1. GROUP
INSURANCE
ORIENTATION VIDEO

2. Renown PPO, EPO & QHDHP/HSA
MEDICAL COVERAGE Claims are paid by funds contributed by the District, its employees, and retirees.
Renown PPO, EPO & QHDHP/HSA

3. PPO PLAN District covers employee’s premium
Comprehensive Major Medical Plan
Preferred Provider Organization (PPO)
PPO PLAN

4. PPO PLAN Hometown Health (HTH) – Processes the Claims
Hometown Health Network – Preferred Provider Panel website is located in the Question/Answers &Highlights Handout
Preferred Provider Hospitals – Renown Medical Center, Renown South Meadows, Carson Tahoe Regional Medical Center & Northern Nevada Medical Center

5. PPO PLAN Deductibles Preferred Provider:
- $500 per employee - $1,000 per family
Non-Preferred Provider:
$1,500 per employee
$3,000 per family

6. Non-Preferred Provider:
PPO PLAN
Eligible Expenses
Preferred Provider:
After deductible has been met,
eligible expenses covered at 80%
Non-Preferred Provider:
After deductible has been met, in most cases eligible expenses covered at 60% for usual and customary costs

7. Non-Preferred Provider:
PPO PLAN
Annual Out-of-Pocket Maximums
Preferred Provider:
$3,500 per employee
$7,000 per family
Non-Preferred Provider:
$7,500 per employee
$15,000 per family

8. PPO PLAN Co-payments for Preferred Provider Office Visits
Primary Care Physician - $35
Specialists/Urgent Care - $50
No deductible & No Claim Forms

9. PPO PLAN Services That Require Pre-Certification
All inpatient hospital admissions
Outpatient services over $10,000
50% paid if not pre-certified

10. EPO PLAN Hometown Health (HTH) – Processes the Claims
Hometown Health Network – Preferred Provider Panel website is located in the Question/Answers & Highlights Handout
Preferred Provider Hospitals – Renown Medical Center, Renown South Meadows, Carson Tahoe Regional Medical Center & Northern Nevada Medical Center

11. EPO PLAN Employee pays a portion of the full premium*
Must reside in the Northern Nevada or North Lake Tahoe service area
Referral required for specialist or no coverage
No referral required for annual Gynecologist exam or Chiropractic services
* Check schedule of premiums in the Questions/Answers and Highlights

12. EPO PLAN
No deductible
No claim forms
Make Co-payments

13. EPO PLAN Co- Payments for Service Listed $35 Physician Visits
$50 Specialist Visits/Urgent Care
$200 Emergency Services; $300 Non-Emergency
$200 Outpatient Surgery Facility
$1,250 Inpatient Hospital

14. QHDHP/HSA Qualified High Deductible Health Plan/Health Savings Account
Healthcare Coverage for Medical Services and RX
Used in conjunction with Health Savings Account (HSA)
You pay 100% until High Deductible is met, and then you share only a portion of the cost
You pay nothing once the Out-of-Pocket max is met (Preferred Providers)

15. QHDHP/HSA Hometown Health (HTH) – Processes the Claims
Hometown Health Network – Preferred Provider Panel website is located in the Question/Answers &Highlights Handout
Preferred Provider Hospitals – Renown Medical Center, Renown South Meadows, Carson Tahoe Regional Medical Center & Northern Nevada Medical Center

16. CALENDAR YEAR DEDUCTIBLE Individual Deductible: $2600
QHDHP/HSA
CALENDAR YEAR DEDUCTIBLE
Individual Deductible: $2600
Family Deductible: $5000

17. Preferred Provider: Non-Preferred Provider:
QHDHP/HSA
Eligible Expenses
Preferred Provider: Non-Preferred Provider:
After deductible has been met, After deductible has been met, in most
eligible expenses covered at 80% cases eligible expenses covered at 60%
for usual and customary costs

18. Annual Out-of-Pocket Maximums
QHDHP/HSA
Annual Out-of-Pocket Maximums
Preferred Provider: Non-Preferred Provider: $6550 per employee $6,500 per employee
- $13,100 per family $ 13,100 per employee

19. QHDHP/HSA District will fund a portion of the Employee’s HSA
The District will fund the employee’s HSA account two times a year; once in the beginning of the year and once in the middle of the year.
The amount that the District funds will be determined by your insurance eligibility effective date.
You own it – No “use it or lose it“ requirements
Most out-of-pocket expenses can be paid with HSA. (Check IRS guidelines.)

