Your Medical Plan Choices

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

Benefit PPO Plan
(Anthem BlueCross BlueShield Network)
In-Network Coverage*
HMO Plan
(Health Plan of Nevada)
In-Network Required
Calendar year deductible

Single: $500
Family: $1,500
(All items shown below are subject to the deductible except preventive care and prescription drugs.)

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 N/A
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.

The amounts shown above are effective as of January 1, 2020, and may change in the future.

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