EMPLOYEE BENEFITS ORIENTATION GUIDE PY 2017

1 New EMPLOYEE BENEFITS ORIENTATION GUIDE BCN BENEFITS Office Contact Information 70 Artemesia Way, MS-0240. Reno, Nevada 89557-1240. Phone: (775) 784-6082. Fax: (775) 784-4221. EMPLOYEE Title Contact Information Noemi Garcia Personnel Technician (775) 784-6112. BCN BENEFITS Sara Hudspeth Personnel Analyst (775) 784-6263. BCN BENEFITS Kristi Roberson Personnel Technician 775) 784-1450. BCN BENEFITS Lisa Taylor BENEFITS Specialist (775) 784-6163. BCN BENEFITS Migle Valunte BENEFITS Manager (775) 784-1496. BCN BENEFITS Health Insurance The information contained in this GUIDE is a summary of the BENEFITS you are entitled to as an EMPLOYEE . In the event of any difference between the terms of this summary document and the plan or governance documents, the terms of the plan or governance documents will prevail. SECTION I. Health Insurance BENEFITS at a Glance Public Employees' Benefit Program (PEBP).

2 What is a Self-Funded Plan? What is a Consumer Driven PPO High Deductible Health Plan? What is a Health Maintenance Organization (HMO)? What is a PPO? Out of State Preferred Provider Organization Worldwide Coverage Health Maintenance Organization (HMO). Dental Plan PPO. COBRA Notification HIPAA Federal Regulations Insurance Definitions PEBP Contact Information Group Health Insurance Provider Contact List SECTION II. Retirement Information Retirement Plan Alternatives (RPA) Plan Medical Resident/Postdoctoral Scholar Retirement Plan Public Employees' Retirement System (PERS). FICA Alternative Retirement Plan NSHE Tax Sheltered Annuity and Roth 403(b) Plans State of Nevada Deferred Compensation 457 Plans Retirement Provider Contact List Workers' Compensation Computer Workstation Setup ORIENTATION to Workers' Compensation Workers' Compensation Incident Report SECTION III. Policy Statements and Information NSHE Aids Policy State of Nevada Smoking Policy Holiday Information Payroll Information Equal Opportunity and Affirmative Action Information 05/2016.

3 BENEFITS at a Glance Plan Year 2017. July 1, 2016 June 30, 2017. State of Nevada Public Employees' Benefit Program (PEBP). BENEFITS at-a-Glance for July 01, 2016 through June 30, 2017. Benefit Description Benefit Summary Active Employees Retiree Life Insurance $25,000 per Active EMPLOYEE $12,500 per Retiree Waiting period is 180 days with a monthly benefit of 60% of monthly earnings up to a maximum benefit of $7,500 per month. The benefit Long Term Disability Insurance may be subject to certain taxes. For a complete description refer to the Summary Plan Description. State of Nevada Self-Funded Dental Plan Same dental plan for: Consumer Driven PPO High Deductible Health Plan (CD PPO HDHP), Hometown Health Plan and Health Plan of Nevada PPO Diversified Dental NON-PPO. (In Network Dentist) (Out of Network Dentist). Plan Year Maximum (per person) $1,500 + Preventive Services $1,500* + Preventive Services Plan Year Deductible $100 per person with a maximum of $300 per family (first three individuals).

4 Applies to Basic and Major Services. Preventive Services 100% no deductible (does not count toward plan year maximum) 100% no deductible (does not count toward plan year maximum). (exams, bitewing x-rays, cleanings) 4 allowable cleanings per Plan Year 4 allowable cleanings per Plan Year Basic Services (fillings, extractions, root 20% after deductible 50% after deductible canals, full mouth x-rays). Major Services 50% after deductible 50% after deductible (bridges, crowns, dentures, tooth implants). * Under no circumstances will the combination of the PPO and Non-PPO dental benefit payments exceed the plan year maximum benefit or $1,500. State of Nevada Health Plans Self Funded PPO Medical Plan Health Maintenance Organization CD PPO HDHP. Networks: Non-PPO Health Plan of Nevada Hometown Health Plan Hometown Health Plan (Out of Network) (Southern Nevada Only). (Northern Nevada Only). First Health Network Separate Non-PPO Deductible $1,500 individual applies to all Non-PPO Services Not applicable Not applicable Plan Year (PY) Deductible $3,000 family $1,500 individual $3,000 family Plan Year Out-of-Pocket Maximum $3,900 per person $10,600 per person $6,200 per person $6,800 person $7,800 per family $21,200 per family $12,400 per family Lifetime Maximum Unlimited Unlimited Unlimited Transplants Included in above Covered under Inpatient $1,000,000.

5 Primary Care Self-Funded PPO - Family Practice, 20% after PPO deductible 50% after $25 copay $15 copay Internal Medicine, GYN & Pediatrics Non-PPO PY deductible Specialty physicians Self-Funded PPO patient can self refer; no 20% after PPO deductible 50% after $45 copay $15 copay referral required) Non-PPO PY deductible Preventive/Wellness Care 100% covered. Services subject Not Covered 100% covered 100% covered to CDC guidelines Maternity Care 20% after 50% after $15 copay per visit. Copay for PPO PY deductible Non-PPO PY deductible $25 primary care copay per visit laboratory, ultrasound, other diagnostic procedures and the inpatient copay State of Nevada Health Plans Self Funded PPO Medical Plan Health Maintenance Organization CD PPO HDHP. Networks: Hometown Health Plan Health Plan of Nevada Non-PPO. Hometown Health Plan (Northern Nevada Only) (Southern Nevada Only). First Health Network Urgent Care 20% after 50% after $50 copay $15 copay per visit PPO PY deductible Non-PPO PY deductible Emergency $20% after 20% after $300 copay $150 copay PPO PY deductible PPO PY deductible (waived if admitted to the hospital).