20. QHDHP/HSA Not Eligibile If:
Enrolled in a secondary health insurance that is non-HSA eligible, including a general purpose Health Flexible Spending Account (FSA) or a Health Reimbursement Account (HRA)
Enrolled in Medicare or Tricare
Claimed as a dependent on someone else's tax return
Other exclusions may apply

21. How much can I contribute?
QHDHP/HSA
How much can I contribute?
2017 HSA Annual Contribution Limits (Set by the IRS)
Single: $3400
Family: $6750
HSA Catch-Up Contribution
$1000 per individual age 55 and over

22. American Fidelity’s GAP Plan
Pay up to:
$1,000 per Inpatient Stay
$200 for Outpatient Services
$25 per Doctor Visit to max of $125 per District covered family
Dependents covered only if enrolled in District insurance
QHDHP/HSA members are not eligible for GAP

23. PRESCRIPTION DRUG PLAN
Welldyne
$50 per covered insured calendar year deductible
$10 co-payment for Generic Drugs
$25 co-payment for Brand Drugs
$50 co-payment for Non-Preferred Brand
Your choice of Nationwide Network Pharmacies
QHDHP Plan is subject to Plan deductible before copay applies

24. PRESCRIPTION DRUG PLAN
Welldyne Mail Order
$10 Co-payment for Generic Drugs
$50 Co-payment for Brand Drugs
$100 Co-payment for Non-Preferred Brand
90 Day Supply- Except for Specialty Drugs
QHDHP Plan is subject to Plan deductible before copay applies.

25. DENTAL PLAN The Preferred Provider Dentist Network is Guardian
Deductibles:
-$50 per employee
- $100 per family
Calendar Year Benefit maximum - $2,000
Children under 19 have unlimited calendar year benefits
No orthodontia coverage

26. DENTAL PLAN If using Preferred Provider Network Dentist:
Preventive: 100% - No Deductible
Restorative: 80%
Major: 80%

27. Vision Service Plan (VSP)
VISION PLAN
Vision Service Plan (VSP)
Premiums paid by District
Dependents covered at no additional expense even if they are not enrolled on your medical coverage
Eye exam once every 12 months
$10 co-payment per eye exam
Lenses/Frames or contacts once every 24 months

28. PREMIUMS
Schedule of premiums is located in the Questions/Answer and Highlights packet
Please review the rates in the PPO,EPO, and QHDHP plans as there could be a difference in cost to the employee
Certified/Administrators – Monthly
12 Month Classified – 26 Pay Periods
Other Classified – 18 Pay Periods
Part-Time Certified – Premiums Prorated based on FTE

29. WELLNESS PROGRAM
To promote and improve employee wellness and reduce health risks through education and wellness activities, goal setting and outreach events.

30. EMPLOYEE ASSISTANCE PROGRAM
GuidanceResources®
Confidential Counseling
- 3 free in-person counseling sessions per person per issue per year
Financial Information and Resources
Legal Support and Resources Work-Life Solutions
Tobacco Cessation
GuidanceResources® Online

31. HEALTH MANAGEMENT Healthy Tracks Online Health Management Tools
Health Insurance Premium Discount Opportunity
Talk to a Trainer or Dietitian

32. LIFE INSURANCE District-Paid Term Life and AD&D
Certified/Classified - $40,000
Classified Confidential - $50,000
Administrators/Psychologists/Pro-Techs - $250,000

33. Premium Conversion Plan
SECTION 125 PROGRAM
Premium Conversion Plan
Allows dependent medical/health and cancer insurance premiums to be paid on a pretax basis
If on the QHDHP, you cannot have a general purpose FSA (Flexible Spending Account) in the household, however, you may have a Limited Purpose Health FSA for dental and vision.

34. Flexible Spending Accounts
SECTION 125 PROGRAM
Flexible Spending Accounts
Dependent Day Care
$5,000 per year
Children under 13
Non-Reimbursed Medical Expenses
- $2,550 per year
- Debit Card available

35. SECTION 125 PROGRAM Example: Salary: $2,000 Insurance Premiums: $200
Taxable Salary: $1,800
25% Tax Bracket: $450 instead of $500
$1,800 x 25% = 450
$2,000 x 25% =500
Extra $50 in Take-Home Pay

36. VOLUNTARY BENEFITS Group Legal Supplemental Life Insurance
Disability Insurance
Long-Term Care
Cancer Insurance
Accident Benefit Insurance

37. IMPORTANT! 90 days to complete forms and add dependents
It is your responsibility to enroll within the required time frame
Risk Management Office (775)

38. RISK MANAGEMENT LOCATION
425 East Ninth Street Reno, NV 89512

39. THE END
This is a brief overview of the coverage provided to you by the District. It is not meant as a full explanation of the benefits provided. Any conflict between this overview and related plan documents or contracts shall be governed by the provisions of the plan document or contract. To access the plan documents please visit the Washoe County School District website, under Risk Management. Thank you.