Public Employees’ Benefits Program901 S. Stewart Street, Suite 1001
Carson City, NV 89701www.pebp.state.nv.us
[email protected] . 1-800-326-5496
Public Employee’sBenefits Program
Pre-Medicare Age In Presentation Plan Year 2019
July 1, 2018 – June 30, 2019
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• Preparing for Medicare Enrollment
• Who Qualifies for Medicare?
• PEBP’s Medicare Requirements
• Enrollment Options
• Who is Via Benefits?
• PEBP Dental Plan Option
• CDHP HRA vs Via Benefits HRA
• How the HRA through Via Benefits Works
• Importance of Maintaining Enrollment through Via Benefits
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Today’s Topics
Happy Birthday! Approximately 2 months before your
65th birthday, PEBP will mail you:
•Happy Birthday letter
•PEBP and Medicare Guide
•Retiree Benefit Enrollment and Change Form - RBECF
*If not received about 6 weeks prior to your birthday month please call PEBP Member
Services to be sure it is on its way*
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It’s as easy as 1-2-3 (4-5)
Contact the Social Security Administration and enroll in Medicare A+B (as eligible)
Send PEBP a copy of your Medicare A+B card (fax, email, mail, walk-in)
Mail PEBP the original Retiree Benefit Enrollment and Change Form-RBECF
Call and schedule an appointment with a licensed benefit advisor and complete your enrollment with Via Benefits over the phone
Wait for your funding packet to arrive from Via Benefits (this can take between 8-12 weeks from your effective date)
Step 1
Who Qualifies for Medicare?
PEBP’s Medicare Requirements
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Premium-Free Medicare Part A
You or your spouse (or former spouse of 10 years) have at least 40 credits (10 years) of work in
any job in which you paid Social Security taxes
or
You are eligible for Railroad Retirement benefits
or
You are under age 65 and approved for Social Security Disability benefits
Please call Social Security to verify your Medicare Eligibility
1-800-772-1213
Note: Everyone age 65 or older can purchase Medicare Part B
CURRENTLY RETIREDApproaching 65th birthday
• Enroll in premium-free Part A*
• Must purchase Medicare Part B
NEWLY RETIRINGAfter age 65
(60-90 days prior to retirement)
• Enroll in premium-free Part A*
• Must purchase Medicare Part B
TRICARE
• Copy of Military identification card (front and back)
• Copy of Medicare A & B card
SPOUSE/DP
Medicare requirements also apply to covered spouses and
domestic partners
ACTIVE EMPLOYEE
Not required to enroll in Medicare until 60-90 days
prior to retirement
CURRENTLY RETIREDUnder 65 and approved for Social
Security Disability benefits
• Enroll in premium-free Part A*
• Must purchase Part B after SSA’s 24 month waiting period
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PEBP’s Medicare Requirements
*Eligibility requirements apply for premium-free Medicare Part A.
Contact the Social Security Administration (SSA) to check your Medicare eligibility.
Steps 2 and 3
Sending In Your Paperwork
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Retiree or newly retiring Medicare A + BNo covered Dependents
Must enroll at Via Benefits
Copy of Medicare A+B card to PEBP
Mail RBECF to elect or decline dental
Newly retiring? Enroll in Medicare A+B 60-90 days prior to retirement
Retiree with Medicare A + B Covering non-Medicare Dependent
Retiree may stay on PEBP PPO, EPO or HMO with dependent(s)
OR
Retiree may enroll at Via Benefits
Dependent(s) may stay on PEBP or terminate coverage
Copy of Medicare A+B card to PEBP
Mail RBECF to elect or decline dental
Retiree or newly retiring NOT eligible for free Medicare Part A
May remain on PPO, EPO or HMO
Must purchase Medicare Part B
Obtain Social Security Eligibility Letter- lack of credits
Complete RBECF
Submit all documents to PEBP
Monthly premium reduced by $134 after receipt of Medicare Part B card
Active- Not yet Retiring
Not required to enroll in Medicare
If Medicare is obtained, submit copy of card to PEBP
CDHP HSA will become HRA (if applicable)
RBECF = Retiree Benefit Enrollment & Change Form Via Benefits = Medicare Exchange
Retiree or newly retiring Medicare A + B and Tricare
Not required to enroll at Via Benefits
Copy of Medicare A+B card and Military ID (front and back) to PEBP
Mail RBECF to elect or decline dental
PEBP’s Medicare Enrollment
Step 4
Who is Via Benefits?
Your Future Coverage
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Almost Done
• First and Largest Individual Medicare Market Exchange
• Licensed advisors provide guidance and ongoing advocacy
• Personalized options with plans from a nationwide network
Who is Via Benefits?
