Health Insurance Plans
UNLV's group health plan offers a comprehensive medical package that includes your choice of a health insurance plan, dental, vision, prescription, and a $15,000 term basic life insurance plan.
News from the Public Employees' Benefits Program
Open Enrollment
Eligibility Overview
Coverage for benefit eligible positions begins on the first day of the month concurrent with, or following, the effective date of your date of hire. If your position begins after the first day of the month, your coverage will not begin until the first day of the following month.
Coverage ends the last day of the month in which your employment ends.
Employees eligible for health insurance coverage include:
- Academic and Administrative Faculty at least 50% Full Time Employment (FTE).
- Classified Staff (working at least 80 hours per month)
- Post-Doctoral Scholars
- Letter of Appointment at least 50% FTE
- Part Time Instructors (benefit eligibility depends on number of credits teaching per semester). Refer to chart for months eligible for health insurance by each semester teaching.
| Term | Month(s) |
|---|---|
| Spring | February - May |
| Summer Term 1 | June |
| Summer Term 2 | July |
| Summer Term 3 | August |
| Fall | September - December |
Monthly Premium Rates
| Plan Type | Statewide CDHP-PPO | Low Deductible PPO | HMO |
|---|---|---|---|
| Employee Only | $46.96 | $68.14 | $161.00 |
| Employee + Spouse | $251.00 | $293.36 | $479.10 |
| Employee + Child(ren) | $123.46 | $152.60 | $280.30 |
| Employee + Family | $327.52 | $377.82 | $598.40 |
Medical Benefits Overview
| Statewide CDHP-PPO | Low Deductible PPO | HMO | |
|---|---|---|---|
| Find a Provider | United Medical Resources (UMR) Sierra Health-Care Options | United Medical Resources (UMR) Sierra Health-Care Options | Medical - My HPN State of Nevada |
| Deductible | $1,500 / $3,500 | $0.00 / $0.00 | $100 / $200 (Only applicable to Tier 4 Specialty Prescriptions) |
| (Individual deductible within family plan) | $2,800 | $0.00 | $100 (Only applicable to Tier 4 Specialty Prescriptions) |
| Out of pocket max | $4,000 / $8,000 | $4,000 / $8,000 | $5,000 / $10,000 |
| (Individual out of pocket max within family plan) | $6,850 | $5000 | $5000 |
| Coinsurance | 20% | 20% | N/A |
| Primary care visit | 20% after deductible | $30 | $20 |
| Specialist visit | 20% after deductible | $50 | $40 |
| Emergency room visit | 20% after deductible | $750 | $600 |
| Urgent care visit | 20% after deductible | $80 | $50 |
| Inpatient hospital | 20% after deductible | 20% after deductible | $600 |
| Outpatient surgery | 20% after deductible | $500 | $350 |
Prescription Benefits Overview
| RX | Statewide CDHP - PPO | Low Deductible PPO plan | HMO |
|---|---|---|---|
| Locate a Pharmacy OR Price a Medication Tool | Express Scripts | Express Scripts | OPTUM Rx |
| Generic |
20% after deductible |
$10 | $10 |
| Formulary |
20% after deductible |
$40 | $40 |
| Non-formulary | 20% after deductible | $75 | $75 |
| Specialty | 20% after deductible | 30% after deductible | 30% after deductible |
Please note:
Eighty-nine full-service pharmacies at Save Mart and Lucky supermarkets have closed in California and northern Nevada. The affected pharmacies have chosen to transfer their existing prescriptions to Walgreens pharmacies.
This impacts PEBP members because Walgreens is out-of-network; therefore, you may be subject to additional deductibles or coinsurance if you choose to fill your prescription at a Walgreens pharmacy. PEBP strongly encourages using an in-network pharmacy to ensure the best coverage for your prescription medication. To find a pharmacy, log in to your E-PEBP portal, to access the Express Scripts site, visit express-scripts.com/findapharmacy or call Express Scripts Member Services at 855-889-7708.
