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
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 Plan with Copay | 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 / $3,000 | $0 / $0 | N/A (only applicable to Tier 4 Specialty Prescriptions) |
| (Individual deductible within family plan) | $2,800 | $0 | N/A (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 | $4,000 | $5,000 |
| Coinsurance | 20% | 20% | N/A |
| Primary care visit | 20% after deductible | $30 | $25 |
| Specialist visit | 20% after deductible | $50 | $25 with a referral, $40 without a referral |
| 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 | $50 ambulatory facility, $350 hospital |
| Telemedicine | $49 (Dr. On Demand) | $10 (Dr. On Demand) | $0 (24/7 Advice Nurse) |
Prescription Benefits Overview
| RX | Statewide CDHP - PPO | Low-Deductible PPO Plan with Copay | 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 for 30-day retail, $80 for 90-day retail and mail | $40 for 30-day retail, $80 for 90-day mail |
| Non-formulary | 20% after deductible | $75 for 30-day retail, $150 for 90-day retail and mail | $75 for 30-day retail, $187.50 for 90-day mail |
| Specialty | 20% after deductible | 30% after deductible | 20% after deductible ($100 individual, $200 family) |
| All other services | 20% after deductible | 20% after deductible | N/A |
Please note:
Starting January 1, 2023, prescriptions will not be covered by your plan if filled at a Smith's Food and Drug Pharmacy. If you continue to fill them there, you may pay a higher cost for your medications. Express-Scripts recommends that in order to avoid any interruption in your treatment, you transfer your prescription before January 1, 2023 to an in-network pharmacy. You may find one by visiting express-scripts.com/findapharmacy
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 Plan with Copay | 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 | Plan pays 80% after deductible | $10 copay, maximum benefit of $100 per annual exam* | $10 copay, maximum benefit of $100 per annual exam |
| Hardware (Frames, Lenses, Contacts) | Not covered | $10 copay for prescription eyeglasses, maximum benefit of $100 every 24 months | $10 copay for prescription eyeglasses, maximum benefit of $100 every 24 months |
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*Out-of-network providers will be paid at Usual and Customary (U&C). One annual vision exam, up to a maximum annual benefit after copayment. For additional information about the voluntary buy-up vision plan, log in to your E-PEBP portal and select PEBP+ Voluntary Benefits. |
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Dental Benefits Overview
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|---|---|---|---|
| In-Network | Out-of-Network | ||
| Locate a Provider | Diversified Dental Services | Diversified Dental Services | |
| Plan Year Maximum | $2,000 per person | $2,000 per person | |
| Plan Year Deductible | $100 per person or $300 per family (3 or more) | $100 per person or $300 per family (3 or more) | |
| Preventive Services** Teeth cleaning (4/plan year), oral examination (4/plan year), bitewing x-rays (2/plan year) |
Covered 100% Not subject to deductible Does not apply towards plan year max benefit |
80% of allowable fee schedule for the Las Vegas area for participants using an out-of-network provider within the in-network service area; OR for services received outside of Nevada, the plan will reimburse at the usual and customary rates | |
| Basic Services** Full-mouth periodontal cleanings, fillings, extractions, root canals, full-mouth x-rays |
You pay 20% coinsurance after deductible is met | 50% (after deductible) of allowable fee schedule for the Las Vegas area for participants using an out-of-network provider within the in-network service area; OR for services received outside of Nevada, the plan will reimburse at the usual and customary rates | |
| Major Services Bridges, crowns, dentures, tooth implants |
You pay 50% coinsurance after deductible is met | 50% (after deductible) of allowable fee schedule for the Las Vegas area for participants using an out-of-network provider within the in-network service area; OR for services received outside of Nevada, the plan will reimburse at the usual and customary rates | |
| Orthodontia Services | No benefit | No benefit | |
| **Allowable fee schedule applies. Family deductible may be met by any combination of eligible dental expenses of three or more members of the same family coverage tier. No one single family member will be required to contribute more than the equivalent of the individual deductible toward the family deductible. Under no circumstances will the combination of in-network and out-of-network benefit payments exceed the plan year maximum benefit of $2,000. | |||
Health Savings Account vs Health Reimbursement Arrangement
Base contribution 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 2023(optional) | Limit $3,850 for individual coverage or $7,750 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 the plan year. |
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Basic Life Insurance
| CDHP - PPO and HMO | |
|---|---|
| Basic Life Insurance | $25,000/ 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
- State of Nevada Office of Consumer Health Assistance
- Virtual Health Care Provider Services
- Voluntary Benefits