1. Prepare for making your medical and pharmacy plan selections by reading all material PEBP will mail to you about 2 months prior to your 65th birthday
2. Get Medicare card, doctor, hospital and prescription information ready, then:
a. Call Via Benefits at 1-888-598-7545 to complete your profile and schedule an enrollment appointment with a certified licensed benefit advisor (LBA)
or
b. Setup an online personal profile through Via Benefits at My.ViaBenefits.com/PEBP and start to “shop” for plans
3. Complete enrollment by calling and speaking to a licensed benefit advisor
4. Wait for your HRA funding packet to arrive from Via Benefits (8-12 weeks)
What to Do Next
YOU’VE ALREADY:
Enrolled in Medicare A+B (Original Medicare) through Social Security, as eligible
└› Medicare provides about
80% coverage and will be your primary coverage
Provided proof of your Medicare enrollment by sending PEBP a copy of your Medicare A/B card
Mail your original RBECF to elect or decline PEBP dental coverage and change your status to “Medicare Eligible”
Via Benefits will now manage your new plan and funding account.
The Via Benefits Process
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Via Benefits Process
Step 3: Manage After Enrollment
HRA funding for eligible retirees
Advocacy assistance, claims support, network provider assistance, etc.
Step 2: Enrollment
Via Benefits Application Data Processor will assist you with the telephonic
enrollment process.
Step 1: Evaluate plan options
A Licensed Benefit Advisor will assist you with selecting: medical, prescription drug, dental and/or
vision coverage that fits your medical requirements and budget.
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Your Future Coverage
Primary CoverageMedicare A and B
How Medicare Coverage Works
Medicare Options
Option 1 –Medicare Advantage Plan
Option 2- Medigap/Supplement Plan
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PPOHMO
Medicare Advantage plans are generally network based plans.
Option 1Medicare Advantage with Prescription Drug Coverage (MAPD)
18Note: You may need to pay your first premium when you initially enroll.
MEDIGAPPLAN
PART DPDP+
Option 2Medicare Supplement Insurance (Medigap) +
Part D Prescription Drug Plan (PDP)
Benefits A B C D F* G K L M N
Part A coinsurance and hospital
costs up to an additional 365 days
after Medicare benefits are used up
100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Part B coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%***
Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Part A hospice care coinsurance or
copayment100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Skilled nursing facility care
coinsurance100% 100% 100% 100% 50% 75% 100% 100%
Part A deductible 100% 100% 100% 100% 100% 50% 75% 50% 100%
Part B deductible 100% 100%
Part B excess charges No No 100% 100%
Foreign travel exchange(up to plan limits)
80% 80% 80% 80% 80% 80%
Out-of-pocket limit**
2018 Out of pocket limit
$5,240 $2,620
Medicare Supplement Insurance (Medigap)- Lettered Policies
Source: www.medicare.gov* Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,200 in 2018 before your Medigap plan pays anything.
** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in inpatient admission.
Please discuss all of your options with a Licensed Benefit Advisor.
• Medical plan through Via Benefits = option to elect the PEBP Dental Plan.
• Effective for entire plan year (July 1-June 30).
• A Retiree Benefit Enrollment and Change Form (RBECF) is required to elect or decline dental coverage.
• No paper claim required for reimbursement. Will occur automatically.
• Dental premium will be deducted from your PERS pension in most cases.
PEBP Dental Option
Plan Year 2018 Dental Premium State RetireeNon-State
Retiree
Retiree Only $40.63 $41.06
Retiree + Spouse/DP* $81.26 $82.13
*Spouse/DP must also have a medical plan through Via Benefits in order to elect PEBP dental.
Step 5
Funding and Health Reimbursement Arrangements (HRA)
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PEBP offers two types of HRAs:
Consumer Driven Health Plan (CDHP/PPO)
• Funded on an annual basis on July 1st
• Funded according to participant tier: $700 retiree and $200 per covered dependent (maximum 3)
• Once transitioned to Via Benefits, remaining funds are no longer available
Via Benefits HRA
• Funded on a monthly basis
• Funded according to the retirees’ years of service (5-20 YOS) and retirement date
Via Benefits HRA vsConsumer Driven Health Plan HRA
You will not get to keep the CDHP HRA when you enroll through Via Benefits.
Any HRA money left on the HealthSCOPE Visa debit card will revert back to the State.
Please note: PEBP HMO and EPO participants do not have a CDHP HRA account.
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What is a Heath Reimbursement Arrangement (HRA)?
• If you retired before January 1, 1994, HRA based on 15 years of service
• If you retired after January 1, 1994, HRA contribution is $12 per month, per year of service
How is my HRA Funded?
