Your Medical Plan Choices
Active employees have two medical plan choices:
PPO Plan (Anthem Blue Cross Blue Shield Network)
This plan is a preferred provider organization (PPO). It gives you the flexibility to see any medical provider. However, you save money when you use in-network providers. Refer to your Summary Plan Description for details on this plan. This plan is self-funded, which means the Fund pays the claims for participants’ eligible health care services, not Anthem or Zenith American Solutions.
HMO Plan (Health Plan of Nevada)
This plan is a health maintenance organization (HMO). You must always see Health Plan of Nevada providers in order to receive coverage, except for life-threatening emergencies. If you see an out-of-network provider, you will pay all costs for those services. Your enrollment packet includes a folder from Health Plan of Nevada with details on this plan. This plan is fully insured, which means Health Plan of Nevada pays the claims for participants’ eligible health care services.
Medical Plan Comparison Chart
| Benefit | PPO Plan (Anthem Blue Cross Blue Shield) In-Network Coverage* |
HMO Plan (Health Plan of Nevada) In-Network Required |
|---|---|---|
| Calendar year deductible |
Single: $500 |
None |
| Out-of-pocket maximum | Medical: Single: $5,600 Family: $11,200 Prescription: Single: $1,000 Family: $2,000 |
Single: $6,250 Family: $12,500 (Includes prescription drugs) |
| Preventive care services | No cost to you | No cost to you |
| Telemedicine services | LiveHealth Online: $10 copay |
NowClinic: $0 copay |
| Physician services | PCP: $10 copay Specialist: $15 copay |
PCP: $35 copay Physician Extender/Asst.: $25 copay Specialist: $70 copay |
| Hospital inpatient services | $100 copay plus 10% coinsurance up to $5,000 |
$500/day up to $1,500/admission |
| Hospital outpatient services | $50 copay | $400/admission |
| Routine diagnostic services | X-ray: $15/service Lab: $5/service |
X-ray: $25/service Lab: $15/service |
| Urgent care services | $15 copay | $40 copay |
| Emergency services** | $25 copay if life-threatening emergency | $400/visit if life-threatening emergency (waived if admitted) |
| Prescription drugs | Generic: No charge Preferred Brand: Greater of $20 copay or 20% coinsurance Non-Preferred: Greater of $45 copay or 45% coinsurance Specialty: $50 copay (Mail order available at different amounts) |
Low Cost: $25 copay Midrange Cost: $50 copay Highest Cost: $75 copay (Mail order available) |
*Note that non-network coverage is different than in-network coverage. See the Summary Plan Description for details.
**If you visit the emergency room for non-life-threatening treatment, the PPO plan pays $75 of emergency room charges and you pay the balance; the HMO plan pays nothing in this case.
