PEBP and Medicare. Public Employees Benefits Program

PEBP and Medicare 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 PLAN YEAR 2016 July 1, 2015 - June 30, 2016

Table of Contents Introduction Medicare Parts A and B.... 1 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 - Health Reimbursement Arrangement (-HRA).. 10 PEBP Dental Plan Option... 11 Unsubsidized Dependent Rates.. 11 Contact Information 12 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 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 (formerly Extend Health) For questions related to medical, dental, prescription drug, and vision plans offered through the Medicare exchange, please call 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. 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

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. 2

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. 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 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 ; however, medical coverage through 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 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 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. 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. 3

Required Action Retiree with Medicare Parts A and B (no covered dependents). Retiree must enroll for medical coverage through. Submit a copy of the Medicare Parts A and B card to the PEBP office. Contact 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, but must transition to 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 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 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 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, do the following: Medicare dependent contacts 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. 4

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, do the following: Medicare dependent contacts 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. 5

Retiree Ages into Medicare AFTER Retirement Birthday Month 1 Medicare Parts A and B 2 and PEBP 3 You complied with 1 and 2 4 You did not comply with 1 and 2 If your birthday is on the first day of the month see below* Enroll in Medicare during one of the following months: Enroll in no later than this month: 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 Oct - Jan 31 Jan 31 Jan, Feb Jan 31 February Nov - Feb 28 Feb 28 Feb, Mar Feb 28 March Dec - Mar 31 Mar 31 Mar, Apr Mar 31 April Jan - Apr 30 Apr 30 Apr, May Apr 30 May Feb - May 31 May 31 May, Jun May 31 June Mar - Jun 30 Jun 30 Jun, Jul Jun 30 July Apr - Jul 31 Jul 31 Jul, Aug Jul 31 August May - Aug 31 Aug 31 Aug, Sept Aug 31 September Jun - Sep 30 Sep 30 Sept, Oct Sep 30 October Jul - Oct 31 Oct 31 Oct, Nov Oct 31 November Aug - Nov 30 Nov 30 Nov, Dec Nov 30 December Sep - Dec 31 Dec 31 Dec, Jan 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. 6

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 and PEBP Enroll in no later than this month: 2 You complied with 1 coverage must start no later than the first day of the following month: 3 You did not comply with 1 and 2 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 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. 7

Dependent of a Non-Medicare Retiree Ages into Medicare Birthday Month 1 Medicare Parts A and B 2 and PEBP 3 You complied with 1 and 2 4 You did not comply with 1 and 2 If your birthday is on the first day of the month see below* Enroll in Medicare during one of the following months: Enroll in no later than this month: coverage must start no later than the first day of the following month: You cannot enroll through until the retiree ages-in or Open Enrollment January Oct - Jan 31 Jan 31 Jan, Feb - February Nov - Feb 28 Feb 28 Feb, Mar - March Dec - Mar 31 Mar 31 Mar, Apr - April Jan - Apr 30 Apr 30 Apr, May - May Feb - May 31 May 31 May, Jun - June Mar - Jun 30 Jun 30 Jun, Jul - July Apr - Jul 31 Jul 31 Jul, Aug - August May - Aug 31 Aug 31 Aug, Sept - September Jun - Sep 30 Sep 30 Sept, Oct - October Jul - Oct 31 Oct 31 Oct, Nov - November Aug - Nov 30 Nov 30 Nov, Dec - December Sep - Dec 31 Dec 31 Dec, Jan - *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. 8

Employee Retires at Age 65 or Older 1 Medicare Parts A and B 2 and PEBP 3 You complied with 1 and 2 4 You did not comply with 1 and 2 Month of retirement Enroll in Medicare prior to or during one of these months: Enroll in no later than the following: coverage must start no later than the first day of the following: PEBP coverage terms no later than the last day of the following: January Oct - Mar Mar 31 Feb, Mar or Apr Jan, Feb or Mar February Nov - Apr Apr 30 Mar, Apr or May Feb, Mar or Apr March Dec - May May 31 Apr, May or Jun Mar, Apr or May April Jan - Jun Jun 30 May, Jun or Jul Apr, May or Jun May Feb - Jul Jul 31 Jun, Jul or Aug May, Jun or Jul June Mar - Aug Aug 31 Jul, Aug or Sept Jun, Jul or Aug July Apr - Sept Sept 30 Aug, Sept or Oct Jul, Aug or Sept August May - Oct Oct 31 Sept, Oct or Nov Aug, Sept or Oct September Jun - Nov Nov 30 Oct, Nov or Dec Sept, Oct or Nov October Jul - Dec Dec 31 Nov, Dec or Jan Oct, Nov or Dec November Aug - Jan Jan 31 Dec, Jan or Feb Nov, Dec or Jan December Sep - Feb Feb 28 Jan 1, Feb or Mar Dec, Jan or Feb 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 Medicare retiree must enroll in medical coverage through by January 31 for coverage to begin February 1. Failure to enroll as indicated on the table above will result in termination of coverage. 9

- Health Reimbursement Arrangement (-HRA) Retirees enrolled in a medical plan through receive a monthly years of service contribution to an Exchange Health Reimbursement Arrangement (-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 - HRA contribution. Retirees with an employment hiring date on or after January 1, 2012, dependents and survivors do NOT qualify for the One-Exchange HRA. The -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. I M P O R T A N T! Eligible retirees who enroll in and maintain coverage in a medical plan through receive a Years of Service -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. HRA Contribution Eligibility (NRS 287.046 (6) (a) (b): To receive the PEBP HRA contribution, an eligible retiree must enroll in and maintain an individual medical insurance policy through the PEBP sponsored Towers Watson. If the eligible retiree does not enroll and maintain medical coverage as described above, the eligible retiree will NOT receive 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. However, these companies and individuals are not associated with PEBP or, and changing your medical plan outside of 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 (you must be enrolled in a medical plan through to remain eligible for HRA and life insurance benefits). 10

PEBP Dental Plan Option Retirees and covered spouses/domestic partners enrolled in a medical plan through 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. By electing the PEBP Dental Plan you will be required to maintain dental coverage throughout the Plan year unless you terminate your medical plan through. Changes to the PEBP Dental Plan may be completed during PEBP s annual open enrollment period. Voluntary Dental Coverage Option for Medicare Retirees Optional dental coverage for participants enrolled in an 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 Unsubsidized Rates PPO Plan HMO State Retiree Dependents 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 11

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 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 12