Effective July 1, 2018
PY 2019 HRA Contribution
Years of Service $ Contribution
11 +132.00
12 +144.00
13 +156.00
14 +168.00
15 +180.00
PY 2019 HRA Contribution
Years of Service $ Contribution
16 +192.00
17 +204.00
18 +216.00
19 +228.00
20 +240.00
PY 2019 HRA Contribution
Years of Service $ Contribution
5 +60.00
6 +72.00
7 +84.00
8 +96.00
9 +108.00
10 +120.00
PEBP will automatically establish your Exchange-HRA once you have enrolled in a qualified medical plan through Via Benefits.
Once established, you will receive the Via Benefits-HRA funding kit with information on how to use the Exchange-HRA.
The kit will include claim forms and a direct deposit form and will normally arrive within 8-12 weeks from your effective date.
Qualifying for your Via Benefits HRA
Must be enrolled in Medicare Parts A and B in order to enroll in a plan through Via Benefits.
Participants must enroll in a medical plan through Via Benefits before their enrollment period ends in order to have access to their HRA (normally within 60 days from the Medicare effective date).
Participants must remain enrolled through Via Benefits each year to continue to have access to their HRA or risk permanently forfeiting the rights to their HRA, basic life insurance, PEBP dental benefits, and any voluntary products (if applicable).
Your Via Benefits reimbursement will be based on yourretirement date and earned years of service credit. It willtake 8-12 weeks from your effective date to be established.
Pay for your expenses
Important Documents
Submit for Reimbursement
Website and your Online Account
Automate your Premium Payment
PEBP Dental is Automatically Reimbursed
Understand your Explanation of Payment Statement
You must submit all claims to Via Benefits within one year from date of service
Initial Funding Packet may take between 8-12 weeks from your effective date to be received
Managing your Reimbursement Funds
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Reimbursement Options
Form is required to be filled out• You pay your requested expense first• Attach required documentation one time• Available for premiums / Medicare Part B
premium
• Enroll in a participating plan• Ask to select option• Pay premiums as required• Available for plan premiums only
Auto-Reimbursement
Recurring Premium Reimbursement
• Fill out paper form to request reimbursement for all eligible expense types
• Attach required documentation • Submit via fax, mail, or online
One-Time (Manual) Reimbursement Request
• Enrollment in a participating plan is required
• Available for plan premiums only
• You pay your premium to carrier directly first
• Ask Via Benefits to turn on auto-reimbursement
Auto-Reimbursement
• Call Via Benefit at 1-888-598-7545 to activate or ask for it to be turned on during your initial enrollment
• Available on most plans
• Works for premium reimbursement only
• No paper forms required, just set it and forget it!
• Can take 2 to 3 months to initiate and receive your first reimbursement
• May also be some delay January – March each year and when you enroll in a new plan
Option 1
Step 2
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How Option #1 Works
Step 2
Step 3
Step 4
Step 1
Participant pays plan premium directly to insurance company
Via Benefits reimburses participant via check or
direct deposit up to allowed monthly
amount
Via Benefits verifies receipt of payment and
eligibility
Insurance company forwards receipt of
payment to Via Benefits
Automatic Reimbursement
• You pay your requested expense first
• Fill out required Via Benefits Recurring Claim Form
• Attach required documentation once
• Available for premiums and Medicare Part B premium
Recurring Premium Reimbursement
• Monthly plan premiums (i.e. vision) or
• Monthly Medicare Part B premium
• Submit once for the entire year or if premium changes for any reason
• Must submit with appropriate supporting documentation and proof of payment
All forms MUST include signature and date.
Expires 12/31 each year
Option 2
Your New Benefit Amount
BENEFICIARY’S
NAME
Marge Simpson
Your Social Security benefits will increase by 1.5 percent in 2014 because of a rise in the
cost of living. You can use this letter when you need proof of your benefit amount to
receive food, rent, or energy assistance; bank loans; or for other business. Keep this letter
with your other important financial documents.
How Much Will I Get And When?
• Your monthly amount (before deductions) is $1,400.90
• The amount we deduct for Medicare medical
insurance is (If you did not have Medicare as
of Nov. 14, 2013 or if someone else pays
your premium, we show $0.00.)
$104.90
• The amount we deduct for your Medicare
prescription drug plan is
$0.00
• The amount we deduct for voluntary federal
tax withholding is (If you did not elect
voluntary tax withholding as of November
14, 2013, we show $0.00)
$0.00
• After we take any other deductions, you will
receive on January 15, 2014.
$1,296.00
If you disagree with any of these amounts, you must write to us within 60 days from the date
you receive this letter. We would be happy to review the amounts.
You may receive your benefits through direct deposit, a Direct Express* card, or an Electronic
Transfer Account. If you still receive a paper check and would like to switch to an electronic
payment, please visit www.godirect.org or call 1-800-333-1795.
What If I Have Questions?