6 Diagnostic (Laboratory, pathology, 20% after 50% after No Charge No Charge x-ray) PPO PY deductible Non-PPO PY deductible Other Diagnostic Services MRI - $250 per visit (MRI/MRA, PET and CT scans) 20% after 50% after CT Scan - $250 per visit No Charge PPO PY deductible Non-PPO PY deductible PET Scan - $350 per visit Hospital Inpatient 20% after 50% after Non-PPO PY $500 per admission $200 copay per admission PPO PY deductible deductible Hospital Outpatient 20% after 50% after $50 copay per admission PPO PY deductible Non-PPO PY deductible $350 copayment per admission Substance Abuse Rehabilitation Inpatient 20% after 50% after $600 per $200 copay per admission PPO PY deductible confinement deductible & Non- $500 per admission PPO PY deductible Substance Abuse Outpatient 20% after 50% after $25 copay per visit $15 copay per visit PPO PY deductible Non-PPO PY deductible Mental Health Inpatient 20% after 50% after $600 per $500 copay per admission $200 copay per admission PPO PY deductible confinement deductible & Non- PPO PY deductible State of Nevada Health Plans Self Funded

7 PPO Medical Plan Health Maintenance Organization CD PPO HDHP. Networks: Health Plan of Nevada Hometown Health Plan Hometown Health Plan Non-PPO (Southern Nevada Only). (Northern Nevada Only). First Health Network Mental Health Outpatient 20% after 50% after $25 copay per visit $15 - $20 copay per visit PPO PY deductible Non-PPO PY deductible Chiropractic Care 20% after 50% after $45 copay per visit $15 copay per visit PPO PY deductible Non-PPO PY deductible $1000 plan year maximum Prescription Drug Benefit Generic Generic Generic 20% after Retail $7 copay Retail $7 copay PPO PY deductible Mail Order $14 copay Mail Order $14 copay Preferred Brand Preferred Brand Preferred Brand Retail $40 copay Retail $35 copay Retail = 30 days 20% after No benefit available Mail Order $80 copay Mail Order $70 copay PPO PY deductible Non-Preferred Brand Non-Preferred Brand Mail Order = 90 days Retail Greater of $75 copay per Retail $55.

8 Non-Preferred Brand script or 40% Mail Order not available 100% of contracted price does Mail Order Greater of $150 Specialty Drugs not count toward the deductible copay per script or 40% Retail applicable retail pharmacy or Max Out of Pocket Specialty Drugs copay will apply Retail 30% coinsurance Mail Order Not available Specialty Drugs Mail Order Not available 20% after PPO PY deductible available in 30 day supply only State of Nevada Health Plans Self Funded PPO Medical Plan Health Maintenance Organization CD PPO HDHP. Networks: Non-PPO Hometown Health Plan Health Plan of Nevada Hometown Health Plan (Northern Nevada Only (Southern Nevada Only First Health Network Inpatient & outpatient services; Hospital admissions including surgical services Home Oral surgical services Pre certification Hospital admissions Health care Outpatient surgery Allergy testing Durable Medical Equipment Skilled nursing facility Carpal Tunnel Some prescription drugs Additional Hospice Care services may require pre- Transplants certification, contact Hometown Diabetes equipment There is a 50% reduction for non- Foot Surgery Health Plan for a complete list of Home Laboratory & Radiology compliance.))

9 Co-insurance for PPO Outpatient mental health/ services services is reduced to 40% and non-PPO is reduced Substance abuse treatment Durable medical equipment to 25%. Prosthetics Reconstructive Mastectomy Mental health/ substance abuse treatment EyeMed Vision Care EyeMed Vision Care Vision Care Wellness Benefit $ Co-payment $ Co-Payment Vision Examination $10 copay (lenses). No benefit 15% - 20% discount Frames $100 allowance per 24. Vision Materials month. Elective contacts $115. allowance. PPO - Health Savings Account PPO - Health Reimbursement Arrangement (PPO-HSA) (PPO-HRA). PEBP EMPLOYEE Only: $700 + $400* = $1,100. CONTRIBUTION Dependents: $200 + $100* = $300 for each dependent (up to 3 dependents). WHAT An interest bearing of investment account established by HRAs are established on behalf of an individual to help pay the EMPLOYEE and administered by a bank. HSAs are for qualifying health care expenses.

10 PEBP-owned and portable and owned by EMPLOYEE . funded Tax-exempt contributions Maximum carryover limit and rules (to be established by PEBP Board in future plan years). PURPOSE Tax exempt account to pay for qualifying health care expenses such as doctor's visits, lab tests, diagnostic tests, prescription drugs, coinsurance, dental procedures, vision exams, etc. ELIGIBILITY EMPLOYEE enrolled in the CD PPO HDHP; and Any PPO Participant that is not eligible for the HSA (all Not covered by another health plan that is not a PPO Retirees; some PPO Employees). high deductible health plan; and Is not enrolled in Medicare, Tricare, Tribal, or other similar plan Cannot be claimed as a dependent on another person's tax return. EMPLOYEE 2016 Calendar Year Maximum Contributions NO. CONTRIBUTIONS $3,350 EMPLOYEE Only Coverage $6,750 for Family (two or more). These maximums INCLUDE the PEBP contribution.