully insured plan which uses a pre-defined group of doctors, facilities, and other health care professionals. (Note: out -of -pocket maximum is $6,800 per person per calendar year).

Participants choose a Primary Care Physician who coordinates their medical treatment .

The HMO Plan is limited to a specific service area (Southern Nevada only).

The plan is not portable for those traveling out of the Southern Nevada area. (Exceptions will be made for out of area medical emergencies only).

Scope of Dental CoverageRegardless of the medical plan chosen all employees

participate ina self-funded PPO dental plan (Diversified Dental Services).Coverage is offered for preventive services (routine exams

and up to 4 cleanings per year). In-network provider service is paid at 100%.

Coverage is offered for basic services (full mouth x-rays, fillings, simple extractions, root canals). The plan pays for in-network service 75% (after deductible).

Coverage is offered for major services (single crown, bridgework, dentures, tooth implants). The plan pays for in-network service 50% (after deductible).

Pharmacy Plan ComparisonRetail Pharmacy - 30 day supply

Category CD PPO HDHP Plan Health Plan of Nevada

Preferred Generic (Tier 1)

25% after deductible $7 copayment

Preferred Brand (Tier 2)

25% after deductible $35 copayment

Non-Preferred (Tier 3)

100% of contracted priceDoes not apply to deductible or out of pocket

$55 copayment

Specialty Drugs 25% after deductible – available in 30 day supply only through Walgreen pharmacies

Applicable retail pharmacy copayment will apply

Pharmacy Plan ComparisonMail Order - 90 day supply

Category Self-Funded PPO Plan

Health Plan of Nevada

Preferred Generic (Tier 1)

25% after deductible $14 copayment

Preferred Brand (Tier 2)

25% after deductible $70 copayment

Non-formulary (Tier 3)

100% of contracted price - does not apply to deductible or out of pocket

Not available through mail order

Specialty Drugs 25% after deductible, available in 30 day supply only through Walgreens mail order

Applicable retail pharmacy copayment applies, copayment applies

Vision Plan ComparisonCategory

CD PPO HDHP Plan

Health Plan of Nevada (Must use provider on EyeMed Vision Care list)

Vision exam One exam every 12 months, paid at 75% Usual & Customary (U&C) after deductible

$10 copayment every 12 calendar months

Hardware (frames, lenses, contacts)

N/A $10 copayment/lenses frames - $100 allowance, contacts $115 in lieu of glasses

CD PPO HDHP Wellness/Preventive Care Benefit (Only for the CD PPO HDHP Plan)

The CD PPO HDHP Wellness Benefit provides a(per person, per plan year) benefit to participants and their covered dependents. Preventive care benefits are not subject to the plan year deductible.

The Wellness Benefit is available only when using in-network PPO providers. ( Note: Wellness benefits are healthcare services that are not provided as a result of illness, injury or congenital defect.)

Self-funded PPO Wellness/Preventive Care Benefit (Only for the CD PPO HDHP Plan)

For example, the following preventive screenings are covered under the PPO Wellness Benefit: Physical Exam, Screening Lab and X-rays Well-child Examinations and Immunizations Prostate Screening (e.g., PSA blood test) Hypertension ScreeningScreening Mammogram Pelvic Exam and Pap Smear Skin Cancer Screening

Life Insurance

Through The Standard Insurance Company, the employee has a $10,000 basic life insurance policy.

Long Term DisabilityThrough The Standard Insurance Company,

the employee, as part of the benefits package, has eligibility for Long Term Disability.

The monthly LTD benefit amount is 60% of monthly earnings up to a maximum of $7,500 per month (less any deductible sources of income and disability earnings).

The minimum monthly payment after subtracting deductible sources of income is $100.00

Medical Plan Comparison Benefit Category CD PPO HDHP Plan Health Plan of

Nevada

Medical deductible Amount You Pay In-Network$1,900 individual $3,800 family (per plan year)

Amount You Pay In-NetworkNo deductible

Out-of-pocket maximum

$3,900 person $7,800 family (per plan year)

$6,800 person (per calendar year)

Hospital inpatient 25% coinsurance after deductible

$200 copayment per admission

Outpatient Same Day Surgery

25% coinsurance after deductible

$50 copayment per admission

Medical Plan Comparison (continued)

Benefit Category CD PPO HDHP Plan Health Plan of Nevada

Primary care visit 25% coinsurance after deductible

$15 copayment

Specialist visit 25% coinsurance after deductible

$15 copayment

Urgent Care visit 25% coinsurance after deductible

$15 copayment

Emergency room visit 25% coinsurance after deductible

$50 copayment, plus $25 physician copayment

General laboratory services

25% coinsurance after deductible

No charge

Monthly Premiums for Plan YearJuly 1, 2011

COVERAGE CD PPO HDHP

Deductible

$1,900/$3,800

HMONo Deductible

EMPLOYEE $43.90 $116.57

EMPLOYEE + SPOUSE $198.40 $338.16

EMPLOYEE + CHILD(REN)

$91.71 $225.25

EMPLOYEE + FAMILY $246.23 $446.84

Monthly Premiums for Plan Year July 1, 2011

Domestic PartnersEMPLOYEE/DOMESTIC PARTNER (DP) COVERAGE

CD PPO HDHP

Deductible $1,900/$3,800

HMO

EMPLOYEE PLUS DP $611.91 $641.67

EMPLOYEE + DP’S CHILD(REN) $219.67 $374.10

EMPLOYEE + CHILDREN OF BOTH $91.71 $225.25

EMPLOYEE + DP + EMPLOYEE’S CHILD(REN)

$659.81 $750.35

EMPLOYEE + DP + DP’S CHILD(REN) $787.77 $899.20

EMPLOYEE + DP + CHILDREN OF BOTH $659.81 $750.35

What is a Health Savings Account? (HSA)

A Health Savings Account (HSA) is an account owned by the employee that is used to pay for eligible health care expenses.

The employer can contribute funds to the HSA and the employee may also contribute money to the account on a pre-tax basis.

Contributions, investment earnings and distributions are tax free as long as the money is used only for eligible healthcare expenses.

Funds deposited in the HSA can be carried over from year to year.

Eligibility for Health Savings Account (HSA)

Must be covered under a high deductible plan

You are not enrolled in MedicareYou cannot be claimed as a dependent on someone else’s tax return

Health Savings Account Summary for Active Employees

Accounts are owned by the employeeAnnual contribution limits to the HSA

(combination of employer and employee). For example, the following limits are for 2011:$3,050 for Employee$6,150 for Family

Income tax reporting requirementsPortable –If you leave, the money is yours to take

with youOnly used for medical related costs without

incurring tax and/or penalty

Specific Plan Design ChangesMedical Plan ChangesEliminate lab tests performed at hospitals except

for pre-admit, urgent care, emergency room and in-patient admissions

Reduce TMJ coverage from 80% to 50%Allow for 90 day supply of certain retail drugsEliminate vision coverage except for annual eye

examEliminate coverage for spouse/domestic partner

with other employer based coverageRemove “or as needed” from Wellness/Preventive

guidelines

Other Benefit Changes

Federal Healthcare Reform ActCoverage will be available for dependent children to age 26 regardless of full time student status

Lifetime limits removed

PEBP Website (www.pebp.state.nv.us) 2012 Open Enrollment Guide

Frequently Asked QuestionsBoard Meeting InformationLegislative Updates

If you have any questions after this session, please contact the Office of Human Resources at x5800 or HRcustomerservice@csn.edu.

Thank you.