Please visit our website at www.socialsecurity.gov for more information and a variety of
online services. You also can call 1-800-772-1213 and speak to a representative from 7 a.m.
until 7 p.m., Monday through Friday. Recorded information and services are available 24 hours
a day. Our lines are busiest early in the week, early in the month, as well as during the week
between Christmas and New Year’s Day; it is best to call at other times. If you are deaf or hard
of hearing, call our TTY NUMBER, 1-800-325-0778. If you are outside of the United States,
you can contact any U.S. embassy or consulate office. Please have your Social Security claim
number available when you call or visit and include it on any letter you sent to Social Security.
If you are inside the United States and need assistance of any kind, you also can visit your local
office.
Part B Premium Deducted From Social Security Pension
$134.00
Option 2 Continued: Medicare Part B
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Option 3
• Attach legible receipts
• Complete all key data such as the date of service, amount of reimbursement request, type of service
• May be submitted:
• Online• Fax• Email
• Paper form that you fill out to request reimbursement for all eligible expense types
• Attach required documentation
• Submit via fax, mail, or online
One-Time (Manual) Reimbursement Request
Used for: Physician copays or coinsurance, prescription medication copays, prescription eyeglasses, etc.
Call Via Benefits for a copy of the new form Sign and Date
Direct Deposit Set Up
• Phone
• Fax
• Online
Direct Deposit Authorization Forms available at www.My.ViaBenefits.com/PEBP
Direct Deposit
Medical Plan Enrollment is Requiredto Receive Via Benefits HRA Funding
• Received mail that seems confusing?
• Is your coverage being discontinued?
• Have questions about your HRA?
• Moving?
Be sure to call Via Benefits!!
Enrollment is Required
1-888-598-7545
IMPORTANT: In order to maintain your PEBP benefits, HRA, Basic Life insurance, PEBP dental, and
any voluntary products (if applicable), you MUST STAY enrolled in a medical plan with Via Benefits.
• Medicare Open Enrollment* provides an opportunity to change
health plans and/or prescription drug coverage. Information for
Open Enrollment is normally made available in October.
• Changes made during the Medicare Open Enrollment
period will become effective January 1.
• If you want to make ANY changes to your coverage, you
MUST make your changes through Via Benefits.
• Making changes outside of Via Benefits will cause
you to forfeit your monthly HRA contribution, Basic Life
Insurance, PEBP dental and any voluntary products (if applicable).
*Medicare Open Enrollment is different than PEBP’s Open Enrollment
Medicare Open EnrollmentOctober 15 to December 7
1-888-598-7545Benefits advisors are available
Monday through Friday, 5:00 AM until 6:00 PM Pacific Time
• Trained in insurance, Medicare, and issue resolution
• Supports retirees with everything from basic questions, reviewing plan benefits and addressing more complex issues dealing with insurance carriers or Medicare
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Lifetime Retiree Advocacy
Questions and Concerns?
• Provider Questions– Billing Issues — why did I get this bill? – Need help finding a network provider
• Carrier Questions– Late cards, incorrect effective date, late
enrollment penalty– Clarification of letters
• Claim Denial/Appeals
• HRA Funding– Providing claim forms and assistance – Explaining qualifying expenses
• Moving or Dual Residences
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Onsite HRA Assistance
A Via Benefits HRA Specialist will be available one week per month to assist participants with:
Call 1-844-266-1395 to set up an individual appointment
regarding your HRA.
• What supporting documents are required to request reimbursement
• Recurring claims, including Medicare Part B Premiums
• How to read the Explanation of Payment (EOP)
• How to navigate the Via Benefits website
• One-time reimbursement requests
• Auto-reimbursement process
• Available balance inquiries
Telephone assistance is always available through the Via Benefits Customer Service Center by calling 1-888-598-7545 Monday through Friday, 5:00 AM until 6:00 PM Pacific Time
Check the calendar of events on the PEBP website for
specific dates and locations.
Want more information?Contact Via Benefits at 1-888-598-7545
https://My.ViaBenefits.com/PEBP
Wait for your funding packet to arrive from Via Benefits before you submit for any reimbursement. This will normally take between 8-12 weeks from your effective date.
Call Via Benefits and select a qualified Medical plan before your enrollment period ends.
Send PEBP a copy of your (and if applicable, your spouses) Medicare A+B card and the original Retiree Benefit Enrollment and Change Form (RBECF) included in your Medicare Packet from PEBP.
Enroll in Medicare Parts A and B.
Contact the Social Security Administration.
Summary Overview
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Contact Information
Public Employees’ Benefits Program901 S. Stewart St. Suite 1001 Carson City, NV 89701 775-684-7000 or 1-800-326-5496 www.pebp.state.nv.us [email protected]
Social Security Administration 1-800-772-1213 www.ssa.gov
Via Benefits(toll free) 1-888-598-7545https://My.ViaBenefits.com/PEBP
Thank you!