For short-term medications, such as antibiotics, use an Express Advantage Network (EAN) pharmacy for lower copays and to maximize your pharmacy benefit. You may still use a nonEAN retail pharmacy, but you will pay a $10 surcharge for each short-term prescription, which does not apply toward your deductible or out-of-pocket maximum.
Long-term medications must be filled in 90-day supply increments through a participating Smart 90 pharmacy. Filling prescriptions in 30-day supply increments or using a nonparticipating Smart 90 pharmacy may result in a higher cost for your medication and will not be applied toward the deductible or out-of-pocket maximum. With the Smart 90 program, you have two ways to get up to a 90-day supply of your long-term medications:
- Express Scripts Pharmacy home delivery service to receive up to a 90-day supply of your long-term medications and have them mailed directly to your home. Please note that not all medications are available via home delivery. Some of the benefits of home delivery include free standard shipping; up to a 90-day supply of your long-term medications; 24/7 access to a pharmacist from the privacy of your home; and you can order your refills online, over the phone, or by using the Express Scripts mobile app. To take advantage of this benefit, ask your physician to write a new prescription for a 90-day supply of any long-term medications you are currently taking.
- Retail pharmacy in the Smart 90 network.
Vision Benefits Overview
| Statewide CDHP - PPO | Low Deductible PPO | HMO | |
|---|---|---|---|
| Find a Provider | No network available; can see any Vision Provider | No network available; can see any Vision Provider | Vision - My HPN State of Nevada |
| Vision Exam |
$25 copayment Maximum benefit of $95 per annual exam |
$10 copayment Maximum benefit of $100 per annual exam |
$10 copayment Maximum benefit of $100 per annual exam |
| Eyeglasses, Frames, or Contact Lenses | Not covered |
$10 copayment for prescription eyeglasses Maximum benefit of $100 every 24 months |
$10 copayment for prescription eyeglasses Maximum benefit of $100 every 24 months |
Dental Benefits Overview
|
|
||
|---|---|---|
| In-Network | Out-of-Network | |
| Locate a Provider | Diversified Dental Services | Diversified Dental Services |
| Plan Year Maximum | $1,500 per participant (per plan year) |
$1,500 per participant (per plan year) |
| Plan Year Deductible | $100 per person, $300 per family (family, 3 or more) |
$100 per person, $300 per family (family, 3 or more) |
| Preventive Care 4 cleanings and exams 2 sets of bitewing x-rays |
Plan pays 100%; not subject to deductible |
Plan pays 80%; not subject to deductible |
| Basic Services Fillings, extractions, root canals, full mouth x-rays |
Plan pays 80%; after deductible |
Plan pays 50%; after deductible |
| Major Services Bridges, crowns, dentures, tooth implants |
Plan pays 50%; after deductible |
Plan pays 50%; after deductible |
| Orthodontia Services | No Benefit | No Benefit |
Health Savings Account vs Health Reimbursement Arrangement
Only available when selecting PPO - Consumer Driven Health Plan. (Not available under Low Deductible or HMO plans)
| Health Savings Account | Health Reimbursement Account | |
|---|---|---|
| Description | Owned by employee and portable | PEBP owned and funded |
| Employee Contributions 2022(optional) | Limit $3,650 for individual coverage or $7,300 for family coverage (2 or more), additional $1,000 for catch up for 55 years or older | Not Permitted |
| Base Contribution |
Prorated if hired during plan year. |
|
Basic Life Insurance
| CDHP - PPO and HMO | |
|---|---|
| Basic Life Insurance | $15,000/ Employee |
| Whether you choose the CDHP or the HMO Plan, you receive these benefits. If you decline coverage, you will not be eligible for these benefits. | |
Resources
CDHP/PPO Resources
Additional Resources
- Benefit Provider Information
- Comparison of Health Plans
- Flexible Spending Account
- Guide to your Health Concerns
- Medicare and your university health insurance coverage
- Open Enrollment Information
- Patient Protection and Affordable Care Act
- PEBP's E-PEBP Portal
- Public Employee Benefits Program
- PY 2023 All Rates
- Qualifying Life Event Guide
- Virtual Health Care Provider Services
- Voluntary Benefits