Active employees have two medical plan choices:
PPO Plan (Anthem BlueCross BlueShield 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
(Anthem BlueCross BlueShield Network)
(Health Plan of Nevada)
|Calendar year deductible
(All items shown below are subject to the deductible except preventive care and prescription drugs.)
(Includes prescription drugs)
|Preventive care services
||No cost to you
||No cost to you
|Telemedicine services (LiveHealth Online)
||PCP: $10 copay
Specialist: $15 copay
|PCP: $35 copay
Specialist: $70 copay
|Hospital inpatient services
||$100 copay plus 10% coinsurance
up to $5,000
up to $1,500/admission
|Hospital outpatient services
|Routine diagnostic services
|Urgent care services
||$25 copay if life-threatening emergency
||$400/visit if life-threatening emergency
(waived if admitted)
||Generic: No charge
Preferred Brand: Greater of $20 copay or
Non-Preferred: Greater of $45 copay or
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.
The amounts shown above are effective as of September 1, 2016, and may change in the future.